Observe and Take Notes, But Try Not to Judge
Home assessments are tricky
Health advocates can collect comprehensive and important information about a patient’s daily life and share the findings with primary care providers.
But it can be challenging to walk through someone’s home and listen and observe without judging and wanting to take immediate action.
The health advocate’s role is to gain a comprehensive picture of the patient’s daily life and give that information to primary care providers, says Jeanne Stanton, RN, BSN, MHA, care manager, LifeSpan Care Management of Haddonfield, NJ. For example, the health advocate might suggest that the family hire home health aides to help the patient clean the house and cook meals, she explains.
“I observe the space surrounding us, as we talk and walk through the home,” Stanton says. “I might find that the home doesn’t have working electricity or running water, or that there is a lot of hoarding.”
But it is not her job to fix it single-handedly. Instead, she brings her observations and concerns to patients’ providers. If there is an immediate safety danger, Stanton might talk with the patient and/or family about the emergency issue and how they might want to handle it right away.
Stanton checks the house for obstacles, such as plants, furniture, vases, or clutter, that could cause the patient to trip and fall or prevent a walker from getting around them.
“It’s not my place to move furniture or even suggest moving it because that doesn’t set you up for a trusting relationship,” she says. “But I observe and find out what the patient’s daily routine is all about.”
Home safety is paramount, and it can be challenging to achieve when patients have dementia.
“When someone has a memory disorder, we are focused on their safety in the home, and we start with an assessment of the kitchen,” says Bobbi Kolonay, RN, BSN, MS, CCM, president of Holistic Aging & Options for Elder Care in Pittsburgh.
Patient advocates are like detectives, examining the refrigerator to get an idea of how well the person is eating. If the refrigerator is filled with spoiled or decayed food, or if it is empty, then the patient’s nutrition may be poor and help likely is needed.
“Or, if there’s a gas stove and a burned teapot sitting on top, then it tells you they’re leaving the burner on and are walking away from it,” Kolonay explains. “It means they need help with preparing meals, and they need someone to organize their cupboards.”
They assess the halls and main rooms for fall hazards. The care manager might watch clients walk to see if they can maintain balance and navigate steps.
“We look at how they’re walking if they go from a hardwood floor to a different surface to see how they are able to make a transition,” Kolonay says. “Do they lose balance when they get up? What is their gait like?”
The next stop might be the bathroom.
“No one will admit that they’re not showering, but if there’s soap that is cake-dry, this is a cue that the shower is not being used,” Kolonay says. “We might ask them to get in and out of the bathtub or shower to see if they have a difficult time doing that.”
A care manager also might ask the client to sit, while dressed, on the toilet to see whether the person has any difficulty standing from that sitting position.
Health advocates can collect comprehensive and important information about a patient’s daily life and share the findings with primary care providers. But it can be challenging to walk through someone’s home and listen and observe without judging and wanting to take immediate action.
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