Realising this, it is necessary to extract the fact in present situation of the older people. This study explored the experiences of older people being discharged from hospital to nursing and residential homes in the north east of england. While there has been considerable research which has looked at the discharge of patients from hospital to their own homes, little literature could be found which addressed discharge to care homes. America has a highly developed health care system, which is available to all people. Although it can be very complex and frustrating at times it has come a long way from the health care organizations of yesterday.

Previously most health care facilities were a place where the sick were housed and cared for until death. Physicians rarely practiced in hospitals and only those who were fortunate could afford proper care at home or in private clinics. Presently the goal of our health care is to have a continuum of care for the patient, one which is integrated on all levels. Many hospitals offer a referral service or discharge plan to patients who are being discharged. The discharge planner is a person who is trained in assessing what the patients requirements for health care will be after discharge from the hospital.

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This enables the patient to continue their care at a level which is most appropriate for them. Items reviewed for discharge planning include but are not limited to therapies, medication needs, living arrangements and identification of specific goals. A few of the options that are available for persons being discharged from an acute care hospital can include home health care, assisted living facilities, long term care or hospice according to growing old in america 1996 , home health care is one of the fastest growing segments of the health care industry p. Alternatives for home care can meet both the medical and non medical needs of a patient. These services are provided to patients and their families in their home or place of residence. Home care is a method of delivering nursing care and other therapies as required by the patients needs.

With transportable technologies such as durable medical equipment, oxygen supply and intravenous fluids there are countless possibilities for treatment within the home setting. As stated in the continuum of long term care home health programs range from formal organizations providing skilled nursing care to relatively informal networks that arrange housekeeping for friends p. This has allowed for home care to quickly become an essential component of the health c! are delivery system in the united states. In a home health care situation the primary care giver is usually not the physician.

The physician is communicated with by phone and with documentation from the caregivers. The primary caregivers are usually the nurses and other team members who are involved directly with the patients care. Although, the original order to begin home care must be initiated by the physician if skilled care is to be obtained. According to the 1995 guide to health insurance for people with medicare medicare pays the full cost of medically necessary home health visits by a medicare approved home health agency p. This coverage must meet specific criteria, but it can be a relief to family members to know that their loved ones can be taken care of at home without worrying about the expenses. Unfortunately, if the care to be given within the home is termed not medically necessary the expense is not covered.

This can include items such as meal and medication delivery, a percentage of necessary durable medical equipment, personal care and homemaker services. My employment within a home health care agency has allowed for review of services that are not covered by medicare and/or private insurance. It is often difficult for family members to understand why specific services are not covered especially when they appear to be necessary for the care of the patient. These costs can add up quite quickly and the impact of the cost can become quite distressing for family members and patients on a limited budget. In these cases a social worker is usually provided to help the patient and family explore other avenues which may enable them to cover their health care costs.

Assisted living is an arrangement to residents of a facility that enables them to complete certain daily activities while remaining independent. The services provided enable the resident to achieve maximum function of their activities of daily living. The services are unskilled and non specialized personnel provide the activities essential to the care of the resident. These services help assist the aged, blind, disabled, and other functionally limited individuals with necessary daily activities which they require help with or are unable to perform on their own. An example of some of the services which may be available are light housekeeping, meal preparation, medication reminders and personal care. The personal care does not include specific health oriented services which would require the services of a certified or licensed professional.

It is stated well in aging although the level of services provided may vary, assisted living communities all share a common goal: e! nabling people to live as active and independent a life as possible p. The goal of an assisted living facility is to have the residents feel independent within their own home. According to the article assisted livings future in michigan debated assisted living facilities can offer consumers a great opportunity to get personalized care in a comfortable setting p. Currently there is some controversy surrounding the different types of assisted living facilities. In michigan facilities termed assisted living have no real legal meaning and are not required to be licensed under this name. According to the article assisted livings future in michigan debated unlicensed facilities, unsubsidized care, untrained staff, and unmet promises make some places seem more like un assisted living p.

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