Psychosocial Impact of Hip Fracture and Transitions in Care

PSYCHOSOCIA
HIP FRACT

TRANSITION

Carol Ram
Medical Soc
Nebraska Me

AL IMPACT OF
TURE AND
NS IN CARE

msey, LCSW
cial Worker
edical Center

THE ROLE OF THE
ON THE INTERDIS

• Address the emotional
family

• Facilitate their transitio
care

E SOCIAL WORKER
SCIPLINARY TEAM

l needs of patient and

on to the next level of

EMOTIONAL RESPO
AND FAMILY

ONSES OF PATIENTS
Y MEMBERS

ELDERLY PATIE
FRACTURES EXH

EMOTIONAL

ENTS WITH HIP
HIBIT COMMON
L RESPONSES

SELF BLAME

• “I’m stupid … I should h
careful.”

• “I’ll be a burden to my

E AND GUILT

have been more
family.”

ANXIETY A

• “Will I ever walk again?

• “I don’t want to go to a

• “My sister Rose died af
fracture.”

• “How will George get a

AND FEAR

?”
a nursing home.”
fter she had a hip

along without me?”

SADNESS A

• “I’m afraid I’ll never go

• “I can’t do anything by
help going to the bathr

• “I have good memories

AND GRIEF

o home.”

y myself … I even need
room.”

s, this is probably it.”

FAMILY MEMBERS A

ALSO FALL (APART)

GU

• “Why didn’t I check on
• “Why didn’t I get more
• “This is more than I can

UILT

n Mom?”
e help for her?”
n handle.”

FEA

• “I’m afraid Dad will die

• “Dad made me promis
nursing home.”

• “I’m afraid Dad will get
up.”

AR

e in a nursing home.”
se I’d never put him in a

t depressed and give

ANXIETY AB

• “WHERE will Mom go?

• “How much will it cost
Security.”

• “Who will take care of

BOUT CARE

?”
t? Mom only has Social

her?”

HOW CAN

WE HELP?

• Listen! Listen! Listen!

• Help patient and famil
and express feelings.

• Reassure them that th
… that it is okay to cry.

!
ly members identify

heir feelings are normal
y.

FIND OUT WHO
AS A PE

• What does he or she li

• What has he or she do

• What does he or she w

• Who are the important

O THE PATIENT IS
ERSON

ike?

one in the past?

want to get back to?

t family members?

HELP THE PATIEN
MEMBERS REALIZE

• Ask how they handled

• Help patient and family
their coping strategies.

• Help patient and family
their strengths.

NT AND FAMILY
E THEIR STRENGTHS

previous crises.

y members identify
.

y members identify

HELP PATIENT AND
IDENTIFY THEIR S

• Extended family

• Friends

• Neighbors

• Spiritual communities

D FAMILY MEMBERS
SUPPORT SYSTEM

TRANSITION

N IN CARE

EXPLAIN TO T
AND FA

RECOMMENDA
PHYSICIAN AND T

CONTINU

THE PATIENT
AMILY
ATIONS FROM
THERAPISTS FOR
UED CARE

PRESENT OPTION
THE PATIENT

• Skilled rehabilitation fa

• Hospital swing bed

• Home care

NS AVAILABLE TO
AND FAMILY

acility

LISTEN TO CO
THE PATIENT

• “People die in nursing

• “People have to wait fo
nursing homes.”

• “If I go to a nursing hom

ONCERNS OF
AND FAMILY

homes.”
or hours for help in

me, I will never get out.”

LISTEN TO AN
INFORMATIONAL Q

PATIENT AN

• “Can I just go home fro
• “Where can I go?”
• “How long will I have t
• “How much will it cost
• “How much will insura

ND ANSWER
QUESTIONS OF THE
ND FAMILY

om the hospital?”

to stay there?”
t?”
ance pay?”

EXPLAIN REHABIL
PATIENT AN

• Reframe skilled nursing

– A rehabilitation program

• professional nurses
• physical and occupation
• social workers

• Acknowledge their fea
make the distinction re
rehab programs.

LITATION TO THE
ND FAMILY

g facility

m with

nal therapists and

ar of nursing homes, but
egarding specialized

• Explain option/availabi

• Reiterate goal for patie
mobility, and to return

• Acknowledge the poss
care or assisted living m
point.

ility of private rooms.

ent to gain strength and
n home.

sibility that extended
may be needed at some

EXPLAIN RES
THE PATIENT

• Provide a list of skilled
hospitals providing skil

• Provide a list of home c

• Explain Medicare and i

SOURCES TO
AND FAMILY

nursing facilities and
lled rehab.

care agencies.

insurance coverage.

EXPLAIN REFERR
THE PATIENT

• The social worker make
the patient’s medical h
and insurance informa
preferred facilities.

• Skilled facility’s RN/SW
determine if patient’s n
will then obtain insuran

• The social worker will c
communicate closely w
family regarding availa

RAL PROCESS TO
AND FAMILY

es referrals and faxes
history, therapy notes,
ation to the patient’s

W will evaluate to
needs can be met and
nce authorization.
continue to
with the patient and
able options.