VI. A. In this milestone, the assessment of Jean’s post-discharge needs is facilitated.
| Need or Concern | Description |
| Prevention and wellness | Although Jean’s medical issues are under the resolution, she still suffers from the stroke symptoms since she is incapable of moving, eating or performing her daily activities by herself due to the paralysis of her left body half. She, therefore, needs full recovery from the condition even after discharge. |
| Emotional or mental health concern | Jean was diagnosed with PTSD after encountering rape case by a neighbor. She is still struggling with trauma effects, and her real lack of movement weighs significantly on her mind. As a result, she needs assistance with the psychological problem. |
| Personal assistance | Jean is a widow and needs help with her daily duties, home chores and during her change in position since her current medical condition does not allow her. Her family is staying in various states, and it is uncertain whether they will live with their mother during her post-discharge care (Potthoff, Kane, & Franco, 1997). |
| Financial advice or assistance | Due to her medical issues, Jean’s savings have been completely exhausted. Her clinical bills are accumulating because her healthcare insurance is now insufficient for covering the clinical expenses. Her small pension and social safety rarely covered costs before her stroke, and will still not cover for her mounting losses from the medical issues. |
B. Strategies for arranging provision of services to the Jean
| Issue | Strategy |
| Prevention and wellness | Provision of a social worker by the discharge planners who receives a referral from the health professional to PAC settings. The expert begins by helping the patient to navigate the healthcare system and operate towards wellness. They assess the client for psychosocial financial or social problems due to their medical conditions. |
| Emotional or mental health concern | Provision of a psychologist who will focus significantly on the psychotherapy and be curing the emotional and psychological suffering of Jean. |
| Personal assistance | Selecting the suitable PAC setting like the nursing home versus rehabilitation. Moreover, the hospital discharge location predictions for stroke patients like Jean are discharged to nursing homes if they are living alone, and have poorer pre-admission duties of daily living scores. |
| Financial advice or assistance | Referring to the Medicare for help. Medicare prospective payment system has created motivations to reduce hospital stays by allowing early discharge into the post-acute care, which is treated as the hospital referral. The attention is catered for by the Medicare throughout the treatment episode (Potthoff, Kane, & Franco, 1997). |
V. Conclusion
In conclusion, if the needs are not fully met, Jean’s length of stay decreases in the hospital and is thus discharged when significantly physically and emotionally unstable (Potthoff, Kane, & Franco, 1997). Furthermore, if Jean continues to undergo the financial problem that interferes with her treatment process, physically, her state of immobility and inability to perform any personal care and daily activities will remain intact. Additionally, she will deteriorate psychologically and can end up developing acute mental disorders that originate from the traumatic event of raping from her neighbor. On the contrary, if she succeeds with the financial support issues, she continues to obtain therapies and can eventually gain her original condition due to stroke resolution. Discharges to PAC are considered as the hospital transfers in which the hospital like the Manchester Community Hospital becomes liable for the costs, which are then settled by the Medicare. Once the healthcare facilities have become fully accountable for the ongoing care of their discharged client like Jean, they are motivated to make right decisions, which thus ensure the greater stability in the physical and psychological condition of the patient when all discharge requirements are met.
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