After being admitted to hospital, the staff of the ward activate assistance if the person is not autonomous or cannot rely on a family support network
The need for care does not always end after hospitalization. The frail patient who has passed the acute phase of the disease has the right to continue to receive assistance (health and social) even outside the hospital if he presents at the time of discharge disabilithas difficulty looking after himself and taking therapy, needs medication, rehabilitation and periodic monitoring and cannot rely on a family network supportive or live in a home environment that is not suited to their needs.
Cure at different intensities
In these cases we speak of protected discharge, guaranteed with interventions of different intensity: home care (medical and nursing), cure palliative in hospice o a casa, rehabilitation and intermediate care at specialized facilitieshospitalization in Rsa, social assistance of the Municipalities. The staff of the department (specialist, nurse, social worker) analyzes the patient’s degree of cognitive and functional autonomy, his social and health needs, and sends the request for intervention directly to the residential structures, the rehabilitation center and the local health services (which in turn activate the multidimensional needs assessment unit and organize social and health care), involving the family and the general practitioner.
The territorial operational centers
The hospital and territorial referents will have to define an individual project with goals of care. The report by the hospital should take place before discharge, in order to organize the service in time, avoiding long and unnecessary hospital stays. One of the pillars of the PNRR is precisely the interface between the hospital and the other services that in the coming months it will have to be insured by over 600 territorial operations centers (Cot), one in each health district of the country. In the context of protected resignations in addition, drugs, aids and necessary aids are prescribedsuch as a wheelchair, walker, diapers, lifter, anti-decubitus mattress.
Fragmented services
The continuity of assistance from the hospital to the territory up to the home a right included in the Lea (the essential levels of assistance that the National Health Service must ensure for everyone), which often remains on paper. The availability of the service is patchy and varies from region to region and even from one ASL to another. Often there is a lack of integrated management of the intervention between the hospital and the territory and there is little or no provision for nursing at home. The patient’s care is then discharged onto the family, who will have to pay for a caregiver or turn to private professionals, he comments Claudio Cricellipresident of the Italian Society of General Medicine (Simg).
In the South it is worse than in the North
In 8 out of 10 cases the patient in need of care is sent home without protected discharge and the caregiver turns to the general practitioner to seek an emergency solution. These are in particular post-surgical oncological cases with the need for artificial nutrition and catheter, he says Ignazio Grattagliano, Simg coordinator in Puglia. By way of example, however, in the province of Verona in 2021 there were 4,432 requests for protected discharge, of which 3,689 at home, 130 in Rsa, 87 in rehabilitation facilities, 60 in community hospitals, 58 in hospice, 69 with a program of outpatient visits, 28 sent to the services of other Asl Veneto or outside the region and 331 died before being discharged reports Chiara Pomaricoordinator of the territorial operations center of the Ulss Scaligera.
Even children
The care pathways that can be activated through protected discharge they are also aimed at children with disabling diseases (cancer, rare diseases, myopathies). All services are paid by the NHS. Except the social support (for personal hygiene, dressing, assisted meals, cleaning of the accommodation) provided by the Municipalities, which provide for a sharing of expenses based on the ISEEand medium and low intensity hospitalization in residential and semi-residential structures (high intensity residential treatment instead is free), with a 50% share to be paid by the user or the Municipality.
House assistance
Integrated home care (Adi) reserved for people who cannot be transported to the clinic. It provides for both nursing, for withdrawals, dressings, management of the bladder catheter, artificial nutrition, mechanical ventilator, and medical, for chronic health problems such as heart failure, diabetes, renal or respiratory failure, neurodegenerative and oncological diseases, explains Manuela Petroni, nursing manager of the home care of the AUSL of Bologna. The duration of the taking in charge defined and reshaped over time according to the need. Depending on the complexity of the patient, the service may be occasional or continuous and may involve other specialists. Palliative care and pain therapy are also provided at home.
Social support
The Municipality provides a home assistance service (Sad) to the non self-sufficient (bedridden or in a wheelchair) who live alone or with an elderly and frail spouse and need help in carrying out daily activities.
Intermediate structures
If the person needs to 24-hour nursing assistance and the caregiver unable to deal with it is temporarily sent to an intermediate facility (such as the community hospital). In a specialized rehabilitation center if you have to reactivate or consolidate walking, recover respiratory function, etc. Rsa and hospice The insertion in RSA can be temporaryalso for relief treatments (to give the family time to organize the care of the patient), or lasting. Mentre the hospice offers the palliative cure to the terminally ill who do not have a caregiver or prefer to be cared for outside the home.
March 27, 2022 (change March 27, 2022 | 18:56)
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