The opportunity to be able to continue living in their own homes and be independent as possible is very important for aging people. This means the elderly people may be reluctant to think of themselves as dependent and in need of care. Likewise, eighty year old Mr Len Robbins desires to retain control over his ageing life in his own home. Mr Robbins has been diagnosed with prostate cancer, pulmonary fibrosis and myocardial infarction. This paper will examine how nurses can provide safe care to Mr Robbins within his home environment. It will also discuss whether nurses can fulfil the wishes of Mr Robbins and his daughter while minimising his risk of physical and psychological injury.
The ageing process requires the elderly to adapt to changes in their physical, social, emotional and mental health states (Thygesen et al., 2009). The elderly are always at risk of physical and mental illness (Boehlke, 2009).Therefore, placing the elderly people in a nursing home is not the optimum solution to keeping them safe and healthy; providing a “Hospital in the Home” to Mr Robbins maybe a better choice in order to ensure that he and his daughter’s wishes are fulfilled. A Hospital in the Home’s patients are visited by doctors and nurses at least once a day and is covered by Medicare for a senior Australian. Hospital in the Home can also provide Mr Robbins with needed equipment such as shower stool and toilet chair to minimise his risk of falls and injuries (Boehlke, 2009; De Blok et al., 2010). For appropriate use of equipment, it will require nurses to organise an occupational therapist to come to his home for the setting up of provided equipment. Provision of home health care services to supervise and alleviate his housekeeping duties will contributes to maintaining his optimal health level, safety, well-being and sense of independence (Durocher & Gibson, 2010). Home health care providers are well trained professionals who are specially trained to provide home help services (De Blok et al., 2010). As there is no place like home, most elderly people favour the comfort of their own familiar surroundings. (Boehlke, 2009; Ausmed Education, 2010). Elderly people will most likely feel more positive about living in their own home with appropriate care, especially those who have positive attachments and memories about their home (Milligan, 2009). According to numerous literature, the strong bond between family members is essential for the maintenance of mental health in older people (Thygesen et al., 2009).
Living in a nursing home can worsen the physical, mental and emotional health of elderly patients, especially those who are homesick (Ausmed Education, 2010). Conversely, the study showed that seniors who remain in their homes are happier and feel more independent than their counterparts who live in a nursing home (Durocher & Gibson, 2010). It has also been found that elderly patients who are entering nursing homes have a higher rate of experiencing psychological distress than their counterparts who are staying in their own private households (Thygesen et al., 2009). High psychological distress can negatively interfere with internal strength that provides a sense of coherence (Thygesen et al., 2009).In addition, the elderly who have a positive attachment to home, feel more secure and in control if remaining in their own home. Further, it has been found that this will enhance their ability to maintain their own mental health which contributes to their overall well being (Milligan, 2009). Durocher and Gibson (2010) established that nurses must prioritise patient’s values and interests when planning residential care. Hence, hospital in the home and home health care services will be preferential when caring for Mr Robbins.
Once nurses have decided to place Mr Robbins in his home environment, they must maintain a regular visit and at the same time evaluate Mr Robbins’s needs (Kozier & Berman, 2012).This must include performing fall risks assessment which will help prevent falls and injuries to Mr Robbins by improving his home safety, such as removing clutter (Campbell, 2011). The presence of Mr Robbins and his beloved family members is essential at the first visit in order that they be involved in Mr Robbins’s care plan. This is because the provided interventions must apply to the patient’s needs, age, culture and environments (Dorrestein & Hocking, 2010). The participation of Mr Robbins in his home modification can also empower him to be positively involved in his own care.
The next step that nurses should then make is to refer Mr Robbins to the Home and Community Care (HACC) Program. HACC services are funded by the Australia Government for the elderly to maintain their independence in their own home environment (Gary & Heinsch, 2009). HACC can support Mr Robbins with his daily requirements such as; delivery of meals, organising group activity, providing personal hygiene and housing modifications (HACC, 2010). Nurses must also work cooperatively with occupational therapists to help Mr Robbins in housing modification by installing appropriate grab rails in toilets and bathroom and change the steps into a ramp for easy access (Campbell, 2011). This will contribute to minimising Mr Robbins’ risk of falls and injuries. Eventually, changes in circumstances will require adjustments in the care and service package (De Blok et al., 2010). To reduce the risk of physical injuries in the home, nurses need to ensure that Mr Robbins has safety devices such as; a toilet chair, a non-slip mat inside the sho,wer and on the bathroom floor and as far as possible, to keep his home free from clutter (Campbell, 2011).
Multidisciplinary teams are important for the patients to receive appropriate services that meet their needs and are consistent across health care settings, especially when caring for the elderly at their home (De Blok et al., 2010). Multidisciplinary teams may include any health professionals that are involved in Mr Robbins’ care, for example nurses, HCCA, physiotherapists and occupational therapists. Maintaining the five rights (right time, right dose, right patient, right route, right drug) when taking medications is vital for patients. As a result, nurses must educate Mr Robbins about his medications and their common side effects. Although, the patient may be managing his own medication independently, nurses still need to assess that the patient is receiving the prescribed medication at the appropriate timed intervals every time when they do a regular visit (Kozier & Berman, 2012).
Nurses must also provide some guidance for Mr Robbins’ daughter about the care management for her father when she is away. For instance, hire a housekeeper to do all the washing and cleaning which will help to minimize Mr Robbins’ risk of a fall (Boehlke, 2009; Campbell, 2011). As well, healthy meal services need to be provided for Mr Robbins so that he can get the correct balance of nutrients and energy (Meals Victoria, 2010). Emergency pendants are a useful emergency alarm system that will help Robbins if he needs urgent care (De Blok et al., 2010). Nevertheless, supplying a personal care assistant to assist him with showering and dressing is important for his well being and hygiene. Nurses should advise Mr Robbins’s daughter to invite her family members to look after her father and spend time with him therefore enabling him to feel loved and cared for. Nurses can organise a physiotherapist for Mr Robbins to help him with his mobility.

With respect to both Mr Robbins and his daughter wishes, as health professionals, nurses could introduce Mr Robbins’ daughter to the home health care services and explaining to her how that can be provided to her father. Also, ensuring her how the home health services could provide her father a holistic care package that will support him adequately in all areas of his needs and requirements. That way, it might decrease her concerns of her father being alone at home. In fact, Mr Robbins does not want to move into the nursing home. In this case, it is also important for his daughter to understand the possibility of her father’s psychological distress that might occur if he is forced to move into the nursing home; a place he does not want to be in. Therefore it is critical for nurses to educate and discuss this possibility. In the end result, the decisions are to be made either by Mr Robbins or his daughter. By choosing home health care services, these will fulfil both of their wishes. Mr Robbins will be safe and will not be isolated from home as his daughter wishes. On the other hand, Mr Robbins will receive sufficient support from nursing services and will be satisfied being at home.

In conclusion, nurses can offer Mr Robbins participation in Hospital in the Home while he is remaining in his recovery process from surgery. This requires nurses to work cooperatively with home health care services to safely care for Mr Len Robbins in his home environment. Home health care services can help Mr Robbins with his daily tasks including nursing care, personal care and housing modification for his safety. As housing modification, removing clutter and providing safety aids reduce the chance of Mr Robbins from suffering any physical injuries, remaining at his home could give him the strength to live well in his aging process. Through the home health care services, Mr Robbins’ independence and happiness can be maintained which means that both Mr Robbins and his daughter’s wishes can be fulfilled; thus ensuring both the effective caring and well being of the patent.