Combined with the widespread entry of women into the labor force, an aging population, and minimal assistance for high quality long-term care at the end of life, these economic and social conditions raise a set of difficult policy questions for health services planning. Set in these broad contexts, this paper situates access to and experience of health services in the home, the hospital, and nursing facility, to demonstrate how economic changes have relocated and redefined health services in ways that distinctively impact how people experience the places where they receive care. This place switching of health services externalizes costs of subacute and "daily life care" (the so-called custodial care) to the sphere of the individual, their family, and communities. The theoretical analysis uses current geographical and philosophical approaches to place and space, and considers the tensions between institutionally managed health care space, and the patient's experience of receiving health services in place. The place/space dilemma of health services provision is examined through several interrelated subjects: long-term care at the end of life, gendered characteristics of care giving, the limitations of Medicare and Medicaid, historical changes in hospital length of stay, the restructuring of nursing practices, and the "no-care zone." The analysis is based on examples of stroke and incontinence care to demonstrate the importance of considering place and space issues in health care planning " IV. NEEDS ASSESSMENT

As already stated in this case study introduction this patient is 67 years of age, has suffered a stroke and has been a patient at the community hospital for the past six months. This patient is scheduled to return home as his mobility has greatly improved however, this patient will still require the assistance of a walker and a wheelchair. Complications in terms of potential barriers presenting is the fact that the patient does not have his own home but lives with his brother and the patient's elderly mother also lives with the brother. While the sister-in-law of the patient does care for the patient's mother, there is no one specifically to assist the patient in the home except two nephews who do not desire to assist the patient and most likely will not do so whatsoever.

Assessment and identification of potential issues in this patient's home health care nursing plan include those stated as follows:

Home entrance...

As well, it would be optimal to secure the assistance of the sister-in-law in tasks that are relatively energy expenditure free but very difficult for the individual in the wheelchair such as a trip to the post office or to the utilities board or the grocery stores.
Medication Schedule Adherence: The stroke victim will likely require, at least in the beginning of their return home, someone to help them remember when to take their medications and which medications to take and in what quantity they should be taken to be effective.

Transportation Barriers: transportation needs for reaching physical therapy and other out-patient services; going to the bank, the dentist, the barber shop, the post office, the library; and to visit the doctor.

Assistance with going to the bathroom: Again, this patient has regained a great deal of his mobility and should there be an emergency arise, the sister-in-law is in the home at nearly all times both day and night;

V. ROLE of HOME HEALTH NURSE

The home health nurse holds the vital role of coordinator, implementer, communicator, facilitator, assistant, information gatherer in an ongoing manner beginning from the patients entrance into the hospital and moving through the transition from the hospital and post-discharge following the patient home in making assessment and identifying solutions to meet those needs in the reality of the every day life of the patient.

Bibliography

Grimmer, Karen, et al. (2006) Incorporating Patient and Carer Concerns in Discharge Plans: The Development of a Practical Patient -Centered Checklist" Journal of Allied Health Services and Practice Vol. 3 No.1 ISSN 1540-580X.

Cartier, Carolyn (2002) From home to hospital and back again: economic restructuring, end of life, and the gendered problems of place-switching health service

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