The Difficult Discharge: How to Navigate

Course Overview

Discharging patients with brain functionality health conditions can be a challenge, it is not only a clinical choice but one with economical questions to consider.  In this course we will look at several factors which might influence care and possible solutions to such an emotionally charged situation.

Upon completing this course, you will be able to:

• Identify and examine goals of discharging a patient
• Determine successful discharge environment
• Determine team to support elder
• Identify medication issues that effect outcomes

Course Leader

Elizabeth (Dr Liz) has over twenty years of experience in providing medical care to the elders. She is board-certified in Internal Medicine, Geriatric Medicine and Palliative Care Medicine. Dr Landsverk founded ElderConsult Geriatric Medicine, a house calls practice, to address the challenging medical and behavioral issues often facing older patients and their families.

Dr Landsverk was an assistant professor of Medicine at University of California, San Francisco, an adjunct professor of Medicine at Stanford University, as well as consultant to the San Francisco Elder Abuse Forensics Center and Hospice Medical Director. She is currently the Medical Director for Silverado and Kensington Dementia Care Communities, as well as on the Scientific Panel for the Alzheimer’s Association. Dr Landsverk graduated from Stanford University, and trained at Cambridge Hospital, Harvard University, and Mt Sinai Medical School.

As a House Calls Geriatrician, she collaborates with local physicians to address the needs of complicated vulnerable elders to alleviate pain, agitation and discomfort through the utilization of geriatric and palliative care techniques.

Learning Objectives

Lesson 1 – Introduction and Key Learning Objectives

This lesson outlines the key themes and learning objectives of the course. The structure and content of the following lessons are examined. The learner is also introduced to external factors that negatively affect dementia care and appropriate discharges, such as systemic issues in healthcare and insurance costs.  

On completion of this lesson the learner will:

• Understand the structure, content and learning objectives of the webinar
• Understand external systemic factors that may exacerbate the challenges outlined in the course. 

Lesson 2 – What are Difficult Behaviours?

This lesson explores the key difficult behaviours most commonly displayed by people with a diagnosis of dementia. The methods utilised to treat and manage patients displaying these challenging behaviours in hospital systems are examined alongside explanation of how these can create problems with discharging the patient to more appropriate care. The learner is also presented with an examination about the most common root causes of these behaviours. Strategies effective for minimizing challenging behaviours are also discussed, including advance care planning, medication review and multi disciplinary team involvement. 

On completion of this lesson the learner will:

• Understand the key difficult behaviours displayed by people with a diagnosis of dementia
• Understand the treatments and techniques used in hospitals to manage difficult behaviours, why these are often inappropriate for people with dementia, and how they delay or cause problems with discharge. 
• Know common root causes and triggers of challenging behaviours 
• Know effective strategies and life changes that can minimize the potential for difficult behaviours and in turn risk of hospital admission.

Lesson 3 – Pain and Dementia Only Communities

This lesson examines the role of pain as a trigger for challenging behaviours. Learners are presented with common pain behaviours and expressions displayed by people with dementia. The importance of treating pain and providing adequate analgesia is discussed in the context of avoiding a difficult discharge from hospital. This lesson also explores the role specialist dementia communities can play in challenging behaviour reduction and in turn hospital admissions. The services offered by dementia communities are outlined. 

On completion of the lesson the learner will:

• Understand the role of pain in episodes of difficult behaviours
• Understand how a person with dementia may express pain, and how this may differ from expressions of pain in people without dementia
• Understand the importance of adequate analgesia in managing challenging behaviours
• Know the role of dementia communities and the services offered. 

Lesson 4 – Case study

This lesson presents the learner with a case study, giving the opportunity for application of learning to management of a real life type scenario. 

On completion of this lesson the learner will:

• Be able to apply knowledge, critical thinking and problem solving to manage care of an elder displaying difficult behaviour, and advocate for their needs in regard to achieving discharge from hospital to an appropriate facility. 

Lesson 5 – Conclusion 

In this lesson Dr. Liz summarizes the learning from the previous lessons. Key points from each lesson are reviewed and broad themes relevant to managing and avoiding difficult behaviour and in turn difficult discharge from hospital are examined. 

On completion of this lesson the learner will:

• Consolidate learning from the previous lessons in order to generate further understanding of course content. 

Summary

This webinar explores expression, presentation, cause and management of challenging behaviours in dementia; and how these behaviours when not well managed can result in hospital admissions and subsequent difficult discharge. Learners completing the course will be equipped to manage and avoid this behaviour through efficient care planning management strategies, and advocate for patients requiring discharge from hospital. On completion learners are equipped with key techniques for regulating behaviours, circumventing potential triggers, avoiding hospital admissions and navigating appropriate discharge in the case of unavoidable hospitalisation.