Implications for Social Workers:

Patients receiving home nutrition support experience a number of psychosocial and economic challenges. Many patients start their nutrition support regimens while moderately or severely malnourished.  Some patients will require long-term, and in some cases life-long, nutrition support. While therapy is often initiated in the home setting, many patients must transition from the acute care setting to home care while still rehabilitating from acute or chronic conditions. Adherence to nutrition support regimens may be compromised if the patient does not adequately cope and tolerate therapy. Independence, sleep patterns, and alterations in social activities can be severely compromised if education and coping strategies are not appropriately introduced early on. Changes in body composition and other features of medical status can occur during home nutrition support therapy and can impair therapy goals toward improvement of health and quality of life.

The studies reviewed in this Journal Club discuss the impact of home parenteral nutrition on quality of life and other patient health outcomes. The first study discusses health status and quality of life issues from the patient's point of view. A standardized questionnaire suggested that patients requiring long-term and life-long home nutrition support may experience impaired physical functioning while their mental health scores were well preserved. Caregiver input is likely to be crucial to the outcome. The second and third studies concentrate on the clinical outcomes in malnourished patients receiving home nutrition support. The second study suggested that lean tissues important to survival and wellness remained somewhat compromised while the activity level and potential for independence was improved. The third study noted an eventual discontinuation of nutrition support with maintenance on oral diet. The social worker will be involved in establishing goals and assisting patients to achieve the transition to weight maintenance on oral dietary intake whenever possible. Additionally, a discussion of strategies to improve communication and cost effectiveness of transition from the hospital to a home setting suggests important roles for all health care team members. Communications between social workers in the acute care setting with care providers in home care as well as social workers in the home care setting with acute care providers is crucial to an efficient transition.

Social workers will gain valuable insight about some of the quality of live and economic issues to be considered and integrated into the social work care plan. This insight will be essential to the tasks of social workers who are assigned to patients transitioning from acute care settings or initiating nutrition support in the home care setting to assure the maintenance and improvement of health and quality of life for their patients.