I'm doing my assessment on my patient. It is broken up into sections and in the discharge planning section I am stuck on what to put. She is 62 and has had 2 strokes and her family is starting to struggle to take care of her. Her husband said that he fears a nursing home is in her near future. So I thought I could use that. She has a in home nursing team that comes in her home and she really can't complete any of her ADL's without extensive assistance. Any thoughts??

And who are you, doctor, RN for nusing home, what is your purpose for the diagnosis,