Some of the difficulties families experience when caring for a patient in the home include which of the following?

1. Loss of work time
2. Loss of privacy when outside caregivers are in the home 24 hours a day
3. Financial stress
4. Transmission of nosocomial infections from patient to family

a. 1 and 3 only
b. 2 and 4 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

ANS: D
In cases where the patient will be going home, a detailed psychological evaluation may be neces-sary to determine the ability of the patient and family to cope with stress. If the requirements for patient care exceed the family's capabilities, professional assistance is essential. The availability of other support systems such as home health agencies, respite care, and psychological consult-ants are often critical to the success or failure of homecare candidates. The need for support and counseling is assessed before discharge and reassessed periodically while the patient remains on mechanical ventilatory support. It is important to recognize that despite the significant savings accrued when a patient receives ventilatory care in the home, the overall cost can strain family budgets, even for those who are insured.