Some gains vs Nursing Home

This next entry is also regarding my neurology placement. One of our patients was a severley affected right MCA.
When we took this patient on, he had been an inpatient for at lest three months, and had achieved small gains in this time. He had severe left, unilateral neglect, very poor trunk control, and a severe left hemiparesis, along with many other impairments.
By the end of the placement, the patients neglect, head and trunk control had improved significantly, and he had attained close to independent sitting balance. In consulting with the multi-disciplinary team, the patient had also made marked advances with both occupational and speech therapy.
The problem was in regards to his discharge. The medical team were pushing to place the patient in a nursing home, and the therapists wanted to keep the patient in the ward to continue making significant gains. Going home was not a viable option, as the patient had most extended family in Singapore, and his elferely wife would simply not be able to cope.
By the end of the placement, the decision had been made to place the patient in a nursing home for his continuing care. This was upsetting in a way, as we could clearly see the gains he had made, and at one point, had even been able to stand the patient (although it was with 3xmax assist!).
I guess what was learnt from this was to never give up on a patient, as he was able to make remarkable gains whilst we were treating him. It is also important to consider discharge from the very beginning of treatment, to have a clear goal of where the treatment is heading. It is also important to be the pateints advocate as well, and to try to do the best for their well-being, even if at the end of the day, you lose.