harddischarge planningtransition of carelong-acting injectablepaliperidone palmitaterehospitalization prevention
A 44-year-old male with schizoaffective disorder, bipolar type, is being discharged from a 21-day inpatient psychiatric hospitalization following stabilization of a manic episode with psychotic features. He was switched from oral aripiprazole, which he had not been taking consistently, to paliperidone palmitate 234 mg initiation injection on day 1, 156 mg on day 8, and is due for his first monthly maintenance injection of 117 mg in three weeks. He is also stable on divalproex sodium extended-release 1500 mg at bedtime with a therapeutic valproic acid level of 78 mcg/mL. He lives alone, has limited family support, a history of four hospitalizations in the past two years primarily due to medication nonadherence, and attends a partial hospitalization program intermittently. He has Medicaid coverage. Which discharge planning component is most critical to preventing rehospitalization in this patient?