I read Harvath's Viewpoint with astonishment. She stated that she questioned the use of Maslow's hierarchy in older adults. Yet in respecting her patient's wish to remain at home and sending her home with "as much support as possible," Harvath supported the applicability of Maslow's hierarchy to elderly patients. The need for safety was considered first, and a balance between the need for safety and the desire for autonomy was achieved. One approach to the care of older adults that validates their self-respect involves asking them their preference in discharge plans. In this case, the discharge team followed that approach and set up a plan that made it feasible to send this patient home; a change in the patient's condition might necessitate a change in location. Maslow's hierarchy is merely a guide for nurses in identifying and prioritizing a patient's needs and addressing them accordingly; it's not the final word.

Debra Kantor, MSN, GNP, RN

Plainview, NY