The facility that I work in is an outpatient facility, so there are no discharge planners and definatley no social workers. There are a few casemanagers, but they are really limited on case loads of only those clients that are almost completely incapacitated. We also have a very short chain of command. One person above me and if a situation is not resolved, I have to take it to a county board that oversees the facility.
This particular patient has not always lived with her parents. She actually went to college, has a college degree, but when her condition hit, it hit her hard enough that she had few financial resources, was initially without health insurance and was not able to work. It's also on a very fine line between disabled or not. And we ALL know how the disability system works. She is not eligible for public assistance as long as she lives at home and would be eligible for very little assistance as a single person without children if she were to move out on her own. In this state, there is virtually no assistance available for a single person. It's unlikely that she can return to work until she shows some signs of improvement in her health.
Personally, I believe that if this patient had some advocacy and direction, rather than coercion, she would probably recover successfully. I think she is in a no win situation right now. I know we have to be cautious in "overstepping" those boundaries regarding physician recommendations, but on the flip side, if we believe something unethical is happening, we also have a responsibilty to respond.
I'm not sure how this situation will resolve itself. I will continue to supply this client with the information that I have available and hope that I am not her only advocate. Unfortunately for her, her condition does not have a huge pool of alternatives, but those that are available, are not only being ignored by the physician, but almost denounced.
She may be an adult, legally, but she does not have the knowledge of the medical system and certainly does not understand the legalities, ethical responsibility of practioners, etc. Haven't we all had patients that walk in to situations blind because one, single doctor tells them it's the "way".
Sometimes the only true "education" that they receive is from us, the nurses. Where do we draw the line?