A popular post of the day discussed patients overstaying their welcome. This was quite a shock to me and in my region the problem is the opposite. My experience has been totally different, and possibly more shocking than the stories of needy patients who aren't acute but remain beyond the usual length of stay--sometimes months, sometimes even beyond a year. What I've seen are patients discharged to the street without a place for recovery. This happens to the homeless, to the elderly who live with a spouse as fragile as they are, it happens with children whose parents are unable to care for their complex needs, and it happens to otherwise healthy adults who are discharged post-surgery and live alone.
For an example that may be horrifying but not terribly unusual, I had a patient who was homeless who had been injured when a car struck him as he was (legally) crossing the street. (The driver was later arrested for DUI and hit-and-run.) My patient had a compound fracture of one leg, broken ribs, internal organ injuries, and deep abrasions. He was in surgery for hours repairing the breaks and debriding the wounds. Less than 24 hours after surgery he was discharged with written/ paper prescriptions for pain meds and antibiotics, wearing a hospital gown and anti-skid footsie socks (his clothes had been cut off by the paramedics), and his other belongings were in a plastic bag. The hospital graciously gave him a walker and $2.00 for bus fare. It was winter and he had literally no where to go. Another homeless man 'took him in' at an abandoned construction trailer and the patient stayed there for a couple weeks (without pain meds or antibiotics). At least the other homeless guy shared food and blankets with him.
Elderly patients are also discharged after a medical crisis when they were barely able to care for themselves before the hospital admission. It also happens when parents have severely ill or injured children; some of these parents are performing tasks that RNs and respiratory therapists are trained to do.
Does anyone else see this happening in their hospital? Do these patients return when their condition either deteriorates or when they are simply in too much pain or unable to care for themselves?
