Discharged at the point of death.

Specialties Geriatric

Published

Are you getting lots of residents admitted from hospitals that are breathing their last breath or still sick as a dog. Hospital sent me a lady, that went back in 16 hours and died, one on 10 lts of 02 (hello, how high do your concentrators go?), he went back before getting off the stretcher, one who lasted like 5 hours before complaining of chest pain (she was in the hospital for an MI) who we sent back and she died.

I thought the new medicare stuff was supposed to stop some of this.

This is one of the main concerns. Family members who have POA need to be educated and ready when the inevitable happens and think first of the person passing on and not of their own needs. If they are full codes then they got to go out .... horrible shame for the most part. When there is a change in status family members must be prepared to do what's right for their loved ones.

What is right is dependent on personal morals and values. Our place is simply to educate and advocate. Many of us have become jaded and see death as inevitable, some people still have faith and it is not our place to question it.

I'm disappointed in this thread. This is a societal problem, a reimbursement problem, a cultural problem, and here we are pointing fingers - LTC vs. Hospital - when that's just a distraction from the greater issue.

Hospitals discharge prematurely because they have to. SOME LTCs accept the patients over the desires of their clinical staff because they get the bed filled and corporate stops breathing down their necks. Physicians in hospitals often don't even know the patient and don't tell anyone squat. Nurses in hospitals don't want to step on any physician toes so they don't broach the subject.

Specializes in Med/Surg, Academics.
I think the biggest problem is that in our society we have stopped believing that death is a natural part of life. Families are loathe to admit their loved ones may be dying or that they may actually be doing the right thing in allowing them to go versus fighting it with all they've got:sniff:. Don't a lot of the newer facilities advocate "survivors" and telling people how much longer they might have if they go w/so-and-so's facility? We live in a world where dying is not acceptable and therefore dying with dignity is virtually unheard of and unacceptable.

maelstrom, you make some very valid points. We've out-sourced death. When I was a kid CPR was still very new and old folks with big problems just - died. If not the first MI then the second, or the stroke, or whatever. Now we can keep people going for decades with multiple morbidities that just a generation ago would have been fatal much earlier.

.....

I don't think emergency nurse was referring to us, but to those unrealistic expectations that people have regarding precisely what we can do. I always liked, "What HAPPENED?" Um, what part of SHE'S 90-FREAKING 8! is beyond your ken?

Someone once said (and maybe it was someone here) that it used to be: you're alive or you're dead.

Now it's: you're alive, you're dying, or you're dead.

With all the medical technology today, it's the "you're dying" part that families just can't deal with. It's only going to get worse.

Someone once said (and maybe it was someone here) that it used to be: you're alive or you're dead.

Now it's: you're alive, you're dying, or you're dead.

With all the medical technology today, it's the "you're dying" part that families just can't deal with. It's only going to get worse.

That is a very ethnocentric view.

That is a very ethnocentric view.

Depending on where the poster lives it may be one ethnos. It sure is here. Our diversity extends to Methodists AND Baptists.

Specializes in Med/Surg, Academics.
That is a very ethnocentric view.

I'm not sure what you mean by that. Could you explain?

I'm not sure what you mean by that. Could you explain?

Our morals, values, and opinions are based upon our personal culture and experiences. We tend to look at the actions of others and judge them through this lens. Ethnocentrism is not inherently bad, just a fact. We must realize that when we judge others that it is with a bias.

The view that technology and improvements in medical and nursing practice have extended peoples lives and that the utilization of those advancements by family is somehow misguided is rather reliant upon your individual culture and experiences.

We are greatly exposed to death and deal with it in a very unique way, we cannot judge how others deal with the dying process, only educate and advocate. We may call it a waste, improper or even immoral but for many the fight to prolong life is called faith.

Specializes in Med/Surg, Academics.

Thank you for the explanation of your comment.

.....but for many the fight to prolong life is called faith.

This was an interesting choice in words. A faith in what?

A preemptive apology to the OP for unintentionally hijacking this thread. :o

Thank you for the explanation of your comment.

This was an interesting choice in words. A faith in what?

A preemptive apology to the OP for unintentionally hijacking this thread. :o

Faith in their family member, our skilled hands, a deity, who knows. When questioned as to why family members choose to prolong life against insurmountable odds, "faith" is often cited as the reason.

Specializes in ED/ICU/TELEMETRY/LTC.

I, too, am disappointed in the way this thread has turned. It was meant as kind of a rant against the system and the insurance companies.

Here were are at ALL NURSES. Nurses do not decide who gets discharged. I am sure that there are some patients that nurses know are not going to make 24 hrs. at the nursing home that get discharged.

But then, with an order, there is nothing else to do. I hate that it turned into an 'us vs them' conflict. I thought we were pretty much on the same side.

I, too, am disappointed in the way this thread has turned. It was meant as kind of a rant against the system and the insurance companies.

Here were are at ALL NURSES. Nurses do not decide who gets discharged. I am sure that there are some patients that nurses know are not going to make 24 hrs. at the nursing home that get discharged.

But then, with an order, there is nothing else to do. I hate that it turned into an 'us vs them' conflict. I thought we were pretty much on the same side.

Actually 99% of the time it is a nurse who decides on the discharge, just not a floor nurse.

Even if the topic did not follow your rant, it is still a fascinating topic and enlightening thread. Thank you OP.

It is a very good thread about a very complex issue. We aren't going to solve the problem but it is important to talk about it.

I agree that we should stop thinking in terms of us vs. them. For a while I was thinking that this is really a question of educating families and patients about the realities of the situation. However, this thread has made me see that this goes a lot deeper than simple education.

We as nurses can see the reality of patient outcomes with a lot of clarity and we have the professional wherewithall to deal with things objectively and at the same time with compassion. At the same time, death is an enormously complicated issue and we all struggle with it, regardless of our role in the healthcare system.

When it comes to the family and the patient, there are even more issues that come up, such as their faith, their attitude about death, and their attitude about healthcare in general. And also, and just as importantly, their attitudes about us and our role in the whole process.

We had a thread going on this site recently about terminal agitation in hospice. And what came up was the issue of patients who had a lot of unresolved issues about life and death and how badly that could play out in the actual dying process, even when the patient had reconciled themselves to the reality that they were dying.

A lot of us may have also seen patients who die badly because they still feel on some level that the family wants them to stay alive.

Someone here mentioned that it seems like something psychological or physiological happens in transport from hospital to LTC that leads to patients dying. The first thought that popped into my mind, whether it is accurate or not, is that there may be a perception on the part of the patient that being in the hospital is about getting better, and leaving the hospital is about having permission to let go.

I think this is a very interesting and educational thread and I hope we can continue to discuss this without falling into conflict.

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