Help with Elopement

pennyaline · Dec 3, 2009

He can't go home now because she'll take him to FL. She isn't accepting the new situation, Penny.
NY makes everyone Medicaid. That won't be a problem.

I understand. It's tough when the family wants what it wants. However, I still can't see how the desire to keep her from packing him off to Florida justifies giving HIM all of those psychotropic meds and keeping HIM in the facility when he doesn't want to be and may not need to be for much longer. When push comes to shove, and it might very quickly now that you have state in the building :eek: , your facility may find itself it deep poopie for chemical restraint.

All of his financial options and care needs should be carefully examined, and potential discharge home with services planned regardless of whether in NYS or Florida. If they are private pay, she could get services in either state. And it has to be remembered that just because the facility feels she shouldn't take him to Florida, it doesn't mean that she can't. If she is his decision maker, she can do it whenever she wants. Remember how this thread started out, as helping to facilitate discharge? If she wants to take him and has the means to get services, she should be assisted to do so, ideally with a legitimate discharge order from the MD.

SuesquatchRN, BSN, RN · Dec 3, 2009

She wouldn't be able to handle it. And she may take him out at any time.

His outbursts are cerefully documented and we're not even under scrutiny for that. Know wht they're on us for? Residents who smoke smoke when they go home for visits.

He's been much better the past few days. She's been there more and this morning, when I asked him how he was feeling, he gave me a huge smile and answered, "Cloudy and unsettled." I like him.

:)

CapeCodMermaid, RN · Dec 3, 2009

I don't understand...you'd 'let' him go home if he was going to be in New York, but since his wife wants to take him to Florida you won't discharge him? There are plenty of skilled and assisted living places in Florida...they have meds, doctors, and nurses. What's the problem?

pennyaline · Dec 3, 2009

...He's been much better the past few days. She's been there more and this morning, when I asked him how he was feeling, he gave me a huge smile and answered, "Cloudy and unsettled." I like him.
:)

LOL! Poor guy!

SuesquatchRN, BSN, RN · Dec 3, 2009

I don't understand...you'd 'let' him go home if he was going to be in New York, but since his wife wants to take him to Florida you won't discharge him? There are plenty of skilled and assisted living places in Florida...they have meds, doctors, and nurses. What's the problem?

CCM, I have nothing to do with his discharge.

He has care and a community here. Continuity. He is not adapting at all to changes and the fear is that, with his deteriorating mental status (sans meds) he will become more confused and decline more quickly in FL and the care is not already in place there should something happen.

All I'm saying is that I know have a better understanding of the reluctance to d/c him.

pennyaline · Dec 4, 2009

...All I'm saying is that I know have a better understanding of the reluctance to d/c him.

Gotcha!

debRN0417 · Dec 7, 2009

We have an elderly gentleman who came in with Parkinson's and was here for rehab. He's been with us a couple of months and wants to go home. He lives a couple of blocks away. His wife would take him home in a hearbeat but PT is blocking it and she is of a generation that will not disoneythe authorities and take him home AMA.
He. Is. Determined.
As his attempts to leave have escalated he has been medicated with Seroquel. Geri-chair with tray. Now he has become combative when he is rushed and wrestled into the chair and Depakote has been added.
I feel like Nurse Ratched. He is fine on certain shifts, but some nurses come in already high-strung and really escalate things by being unable to approach him calmly, and when he is surrounded by a bunch of people his behavior is certain to become combative from fear.
Help, please.

The hair is stnding up on the back of my neck...Seroquel and a Geri-tray because he wants to go home? Sounds like chemical and physical restraints to me.

PT keeping someone from going home? That's the craziest thing I've ever heard of. If it is because he had Medicare and it is for the reimbursement, it could be fraud.

Did someone contact Adult Protective Services? Your social worker should be in there fighting all about the resident's rights not the rights of the facility getting his reimbursement- Social Services whould be concerned about his welfare and the rights of he and his RP....what in this world.....

Why in earth can he not go wherever he wants to when he is discharged with his wife? I am missing something here. Sounds like he is being kept against his/wife's will.

Where is the ombudsman and APS? This is crazy.....

SuesquatchRN, BSN, RN · Dec 7, 2009

Did you read the rest of the thread? She can sign him out at any time. And yes, they can go wherever they like.

It's not as simple as "he wants to go home." He has struck people, bitten them, cursed them, and we can not allow our incompetent patients to leave the building without being cited for neglect.

debRN0417 · Dec 7, 2009

I ubderstand that, it just sounds concerning. I hope it works out. Just need to be careful and document, document, document. It is very sticky when there are so many contributing things going on, and very difficult to deal with. As a nurse, we are often left to pick up all the pieces, when we are the ones carrying the load anyway. Good luck.

SuesquatchRN, BSN, RN · Dec 7, 2009

Thanks, Deb. Yeah, it concerned me, too, which was why I started the thread. It isn't an easy one.