Family refusing pt discharge - California

  1. 0
    I had a case recently where a severely disabled patient was admitted for an acute disease. That disease has been controlled but the family is refusing discharge. The patient had 24 hour caregiving prior to admission paid for by the state, but now they want two 24 caregivers where one is a nurse. As far as I know, the state has not approved their claim for having 2 caregivers.

    Given that the acute disease has been dealt with, can they legally refuse discharge? One nurse mentioned how families are not able to get away with this in other states so maybe being in California is a factor?

    The patient is basically living in the hospital at this point. I'm thinking that the family is completely exhausted from taking care of this patient.
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  3. 20 Comments so far...

  4. 4
    Legal advice against TOS, however, I have heard of instances where the state takes over the care of the patient, a guardian is appointed, and the patient moves to a LTC facility.

    There are many, many families who like the idea of keeping someone home, but the reality is much more difficult than anticipated.

    There are families who live off the social security disability, so are reluctant to give that up in lieu of placing a disabled family member in a facility.

    Some believe the hospital is the best place for their loved one to be, with a higher level of care.

    Most is a grey area in between, where this patient lingers, unfair to be away from everything they know, and their routine.

    Very sad. And it is not just exclusive to California. Happens just about everywhere.
    redhead_NURSE98!, GrnTea, ktwlpn, and 1 other like this.
  5. 0
    Thanks for your response. I wasn't soliciting legal advice, I was just wondering about the legality of it, i.e. can people "get away" with it indefinitely. I wasn't sure what happens in these scenarios but it sounds like it is not a unique situation.

    It's a pretty sad case (won't provide details) but I feel it's time for the patient to either go back home or live in a SNF if the family continues to refuse discharge.
  6. 2
    No they cant "get away" with this indefinitely. Eventually the hospital social workers will have the pt placed in a home. Its not the nurses job to place the pt fortunately, but you can bet it is being worked on, the insurance is not going to pay for this pts extended pay and the hospital will not want to absorb the costs of taking care of a healthy person who only needs additional assistance for very long.

    Thats just my two cents. Thank you.
    Altra and GrnTea like this.
  7. 3
    The cost and burden of this care is devastating that family.
    Some people get to the end of their rope and do what ancient traveling tribes did...they leave the infirm behind...it is the only way for them to survive. Those decisions have haunted families and groups since the beginning of time...
    GrnTea, morte, and IowaKaren like this.
  8. 0
    Would respite care be a solution for this family? It would give them a break plus some time for a social worker to help them come up with a workable solution?
  9. 5
    The OP states the individual already HAS 24 hour/ day care at home by a caregiver and now they want a nurse in ADDITION to that. Respite care cannot be provided. Respite from what? The person HAS round-the-clock caregivers.
    Fiona59, BloomNurseRN, Altra, and 2 others like this.
  10. 2
    In my experience the patient would be placed in LTC. The hospital is required to ensure, or at least make a good faith attempt to ensure ongoing care if ongoing care is required at discharge. 24 hour care in the home is very expensive, so unless you're willing to pay for it yourself it's not something you can demand, obviously two 24 hour caregivers with one being an RN is even more expensive, so if anyone is helping to foot the bill, such as public assistance, then it's up to them to decide how best to spend their money, which is typically an LTC.
    BlueLightRN and jadelpn like this.
  11. 5
    And I hate to say it, but 9 times out of 10 the reasoning has to do with the SSDI check the family receives each month as a "let's keep them at home" thing.

    Otherwise, there's a great deal of viable options for skilled care at a facility.
  12. 2
    I trust the hospital's legal counsel is already involved in this situation.
    Altra and GrnTea like this.


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