Obama orders same-sex hospital visits - pg.2 | allnurses

Obama orders same-sex hospital visits - page 2

"Gay, lesbian couples must be allowed visitors, medical power of attorney. President Obama mandated Thursday that nearly all hospitals extend visitation rights to the partners of gay men and... Read More

  1. Visit  Chico David RN profile page
    2
    It's obvious that practices have varied widely about this issue from stories that I have read in the media. Clearly there are relatively recent cases of same-sex partners being denied normal visitation by hospital staffs, but I think those are relatively rare exceptions. More common is the case where the patient is unable to express their wishes and the blood relations have not accepted the patient's sexual orientation or their relationship. In those cases the denial of visitation and/or rights to participate in care decisions are forced on hospital staff by the family. My impression of this new rule is that in that case - where the patient could not speak for themself - there would need to be documentation, such as a DPA, for the partner to trump the family.

    I'm a cardiac rehab nurse in a relatively conservative area and I can remember doing patient education post MI or CABG with gay couples as far back as the 80s and it was no big deal for anyone. Obviously my hospital, whatever its failings, must have been more enlightened than some others.
    nursel56 and Not_A_Hat_Person like this.
  2. Visit  tewdles profile page
    0
    I agree Chico...many hospitals do this right...

    I have, however, been witness to the gay significant other of a burn patient be denied access to the burn unit because of the "immediate family" rules. I watched a gay partner struggle with his dying partner's ICU visitation as the family was not sympathetic and monopolized the visitation time...the gentleman was finally able to communicate his desire for hospice and was sent home for his care...which was provided lovingly by his partner of many years.

    I think most hospitals try to meet the psychosocial needs of the patient regardless of sexual orientation...but others may need a bit of encouragement.
  3. Visit  KaroSnowQueen profile page
    2
    I really don't see how this helps a lot. Maybe I'm obtuse, but if someone had drawn up a POA and named their SO to make their medical decisions, wouldn't that automatically trump whatever family claims made? And if they hadn't, then they were indeed stuck with the family who is closest, SO notwithstanding? And most places let people in to visit, no matter the relationship. So I'm not seeing that this is a big step forward - it appears to STILL require the legal paperwork be made up, which was the sticking point before.
    Otessa and Not_A_Hat_Person like this.
  4. Visit  DoGoodThenGo profile page
    1
    Quote from KaroSnowQueen
    I really don't see how this helps a lot. Maybe I'm obtuse, but if someone had drawn up a POA and named their SO to make their medical decisions, wouldn't that automatically trump whatever family claims made? And if they hadn't, then they were indeed stuck with the family who is closest, SO notwithstanding? And most places let people in to visit, no matter the relationship. So I'm not seeing that this is a big step forward - it appears to STILL require the legal paperwork be made up, which was the sticking point before.
    Apparently the recent case in Florida notwithstanding, many have voiced the same thoughts as yourself. Most hospitals stated they already had a liberal visitation policy and or complied with either a patient's wishes or what have you. However there was enough of a problem that some pushed for/thought this rule to clear things up needed to be done.

    According to some media reports one has read, many felt the problem came from the nursing staff (surprise), who either did not know a hospital's and or local laws regarding the matter, or simply used their own judgement. Either way once the rules have been written and published, in theory every hospital from Maine to California will be the same, so there can be no mix-ups.

    Still feel while the new rule may be a blessing for some areas of society, it may prove a nightmare for nursing staff, who one presumes will be left to administer the policy.

    As anyone who as worked in an ER, unit or even the floors can attest to, there are a whole lot of married men stepping out on their wives with a vast array of other persons, some of whom may or may not know of the man's marital status. Often when there is an accident or health crisis such men are rushed in with the "other woman/person" trailing behind, then the spouse shows up. Under this new rule, if the patient has a health directive in place, whomever is named gets to primary visitation rights and calls all the shots. If that person is not the wife, it is going to fall to the nurse on duty to explain this and possibly seek to have her removed should the situation warrant. Now if there isn't a vaild directive in place and the patient cannot (or will not), name anyone, and the nurse goes by family realtionship, thus putting the wife or other family member in charge, the offended person may choose legal action or some other remedy based upon presumption of rights they may or may not have had.

    OTHO can see quite allot of mistresses and others now putting pressure on their "lovers" to put everything in writing in case "something happens to you....".

    Again, this rule does not just apply to gays, but to anyone. So if your 80 year old mother has retired to Boca and taken up with a man you consider "unsuitable" and have reason to think he is up to no good, but she names him in her POA, or tells the hospital staff she wants him, you are out of luck. Unless legally challenged and altered or voided that man will be making your mother's healthcare decisions if or when she cannot do so herself. This applies across the board so it could be your son deciding he wants his dorm mate, or your daughter choosing "that nice lady who lives in the apartment upstairs", or any other various combination.
    RetRN77 likes this.
  5. Visit  HeartsOpenWide profile page
    0
    We had an ethical case study in my Leadership Nursing class regarding a Lesbian couple that was in a car accident together with one winding up in the ICU and life support...situation with the family stepping in and not allowing the partner to make any medical decisions or even be in the room...guess this new law would solve this type of situation?
  6. Visit  outrunningzombies profile page
    6
    Quote from DoGoodThenGo
    Should llike to point out that although this rule was designed to benefit gays, it is worded as to apply to *all* patients.

    So if your daughter, son, husband or whatever is in hospital and directs someone else other than yourself to make decisions about their care, and or who gets first dibs on visitation/remaining at bedside, you are now out of luck, and will be chucked out regardless of family or blood relationship.
    I hope that's the case! My fiance cut his mother out of his life because she's more toxic than a Superfund site. One of my nightmares is him getting hospitalized and her showing up and trying to take over and do things he doesn't want or try to kick me out because I'm not his wife yet. He won't do a POA because he's in his 20s and indestructible.

    Forgive my starry-eyed just-accepted-to-nursing-school innocence, but I would like to think that nurses try to go by what patients want. I imagine it's not always possible and certainly not a pleasant experience a lot of the time (my faith in people acting decently died when I worked customer service for a credit card company) but ideally (key word) a nurse would just let the patient make their own decisions and not really worry about why Bobby doesn't want to see his mom/daughter/wife.
    Ok, you can stop laughing at my idealism now.

    I still love the decision, especially since it applies to lots of different family situations.
  7. Visit  NRSKarenRN profile page
    1
    White House Link shows covers much more than just same sex visitation:

    Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate Decision Makers for Medical Emergencies

    There are few moments in our lives that call for greater compassion and companionship than when a loved one is admitted to the hospital. In these hours of need and moments of pain and anxiety, all of us would hope to have a hand to hold, a shoulder on which to lean -- a loved one to be there for us, as we would be there for them.

    Yet every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides -- whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives -- unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated....

    ...My Administration can expand on these important steps to ensure that patients can receive compassionate care and equal treatment during their hospital stays. By this memorandum, I request that you take the following steps:

    1. Initiate appropriate rulemaking, pursuant to your authority under 42 U.S.C. 1395x and other relevant provisions of law, to ensure that hospitals that participate in Medicare or Medicaid respect the rights of patients to designate visitors. It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. The rulemaking should take into account the need for hospitals to restrict visitation in medically appropriate circumstances as well as the clinical decisions that medical professionals make about a patient's care or treatment.

    2. Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations, codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care. Additionally, I request that you issue new guidelines, pursuant to your authority under 42 U.S.C. 1395cc and other relevant provisions of law, and provide technical assistance on how hospitals participating in Medicare or Medicaid can best comply with the regulations and take any additional appropriate measures to fully enforce the regulations.

    3. Provide additional recommendations to me, within 180 days of the date of this memorandum, on actions the Department of Health and Human Services can take to address hospital visitation, medical decisionmaking, or other health care issues that affect LGBT patients and their families.....
    Last edit by NRSKarenRN on Jul 3, '10
    Perthgirl likes this.
  8. Visit  Fribblet profile page
    11
    Edit: Answered my own question.

    Glad to see this legislation passed. Next up: marriage!

    (After that: legalization of marijuana. Then we can all heal, live, love, and chill the **** out with the people we love.)
    SnowShoeRN, DolceVita, netglow, and 8 others like this.
  9. Visit  Not_A_Hat_Person profile page
    0
    Quote from DoGoodThenGo
    Should llike to point out that although this rule was designed to benefit gays, it is worded as to apply to *all* patients.

    So if your daughter, son, husband or whatever is in hospital and directs someone else other than yourself to make decisions about their care, and or who gets first dibs on visitation/remaining at bedside, you are now out of luck, and will be chucked out regardless of family or blood relationship. Methinks hospitals aren't going to wish to get caught up in this and risk ticking off the Obama administration, and will follow the rules to the letter. If a patient's family has problems with the rule and how it is applied they will have to turn to the courts or elsewhere for satisfaction.

    For nurses, this is probably going to result in some interesting situations when a wife or husband turns up at hospital and finds themselves not in charge by right, but anyone else from a mistress to a spouse's parents named to be calling the shots.
    Didn't that happen to Gary Coleman? Since his ex-wife was his Medical POA, she got to direct his care, not is parents.

    I support the law, but I also believe in the Law of Unintended Consequences.
  10. Visit  PetiteOpRN profile page
    1
    This seems like a complete non-issue to me. Others have mentioned that their hospitals have been allowing same-sex visitors for decades.

    If a hospital has a history of not allowing same-sex visitors, chances are high there are other practices at these hospitals that members of the GLBTQetc population might find offensive. I know there's a little more that goes in to choosing a hospital than choosing where to go for dinner (ie third party payer issues), but it can be done.

    There are plenty of GLBTQetc friendly health care facilities out there. Just because a few have practices/policies that the majority disagrees with is not a reason to make a law. This is not a human rights issue, it is a PR issue for the administration.
    nursel56 likes this.
  11. Visit  UVA Grad Nursing profile page
    6
    Petite:

    Not all hospital visits are planned.

    I know a male couple who were driving from their home in DC to FL. One became very ill on the drive, and they ended up in an ED in South Carolina. This ER would not recognize their relationship (even though they had been a couple for 20 years) and the 'well' one was kept waiting, uninformed in the Waiting Room. They separately told the admin that they had MPOA, but no go. One had to drive back to DC and get the actual MPOA forms from the safely deposit box, and then drive back to SC.

    After that point they 'shrunk' the documents to credit card size, laminated them, and carried in their wallets.
    SnowShoeRN, NRSKarenRN, Moogie, and 3 others like this.
  12. Visit  PacoUSA profile page
    11
    Quote from UVA Grad Nursing
    Petite:

    Not all hospital visits are planned.

    I know a male couple who were driving from their home in DC to FL. One became very ill on the drive, and they ended up in an ED in South Carolina. This ER would not recognize their relationship (even though they had been a couple for 20 years) and the 'well' one was kept waiting, uninformed in the Waiting Room. They separately told the admin that they had MPOA, but no go. One had to drive back to DC and get the actual MPOA forms from the safely deposit box, and then drive back to SC.

    After that point they 'shrunk' the documents to credit card size, laminated them, and carried in their wallets.
    That is utter ridiculousness, seriously. Gay marriage would solve all these kind of problems. I mean, if a hetero man or woman simply say they are married to ED staff, I don't think they are asked to prove it, right? No need for a MPOA. We still have a long way to go before we become an accepting and benevolent society
    SnowShoeRN, Moogie, nursel56, and 8 others like this.
  13. Visit  PetiteOpRN profile page
    1
    Quote from UVA Grad Nursing
    Petite:

    Not all hospital visits are planned.

    I know a male couple who were driving from their home in DC to FL. One became very ill on the drive, and they ended up in an ED in South Carolina. This ER would not recognize their relationship (even though they had been a couple for 20 years) and the 'well' one was kept waiting, uninformed in the Waiting Room. They separately told the admin that they had MPOA, but no go. One had to drive back to DC and get the actual MPOA forms from the safely deposit box, and then drive back to SC.

    After that point they 'shrunk' the documents to credit card size, laminated them, and carried in their wallets.
    It is possible to deal with those cases without putting a law into place.

    When my son was hospitalized, the resident refused to let the consulting physician see his chart, and sited HIPAA when asked, even though she was noted as a consulting physician. When I found out, I requested the attention of the resident and supervisor on duty for the unit and explained that if they refused to keep our child's physician in the loop, we would need to be transferred immediately to a hospital that could accommodate our request. They decided to accommodate us.

    This is totally non confrontational. "Ok, I understand that my request violates your policy. Please bring me the appropriate forms to fill out to be transferred to another facility."

    Yes, it's a hassle, but in some cases I'm sure it is preferable than staying for weeks in a place where 'no same-sex visitors' is probably the tip of the iceberg.

    The other strategy I find effective is calling the local news station for a tear-jerking story on discrimination at the local hospital. That gets policies reversed in a mighty-quick hurry.
    3rdcareerRN likes this.


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