Woman refuses discharge for one year - page 3

woman overstays hospital stay by a year wed feb 16, 8:39 pm et u.s. national - ap by brian skoloff, associated press writer more than a year after sarah nome was deemed healthy and... Read More

  1. by   UnewmeB4
    Quote from NRSKarenRN
    Clue phone here:





    Patient been in SEVERAL SNF since 1982, "insist on staying in Marin County" this is a discharge planning nightmare. Daughter obviously not a "willing and able caregiver" or would have been sent to her home with homecare services. Patient is bedbond, just can't show her to the door.

    We get way too many like this, esp on the resp floor. Family wants EVERYTHING done for beloved family member. They may be paralyzed and on a vent, but, do everything to keep her alive! and, I am NOT talking about an 18yr old here... When everything has been done, and pt is still paralyzed and vent dependent, they refuse to have them transferred to a facility that are qualified to take such pts(few and far, of course)because "it is too far away...it will be too much for us...and on it goes, as they reject each offer. In the meantime, the family camps out at the hospital, hovering over pt, making more and more demands on the staff. It does get old.
  2. by   stevierae
    Quote from 3rdShiftGuy
    We do a lot of indigent care at my facility. As cold-hearted as it is, we've sent them to homeless shelters in a cab when it's time for discharge, if they are homeless when they are admitted.

    Prmenrs, I'm sure after a year case managment has considered all their options. My guess is she's been refusing them.

    She's obvioiusly using them for a hotel. Wonder why she's suing them?

    Interesting.
    The ironic thing is that she is by no means indigent. Marin County--across the Golden Gate bridge from San Francisco-- is where the filthy rich and the famous of the SF Bay Area live. She states she does not want to relocate from Marin County--hell, who WOULD? I'd kill to live there!!

    I suspect her bills are paid by Medicare. Now, what I don't understand is this----why can't she get prosthetic legs, and, if that is not an option, why can't she have home health, including aides to help her with ADL, in her home? Also, wheeelchairs, even those really fancy ones (Rascals? Hovarounds?) are heavily advertised as being paid in full for by Medicare.

    Why can't she and her daughter hire and pay for housekeeping help? If her daughter lives in Marin, then I guarantee you that she is well-off.

    If this was any other area of the country, the police or sheriff would have carried her out bodily for trespassing. However especially in CA, (where I often worked, and worked for 2 different Kaiser facilities there) people are very, very aware that Medicare and, especially Medicaid (MediCal, in CA) recipients are very litigous. They are alwys treated with kid gloves, lest some civil rights attorney jump on a class action lawsuit (and a chance for his own wealth and fame) on behalf of Medicaid/Medicare health plan recipients.

    And we wonder why Kaiser health plan premiums are skyrocketing!! Kaiser health plan insurance used to be free for Kaiser employees---no more. Man, I am so glad that I no longer work for Kaiser. I suspect, as someone else stated, that she uses the aides and nurses as her personal servants--and that administration looks the other way.
    Last edit by stevierae on Feb 18, '05
  3. by   roxannekkb
    Quote from stevierae
    The ironic thing is that she is by no means indigent. Marin County--across the Golden Gate bridge from San Francisco-- is where the filthy rich and the famous of the SF Bay Area live. She states she does not want to live Main County. I suspect her bills are paid by Medicare. Now, what I don't understand is this----why can't she get prosthetic legs, and, if that is not an option, why can't she have home health, including aides to help her with ADL, in her home?

    Why can't she and her daughter hire and pay for housekeeping help? If her daughter lives in Marin, then I guarantee you that she is well-off.
    I actually used to live in Marin, in Tiburon in fact, and I can assure you that not everyone in Marin is well off. Many people are quite poor in fact. There are pockets of poor in many communities, and towns like San Rafael have large numbers of MediCal patients. In central and West Marin, you'd be surprised at how some of the people live. Yes, there are many very wealthy people there, but this woman may not be one of them. That said, I don't understand the problem with her daughter. Does she really want her mother to be sitting in a hospital, day after day, where she will eventually pick up a nosocomial infection--and possibly die of it.

    The woman needs to be moved to a nursing home, be it in Marin County or elsewhere. But she should not be taking up bed space if she doesn't belong there. And since she does have a daughter, then she should be discharged to the daughter's care.
  4. by   sunnyjohn
    Why doesn't her family take care of her? Isn't that what Family is for???
    If this was my mother and I was physically able to care for her THEN I WOULD!!!
  5. by   stevierae
    Quote from roxannekkb
    I actually used to live in Marin, in Tiburon in fact, and I can assure you that not everyone in Marin is well off. Many people are quite poor in fact. There are pockets of poor in many communities, and towns like San Rafael have large numbers of MediCal patients. In central and West Marin, you'd be surprised at how some of the people live. Yes, there are many very wealthy people there, but this woman may not be one of them. That said, I don't understand the problem with her daughter. Does she really want her mother to be sitting in a hospital, day after day, where she will eventually pick up a nosocomial infection--and possibly die of it.

    The woman needs to be moved to a nursing home, be it in Marin County or elsewhere. But she should not be taking up bed space if she doesn't belong there. And since she does have a daughter, then she should be discharged to the daughter's care.
    Interesting. I used to work at several SF Hospitals, and it seems like all our Tiburon patients were there for cosmetic surgery--the works---facelifts; botox; collagen; lipo, tummy tucks----and many were the young, spoiled wives of wealthy dot com entrpreneurs who made their $$$ before the dot com crash--or the 3rd or 4th young wives of famous musicians, many of whom made their fortunes in the '60s, '70s, and '80s.

    Those folks hired private, around the clock operating room nurses to tend to them in their Marin homes (or sometimes fancy SF hotels) around the clock after their cosmetic surgery, so that they could get the one-on-one attention they were accustomed to. They did not want to be on a med-surg floor with the great unwashed masses whom they scorned. Many of these nurses who did private duty nursing for these folks were colleagues of mine, making a pretty penny on the side---and why not? Anyone can put up with spoiled divas, as long as the price is right and the situation is temporary.

    I guess the folks of whom you speak must have sought their health care at the General. I sure never saw them.

    I do agree with you that she needs to be discharged to the daughter's care.
    Last edit by stevierae on Feb 18, '05
  6. by   roxannekkb
    Quote from stevierae
    Interesting. I used to work at several SF Hospitals, and it seems like all our Tiburon patients were there for cosmetic surgery--the works---facelifts; botox; collagen; lipo, tummy tucks----and many were the young, spoiled wives of wealthy dot com entrpreneurs who made their $$$ before the dot com crash--or the 3rd or 4th young wives of famous musicians, many of whom made their fortunes in the '60s, '70s, and '80s.

    Those folks hired private, around the clock operating room nurses to tend to them in their Marin homes (or sometimes fancy SF hotels) around the clock after their cosmetic surgery, so that they could get the one-on-one attention they were accustomed to. They did not want to be on a med-surg floor with the great unwashed masses whom they scorned. Many of these nurses who did private duty nursing for these folks were colleagues of mine, making a pretty penny on the side---and why not? Anyone can put up with spoiled divas, as long as the price is right and the situation is temporary.

    I guess the folks of whom you speak must have sought their health care at the General. I sure never saw them.

    I do agree with you that she needs to be discharged to the daughter's care.
    Many Tiburon residents are wealthy, but my point was that Marin County does have many poor residents. Even in Tiburon, there was public low cost housing. Many of the other communities had lower income residents--in particular, Marin City and San Rafael, and some of the communities in West Marin. It certainly isn't all glitter and glamour. In fact, I did some work for a center that opened for low income pregnant women on MediCal, and the place was booming. All of the women were from Marin, the majority Hispanic.

    I also don't think you have to be a spoiled diva to have healthcare in your home. I would much prefer to have a nurse tend to me in my home, if I could pay for it, than be in a hospital. And I certainly wouldn't want to be on your average med/surg floor, with nurses running around short-staffed (although the ratio should improve things), and being exposed to all kinds of nosocomial infections. Sorry, but I see nothing outlandish about choosing to be cared for in your own home. It would be my choice, and believe me, I'm far from a spoiled snobby diva.
  7. by   stevierae
    Quote from roxannekkb
    I also don't think you have to be a spoiled diva to have healthcare in your home.
    I didn't mean that you did, and I certainly think that most elderly foks who are non-ambulatory are deserving of in-home nursing as well as non-nursing services (i.e., aides to help them cook, clean, etc.)

    What I was referring to was the "nursing" care delivered to the wealthy cosmetic surgery patients in their homes or 5-star hotels by colleagues of mine, who were paid very well in the interest of generating future referrals to the cosmetic surgeons involved---and, of course, more work for those nurses.

    Mostly all they had to do was sit by the bedside, read, and, if they felt like it, admire the home's furnishings, china, books, etc. while the patient was asleep. This was a coveted, lucrative, money under the table, piece of cake job.

    They were there for little more than hand-holding, ordering in meals from fancy restaurants (to be delivered,) replacing ice packs, offering sips of beverages, and giving p.o. meds---really, just for the patient's own security; waking up out of a haze and knowing that someone was by the bed. Any family member could have served the same purpose, but these women did not want their family members to see them looking "ugly---" and, anyway, they were used to being tended to by hired help.
    Last edit by stevierae on Feb 18, '05
  8. by   KarafromPhilly
    Quote from sunnyjohn
    Why doesn't her family take care of her? Isn't that what Family is for???
    If this was my mother and I was physically able to care for her THEN I WOULD!!!
    Well, I like to think I would too, but...I live in an apartment and work full time. I could certainly understand not wanting to stay home and entertain a bored, wheelchair-bound elderly woman who expects me to wait on her hand and foot, even if she were my mother.
    Anyway, she can't legally be forced to care for her mother.
    But I don't really understand why they don't stick this woman in a wheelchair and roll her to the curb. Is it so terrible to move a few miles out of the county in which you've lived for many years if COUNTLESS OTHER PEOPLE CAN RECEIVE POTENTIALLY LIFE-SAVING TREATMENT IF YOU DO SO? Isn't that what hospitals are for?
  9. by   P_RN
    During my time on our floor I recall 3 patients who "boarded" for a year or more.
    The first lady had no relatives except her nephew the lawyer. He had lawsuits going against 3 or maybe mor ECF. No one wanted to have him start on them. We kept Mrs Q in a corner room facing the heli-pad. She was considered in a swing bed-I assume they're still called that. At least the hosp. was able to recover some $ She was finally placed in an ECF 100 far away from her roots. She died about 2 weeks later.
    She was one of those ladies you wish were your aunt or favorite granny.

    2nd patient short story. Street person brought in with fx femur. No one would take him as a patient, he was blind, aphasic, diabetic combative and by this time his toes had started to get gangrenous.....whew! We took him on. 100 year old AA med sometimes like pigs feet-why not my dad loved them. So did Mr P.with cane syrup. Small bunches of bananas, a pretend watch to replace the one he was mugged for. Dietary approved all of this as he lived 100 years doing this kind of diet and his sugars were still OK,
    He got sent to the geriatric campus of the State (mental hospital). He died there a week
    later.

    Another was a Taiwanese man on a work visa who had a stroke and his land lady kicked him out for improper advances. He lived in on of our private rooms about 3 months. Finally the govt. agreed to send him to Taiwan but he needed an escort. Our night time director flew to Atlanta got a passport fast track and the next day they left. He was dropped off at the Police Station who returned him to his family who thought he had died.

    Frankly I think your lady shoud be left alone. She already knows they're fighting over her case...no body wants her. That would be a crushing blow for one at any age. The hospital can eat the bill and get her Social Security check and possibly Medicaid if she has it sent to them in partial payment.

    It would be a good thing, a mitzvah to allow dignity instead of indignation to color this situation.
  10. by   GingerSue
    Quote from spacenurse
    A friend of mine suggested, "Give this lady a job. Send her to Peds and have her read stories to the kids."
    I would agree with spacenurse and sunnyjohn - help this woman - give her something constructive to do, use her for publicity for the facility.
    While at the same time making plans for her accommodation and care.

    The thought of "removing her to the street" seems contradictory to the purpose of health care. Making someone homeless seems more like an action that would kill someone, and put that person at risk of danger. I can't believe some of what I am reading!
  11. by   stevierae
    Oh, I just re-read the article about Mrs. Nome. For some reason, I thought she had LOST both her legs. Actually, it says she is bedbound because she BROKE both legs in 2002, and had several unsuccessful surgeries.

    I wonder why she was not able to be rehab'ed successfully--that is, by PT? One wouldn't think a person would be bedbound, particularly since she says she is in no pain. I could see if she had severe post-traumatic arthritis, or suffered from severe osteoporosis, and needed a narcotic PCA or Duragesic patches, but even that could be overseen by home health--and, it's a moot point anyway, since she says she is not in pain.

    Yeah, I think she should definitely earn her bread and board if they can't get her to leave. She could sit behind the cash register at the gift shop, or in the cafeteria, or even answer phones at the switchboard. She could ditribute books to patients on othr floors by means of a motorized cart or wheelchair. Reading to the children or cuddling preemies or fragile children whose parents can't be there because they are working or caring for their other children would be good for all parties involved.
  12. by   GingerSue
    or let her on the phone to do telemarketing/fundraising for the facility -- businesses and people will donate to worthwhile causes.
  13. by   smk1
    ok i don't know what all is involved in the care for a woman who would be completely bed bound, (not a nurse yet) but i know people who don't have money for their elderly parent to go to a nursing facility, and they work like most people do, so they give mom the phone, ready made sandwiches and and thermos of water tv remote and mom wears depends. Is it ideal? no! but you do what you have to and i don't see why mom can't stay with her daughter. Many people have to work and can't stay home to care for an ill relative, but the relative still has to stay at home because their is no money for nursing care.

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