Abandoning family in the ED during the holidays

[SubSippi]

Every year, during the holiday season, we have an influx of patients that seemed to have been dropped off in the ED for the convenience of their family. Some people will probably say that there's no way for me to know if that's what is really happening, but we have noticed there are a few things these patients have in common. Nurses that have been there a while say it happens every year.

These people will come in via ambulance, from home, no family present. Chief complaint will be something like the patient suddenly started acting weird. The patient will show no signs of distress, all vital signs normal, labs and scans will be either normal or no changes since their last visit. Pulling up the patient's history will show an extensive and well documented history of Alzheimer's or dementia. All phone calls to emergency contacts will be ignored. While in the hospital, these patients are always VERY difficult...they are confused, trying to escape, biting, kicking, screaming.

Occasionally we will get someone who is A&Ox4, with reported suicidal ideations (which they deny). They will have some sort of chronic illness, but no s/s of an exacerbation. These people are usually HUGE jerks, abusive towards staff, sometimes to the point of being violent.

A day or two after the holiday, right when we've started trying to line an LTC bed, the family shows up, and wants them discharged immediately.

It's not just a couple people, it's a TON of them, each holiday. Sometimes, the same person will be there over Thanksgiving and Christmas. It's almost like word has gotten out in the community that the hospital can babysit Grandpa so they can enjoy Thanksgiving without any interruptions. Am I crazy, or is this a common occurrence?

[canigraduate]

I've never worked ER, so I honestly don't know if you have strategies in place for this, but aren't there legal ramifications for defrauding the hospital, especially the Medicare pts?

Because I think that's what this should be classified as, fraud. I would think that the responsible parties would be facing fines at the least. Moral and ethical issues can be pushed to the side, but legal ones usually get followed up on, right?

I may be totally off base, not having any experience in that area.

[jadelpn, LPN, EMT-B]

I've never worked ER, so I honestly don't know if you have strategies in place for this, but aren't there legal ramifications for defrauding the hospital, especially the Medicare pts?

Because I think that's what this should be classified as, fraud. I would think that the responsible parties would be facing fines at the least. Moral and ethical issues can be pushed to the side, but legal ones usually get followed up on, right?

I may be totally off base, not having any experience in that area.

No, they need a disposition, are party to many, many un-necessary tests, IV placement for "fluids" rule outs upon rule outs--because symptoms are what they say they are--much like pain--until proven otherwise. Which sometimes can take a couple of days.

And no, as long as a survey comes back awesome (and it will not if one sends an elderly person home before the family is going to accept them) then all is good--PLUS--if you send the person home, guess who comes in via rescue the very next day--YUP--that same person--and that just messes with the reimbursement....

Sad state of affairs!

[canigraduate]

No, they need a disposition, are party to many, many un-necessary tests, IV placement for "fluids" rule outs upon rule outs--because symptoms are what they say they are--much like pain--until proven otherwise. Which sometimes can take a couple of days.

And no, as long as a survey comes back awesome (and it will not if one sends an elderly person home before the family is going to accept them) then all is good--PLUS--if you send the person home, guess who comes in via rescue the very next day--YUP--that same person--and that just messes with the reimbursement....

Sad state of affairs!

Wow. That's awful. It's a total breakdown in the system. Thank you for elaborating for me.

[RN_2012, BSN, RN]

disregard

[anon456, BSN, RN]

I've never worked ER, so I honestly don't know if you have strategies in place for this, but aren't there legal ramifications for defrauding the hospital, especially the Medicare pts?

Because I think that's what this should be classified as, fraud. I would think that the responsible parties would be facing fines at the least. Moral and ethical issues can be pushed to the side, but legal ones usually get followed up on, right?

I may be totally off base, not having any experience in that area.

We did have one kid who came in literally every other week right before the weekend, and on every major holiday. Social work got involved and wanted to look into the child's quality of care at home, and whether or not the family was able to adequately care for the child. They stopped coming in after that unless the child was truly sick. It cut down visits to about 3-4 times a year.

[anon456, BSN, RN]

Problem is, when you can't get a hold of the family, and there is no way to send these poor souls home alone. They don't need hospital but aren't capable of caring for themselves.

In our case, we can't send a kid home who has complex needs, and has been reportedly hypoxic or had uncontrolled vomiting at home. It takes a few days to observe them, run tests, and figure out they are not sick worse than baseline. I imagine it's the same with the fragile older people that come into adult EDs.

[imbatz, BSN, RN]

It is illegal to dump in Florida. I remember one nurse chasing a caretaker down in the parking lot who just dropped off an elderly patient.

[ANnot4me]

Too complex an issue...

[brandy1017, ASN, RN]

I was told it used to be ok to place an elderly patient in a hospital for a break for the caretakers. One sad case was an elderly lady whose children were fighting with each other, one stayed with her to care for her and was essentially homeless, the other POA used her credit cards for personal use, while they fought with each other. The caretaker admitted being overwhelmed and needing a break and at the same time homeless if not for staying with the patient. Months later the poor patient was made hospice and died and I don't know what became of the rest of the family as they all had serious financial problems and/or struggles with unemployment as well as health problems themselves. Sadly I think this is more common than people realize where adult children have become financially dependent on their frail, poor elderly parents whether because of drugs, alcohol, mental illness, unemployment or underemployment.

[TiffanyMonroeRN]

I float at my hospital, and this includes floating to the psych unit. I've seen this happen many times during the holidays, and it's so sad. It happens a lot with the elderly patients.

[imintrouble, BSN, RN]

Out here in the boonies, our dumpers are made of sterner stuff.

They just look the MD in the eye and say, "We're not taking them home."

[RNsRWe, ASN, RN]

Out here in the boonies, our dumpers are made of sterner stuff.

They just look the MD in the eye and say, "We're not taking them home."

Seriously ridiculous! Surely these people have been told (when appropriate) "Sorry, your mother doesn't need to be admitted, you HAVE to take her home, and if you don't want to keep her there, you can arrange for a nursing home"?

I'm not naive, believe me I know how the dumping happens, but I *AM* used to it being more covert, as in "she's really been sick, I think she needs to be admitted, she isn't safe at home". Key words to GET that old lady admitted. But "I don't want her anymore"? How is that allowed to turn into an admission to the hospital?