Discharging a resident who does not want to leave?

[fulzgold]

Ever had to or tried to discharge a patient who does not want to leave? Been lucky so far, but we have had a few who were either not sick enough to qualify with their payor source and did things like " fall.. then say .."can I stay now?" or refuse to leave and refuse to pay and demand all sorts of care they don't need. I read an article where this hospital, I don't remeber where it was, had a female patient that had been living there for 18 months because no one ( LTC) would take her and the hospital could not legally discharge her. She had cost them 100s of thousands of dollars. What are some of your experiences with this issue.

[VivaLasViejas, ASN, RN]

Oh, brother.....BTDT, got the battle scars to prove it.

At the assisted living facility where I worked for several years, we had a few of these. They'd keep falling, or every few months their mental status would decline more, or they would simply have to be hospitalized over and over and come back with higher care needs each time. Sometimes it wasn't the resident him/herself but the FAMILY that would get their knickers in a twist when I had to ask them to leave, and that was much more difficult because they were usually the ones with POA AND a lot of money. They'd tell me "We'll pay for whatever Mom needs, just don't make her go to a nursing home!"

Unfortunately, there are just some medical needs that can't be met in an ALF---that's why there are nursing homes. We couldn't handle the woman who sat in her chair in the dining room and threw fistfuls of her own poop at her tablemates. We couldn't take care of the diabetic man who kept bottoming out on his blood sugars and needed his FSBS checked every two hours, IM glucagon given when he was unresponsive etc. (nurse in building only 32 hrs. a week, caregivers couldn't give IMs---what was I going to do, come in at 0200 when they checked his sugar and it was 13??). But to hear some folks, we were supposed to be St. Jude: patron saint of the impossible.

Sometimes it did get ugly when people didn't want to move to a higher level of care, so I usually involved Senior Services and the resident's physician to get them on board with the move, then called a meeting with all concerned. Usually that was enough to persuade folks that it was in their best interests to comply with the discharge. But every now and again, we'd have to wait weeks or months to get someone out of the building......in the meantime, we had to provide care to the best of our ability, and get home health agencies in to help with the rest.

[CapeCodMermaid, RN]

With the ongoing cuts in Medicaid, we are all worried about keeping residents who don't really need 24 hour care. Our social worker and I are calling rest homes and other places to come screen some of our residents who don't belong where they are now.

[susanthomas1954]

Short stay patients with a Medicaid payor source (emergency acute insurance) frequently have come from the street, and our administrator really doesn't like seeing them go back to the street, so we end up keeping some people until we can find a shelter. If you haven't ever worked with truly destitute people you cannot imagine discharging with a wheelchair, WITHOUT leg rests because leg rests are weapons, once they hit the street. AND they can't afford insurance or housing, but they can afford METH. We really try not to admit people that have no discharge destination, but our reputation in the community has been just that, and we don't get a lot of easy discharges. We are private and for-profit, as well.