Family refusing pt discharge - California

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Specializes in ICU.

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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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.

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Specializes in ICU.

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.

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Specializes in Medical Surgical.

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.

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Specializes in ICU, BURNS, TRAUMA, TRANSPORT, HH.

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...

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Specializes in ortho, hospice volunteer, psych,.

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?

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Specializes in NICU, ICU, PICU, Academia.

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.

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Specializes in Critical Care.

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.

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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.

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I trust the hospital's legal counsel is already involved in this situation.

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Specializes in ICU, BURNS, TRAUMA, TRANSPORT, HH.

Care in a SNF or LTC is not cheap.

If the elder has no assets, and no 5th level of insurance coverage, the family is in a pickle.

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Specializes in ortho, hospice volunteer, psych,.

When I suggested the respite care, I think it was because I was remembering when I had in home hospice care when my mom was dying.

I had help on two shifts, plus which, I'm an RN with a MSN. I had my mom's twin sister who had been there for weeks, breathing down my neck, treating me as though I were a rather dim six year old, plus other assorted relatives from my mom's and grandma's generations questioning almost everything either the hospice nurse or I said.

Even a week of respite care would have been a Godsend because it would have given me a chance to mentally pull myself together again and become a better daughter and caretaker. For her final moth or so, my wonderful loving mom thought I was trying to poison her and wanted no part of me. I had to keep an eye on her from the wings, which was hard. I never felt I could leave and just take a week off. A week of formal respite care would have been so good and I was thinking of that for the family.

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