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.
In my experience some families would refuse discharge and also placement in long term care facilities. One family flat out told me that they relied on the social security check too much to allow transfer but also didnt want to take the pt home.
We had the same problem to!! In a California hospital as well...sometimes families drive me nuts! Today I had a son lash out at me about his dad being in pain! And his dad didn't even complain about pain!!! When in actually the son just didn't want to take care of his dad!, I love the ER because we ship these crazy families on to floor!!!but damn I don't know how nicely to say "look I have other PTs who are sick and critical and, we have a coding pt. in the parking lot!!! and people running like headless chickens!! were completely full, and your dad is fine!!! He is just old!!!!! so hold your dads damn urinal yourself as*hole" Venting done
Patients with Medicare can contest discharge..It used to be they could get 3 extra days..but I dont know all the technicalities now. Our Case managers and registrations handle that.
I don't know about California, but in my state the maximum number of private duty nursing hours the state's Medicaid will pay for is 112 hrs/week which is 16 hrs per day. If this patient is an adult, I would guess he has Medicare which does not pay for block nursing. If someone is stable enough to be kept home, I highly doubt that the state will approve TWO ATC caregivers for him. People cannot indefinitely refuse discharge, though they will try...
No one can force a family to open their front door to accept a returning pt. But I'm sure hosp legal depts have some avenue of recourse.
Some many years ago, my hospital had a pt they couldn't discharge. I believe there was some monies or a house as assets. So the hosp put a lien out on her house and served an eviction notice. Big old Sheriff's officer comes out to the hospital, goes to LOL's bedside to identify her and give her the notice of eviction. LOL smiles & giggles at him, takes the eviction notice and then promptly start to eat it! Don't remember whatever happened to her.
There's almost always money/assets issues involved when family refuse to do the paperwork for Medicaid. So discharges get held up. I think pediatrics has a name for parents who drop off their kiddos and don't come back for them.
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
In my experience some families would refuse discharge and also placement in long term care facilities. One family flat out told me that they relied on the social security check too much to allow transfer but also didnt want to take the pt home.
I may be wrong, but won't the patient stop receiving ssdi after a month hospitalized? Or is that only with ssi?
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.
Yyyyyyep. As soon as they hear that the hospital will be petitioning to have a guardian appointed and for the patient to be placed in LTC they will change their tune. Happens over and over where I work.
I'm not aware, but that would be fan-*******-tastic.
That sounds like one might be anxious to take money away from the old, infirm, and disabled...who are by and large poor, because their condition has deteriorated requiring lengthy hospitalization.
manusko
611 Posts
In my experience some families would refuse discharge and also placement in long term care facilities. One family flat out told me that they relied on the social security check too much to allow transfer but also didnt want to take the pt home.