How UNSAFE Does It Have To Be????

[tencat]

Hello all! I'm having some issues with a patient and the possibility that patient will be sent home to an unsafe, substandard house with no family to help out patient. Patient had a stroke and was found semi-conscious on floor of HORRIBLE home (roach and mouse infested, rotting food, dog feces) not able to answer questions or follow commands. Patient gets shipped to a facility, and they are claiming that patient is 'competent' enough to make a decision on whether or not to leave said facility. Patient cannot walk without extensive assistance at this point. Patient has no one able or willing to come and help out in the home. Patient is unable to cook for self or do any ADLS at this point in time. According to the nurse caring for patient in the facility, patient is unable to answer questions appropriately and is very confused. The door of the house was bashed in by the fire department to get to the patient, so there is no door on the house (slum lord owns it and probably won't replace it). How in the blazes can 'they' send this patient home?????? And if they do, do I have to accept patient back into my caseload? Patient CANNOT be left alone (totally unable to care for self, even before the stroke). When does it become too unsafe for a patient to return to living by him/herself? Do I become responsible for patient if he/she goes back to home? Do I commit abandonment if I refuse to accept patient back into my caseload? Do I have the right to refuse the patient at this point in time? Any feedback would be appreciated! Thanks!

[TheCommuter, BSN, RN]

Get APS (Adult Protective Services) involved on this issue.

This agency is similar to CPS (Child Protective Services), but their focus is intervening for endangered adults who can no longer speak up for themselves.

[tencat]

APS is already aware of the situation and numerous referrals have been made to them by our agency and by various other facilities....

[TheCommuter, BSN, RN]

If APS is unwilling or unable to take swift action, then the aforementioned patient might be forced to go home and (unfortunately) injure self again before anyone intervenes on his/her behalf. It is very disillusioning when nobody acts until something bad and preventable has occurred.

It's better to be proactive instead of reactive, but some people will never get it.

[tencat]

Is documenting everything enough? I'm probably being paranoid, but I can see some family member crawling out of the woodwork after patient passes and suing the pants off of someone.....My 'Spidy' sense is tingling.....so if I knowingly accept patient with knowing the history, will I be hung out to dry should it come bite me in the derriere?

[Katnip, RN]

Is there a care manager on your unit or are you it? In my experience, our care/case managers would work with resources on setting up care for after discharge or sometimes arranging alternative housing for a patient who was unable to care for himself.

[Marvie]

I agree, it is a terrible situation. Unfortunatly too many people have the MYOB mentality and those who suffer for it are the most vulnerable-like this patient who is unable to care for herself and has no door and poor living conditions (probably due to the fact that she couldn't care for herself to begin with). I agree that adult services should be involved and soon.

Good luck

If APS is unwilling or unable to take swift action, then the aforementioned patient might be forced to go home and (unfortunately) injure self again before anyone intervenes on his/her behalf. It is very disillusioning when nobody acts until something bad and preventable has occurred.

It's better to be proactive instead of reactive, but some people will never get it.

[FLArn]

Several years ago when I was the Nursing Sup. of a non-Medicare home health agency I had a pt in similar circumstances. Physically unable to care for self in an insect/rodent infested home w/ no running water etc. Tried to get APS involved and was told that "mentally competent adults have the right to live as they choose" and "if there are no minors or mentally incompetent persons in the home" there was nothing they could do. Sounds like nothing much has changed. Our patient developed an infection (DUH!) and we shipped the pt back to the hospital (AMA - Doc said pt. didn't need to go - nothing they could do about the situation) Then we gave pt and MD 72 hr notice that we could no longer provide care (no nurses would accept visits - gee wonder why?:banghead:) Giving 72hr notice while pt has existing care situation (in hospital) takes care of abandonment issue. Maybe hospital MSW can check into placement if pt is willing?