And boy was I right [emoji27] I recently finished a five day stretch- while exhausting you really get to know your patients. One went home yesterday, too early. She was getting worse- not better- more confused- needed SOMETHING from the doctor, the previous four days I called him at least four times a shift and got hung up on several times- he didn't care. Thank goodness I charted everything- wish I had charted it a little better in hindsight but I put enough down to cover my license in this case....
Anyway- she was discharged yesterday- confused- I asked family if they were sure they were ready to take her home- that this would be hard- that she would need a lot of care and help and I TRIED to educate them on how to keep her safe- and offered again to send her to a nursing home where this lady should have gone...... And CHARTED that I had this conversation.... Then I broke down her chart and moved on with my day.....
Until three hours later when the respiratory therapist comes up and sits next to me and tells me she is in the emergency room on a VENTILATOR!!! The family had her for less than three hours and according to the ED there were some drugs involved and she fell or was dropped as she can't get up on her own (88 yrs old) and hit her head and was brought in seizing and had to be placed on the vent to breathe- they sent her to another hospital- I have little hope that she will make it out of this- she was very sick before this massive head injury..... I TOLD THE DOCTOR I DIDN'T THINK FAMILY COULD HANDLE HER. I told family I didn't think they could handle her. Legally I had to release her though- they had not been abusive- there was no crazy labs that said she wasn't ready for discharge- just my gut- and dammit I was right - I hate that I was right.....
In some cases, I've seen families take home an elderly relative for unselfish reasons. One man, in particular, was very active but unsteady, confused, and had an impaired swallow. The family could have opted to put him in a nursing home, physically or chemically restrain him, place a G-tube and deny him the PO food and water he asked for. Instead, they took him home to live out what was left of his natural life.
It's the kind of ending I would want for myself ...not sure about your family and the ventilator, though.
I selected nursing home placement for my mom back in October. Exactly 6 months and 27 days later, (1 year and 28 days into my oh-so-loved regulatory position), I'm on family medical leave with no money, no freedom, no prospects for another placement for mom, but a STRONG possibility that I'll have to resign my position. You guessed it....mom got kicked out of the nursing home, bags first!! She's sitting over on the loveseat as I type this, just as happy as a lark.
I agonized over placing her there, but when I arrived at acceptance, she gets tossed out because she won't stop fighting! A couple of years ago, I created a thread here called "When Do I Get To Cry". Well, the universe's answer to me was, "you don't". So, I'm trying to make the most out of an unavoidable situation. I was shocked that even memory care units would not take her, neither would behavioral health facilities. I can't even take her to area day programs while I work because of incontinence issues. After seeking facilities out-of-state near other family members (thinking she'd behave herself if they visited frequently), even those facilities said no.
So, here I am. With only one day of freedom away from her in which I go to work a single 12-hour night shift in an effort to make ends meet.
God has a way of working things out, though. My practically non-existent income while caring for my mother has made me exempt from repaying my student loans that came due 2 years ago. I'm very grateful for that, however, there is no price tag large enough to place on my personal freedom, forfeiture of retirement, health insurance, vacations, etc.
But, every night that I tuck her in, (she has the best nurse in the world, ya know:D), I thank God that she had at least one child that could take care of her at home to avoid situations like the OP described; and that I'm sitting here watching her watch Matlock instead of humping up and down those halls, trying to be in 6 places at once. We're ok and I love her, the pit bull that she is.
A little harsh to accuse the family of taking her home because of the money.
Newsflash-some people will NEVER put another family member in a SNF after having one family member already in one. I know because that's what I did and I will NEVER do it again.
Specializes in MICU/CCU, SD, home health, neo, travel.
jade - you said it all!!!! Like you, whenever I've seen the discharge/placement issue, usually, money is at the root.
Families are reluctant to reveal any details about the pt's financials. A liquidation of assets and/or 'spend-down' will deplete any potential inheritance that families expect. And families have no real idea of the difficulties that they will face in trying to provide adequate care for their relative, or they just don't care. All they see is the MONEY slipping away.
OP's family might have been experiencing denial or ignorance re discharge care options. Or they were trying to 'protect' the assets.
I wish there were a MANDATORY course in all nsg schools (right before graduation time) that would start to explain the "Intricacies of Financing Healthcare for Pts 101". Something that would only begin to start to explain application, eligibility & services, etc for the layman consumer. I believe it would open a lot of eyes and generate a better sense of fiscal responsibility for all.
I really think there may have been more to OP's post that was unknown re the pt's disch. Sad for the pt.
THIS^^^^^^
Money is the root of ALL evil! I saw this a lot when I did home health care in a poor rural area. Families were living off of someone's check--not so to say dependent on it, but actually living off it, if you get my meaning (there's a difference). They would take them home when they were completely unable to care for them, then expect us to do it all. The phone calls you'd get when you were on call were just unreal sometimes.
On the other side, I also received patients home from the hospital who were completely unready for other reasons, and in those cases it was mostly on the hospital or the doctor. I remember getting one home who had a temp of 103 when his caregiver called me just a couple hours later (I wasn't supposed to do his post-hospital visit until the next day, of course)--turned out he'd been sent home with a raging UTI. Or caregivers who totally didn't understand the discharge medication instructions; when I was back working in the hospital, I got one back in after two weeks with a huge GI bleed because the caregiver had somehow managed to give her her regular Coumadin dose along with the generic Warfarin that had been prescribed at discharge, and which they'd picked up on the way home. Caregiver didn't understand that they were the same drug, so she'd been giving her mom a double dose. Of course she felt horribly guilty, but it wasn't entirely her fault. And those are just two of the many.
jade - you said it all!!!! Like you, whenever I've seen the discharge/placement issue, usually, money is at the root.
Families are reluctant to reveal any details about the pt's financials. A liquidation of assets and/or 'spend-down' will deplete any potential inheritance that families expect. And families have no real idea of the difficulties that they will face in trying to provide adequate care for their relative, or they just don't care. All they see is the MONEY slipping away.
OP's family might have been experiencing denial or ignorance re discharge care options. Or they were trying to 'protect' the assets.
I wish there were a MANDATORY course in all nsg schools (right before graduation time) that would start to explain the "Intricacies of Financing Healthcare for Pts 101". Something that would only begin to start to explain application, eligibility & services, etc for the layman consumer. I believe it would open a lot of eyes and generate a better sense of fiscal responsibility for all.
I really think there may have been more to OP's post that was unknown re the pt's disch. Sad for the pt.
Completely agree. There is much naivety in the nursing population in general re reimbursement and admission criteria.
I can't speak for the healthcare giants with shareholders et al but in regard to OP's small facility, it's probably a constant scramble to stay viable.
I'm so sorry. Sorry about the whole mess. The MD's rudeness, the family's lack of ability to comprehend what they had on their hands, and most of all for that poor woman.
Zoom ahead any number of years in the future - that could be any of us, or our loved one's. {Shudder} …
I do not discount what Jade said, although I DO agree that occasionally some take people home for all the right reasons. I had altogether too many families who refused all instruction on how to care for their loved ones, and some actually admitted that they would lose their place of residence if they did not take "mom" or "dad" home. And I had some admit that they did not work and needed the Social Security money to live on. Every case is different, I have a couple home visits now where the family refuses to do any care and calls VNS for every little thing.
I selected nursing home placement for my mom back in October. Exactly 6 months and 27 days later, (1 year and 28 days into my oh-so-loved regulatory position), I'm on family medical leave with no money, no freedom, no prospects for another placement for mom, but a STRONG possibility that I'll have to resign my position. You guessed it....mom got kicked out of the nursing home, bags first!! She's sitting over on the loveseat as I type this, just as happy as a lark.
I agonized over placing her there, but when I arrived at acceptance, she gets tossed out because she won't stop fighting! A couple of years ago, I created a thread here called "When Do I Get To Cry". Well, the universe's answer to me was, "you don't". So, I'm trying to make the most out of an unavoidable situation. I was shocked that even memory care units would not take her, neither would behavioral health facilities. I can't even take her to area day programs while I work because of incontinence issues. After seeking facilities out-of-state near other family members (thinking she'd behave herself if they visited frequently), even those facilities said no.
So, here I am. With only one day of freedom away from her in which I go to work a single 12-hour night shift in an effort to make ends meet.
God has a way of working things out, though. My practically non-existent income while caring for my mother has made me exempt from repaying my student loans that came due 2 years ago. I'm very grateful for that, however, there is no price tag large enough to place on my personal freedom, forfeiture of retirement, health insurance, vacations, etc.
But, every night that I tuck her in, (she has the best nurse in the world, ya know:D), I thank God that she had at least one child that could take care of her at home to avoid situations like the OP described; and that I'm sitting here watching her watch Matlock instead of humping up and down those halls, trying to be in 6 places at once. We're ok and I love her, the pit bull that she is.
((((((HUGS))))) to you. For everything there is a reason...
I hope things start looking up for you. Take care.
((((((HUGS))))) to you. For everything there is a reason...
I hope things start looking up for you. Take care.
Thank you! In currently on break now at my weekend hospital job. I work one night per week. All I can say is, thank God I don't have to do this on a full time basis anymore!
Even if you didn't document that conversation, you would be fine legally. This comes down to the family and the doctor. I work in 23 hour unit, and I can't even begin to tell you how often this happens. Unless there is a clear indication while on the unit that the patient needs placement, the family has every right to take them home. It is both terrifying and sad, that the patients are
Like you, whenever I've seen the discharge/placement issue, usually, money is at the root. 
Emergent, RN
4,300 Posts
I'd just like to mention, 88 years old is a full life lived. I would hope that, at that age, my family will take me home, and allow a natural death.
(((Hugs))), it sounds like you fulfilled your professional responsibilities.