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Patients overstaying their welcome in hospitals

Posted

I just watched Rock Center with Brian Williams tonight on NBC and he had a story about patients in hospitals that are no longer receiving acute care, but stay for years because they do not have anywhere else to go and can not be kicked out. I have heard of a few months stay,,,but 2 years? That's a long time.

Have any of you actually known patients that were 'stuck' in the hospital with no where to be discharged to?

Sun0408, ASN, RN

Specializes in Trauma Surgical ICU. Has 4 years experience.

Yes, and the pt was on our floor for 11 months til placement was found. She was not "sick" but a psych pt and everyone kept refusing her. We got her a small Christmas tree for her room during the holidays and got her a gift. She would not allow us to touch her so we just checked on her and made sure she was safe and fed :)

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

I work on a Complex Continuing Care floor and we have many that are not able to manage at home and have their names on lists waiting for a nursing home.Many stay several months, some close to a year.We can't discharge them home if they need constant care so they stay.Usually we have about half our floor are waiting for beds. Depending which homes they have picked and what kind of room(ward, semi or private) the wait may be a few weeks or a few months.

Edited by loriangel14
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I've seen patients stay for years. Nursing homes don't have beds, the patient refuses an available bed, the family refuses the bed, nursing home can't take them due to behavioural issues, etc... Essentially these patients live in the hospital.

That Guy, BSN, RN, EMT-B

Specializes in Emergency/Cath Lab. Has 6 years experience.

I've seen patients stay for years. Nursing homes don't have beds, the patient refuses an available bed, the family refuses the bed, nursing home can't take them due to behavioural issues, etc... Essentially these patients live in the hospital.

What a horrible "life".

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

Yup. And I have not been a nurse very long. Every year starting in the next couple of months we have patients who cannot get placed due to being a charity case and all the LTACs having used up all their charity funding for the year. So the patient lingers in the hospital, sometimes for months on end, until a solution can be found.

I just watched Rock Center with Brian Williams tonight on NBC Did anyone think about the need to pay relatives to care for their elderly. Many cannot quit their jobs to care for relatives even though they want to. Why not pay the relatives instead of the hospital so both can survive and probably get much better care than in nursing homes. I was able to quit my job and care for my mother. Many cannot. Paying the relative a reasonable wage would be much less than the money it costs to be in nursing home or assisted living

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

Many need around the clock attention.How would one person provide 24 hour care and assess their health on a regular basis.Many need nursing care not just someone to help with ADLs.

This is a common occurrence where I work. Nothing as dramatic as a year, but we have patients who have no need for acute care but have to stay for weeks due to no insurance coverage. We see a lot of osteomyelitis and endocarditis that require many weeks of IV antibiotic therapy. Once they are no longer acutely ill, the insured patients are discharged to a subacute facility or to home and receive their antibiotic therapy via home health. But the uninsured stay with us for weeks and weeks and weeks. And that means thousands and thousands of dollars. And guess who's paying for it, folks?

How people can think we don't need health care reform is beyond me. The current system is insane.

It would be cheaper to pay a family member who could be assisted by home health nurse than it is to keep these folks in acute care.

TPN feeding seems to be one factor that makes a pt difficult to place (of course w/ no insurance). TPN is really expensive.

I have seen pt's hang around for months on your basic acute med-surg floor just waiting for placement. They just keep getting denied and the hospital is "stuck" with them at the cost of the hospital.

Many need around the clock attention.How would one person provide 24 hour care and assess their health on a regular basis.Many need nursing care not just someone to help with ADLs.

Actually many AD spouses take care of ther loved one 24/7. Sadly, if the family or husband/wife does not qualify for Medicaid, there is nothing else that can be done. They will shoulder the responsibility on their own and assume the responsibility of the nurse--I am not just discussing assistance with ADLs. The 24/7 care, stress and lack of help is the reason why the caregiver is at the highest risk for death.

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

I am in Canada so it is different. There is no question of having to qualify.LTC is accessible to everyone.Not having coverage is ever an issue.

BostonTerrierLover, BSN, RN

Specializes in Adult/Ped Emergency and Trauma. Has 16 years experience.

Yes, and the pt was on our floor for 11 months til placement was found. She was not "sick" but a psych pt and everyone kept refusing her. We got her a small Christmas tree for her room during the holidays and got her a gift. She would not allow us to touch her so we just checked on her and made sure she was safe and fed :)

You are an awesome nurse for being part of that. I have a whole new respect for you. And, I am humbled.

:redbeatheBoston

GitanoRN, BSN, MSN, RN

Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR. Has 52 years experience.

needless to say, is not exactly a secret that there’s a critical shortage of beds in all healthcare facilities. pursuing this further, there are beds in hospitals that are being occupied by patients who are medically ready for discharge. however, the facilities seem to have their hands tide regarding this issue. when in actuality these pts. are ready to be transfer to nursing homes, or to their homes, where they can utilized medical aids to assist them with their daily living. having said that, the patients who remained beyond their normal d/c date, end up taking valuable beds needed by truly sick patients waiting for admission. in conclusion, is no mystery to the medical staff that some patients overstay their welcome in hospitals for months, even years. evidently, this goes on even when we nurses have gathered all resources from social services, home care assistants etc. in order to get the ball rolling. with that said, we are not contributing towards the wealth fare of these patients.

GitanoRN, BSN, MSN, RN

Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR. Has 52 years experience.

yes, and the pt was on our floor for 11 months til placement was found. she was not "sick" but a psych pt and everyone kept refusing her. we got her a small christmas tree for her room during the holidays and got her a gift. she would not allow us to touch her so we just checked on her and made sure she was safe and fed :)

just wanted to applaud your gesture towards this pt. :bowingpur:yeah:

BostonTerrierLover, BSN, RN

Specializes in Adult/Ped Emergency and Trauma. Has 16 years experience.

Yeah, I totally agree with you Gitano on the financial bit, I just think it is usually these type patients that leave a little hole in me everytime they left when I worked Med-Surg. But you are right.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

I had a patient this week with a mitt on. Just one, due to inability to keep from picking at a brace on their other hand. A facility refused this patient because of that mitt.

Patti_RN

Specializes in .. Has 10+ years experience.

This must be a regional dilemma or a problem faced by truly non-profit hospitals (not those who function more as for-profit businesses).

I've seen the opposite: patients being discharged without adequate accommodation for their post-hospital care. These unfortunate individuals may not be acute or in need of skilled nursing care, but they are unable to care for themselves and have no one else to care for them. The cost of premature discharge can be burdensome on the patient, the hospital, and on health insurance--and on society who ends up paying for the unreimbursed expenses. I'm not suggesting that patients stay in the hospital for extended periods of time (like in the 1950's when mother and baby stayed two weeks after birth). But when a patient is post-op, or has a seriously debilitating condition and is unable to ambulate, feed themselves (or get to the fridge for food), discharging them is a pretty sure avenue to having them return within a day or two. It's not the hospital's responsibility to keep them, but it's not fair to discharge them, and other facilities might not take them. This is one place the system is 'broke' and needs to be fixed.