Patients overstaying their welcome in hospitals

BostonTerrierLover, BSN, RN · Apr 26, 2012

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 · Apr 26, 2012

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 · Apr 26, 2012

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 · Apr 26, 2012

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.

allnurses Guide · Apr 26, 2012

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 · Apr 26, 2012

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.

Sun0408, ASN, RN · Apr 26, 2012

Thank You Boston and GitanoRN.. She was elderly and refused her family's help due to her psych issues. Boy did she smile when we brought her ice cream, Pepsi and crackers :)

**NickiLaughs, ADN, BSN, RN** · Apr 26, 2012

11 months. The patient was an illegal immigrant who had gone into DIC. Ended up trached/vent/pegged/dialysis. No one wants to take someone who will end up costing money. Can't afford it. They did place her, but it took a long time and they had to work something out with Medi-cal.

She was at my job almost as long as me.

Now I'm on the case management end where it's our job to try to find places. And yeah, half the time facilities don't have beds. There's so many custodial patients now who have nowhere else to go because their family can't care for them. LOL can't turn their husbands every two hours and manage the tube feedings etc that they need.

A big part of our job is discussing quality of life with families and trying to push for them to be realistic with what their loved one would want. Not everyone wants to be tubed everywhere and kept alive just because. The saddest are the cases where the member has no family, breakdown everywhere and they are just stuck.

LadyinScrubs, ASN, RN · Apr 26, 2012

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.[/QUOTE]
Discharge planning and finding placement from acute to a lower level of care can be a problem. While the nurse discharge planner (DP) or the social work DP follows the algorhythm for discharge, sometimes it does not go as planned. A physician may not want to discharge although there is no reason for the pt to be in acute care; a family "dropped" off frail, complete care mom/dad at the ED (for various health reasons). When mom/dad was ready for discharge, we found the family went on vacation.
One time we had a homeless man in acute care who went missing one Saturday. What we found (because he was seen) that he had decided he wanted to go to the West Hollywood gay parade--after all, we were told, it was a beautiful day and the parade draws so many people. He returned to the hospital that night. We had a serious problem with him as he continued to go AWOL from time to time. Unfortunately, we could not find any lower level of care placement for him for more than a month. Eventually, he just signed himself out.
I have had problems discharging patients to a lower level of care because facilities are simply not available. A few years ago there was a rash of homeless patients being discharged and dumped on the street down on skid row because the DP could not find placement (the district attorney dealt with the DP(s) and hospital(s) involved.
Nursing is difficult but combine nursing with discharge planning, and the stress is even higher.

lindarn · Apr 26, 2012

I heard about this Polish woman last year. She had the opportunity to go back to Poland on other occasions. but she just did not want to. I am glad that they forced her to go. She is not the responsibility of the US taxpayer.

The person who wrote this story was POed because her sister was in the hospital, had lost her home, and the hospital was going to send her to a homeless shelter. Her question was, why was a homeless shelter OK for a citizen of the US, but not OK for, what amounted to, an illegal immigrant? Which, by the way, is what she became when her Visa expired.

There is a male, illegal alien, who was paralyzed in a drunk driving accident, caused by himself, because he was the one who was drunk.

He is now paralized from the chest down, vent dependant, and he and his family in Mexico, refuse to have him sent to a LTC in Mexico, because it is not as good as the one he is at, in the US. I think that he is still here.

What is wrong with this picture?

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

MLB55 · Apr 26, 2012

We've had multiple pts over stay there welcome. One was a prisoner with a SAH who happened to be here illegally. The prison signed off on him (grade 5 SAH) He was trached and pegged, no ltach would take him. Last I heard he was waiting for citizenship. He stayed about 4 months.Guillen barre, admitted in October 11'... No movement, couldn't even communicate with his eyes. Should of been at an ltach in nov, dec but family pays cash so the hospital let them stay with us. He's currently still on step down, still on a vent. Another guy with a stroke, s/p trach and peg, homeless. No ltach will take him. No social security number. He's been with hanging with us in the ICU since October. We got him clothes, we wheel him around the unit and outside occasionally. Big teaching, non for profit hospital has to give x amount of money to free healthcare. I could go on for atleast another 2-3 pts over the past six months. ICU days are not cheap.

allnurses Guide · Apr 26, 2012

I have had families who don't want their loved one to go to on to rehab or a SNF as well because they realize the ratios are different and the focus of care less acute. Have had some fight it pretty hard actually.