Repeat patients

[tweetieRN]

I've been in critical care for many years - recently went PRN and oriented to our 8 bed psych unit so that I can pick up shifts there. I'm ordering a book course to have some background with the terms and conditions.

Here's my question - does any unit have a policy for repeat etoh/drug detox patients. We get a lot of them, and some are in as often as once a week. They know the ropes and treatment, probably better than I do at this point. I feel a little depressed about the whole thing - like they have no intention of trying to quit their particular habit. I also think the whole thing is a little unfair to have the taxpayer continue to support them. I know that with substance abuse, it may take some time to get it under control - and they may backslide - they aren't the problem. Its the ones that seem to have no intention of doing anything positive about their addiction - just want a bed, a meal and some medications.

[ruarhi]

Grrrrrr! I know what you mean, the same thing happens here in Western Australia, the problem is the system that allows the patient to manipulate the strings. They do it because they know that the hospital cannot refuse them...bugger.

[glcas]

The revolving door problem. It has become worse over that last few years because no one gets to stay long enough to really get anywhere, then they dont show up for the aftercare so they have no support. It is because of the cutbacks in insurance.... money.

We barely get them detoxed and they are out the door.

The real problems are the "three hots and a cot" people you are talking about. They have no intention of getting sober. They come for the detox drugs, a warm bed and three meals a day. And they can bum cigarettes off people who have no ability to refuse. They get a medical check up and treatment for medical problems they wouldn't bother with outside. Since they have state health insurance, they get admitted easier and seem to be able to stay longer. Go figure.

Think we make life too easy for them?

[glcas]

The revolving door problem. It has become worse over that last few years because no one gets to stay long enough to really get anywhere, then they dont show up for the aftercare so they have no support. It is because of the cutbacks in insurance.... money.

We barely get them detoxed and they are out the door.

The real problems are the "three hots and a cot" people you are talking about. They have no intention of getting sober. They come for the detox drugs, a warm bed and three meals a day. And they can bum cigarettes off people who have no ability to refuse. They get a medical check up and treatment for medical problems they wouldn't bother with outside. Since they have state health insurance, they get admitted easier and seem to be able to stay longer. Go figure.

Think we make life too easy for them?

[glcas]

The revolving door problem. It has become worse over that last few years because no one gets to stay long enough to really get anywhere, then they dont show up for the aftercare so they have no support. It is because of the cutbacks in insurance.... money.

We barely get them detoxed and they are out the door.

The real problems are the "three hots and a cot" people you are talking about. They have no intention of getting sober. They come for the detox drugs, a warm bed and three meals a day. And they can bum cigarettes off people who have no ability to refuse. They get a medical check up and treatment for medical problems they wouldn't bother with outside. Since they have state health insurance, they get admitted easier and seem to be able to stay longer. Go figure.

Think we make life too easy for them?

[Will Benson]

Tweetie, if you stay in Psych nursing for long, you will find that "repeat patients" is a long-standing problem, sad to say. Some of this is due to the nature of psychiatric disorders (patients have exacerbations and relapses). Some is due to Medicare and Medicaid (These forms of insurance allow the doctors to admit patients more frequently than "private" insurances). Drug / ETOH patients can be really hard to deal with. Repeat admissions is a common occurrance and you really have to question their motivation for being there. If their reason for being there is anything other than WANTING help (ie court order, spouse is leaving if they don't quit) you can pretty much count on repeat admissions. This is one of the facets of Psych nursing that is discouraging. After nearly 20 years of doing this, I don't know if you can help someone who doesn't want to help themselves. But you might consider doing things to make them want to help themselves.

[TopazStone]

I just want to say, you never know when the tiger will change his stripes. I recently ran into a "frequent flyer" and was floored! I saw this man about two times a month for two years. Sometime within the last 6 months, he had some med changes, is sober, working, lost about thirty pounds and looks better than I do!! He thanked me for being "so kind" to him and for not giving up!