SNF Patient demanding to leave

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What happens when a competent patient who is a Hoyer lift 2 person transfer demands that they go home?

BBP42

106 Posts

At the last facility I worked, if someone was signing out AMA, it was then up to them to get out the door under their own steam. They would need to get family in to transfer them to the w/c and then the car. Once they were no longer our patient, we would not take responsibility for Hoyer transferring them, we were not supposed to put hands on them at all.

CrunchRN, ADN, RN

4,530 Posts

Specializes in Clinical Research, Outpt Women's Health.

What if the family knows they need to stay? What does the family do?

Oldmahubbard

1,487 Posts

This is where I get called in. Often times people who seem like they are fully oriented and competent are really not.

If the pt wants to leave, you cannot stop them, nor can you help them.

I encounter this frequently. The patient eventually adjusts, although they don't stop complaining.

jodispamodi

230 Posts

Is their HCP invoked? are they able to make their own decisions? That is the determining factor.

CrunchRN, ADN, RN

4,530 Posts

Specializes in Clinical Research, Outpt Women's Health.

Difficult to say. Patient would get a 30 on the MMSE, but is not quite right. This is my mom, but I am a research nurse so do not normally deal with these types of issues. No way can she go home, but by legal terms she is competent.

gypsierose

81 Posts

They aren't prisoners. Ideally they would have an accessible home and home care help. I've worked in homes with very severely disabled people so it can happen. We need to rethink nursing homes. People shouldn't be stuck there and forced to endure conditions that are sometimes horrible. I know that its more complicated than this but with some effort, people can live in less restrictive places.

TruvyNurse

354 Posts

Tough one. Honestly I've never encountered such a physically dependent person wanting to AMA out. Darn it we need policies on this stuff!!

Specializes in LTC, Hospice, Case Management.

Hi - I'm a Director of Nursing in long term care. Yes, if she is competent she can very well decide to go home. If she is competent, she should also be able to manage figuring out HOW she is getting home and HOW she is going to survive at home.

She can demand to go all she wants, but she can't demand you or anyone else take her & take care of her. (Sorry, I know this puts you in an awful spot and one she's likely really going to give you a hard time about).

Some thoughts:

Is she getting good care where she's at? Or is this frustration about not being taken care of well? Maybe a different facility might be a better fit?

Does she have the funds to go home with a private care giver 24/7? It is easy enough to buy or rent a hoyer lift for home use.

Does she just need an outlet to voice her frustrations about being dependent and deep down she really knows she's in the best place to meet her needs?

kbrn2002, ADN, RN

3,822 Posts

Specializes in Geriatrics, Dialysis.

A SNF isn't a prison and we really can't force anybody to stay. That being said, if a resident is determined to leave there's only so much we can do to help them. It happens sometimes that a facility just isn't a good fit, in that case a referral to a different facility can be made and we do everything we can to make the transition easy on both the resident and the family. Not every resident requires the level of care a SNF provides, if that resident can be cared for in a different setting the social worker is a great resource for referrals to alternate placement . Sometimes, but not always, home health can be a viable option and again we will do everything we can to make that happen if the resident can function safely in the home setting and has the family support to make that an option.

But these things take time. Every now and then we get one that's just going to leave NOW regardless of all our attempts to convince them to stay long enough to help them find a better option for themselves. Once that resident decides to leave, there's really not much you can do but watch them go. We can't find them a ride, we can't help them transfer into a car. We can't help them get meds or medical supplies when they get home or wherever it is they are going. We had one resident that left AMA riding his electric scooter last winter during a cold snap while it was snowing out. We were all concerned for his safety but still couldn't stop him from leaving. Once he left AMA he was also deemed ineligible for readmit. He did end up at an ER eventually and when the ER called us trying to send him back to us we had to say no. I still wonder what happened with him and hope he's safe somewhere.

Neats, BSN

682 Posts

Specializes in Case Manager/Administrator.

Patients that want to sign themselves out and have the competency to do so, they will need to make the arrangements to leave. Make sure of the reason why they want to leave if it is some sort of neglect then I would contact the DON, MDS coordinator, unit manager and social service director no matter what time it is. Let them handle the rest (I would contact the leadership any reason for AMA). I would ensure until the patient leaves all concerns regarding ADL's, are taken care of on time and well documented. I would also fill out an incident report and notify the ombudsman. Maybe an outside person can help set things in a better direction. Ultimately it is the patients choice to go. As a LNHA I had a patient- paraplegic leave because the personal TV in the patients room was not working, and the community TV had the ball game on with 15 people of which 12 were patients watching the game, the patient did not want that ball game on. The patient left after calling friends, we never did know what happen to this patient. We did report, document, and saved their personal belongings for a year until the activity director recycled what we could and gave the rest away to a local charity. If I knew the real reason why the patient left and could continue to care for the patient I would take them back.

CrunchRN, ADN, RN

4,530 Posts

Specializes in Clinical Research, Outpt Women's Health.

Thank you all for your responses.

Currently she is at a very nice rehab and getting excellent care. She is truly lucky to have gotten into this one.

Her confusion has increased even after UTI treatment. However, she is confused, but can answer almost all questions appropriately and is being manipulative. So not like my mom who up until this started was very intelligent and had great common sense although id not like the changes of aging. She has gone from being fully functional to a 2 nurse+hoyer transfer in 4 months.

Home care is not possible as it would require 2 aids in the home around the clock. We are going to sell the house to pay for assisted living as my dad cannot make it alone. My mom was his caregiver until just recently.

They are calling what she has "Parkinson's Plus" not a regular version in any way, but definitely progressive.

My brother is up there now and trying to find viable options, but the one thing we know is that she needs the rehab so that hopefully she can get functional enough for assisted living.

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