SNF Patient demanding to leave

Posted
by CrunchRN CrunchRN, ADN, RN Member Nurse

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

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hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 4 Articles; 4,578 Posts

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.

In California refusing to re-admit an AMA would be considered taking punitive action against the patient and not allowed by law. Patient's who have "reconsidered" are allowed to change their minds and come back.

Hppy

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 4 Articles; 4,578 Posts

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.

I went through the same thing with my mother. She had moderate cognitive impairment and was living independently until she fell walking her dog two years ago. She insisted on going back to her home after she completed rehab. She even arranged for 24 hour care and a ride home. When the first bill came she refused to pay it "I never imagined it would cost so much!" (contract that she signed was for $22.00/hr Plus extra for overnight. She called the police saying that she was the victim of fraud. After some wrangling with her Doctor we (Treatment team and family) determined she was not competent to meet her own needs. Dr. signed the paperwork and we moved her into an assisted living against her will. She attempted to leave more times than I can count so we had to move her into a locked memory care. She was in a total of 4 facilities before we found the right fit. Medicare does not cover Alzheimer's care as it is considered custodial and our average monthly bill was $9,000.00. This all started two years ago. She passed away last Saturday. It was rough two years but she is now at peace.

Hppy

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis. Has 20 years experience. 3,669 Posts

In California refusing to re-admit an AMA would be considered taking punitive action against the patient and not allowed by law. Patient's who have "reconsidered" are allowed to change their minds and come back.

Hppy

That's interesting. Wisconsin obviously has no such law, unless my facility is breaking that law without being aware of it. The corporate owners are not based out of WI and frankly I wouldn't be surprised if they weren't aware of a law that disallows that.

nurse lala, BSN, RN

Specializes in Psych. Violence & Suicide prevention.. Has 44 years experience. 110 Posts

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

In my state we can place individuals on a legal hold if the person is unable to communicate a viable plan for self care.

In this case family would have to agree to accept the individual back home, if not the individual can be kept for Grave Disability.

Edited by nurse lala
Added info

Sunshine.nurse

Sunshine.nurse

21 Posts

If she has been declared competent to make her own decisions by her MD, then you are SOL. You do not have the power nor the authority to legally usurp her right for self determination. The only thing you could do is take to the court level and have her declared incompetent by a judge. However, that gets UGLY quick and the emotional toll it takes on both sides need to be weighed.

If it were my family member, I would be very suspicious that the UTI has not been cleared, and I would be insisting on getting another UA & urine culture with sensitivity via straight cath. I cannot tell you who many times I have seen patients still have a raging UTI even after treatment and providers blow it off either as it is within the 1st 30 days s/p tx or the specimen was contaminated. Especially with the over 85 crowd. Duh.. people can be infected with their own natural flora.. it is called overbloom! It was a running thorn in my side dealing with this issue. If confusion is worsening, I suggest talking to provider directly about your concerns of worsening confusion and risk of urosepsis. And ask her nurse to document that you have requested the tests.

Edited by Sunshine.nurse