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why can't we tell them?


I just feel like venting! i am a psych nurse who acts as liaison for inpt psych,when we have indigent clients we assess them for acuity,if they meet criteria we admit them or petition them to the state hospital, but when we have substance abusers who are not in withdrawal,who have been medically assessed,we are not allowed to tell them we cannot admit them for inpatient because they have no insurance,that is an EMTALA violation...why? they know they have no insurance,we obtain funds from mental health when we can,and we never let anyone go who is a danger to themselves or others...why do we have to make something up to tell them they cannot be accepted inpatient for detox or whatever rather than admit it is a funding issue? we often medicate people so they can get to a rehab the next day which has funding,but we are not allowed to tell them why we do this...i don't understand why we are not allowed to be honest or why it is a violation because we are providing services and ensuring safety,please explain this

Why is it neccessary to make something up? Since they are not a direct threat to self/others, at this point, that's "good" news. Ultimately if they keep drinking and/or drugging there will likely come a day where they will need the inpatient psychiatric care. But, at this point it appears that they are on the road to "getting sick and tired of being sick and tired" and they need to recognize the "insanity" of "doing the same things over and over while expecting a different result". In the meantime, you can encourage them to attend AA and/or NA (doing a 90 & 90) and give them a list of SA tx facilities for them to followup with.

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education.

Do you have inpatient treatment for addictions that extends past a detox period? If not, then you could just tell them that you don't have addictions treatments other than detox. Or are you saying someone has to be having negative consequences to being off their drugs or alcohol before they can be admitted to your facility? They can't just want to detox safely if they don't have insurance? (just clarifying my thoughts here)

EMTALA requires us to provide medical screenings and prevent negative consequences,so yes,if they are without medical symptoms and have no insurance and we have no indigent beds or money from the state/county and if our local inpt rehab has no indigent beds the we would not have to admit them

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education.

It seems to me you could just tell them policy is such and such and let it go at that, giving education and referrals as David mentioned above. I wonder if your facility is trying to avoid problems with publicity about not admitting the poor?? I think lying to them is not ethical. What DO you tell them?

RochesterRN-BSN, BSN, RN

Specializes in Psych, ER, Resp/Med, LTC, Education. Has 6 years experience.

You can hold a patient for mental health treatment if he or she is a danger to themself or others --involuntarily however you can not hold someone against their will for CD treatment. You can offer it but 9.45 law does not cover CD only mental health. So I am a little confused reading your post--its confusing. A patient with straight CD issues or like a patient with Axis II and CD even does not warrent a PSYCH admit. They may need CD tx but not psych. As far as if they are a risk medically r/t withdrawal from ETOH or Benzos then they need to be admitted medically-- as these are really the only ones that can be life threatening. So I don't see what insurance has to to with any of it--confused.

i am wondering why we can't be truthful,but we have been told to avoid stating why we are not keeping them after medically stabilizing them,i have been truthful and have been,shall we say,redirected ?

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

I'm confused. Why is it not enough to say that you are sending them home

because they do not meet admission criteria, and leave it at that? You can't

admit someone to a hospital for no really good reason even if they HAVE insurance,

can you? Insurance will not pay for it!

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