The dreaded 911 calls

[silverwillow]

Second time this year, I just had a spouse completely fall apart and become completely unable to care for the patient, called 911 in the middle of the night and called me after the paramedics left with him. Now I have him inpatient and can't seem to get him placed anywhere. Does anyone have any experiences like this? Any ideas on the documentation I need to be doing to justify the hospital stay?

[doodlemom]

It really depends on what they are doing for him at the hospital. What's his diagnosis? Is he having some kind of symptoms that they are treating at the hospital - or do they just have him there because they can't get him out? Do you have an inpatient contract with the hospital? Are you trying to place him in a nursing home? Is your SW working with the hospital to try to get him placed? Is he actively dying? As far as your documentation, I would be documenting any sx they are treating and info about discharge planning.

[silverwillow]

Thanks for your response. He has occasional agitation where he tries to climb out of bed, but I'm not sure how much more we can actually sedate him at this point. He's pretty sedate already, just arouses occasionally. His symptoms are otherwise managed. We do have a contract with the hospital where he is staying. He has metastatic ca, end stage. I am suprised he has made it this long actually. We have him on a Fentanyl 100 patch and ativan. He is still inpatient because we have not found a SNF willing to accept him.

[doodlemom]

Is he still eating? If he isn't you're probably better off just leaving him in the hospital until he dies (it doesn't sound like you have an inpatient facility.) If he is in the shape you are saying, then most nursing homes would not take him because he would be a lot of work for the amount of cash he would generate for them.

[silverwillow]

Thanks. I feel much better after your post. He is not eating. I figured since we weren't going to be able to transfer him anywhere we might as well start him on morphine IV since he's inpatient anyway. He was still pretty restless. We now have him up to 20mg/hour with S.L ativan and he's still restless, but settling down and having cheyne stokes, etc. So my gut instinct at this point was to just leave him in the hospital. Glad you felt the same way. Sometimes it's just having another opinion that makes the whole difference. Thanks for replying.

[jessica]

Also, in terms of documentation, couldn't you document caregiver breakdown and/or unrelieved or uncontrolled symptom management? Just a thought

Jessica