When should nursing homes be allowed to evict residents?

[Emergent, RN]

Here's an interesting article from NPR. It's about the eviction of one man in particular from a nursing home after he was hospitalized. He is spent a very expensive year on the state tab, paying for a hospital room instead of him returning to the nursing home

Nursing Home Evictions Strand The Disabled In Costly Hospitals : Shots - Health News : NPR

When should nursing homes be allowed to evict their residents?

[jadelpn, LPN, EMT-B]

This is a ploy used by any number of not so awesome nursing homes. Because the resident's could be considered a "nuisance" or have comorbidities that make them a great deal of work or skimming around scope issues, the nursing home sends the person to the hospital for some sort of change in mental status, failure to thrive, general weakness thing, and then decline to take them back.

The hospital can not discharge without a plan in place. They play skilled care/nursing home roulette in attempting to place the patient. Family is unable or unwilling to bring them home. So it drains resources. Sometimes for years.

Not sure why they wouldn't put the patient in the article in his own apartment with 24 hour care, and a day program for activities. Would perhaps be a heck of a lot cheaper and more importantly, good for the patient.

[mrsjonesRN]

I don't get how this gentleman has stayed in a hospital for a year... there had to be somewhere else he could go. Could he not qualify for private duty?

I personally would not want my family member to go back to a nursing home where he was not "wanted." If he goes back, this sets him up for potential abuse.

[Libby1987]

I wonder how much time his family spent at the facility to supplement his supervision.

I think we all need to prepare to shift our public budgets to care for the increasing number of patients, from both our growing aging populations as well as the growing number of younger people with lifestyle related debilitating illnesses that lack adequate retirement plans, who will need 24 hour supervision and care.

[tsm007]

I think there are probably some missing pieces in this article. My questions would be how combative was this patient? Was this guy a risk to other patients? I saw a lawsuit posted not too long ago about a resident killing another resident and the victim's family was now working around the laws so they could sue the facility. A lot of nursing homes just are not staffed for that kind of care. There seems to be a growing need for long term care for dual diagnosis - medical and psych. I think cross training staff and billing/insurance laws to cover the needed staff are going to have to change or this is going to continue to be a problem.

On a related noted, I see patients that are abusing the system and cannot be kicked out of their facility due to cumbersome rules and regulation. One of the places I go to has a patient that regularly smokes pot outside the facility door and has been caught smoking in his room too. He's abusive to staff, has keyed some employee's car, and yet he's still there and eviction has been extremely difficult. To be honest I can't even figure out how he got placed there in the first place, other than being in a wheelchair, I don't see why he's not independent with home care.

Anyways, I guess my point is this article is very one sided. I think it's a more complex problem then how it is presented.

[Here.I.Stand, BSN, RN]

Not the same thing, but we kept a pt with an anoxic brain injury/vent dependant for life in the ICU for months. None of the area LTC vent units would/could take him, and he wasn't appropriate for LTAC (no chance of him weaning from the vent, not enough neuro fuction left for him to have rehab.)

[AJJKRN]

We've definately kept people over six months to a year plus that were in MVA's that resulted in TBI's.

Some where Pt's with felonies but most have been young adults that were here on a visa to attend the local university, got into a car accident, and family (even with the hospital offering to pay for flight home and round the clock home care, etc for the rest of their lives) would not claim their children/family member!

We luckily don't have as many issues with assisted living and LTC Pt's. I don't know if it's a difference in regional resources or not.

[flying_ace2]

I think there are probably some missing pieces in this article. My questions would be how combative was this patient? Was this guy a risk to other patients?

Anyways, I guess my point is this article is very one sided. I think it's a more complex problem then how it is presented.

I agree with both of these points. While reading the article I was wondering the same thing about the patient - had something happened that made him an extreme threat to the safety of other residents or staff? Or to himself? Or is this a case of a shady facility abusing the system (I don't know how often this occurs as I have no experience in LTC)? Or, does he have such complex medical needs that the facility is unable to provide the level of care he needs? Many, many questions.....

[Cheyenne RN,BSHS]

My daughter is the nurse supervisor for an LTAC and has a passion for the elderly. She always has loved older people and she dearly loves working with them. There are times however when a Pt is verbally abusive and inappropriate. In some cases they are violent and mean by choice, not just due to dementia. There are ex-cons admitted and Pts who have been domestic abusers, there are all types and there are really times there need to be limits. If the staff are being physically injured, abused and other Pts hurt something has to be done, especially if no one can rationalize with the patient or the family. Manipulation by patients using threats and calling the state and making false claims can wreck havoc on a facility.

[Ruas61, BSN, RN]

There is likely a lot more to this story than written.

No doubt there are some facilities that may dump patients for minor reasons or unfairly.

However, the times I have seen it happen it is because the person is beyond what the facility can handle. I am talking behaviors that endanger themselves, peers and staff. The hospital psychiatric resources are stretched thin and/or not available.

We have some at our facility that are almost to that point and we have had some that were beyond that point. We could not take them back. It wasn't financial.

I won't elaborate because I don't want to be identified but sometimes resident's are just not manageable in some care settings.

[kiszi, RN]

After the patient is admitted to the hospital for a period of time (I think 24 hours) they are discharged from the nursing home. The NH can then accept the patient for readmission, or not. It's not really an eviction, though I'm sure it feels that way to the resident.

[Karou]

Yeah, I am with everyone else who believes there is way more to this story than the article presented.

It can be appropriate for a facility to "refuse" to re-admit a resident back.

Once accepted, it's incredibly difficult to get a resident removed from the facility (even violent ones).

Unfortunately, this dump and refusal can be the quickest and easiest way for a facility to get an inappropriate resident out. Is it the right wag or the best way? No. But I can understand why it happens.