When should nursing homes be allowed to evict residents?

[Emergent]

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?

[KatieMI, BSN, MSN, RN]

I work in LTACH where there is at least one just such patient at any time. Most of them were transferred to acute for whatever, sometimes quite clearly made up reasons, then the patient is not admitted back.

In what I see, about 3/4 cases are about resources/services/care level that particular SNF/ECF just cannot manage. A SNF in the middle of nowhere and an hour and a half drive from nearest hospital cannot manage anyone who needs visits with three specialists, regular Bipap refitting and weekly blood draws. The family which made it possible because they happened to live near that SNF should think a bit more before getting Mother into her new home there. Some patients indeed live happily in a place till their dementia progresses and they start to need level of care their former SNF cannot offer. I think thst in many cases like these "eviction" done diplomatic way can be justified.

The most difficult cases are those involving patients "acute for life" (dialysis, vent with no weaning chance, TPN, supportive chemo, chronic deep immunosuppression, HAART, chronic wounds, LVAD and brittle diabetes... whatever combination of four or more of these). Sometimes, unbelievably, these people live as full as they can, and their enjoyment of life is infectious. But when family in deep denial starts to search for the "best care" for just such patient with GCS of 4 (for minimal motor responce), it drives me crazy. These families become very well known in vicinity (I really suspect that some case managers exchange more than just health information) and then these poir souls barely holding here are dropped on us, still full code.

[Tenebrae, BSN, RN]

For us it took a long time and many staff assaults before we finally got a patient moved to another rest home.

$$$ usually govern the decision

[nutella, MSN, RN]

Long-term care facilities that have enough residents or are always booked can be picky and will refuse straight up patients with behavioral issues or who are "difficult". Once the patient is at the facility and turns out to be impossible (in many regards) the only way to get the patient out is to transfer to the hospital for something.

[dishes, BSN, RN]

When long-term care facilities play hot potato and refuse to accept a patient back after sending them to a hospital's emergency department, it makes it more likely the hospital will want to avoid admitting LTC patients in the future. Hospitals can try to circumvent the problem by having a repatriation agreement.

[djh123]

I had no idea that 'thousands' of people were in this situation. We did have one guy who was a huge problem who was sent to a hospital, then to at least 2 different psych facilities, and I heard (never knew for a fact) that the state made our facility take him back.

[dishes, BSN, RN]

For us it took a long time and many staff assaults before we finally got a patient moved to another rest home.

$$$ usually govern the decision

Did the staff who were assualted lay criminal charges against the patient? I think in these cases, staff should lay charges, with the hope that the violent patient is found not criminally responsible and sent to a forensic psychiatric hospital.

[Psychtrish39, BSN, RN]

In the state I practice in its 30 days before a LTC can formally discharge a patient.

[TriciaJ, RN]

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.

The first comment after the linked printed article sums it up very well. Ever since psychiatric hospitals have been closed down, there's been a huge gap in services. The "community-based care" that these people were supposed to receive doesn't exist. Now nursing homes get burdened with expensive patients that they are not adequately compensated for, jails are full of people who don't really belong there. The de-institutionalization pond has many ripples.

Someone made a comment that there were so many abuses at the state psychiatric hospitals that they had to be shut down. I always thought that was throwing the baby out with the bathwater. If the states funded properly-run psychiatric hospitals, the burden would be lighter on everyone. Nursing homes could run the way they are supposed to, and the jails would only house those who demonstrate criminal intent.

I don't think sticking it to the nursing home is the best answer.

[NickiLaughs, ADN, BSN, RN]

Part of the issue is different levels of care and what a facility can handle. In the ER we get board and care dumps all the time who were trying to care for chronically ill patients who needed much more care but the b & c only saw dollar signs when they initially accepted them. Many also don't know that there is a difference between a SNF, ALF and a B & C. Etc.

I remember when I was an LVN there was a resident who'd been admitted to the hospital and when they were giving me report for him to come back they told me he needed night time insulin, I had to refuse him back. An LVN was only there until 5 pm and the med assistants could give pills but not injectables and as a patient on an Alzheimer's unit he could not administer it to himself. The hospital was peeved, but the reality is that one thing made him inappropriate for our facility unless they arranged a home health nurse nightly.

Theres so many complicated patients now that it's hard to find good placement that will keep them out of the hospital, keep staff safe and the patient safe. We tend to throw money at the wrong solutions.

[feelix, RN]

I think LTC is like a marriage. Both parties should be given an option to discontinue the relationship if things are not working out. I have heard of patients being sexual predators, combative, manipulative. Of families being a pain in the rear end. No health care facility likes losing business. There is more to this story.

[neenrn]

When the facility has gone through all efforts to try and have the client settle..... The only client I know of being shipped out is a woman who was daily violent to staff and other clients..... We tried for about a year. Finally she punched a nurse in the eye and that was it. We didn't take her back.

[CoffeeRTC, BSN, 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.

In my state, Medical Assistance (Medicaid) pays for a 15 day bed hold. After that the facility doesn't need to hold the bed.