Where do patients go?

[NextGen]

I have been a nurse for 7 years, worked 5 in acute care and the last 2 in Acute Rehab. Patients are being discharged from acute care much sicker than they were 5 years ago.

The theory behind Acute Rehab is that patients are medically stable when they are admitted. So the unit is staffed for medically stable patients. That means the unit has 2 RNs only for 8 patients and when we get a PCA when we get a 9th patient.

The problem is that Acute Rehab is admitting more and more patients who are not medically stable but have been discharged from acute care. Our doctors are not medicine doctors, they are PM&R docs.

Acute care is like closing time at the bar "You don't have to go home, but you can't stay here".

In your state, where do patients go who still need medical management but are being discharged from acute care? Are they going to a facility that medically manages them?

Thanks.

[Hoosier_RN, MSN]

9 hours ago, Thanksforthedonuts said:

OMG YES! I’m so glad I’m not the only one with the same opinion. Luckily I’m in a position where I can visit the patient in acute care to assess before admitting to our facility.

... many of the discharge planners and case managers don’t like me anymore ?. Ridiculous stuff they pull.

I'd visit the acutes that were near, but unfortunately many came from 1-2 hours away. I'd depend on our sister facilities to do the visit, who I'm honestly sure never set a foot to visit. They had no skin in the game in our facility-and had relationshipsto maintain with their area d/c planners, so I'm sure they didn't care who we got stuck with.

[Thanksforthedonuts, BSN, RN]

5 hours ago, Hoosier_RN said:

I'd visit the acutes that were near, but unfortunately many came from 1-2 hours away. I'd depend on our sister facilities to do the visit, who I'm honestly sure never set a foot to visit. They had no skin in the game in our facility-and had relationshipsto maintain with their area d/c planners, so I'm sure they didn't care who we got stuck with.

I can see how that would put you in a difficult place. It’s not easy, and sadly no one seems to want to correct anything (those in acute care). There has been a noticeable uptick in these type of discharges the past year from our nearest hospital. Another nearby hospital doesn’t participate in these type of discharges nearly as often.

I’ve noticed that even people who have an interest in the company will provide a biased opinion based off what you had mentioned above, maintaining relationships with the DC planners.
Our DC planners rarely seem to give facility referrals based off need/skill because they refer to their BFFs first. I couldn’t care less if I ruffle their feathers if it means I can sleep better at night. It just not worth the risk.

I’ve also become a bit... passive aggressive ... I’ve sent an unsafe discharge RIGHT BACK to acute care within 2,4,48hrs to be readmitted. Surprisingly DC planners often don’t expect that, and are clearly irritated when it happens. I hope it hurt their reimbursement rates!

Apparently, they think we don’t notice they are trying to clear beds with these unsafe discharges typically occurring on Sunday? So they can have more beds available on Monday.

[NurseSpeedy, ADN, LPN, RN]

On 1/2/2020 at 6:31 PM, beekee said:

And yesterday, in acute care, the nurse had 4 patients. Today, in subacute, the nurse has 15. Seems safe, doesn’t it?

I worked acute care-I never had 4 patients-usually 6-7 at any given time, and not unlikely to start with one set of seven and discharge and admit a whole new set by the end of the 12 (cough) hour shift. Never a 12 hour shift, never a reasonable assignment-nothing like waking up every morning knowing you’re about to run around like a chicken with hour head cut off.....but, don’t forget To update the white boards And tell the patient “I have the time”. Acute, subacute, or long term-I haven’t found a facility yet that won’t stretch staffing as thin as they possibly can and then *** if the satisfaction scores are low.

[Dani_Mila, ADN, BSN, RN]

On 1/2/2020 at 6:27 PM, Glycerine82 said:

They come to me in sub acute short term. ?

LOL Sub-Acute indeed. Like you said, patients get admitted only to return back to the hospital after 2-3 days. SNF nowadays like to admit any patients that they can because they need to meet with the profit expectations of the facility.

[ocean.baby]

They go to the rehab unit at nursing homes, or to the rehab hospital, neither which is a good choice in the area where I live.

Having worked at the nursing homes, I can tell you that the nurse has 20-25 patients regardless of the care that they need. Many of the nurses do not have hospital experience. Once a patient was admitted with TPN and not one person on that unit, or in administration, had a clue about checking the orders, hanging it, monitoring, etc. But you can bet that the admissions nurse got kudos for the money that patient brought in! This is not a slam to admissions staff everywhere, but 2 out of the 3 nursing homes in our area are owned by companies that want the money and to hell with the patient and the staff.

Many nurses that work in nursing homes have also worked in the hospital. Some have gone straight from school to the nursing home. The problem here is they are being made to care for these acute patients with no additional education/training since they did their clinicals.

Our rehab hospital is a joke. They are only concerned about the therapies. If you have medical issues such as complications from a recent surgery and are unable to do the 3 hours of therapy per day, you are non-compliant and they discharge you. So many of the patients that have been discharged go directly back to the hospital because they did not receive the follow-up medical care that was needed while at rehab.

[Nurse SMS, MSN, RN]

The falling reimbursement rates for hospitals remain an issue. I am not excusing lying about patient conditions even remotely. I was fortunate to work somewhere that did not happen, or at least didn't happen with my patients. I gave report myself.

The facts are, Medicare/Medicaid/Insurance companies all decline to cover care after a certain time/date/lack of improvement. Acute care was never meant to house these patients long-term and once we can no longer improve them, we have to make room for the other patients waiting for a bed who are acutely ill.

It is a fundamental flaw in the American for-profit even-when-not-for-profit healthcare system.