Nursing home patients right to refuse care

[Akulahawk]

A nursing home can not turn away a patient that needs immediate care.... even if that means the tax payer picks up the tab in the end.
Make no mistake, they will bill the patient and will ruin that persons' credit file for years to come. But nonetheless... we pay for this type of service and for too many people it is the only way to get health care.
The acute appendicitis is a "clean story" compared to the Stage 4 cancer patient that finally enters an E.R. because the pain is unbearable and the nursing home can do nothing other than hand him painkillers and send him on his way again.
What we lack is affordable and available health care that allows for regular check-ups and the usual testing necessary to detect cancer early.
Yes, we have free Mammogram programs... but do you realize that this is just one type of cancer? That ovarian cancer, prostate cancer, colon cancer does not have any "free or affordable" tests that could save a lot of people from an agonizing death?
Any civilized country in Europe has this type of health care service available for their citizens, young and old.

Skilled Nursing Facilities can turn away any patient that they're not able to provide care to. They don't have to provide a medical screening exam and stabilize a patient... they're not acute care facilities. I know of no "nursing home" that dispenses pain medication to people that walk in "off the street." If a SNF takes a private pay patient, you can believe that they did a wallet biopsy to ensure that patient is able to pay the bill. Even if a SNF accepts Medicare or Medicaid, if the patient doesn't qualify for either program, the SNF doesn't have to accept that patient.

 

[mycrofft]

SNF has no duty to act. Notice that some hospitals do not have a sign saying they are an emergency facility? Same deal.

Yes, you can lose autonomy in a SNF IF you are legally declared in need, or (temporarily / short time) you lose your ability to think and care for yourself. HOWEVER, there are time limits. Look up rules on that, and chemical restraint.

Occasionally a patient will slip into such a non-self care state. If they are still ambulatory, that can lead to these stories about patients wandering away….because they aren't patients, they're "residents".

PS: Call a SNF and ask! Get back when you…oh, wait, this was five years ago!?

PPS: I took an injured kid into a doctor's office one day. Had to shame them into letting us wait in their lobby for the police and his parents to come.

 

[Bullets]

We have a hospital in town, so with that comes all the associated healthcare facilities that support the hospital. Multiple SNFs, dialysis centers, an autism day care center, the county run special needs school, ect.


We deal with this constantly. Patient either getting acutely ill or injured and each facility has a "policy" that any patient or attendee injured HAS to go to the hospital, and the SNFs send patients out for all the variety of things they do. We often have to explain to them that their policy is irrelevant to us, that we do not have to transport patients who are competent and understand the risks associated with refusing care. Ive also had to explain to family that their POA is irrelevant because the patient is fully competent

 

[fortsmithman]

In my town the extended care unit is actually another dept of our towns hospital. So it's not really an IFT if we take the pt to the main hospital from the extended care unit its not really an IFT burt an inter dept transfer much like taking a pt to the ward from the operating theatre.

 

[topemttraining]

The state and federal laws have conferred certain rights and protection to patients, and each hospital staff is authorized to explain or answer about these rights to patients, and inform them of ways to protect these rights, but ignorance on the part of patients allows nursing homes and staffs to ignore these rights and act unilaterally without consulting the patients. :angry:

 

[mycrofft]

The state and federal laws have conferred certain rights and protection to patients, and each hospital staff is authorized to explain or answer about these rights to patients, and inform them of ways to protect these rights, but ignorance on the part of patients allows nursing homes and staffs to ignore these rights and act unilaterally without consulting the patients. :angry:

Yup!

It gets hairy either/both when the independent living facility (ILF) tries to ramp up their service to a declining patient, OR they scrape an otherwise independent patient out for one or two deficits.

 

[whisperingsage]

Thank you folks for your awesome teaching experience. I am an LPN, 12 years, was a CNA for 10 years, (1980's) and seen various policies and ways of dealing with these difficult concerns. I am saving this conversation in my nursing files as I think I can have need to return to the wisdom here and put it to use.
Agreed about respect. I have been pressured buy nurses to give a med to knock someone out that was very confused when that person was such that their moods would change in seconds. But because crying was part of their behavior, since that nurse was uncomfortable with it, they wanted that patient knocked out. I felt this was wrong since the crying wasn't consistent, they would revert to happy and laughing in seconds. So forcing meds on people is one I have to deal with a lot.
The reason I found this site was I was looking for patients' rights r/t a 66 yr old A/)x4 BUT schizophrenia, Dx with CA, who is refusing treatment. The state is going to force treatment on this woman. I have to in my heart say "why?". My mother was FASD and Schizophrenic. But she knew what she wanted and I wasn't going to stand in her way. (We had discussed death and what we wanted as a class assignment when I was 19). When it was her time to die, I asked her daily, Do you want to go to the hospital? She daily told me, No, I just want to die. And I respected her wishes. I felt I helped her have a "good death" She was 82. There are few things as personal as that.
And if I had interfered with her wishes, I am sure she would have haunted me. No doubt.

 

[DrParasite]

We deal with this constantly. Patient either getting acutely ill or injured and each facility has a "policy" that any patient or attendee injured HAS to go to the hospital, and the SNFs send patients out for all the variety of things they do. We often have to explain to them that their policy is irrelevant to us, that we do not have to transport patients who are competent and understand the risks associated with refusing care. Ive also had to explain to family that their POA is irrelevant because the patient is fully competent

I've had the same discussion with SNF staff, but I've also been told this as well:

However, I've asked a nursing home nurse about this, actually, and according to her the nursing home has the right to discharge them from the nursing home if they don't cooperate.

So it's the SNF's policy that if a patient falls (which is usually the most common non-patient request for an ambulance), they MUST go to the hospital, even if not injured. The patient is well within their rights to refuse to go, however the consequence to this action is they get evicted from their home. One is being a patient's advocate, and one is supporting the patient's rights.

Pretty much a sucky situation all around, and unfortunately, we can caught in the middle.

 

[Bullets]

Holy Necropost Batman

I've had the same discussion with SNF staff, but I've also been told this as well:So it's the SNF's policy that if a patient falls (which is usually the most common non-patient request for an ambulance), they MUST go to the hospital, even if not injured. The patient is well within their rights to refuse to go, however the consequence to this action is they get evicted from their home. One is being a patient's advocate, and one is supporting the patient's rights.

Pretty much a sucky situation all around, and unfortunately, we can caught in the middle.

While this is true, its also not an immediate eviction as others have pointed out there has to be a track record of refusing treatment.

Im not one who searches for refusals, but at the same time, i tell other healthcare and public safety partners that i am on the side of the patient above everything else.