Hospital Policy Question - Being Released With COVID

2,255 Views | 20 Replies | Last: 5 yr ago by ramblin_ag02
HotardAg07
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
2:13p, 2/2/21
AG
My grandmother has been in the hospital for a week with COVID and is on day 12 of symptoms. Skipping over all the unnecessary details, she has requested to go back home and die in peace at her house. However, it seems like the hospital will not "let" her due to the health risks involved to others.

For anybody who would know -- is it true that my grandma couldn't go home even if she wanted to? I was surprised because, by most accounts she's most likely not even contagious anymore.

I know that in the case of patients with mental issues that may be a threat to others, the hospital won't let you leave. I did not realize that was the case for COVID as well, especially after the point where patients are shedding live virus.

For my grandmother, she just doesn't want to die all alone in a hospital. Many of my family members also have COVID currently or recently had it, so they could see her without further risking themselves. It feels like a question of human dignity. I am surprised that hospitals have not found any way to give patients any kind of visitation, even if just through a glass wall.
Reply Quote
1
FratboyLegend
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to HotardAg07 • 2:19p, 2/2/21
I'm sorry to hear about your Grandmother.

"However, it seems like the hospital will not "let" her due to the health risks involved to others."

I cannot imagine that the hospital has the authority to do this. Clinical semantics don't matter. I would go down there and raise hell.
#CertifiedSIP
Reply Quote
9
1 edit
HotardAg07
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to FratboyLegend • 2:25p, 2/2/21
AG
FratboyLegend said:
I'm sorry to hear about your Grandmother.

"However, it seems like the hospital will not "let" her due to the health risks involved to others."

I cannot imagine that the hospital has the authority to do this. Clinical semantics don't matter. I would go down there and raise hell.
That's what we're being told, which is why I came here to be informed of the reality and our rights in this situation.
Reply Quote
Charpie
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
2:50p, 2/2/21
AG
I'd reach out to the hospital advocate. Then start threatening contacting an attorney.
Reply Quote
11
AgResearch
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to Charpie • 2:54p, 2/2/21
AG
Charpie said:
I'd reach out to the hospital advocate. Then start threatening contacting an attorney.
Don't threaten contacting. Just go for it. Wasting time with threats that the hospital can move quickly against resulting in the family member being stuck there until a judge says otherwise. Get an attorney to spring them out so she can die in piece.
Reply Quote
4
FratboyLegend
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
2:59p, 2/2/21
In addition to an atty, you may want to find a home hospice service that knows how to transition your grandma.
#CertifiedSIP
Reply Quote
5
Dr. Not Yet Dr. Ag
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
3:16p, 2/2/21
The hospital can't force anyone with the capacity to make their own medical decisions to stay against their will. I know there are some doctors and nurses that get overly paternalistic about these things, but a hospital is not a prison.

What is the issue you are running into? Are they claiming she doesn't have the mental capacity to make these decisions? Are they refusing to set up things like home oxygen? Or are they literally refusing to even let you in to assist with transporting her out of the hospital?

I would agree with others here that if they are literally refusing to respect the wishes of their patient or the patient's family, you should be contacting a lawyer to assist you immediately given you do not have a lot of time.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reply Quote
7
HotardAg07
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to Dr. Not Yet Dr. Ag • 4:38p, 2/2/21
AG
Thank you to your response (and to others). I found this article which touches on the situation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256554/

Unfortunately, I was not able to speak directly to the doctor or nurse myself. My family members who spoke to them during their one phone call allowed per day today were told that she would not be allowed to leave since she was a health risk to others. They were not given any explanation beyond that.

I understand that my grandma has continued to demand to go home and the people taking care of her have admitted that they can't FORCE her to stay, but they would like her to wait and see if xyz new treatment works before making a final decision. They proposed some "new, stronger drug that they have not tried yet", of which they have not told us the name and she can't recall. They also talked to her about the possibility of intubation if her condition does not improve, which my grandma has rejected the possibility outright with DNI, DNR. It seems like they are trying to delay her decision.

We understand the situation better now (some people in my family just accepted that she couldn't leave earlier), so we'll see what happens.
Reply Quote
1
AgResearch
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
4:44p, 2/2/21
AG
Does the hospital have a copy of her DNI / DNR instructions?
Reply Quote
88planoAg
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
4:55p, 2/2/21
AG
Surely she can just leave AMA?
Reply Quote
Dr. Not Yet Dr. Ag
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to HotardAg07 • 5:27p, 2/2/21
HotardAg07 said:
Thank you to your response (and to others). I found this article which touches on the situation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256554/

Unfortunately, I was not able to speak directly to the doctor or nurse myself. My family members who spoke to them during their one phone call allowed per day today were told that she would not be allowed to leave since she was a health risk to others. They were not given any explanation beyond that.

I understand that my grandma has continued to demand to go home and the people taking care of her have admitted that they can't FORCE her to stay, but they would like her to wait and see if xyz new treatment works before making a final decision. They proposed some "new, stronger drug that they have not tried yet", of which they have not told us the name and she can't recall. They also talked to her about the possibility of intubation if her condition does not improve, which my grandma has rejected the possibility outright with DNI, DNR. It seems like they are trying to delay her decision.

We understand the situation better now (some people in my family just accepted that she couldn't leave earlier), so we'll see what happens.


If they are talking about mechanical ventilation despite her being DNR I would make sure that there is an in-hospital DNR order for her. If there already is one ordered what they are doing is pretty inappropriate given what we know regarding mechanical ventilation for COVID especially in 80+ year olds. I have seen this a few times in the past where I respond to a code, intubate them and then am made aware by family afterwards that the patient was DNR but no order was placed by the patient's physician, so the nurses have no choice but to call a code blue.

I also am a bit concerned about the "one phone call per day" rule which is kind of ridiculous. Obviously there are families that abuse nursing staff by calling every 30 minutes, in which case we do set limits on their interactions, however, for the large majority of reasonable people, their loved one is dying alone. There is no way I am ever telling a family who can't physically be there as their family member slowly dies that they are limited to one phone call.

What I would strongly encourage you to do is talk with your family and grandmother, choose either the medical power of attorney or the individual who will best advocate for your grandmother's wishes to be the "point man" in these conversations. You need to have a discussion about what her exact wishes are. You then need to have a family meeting with the physician in charge of her care, and you all need to come to a consensus regarding what to do.

I am so sorry you and your family are having to go through this.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reply Quote
6
Not a Bot
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
5:41p, 2/2/21
AG
Hospitals are not prisons.

Have them call and ask to speak to the unit case manager and unit nursing director. They will usually be there 8 to 5. Try to get a conference meeting set up with the physician and case manager.

I've never heard of a hospital limiting phone calls to one a day. I get them limiting information sharing to one designated person, but they should be able to call multiple times.

My guess is, and obviously just a guess, is that they believe she is confused and not capable of making her own decisions. If that's the case, they need to make sure the family is aware of this and explain the situation clearly to them. Pretty clear there's been a communication breakdown here.
Reply Quote
2
1 edit
ramblin_ag02
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
6:18p, 2/2/21
AG
Honestly that all sounds awful. The easiest out is probably contacting a hospice company and telling them she wants to be home. They can help you fight through the nonsense
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reply Quote
2
Marcus Aurelius
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
6:40p, 2/2/21
AG
Have them consult home hospice. This has come up for me, and the hospital cannot retain her against her will. My pt was an elderly man with covid who didn't want to come to the hospital in the first place. I forget who brought him. He got very upset and demanded to leave to go home to die. She has every right to go home with dignity, quarantine and have hospice staff attend to her wearing PPE. Family will need to don PPE to be close with her. Obtaining that may be difficult - but the case mgr should help you. They did for my pt.

If they don't cooperate get an atty.
Reply Quote
8
1 edit
HotardAg07
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
7:25p, 2/2/21
AG
Thanks for all the advice. We are organizing as a family and formulating a plan for tomorrow with a home hospice company.

For those curious, I am talking about West Methodist in Houston. They have been enforcing a one phone call a day limit with my family, between the hours of 1 and 3. Otherwise, we only get information directly from my Grandma, who isn't exactly taking detailed notes. When we have had a chance to talk to someone, it's been different nurses and they've reportedly been varying degrees of impatient.

My family isn't good at this. They're naturally distrustful of traditional medicine, doctors, hospitals and don't know how to work the system. Not to mention they're an emotional mess. Tomorrow I'll probably be taking point to spearhead things more cogently.
Reply Quote
5
1 edit
Tabasco
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to HotardAg07 • 7:36p, 2/2/21
AG
HotardAg07 said:
Thanks for all the advice. We are organizing as a family and formulating a plan for tomorrow with a home hospice company.

For those curious, I am talking about West Methodist in Houston. They have been enforcing a one phone call a day limit with my family, between the hours of 1 and 3. Otherwise, we only get information directly from my Grandma, who isn't exactly taking detailed notes. When we have had a chance to talk to someone, it's been different nurses and they've reportedly been varying degrees of impatient.

My family isn't good at this. They're naturally distrustful of traditional medicine, doctors, hospitals and don't know how to work the system. Not to mention they're an emotional mess. Tomorrow I'll probably be taking point to spearhead things more cogently.


Let me know if I can hel0. I will be out that way tomorrow? Ams can grab lunch for anyone. Just let me know numbers.
Reply Quote
1
Infection_Ag11
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to HotardAg07 • 7:37p, 2/2/21
AG
The hospital doesn't have the authority to do this to a patient with capacity who isn't an immediate threat to themselves or others (and their disease process doesn't constitute a threat, assuming that disease doesn't impact their capacity). Worst case scenario she can sign out against medical advice, but that shouldn't be necessary if she's going home with hospice.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reply Quote
2
FratboyLegend
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to HotardAg07 • 9:17p, 2/2/21
HotardAg07 said:
Thanks for all the advice. We are organizing as a family and formulating a plan for tomorrow with a home hospice company.

For those curious, I am talking about West Methodist in Houston. They have been enforcing a one phone call a day limit with my family, between the hours of 1 and 3. Otherwise, we only get information directly from my Grandma, who isn't exactly taking detailed notes. When we have had a chance to talk to someone, it's been different nurses and they've reportedly been varying degrees of impatient.

My family isn't good at this. They're naturally distrustful of traditional medicine, doctors, hospitals and don't know how to work the system. Not to mention they're an emotional mess. Tomorrow I'll probably be taking point to spearhead things more cogently.
Thank you very much for the PSA in your second paragraph. That may help someone with a loved one admitted to the same facility.

Godspeed and Godbless you and your Grandmother and family.
#CertifiedSIP
Reply Quote
1
AggieMPH2005
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
9:23p, 2/2/21
Something to keep in mind: hospitals don't admit or discharge patients, that is the privilege of the medical staff. in other words her treating physician. You need to speak with the admitting physician who is primary on the case and get everyone on the same page.
Reply Quote
HotardAg07
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
8:49a, 2/3/21
AG
Just an update for anybody else who may go through this situation:

1. The one-call-per-day policy is a real policy from the nurses station due to their current overload and PPE requirements.

2. Thanks to those who suggested I call a patient advocate. I did not know this existed and that person was very helpful in informing me of the situation, who we could talk to, what our rights were, etc. She is setting up a meeting between our main contact for my grandma and the case manager for my grandmother to discuss the situation

3. For going home, I guess there are two situations at play
Scenario 1: If my grandma is deemed stable for transfer by the doctor, she can be approved to go home with home hospice care, similar to if she were transferring hospitals.

Scenario 2: If my grandma is not deemed medically stable, then her transfer would not be approved and she would have to leave AMA. What I understood is that in this situation they wouldn't let a home hospice service take her, but I'm not completely clear on that.

In my grandma's case, yesterday she was supposed to be transferred to a hospital for long covid care, but she was deemed unstable due to a sharp drop in her sats and her oxygen delivery method/volume had to be increased, so she was not transferred. We'll talk with the case manager today and go from there.

Thanks again for all the help.
Reply Quote
2
Charpie
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to HotardAg07 • 8:51a, 2/3/21
AG
Good to hear that you know what your options are
Reply Quote
1
ramblin_ag02
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to HotardAg07 • 9:00a, 2/3/21
AG
I would push back on the "stable for transfer" requirement for her going home on hospice. If she wants to go home, then she has every right to go home on hospice whether "stable" or not. That's one of the reasons hospice exists. Short of aggressive interventions like intubation, which she already declined, they can't do anything in the hospital that hospice can't do at home.

Offer a private vehicle if possible. If you are using a transport service, they may have special liability issues and procedures.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reply Quote
4
Refresh
Page 1 of 1
 
×
subscribe Verify your student status
See Subscription Benefits
Trial only available to users who have never subscribed or participated in a previous trial.