NShore Patient Advocates, LLC
150 S. Wacker, Ste 2400, Chicago, IL 60606
info@northshorern.com  ·  312-788-2640

The NSPA Blog

Ethical considerations for discharge planning

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Last week, we shared an article from Kaiser Health News on the care that should go into discharge planning for patient from hospitals. That article can be found here. We found the piece to be spot on, especially given a few recent interactions our own clients have gone through.

NShore’s CEO and Chief Advocate, Teri Dreher, recounts the situation.

Discharge planning is complex. Figuring out where to discharge elderly seniors with no family or ability to care for themselves can be challenging. A couple of weeks ago, I received a call from a church leader I know. He told me that one of their long term church members had been admitted to a local hospital. A neighbor had found her alone at home after a fall. She refused to go to the hospital and when he checked on her three days later she had not moved from the living room recliner he had left her in three days earlier. She had not been able to get up and fix herself a meal or get a glass of water due to the leg pain. He insisted upon calling 911. This is when she was transferred to the hospital. 
When I met her I could tell she had lost significant weight. She was still refusing help due to her financial limitations, though . I knew her home was unsafe. She had a leaky roof, extreme clutter, and no one to help her with meals. Her personal hygiene was also suffering. A psychiatrist evaluated her and said she was competent. The hospital decided she had the right to refuse care, and sent her home. Four days later she was again found on the floor of her living room, disoriented and dehydrated after another fall. I called the hospital care manager to let her know the patient was headed back to the hospital. I hoped that they would be able to find a better discharge plan for this dear woman, but I was uneasy. After a long conversation, I’m happy to say she is now in a local skilled care facility.

An all too common mistake

Medical ethics and justice can become compromised when hospitals hurry to discharge patients and protect their profit margin. I get it. Most hospitals operate on a very narrow profit margin. 3-4% is considered great, while many hospitals only make 1-2%.  I want to remind them that common sense is called for in these situations. The three pillars of medical ethics are: autonomy (the patient has a right to choose their own direction), justice (is this the right, fair and just thing to do?) and non malfeasance (to do no harm, part of the Hippocratic oath taken by all physicians). One pillar alone will not justify discharging a patient to an unsafe living environment. When those conditions have been clearly documented by a professional advocate, it’s even less responsible. The local police department and a neighbor involved in her care had also voiced concerns. Unfortunately and understandably though, they couldn’t keep constant watch on her.
I hope that someday hospitals and policy makers will realize the great value that can be realized when working with professional patient advocates. With everyone trying to do more with less, partnering with professionals would seem to make sense. Private advocates do not cost a thing for hospitals or physicians. Our allegiance lies only with the patient, but we work to benefit everyone involved. I believe that keeping the patient at the center of the care model is possible through collaboration and caring.
If you or someone you know could benefit from hiring a private patient advocate, give us a call or check out our main page at www.nortshorern.com

With over 36 years of clinical experience in Critical Care nursing, home based health care and expertise as a cardiovascular nurse clinician, Teri is well acquainted with the complexities of the modern healthcare system. She has served as a nursing leader, mentor, educator, and consistent patient advocate throughout her career in some of the best hospitals across the country. Her passion to keep the patient at the center of the model of nursing care led her to incorporate NShore Patient Advocates, LLC in 2011, serving clients throughout the northern suburbs of Chicago.

For a no-cost 30 minute initial consultation, please call 847-612-6684 or click here to fill out our online callback request form.