Who is responsible in deciding discharging in safe manner? Who oversees case managers? Can unsafe discharges be considered gross negligence?

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SuperHawk Asked May 2020

Who is responsible in deciding discharging in safe manner? Who oversees case managers? Can unsafe discharges be considered gross negligence?

After a 5 day stay at hospital, 3 of those awaiting for an "emergency" colonic decompression, my otherwise healthy 90 year old dad was unsafely discharged without any PT evaluation.
Case manager simply wanted signature so I made sure she knew father was too weak to stand up, walk nor go up any single step. Regardless later that day he was transported back home via ambulette. 15 hours later dad was back in ER after falling while trying to put his foot down to get up next morning. As noted, he was not ready to transition home. So now back in hospital and was in a worse condition and prognosis than previous ER visit. This time with a painful broken hip.
In retrospect a same day discharge order seems unfair to the patient and advantageous only for the insurance since there is no time for patient nor advocate to search for second opinion or legal consult. To tell you the truth .....things can always get worse and they are. I wish there was a way to bring this daily wrongdoing to light so it would deter doctors and case managers taking advantage of the weak and elderly by withholding treatments meant to improve their health. I feel more emphasis is placed on supporting their organic winding down thus openly promoting their ultimate discharge from this world. This is true elder abuse. Knowingly endangering lives while being very professional about it.
What I have written here is simply the tip of my current iceberg.

Elder Abuse Hospital Discharge

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score 1 · Answer 1

Don't you just love working with the health system. Its a learning experience. I swore after Moms last rehab visit, if she didn't break anything, she wasn't going. I got a call from the discharge person saying she was setting Mom up for rehab and gave me two choices. This was after being in the hospital 4 days with a UTI. Just wanted to get her strength back. (They almost killed her with the antibiotic they gave her but thatscanother long story) I was smart enough to say that they had 20 days because she could not afford to pay past what Medicare paid 100% for. They kept her 18. PT was a joke. In our meeting the therapist would say, "She can't follow instructions" my response "she has Dementia". "She doesn't remember her exercises" "she has dementia". Now this is a meeting it took them 10 days to set up and it should have been the first week. Lots of other things. So I told myself that she would never go back to rehab just to get her strength back.

You can always request in home therapy. Medicare does pay for it.

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score 4 · Answer 2

Unfortunately you accepted the patient home. Refusal to accept your Dad home would have changed this. You would get nowhere in field of law suggesting unsafe discharge. They know all the tricks. But you can claim unsafe discharge to JCAHO which is responsible for a hospital's accreditation. They will investigate. Too many dings on this, on bedsores, can endanger the license of an institution. Next time contact the Social worker and say that you cannot physically or mentally accept the patient back into your care. This alone will get rehab while they bide their time scurrying to make it OK. It is all about money. Follow the money. That is what it amounts to in our system.

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Thanks much for your sound advice Alvadeer. This unsafe discharge thrusted my father to his current stage.
Will look into JCAHO and anyone who may be able to make a dent in a corrupt philosophy of care. These ARE lives. Not apples in a market stand.
The problem will be then....if these boards are colleagues of colleagues etc... then how can they act without conflicting interests on behalf of the "common citizen"?
When I wanted to get a second opinion of treatment, I was told I would need to get it from a doctor under the same group. I responded that defeated the purpose of a second opinion, getting it from the same group mentality you are questioning is wasting time. Doctors will never incriminate a colleague much least selfincriminate . So ...things remain the same. Unless maybe a good lawyer pro bono agrees with you....and does not work for any medical board. I wish there were lawyers posting here. I feel all people here are gut drenchfully truthful to themselves. That makes honest character. Good witnesses.

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score 2 · Answer 3

I totally understand, currently going through a similar situation.

Hopefully you can get the social worker involved and get grandpa into a good skilled nursing facility for rehabilitation.

Ask everyone and anyone you know what they recommend. It makes a huge difference for the outcome. Make sure that they have intensive highly rated rehabilitation.

I am so sorry that your grandfather has been treated so poorly.

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Thanks much Isthisrealyreal. A social worker called me to explain there is always the last minute recourse of requesting an appeal through medicare, they review discharge plans and give an answer within 24 hours. That gives you at least one more night. It could make all the difference. It was in writing in the admission documents and later I remember reading through them and stopping there also learned about hospitals patient advocacy. But....they advocate first for the hospital ....later I learned. I reached out to patients advocate to request SERVICE.
I was able to get a call back from doctor in 15 minutes. So it helped in that sense.

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Who is responsible in deciding discharging in safe manner? Who oversees case managers? Can unsafe discharges be considered gross negligence?

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