Person lacking capacity with no surrogate, family, insurance, homelessness,

Im shocked that you weren’t informed of hospital protocol on this, and even more shocked that there may not be one.

You’ll see the words social admit” uses a lot here. Generally, our understanding is that the social worker is compelled to find a N.H. , get a state guardian if the family won’t pick up. Can you find out if this is true?

As a social worker, you should contact NASW legal services for free advice.

I am sorry Karen, but you don't go to a forum of lay people and expect a legal answer. We r from all over the US, Canada, UK, Australia and other countries.

"escalated to all admin with no answers. (legal, APS, managers (of social work) and case managers) directors of hospital etc."

I think its sad that these people had no idea how this would be handled. Of all people, they should know. And now the question has been asked, they better find out how to legally handle this.

I’ve just read all the posts, and by far the ‘nastiest’ was OP’s comment about “judgement that was thick and obvious with most wanting to vent their feelings in an almost hostile way”. Rubbish! OP's post was deliberately misleading about her experience - depending on which version was true. This is definitely not the site for her!

My daughter is an RN and worked for a large busy hospital downtown Denver. One day, an elderly woman showed up.....she was put on a bus from New Mexico by a boyfriend who didn't want to deal with her dementia anymore! She was homeless, sick and disoriented, had one bag with her and nothing else.

To make a long story short, the ER admitted her and she stayed in the hospital for FOUR MONTHS bc she had nowhere to go and the bf would NOT take her back. Her health issues were remedied, aside from the dementia, but she was a huge handful for the nurses in charge of her care. She'd try to escape and all sorts of things, my DD would tell me.

Eventually, she was granted a state guardian and sent to a Skilled Nursing facility. She wound up coding, was brought back to the same hospital where she died shortly thereafter. An all-around sad story.

This is a global forum and I'm assuming you're in the U.S., where things may differ by state and possibly even by county. Are there no other social workers in your hospital who are experienced that you can ask? I think that'd be the fastest way to get an answer...

I believe the hospital has an ethical duty to hold that individual until a state social worker can intervene and find an appropriate facility to take care of him/her. The hospital should not release the patient to an environment that is unsafe or would put that person's life in danger. Sometimes family does not have the ability or resources to keep that person safe. May I ask if you've received any guidance or instruction from supervisors on what to do if family doesn't pick up loved one from the hospital?

I find it interesting that a forum that I reached out to for a situation was reacted to in such a negative way. The judgement that was thick and obvious with most wanting to vent their feelings in an almost hostile way.

For more info for those that really are interested in being helpful and not just pure mean, I was putting out a scenario that has obviously been escalated to all admin with no answers. (legal, APS, managers (of social work) and case managers) directors of hospital etc.

I actually think the more concerning part about people that commented negatively is the idea that a social worker has all the answers. Little secret, there are things that we don't have answers for and yes we always try to figure it out.

I work in one of the busiest ED's in the state and I am not a new social worker and yes I am new to the ED. Yes I meet daily with many people and have "notebooks" with resources and have worked in most every type of situation you can come across. Yes I know regulations and resources and who to call for patient dumping.

I was hoping to find more input from a legal standpoint with the situation I presented as not one person is sure what to do in the situation. I realize now this is more of a caregiver type forum so my mistake on posting here.

I was posting as a more neutral way to ask a specific question and I have learned from the hostility that I will not be posting on here again.

Good luck everyone and remember kindness wins !

You notify the hospital attorney because keeping an indigent patient affects the bottom line. The attorney will ask probate to assign an appointed guardian which is usually legal services if the patient is deemed incompetent and needing nursing care. In your case, you are an ER social worker. In the case of homelessness, the patient will be given prescriptions and occasionally be handed a few days of meds. The social worker calls local shelters to find an available bed and hands them a taxi voucher. My major question to you is who trained you?

The Hospital should have a lawyer associated with them. Good question for him/her. One problem is I think Hospitals don't have the same responsibilities to patients as Rehabs do. If in a Rehab, they have to discharge safely. If the person has no one to care for them then the State steps in and becomes guardian.

I would say that if a patient is not picked up by a family member or friend within a reasonable time frame, then you call Adult Protection Services. There must be some regulations regarding your question. Would an Ombudsman be able to answer these questions. You have State inspectors who come in, one of them maybe? Your questions are valid and you need to know how these scenarios are suppose to be handled legally. You need something in writing that you can refer to. And what you can say to family members. Ex: family members have 24 hrs to pickup a LO or call to say they will not be picking up. Do you have the legal right to tell the family, after 24 hrs of either not showing up or at least calling, that you will be calling APS. Because its a threat that you will need to follow thru on. There is no reason a Hospital should wait days for a patient to be picked up once discharged. Actually, you should be able to set up transportation, at their expense, to take them home. The ethical problem is, the safety of sending them home.

You need to find out how this all works in ur State.

As a social worker I would think that you would know this?

Because YOU are the one that "they" will go to. You are the one with the notebooks full of every single city, state, and federal program. You are the one with all the resources that can be drawn in to care for a helpless indigent. You are the ONLY ONE.

I am wondering about what sort of mentoring you received as a NEW social worker?

I had my first dreadful experience with a social worker a year ago almost exactly when my friend, who had NO ONE but casual acquaintances she once worked with and old neighbors, went home dying on Hospice care. I, her former co-worker, and a former neighbor did it ALL. And I found the Hospice Social worker to be absolutely (so sorry--but she wasn't you) worthless. She knew NOTHING. We, as former medical RN (me) and neighbor with partner who was a bit knowledgeable about the law) had to muddle our way through wills, POAs, banks, unpaid taxes, hiring home aids 24/7. Somewhat of a nightmare without a good social worker for us, to help us.

Anyway, back to the question:
What happens to such a person when they go into care in hospital?
The medical team swings in to save this person. They give the medical care even to the indigent. Stablizing for transfer ( if a private hospital ) to a public, and treating as they would any other patient. It's up the the billing department later to decide who will, if any will, pay for this.
And guess who they ALL GO TO THEM? All those medical people? Any family that shows up out of the woodwork?
YOU! Only YOU.
They will ALL GO TO YOU.

I always said that a good social worker and a good PT person is of more value to any hospital than most of its MDs lumped together.

They go to you for getting this person signed up and onto any public assistance, for finding any relatives you can, for finding rehab (given people stay in the hospital now for two days if that) or SNF, finding placement in psychiatric care (rare as hen's teeth now) and in nursing homes. Going back not to the street but to city and state shelters (where most will not stay for 10 minutes) , getting help with city and state drug programs. Homeless programs.
And on and on and on and on.

They go to YOU, the social worker.
Now, how you will do this if you don't know how to do this?
I cannot even begin to imagine.
But trust me, as a new RN I saw other RN's standing with enema bags saying "How do I DOOOOO this".
We always had mentors. We all learned.

Can you tell us a bit about when you graduated. Where you started working? And what the mentoring program is. We on AC I think would love to know, because as I tell people "When you get to the ER start saying "I want to see the Social Worker FIRST THING".

You can do this. It will be tough if you aren't mentored. In fact, impossible. A steep learning curve because you have to know a little about everything from housing to law. And the first year or two, just as with MD or RN, is going to be shocking. It is going to put all you learned in the clean pristine world to the test. You will find out that you have a tremendous amount to learn. You will have a jumble of notes so thick you can't find your way through them. Resources. You have to collect resources!

I wish you so much luck. It is fascinating to see a social worker show up who has no idea what to do, but it does let one know that is how we ALL start ANY job. Helpless and terrified.
I wish you the best. Some day some RNs are going to look at you as the best thing (along with a PT person or two) that every happened in their world. If you stay in hospital work know it is a crucible. But what you learn will be invaluable to the humanity around you.

You're a social worker and you don't know how to handle what is clearly your job to handle?

You've never heard of a 'Social Admit' also known as an 'ER dump'?
This is where a family has no choice but to bring a LO to the ER and leave them there because they are receiving no support and cannot manage their care needs anymore.

What your job is to do with such a person or one who is homeless and mentally incompetent, is to do an actual 'Social Admit' for that person.

They will then be admitted into the hospital or some hospital and the social work department (you and your colleagues) then finds them a bed in a nursing home, or mental facility which are basically the same thing today and also communicate with the state's department of social services. They will take it from there. Now it will be the responsibility of their social workers to find a group home or some other form of suitable supervised housing for the individual and will get a conservator appointed for that person by the court.

If the person has a guardian or conservator already who is not providing for their basic needs because they either cannot or will not, then the court will appoint another one. The court usually appoints a lawyer or a social worker.

It's pretty disheartening and not a little bit frightening that an actual social worker in a hospital doesn't know these things.

You could also review what your hospital's policy is on such matters. Or speak to the legal department of the hospital. Or your supervisor. God help us all if you're the level of competence we can expect to find in a hospital.

Welcome, Karen!

You do know that family has no legal obligation to come and pick up a family member, right? We see many, many situations here where a family member is stubborn, demented, abusive and/or mentally ill where our advice is what can be termed an ER dumb or "social admit".

I think you would need to push back on the public guardian not accepting the referral. That's exactly who should be looped in.

There is almost certainly hospital policy about how to handle this situation. I'd seek guidance from those higher up.