When the bureaucratic tail tries to wag the medical dog

December 12, 2014

A bed could not be found for my mother at the case manager’s first choice for a nursing/rehabilitation facility, this Friday afternoon, and she suggested maybe they should just send my mother home instead and have her hire some services.

I did not take to this idea well.

Long story short, my mother will be discharged tomorrow to a bed at a different facility.

I knew from many perspectives that the attempt to change the discharge plan from rehab to home made no sense.  The medical team hadn’t changed their conclusion that my mother needs to regain her strength and mobility and such before she goes home.  The kind of services a patient can hire, especially on short notice, would not provide the type of care and therapies for improvement needed at this point.  On a weekend, there is even less access to supervisory help, and often the people who work weekends are new hires, so it would be even less likely the work offered by the in-home services would be adequate.  The out-patient specialist had told us that the rehab center would be familiar in their own right with the symptoms that need management, even without her instructions and prescriptions — in other words, the specialist was relying on my mother’s being discharged to a rehab center.

In addition, I did not take well to the idea that I would be the person on the spot to take up the slack, should the hired services be as inadequate to the situation as I expected them to be based on my prior experience with other ill family members.

I also made the point that without adequate discharge plans, my mother would ricochet back into the hospital.

As I said, the case manager abandoned her home discharge idea and found a bed at another rehab center.  All’s well that end’s well, but I was appalled at the process.  Having been around this block before, I knew enough to object and to be able to object effectively, but I was not a happy camper.  The hospitalist I spoke to later assured me my mother would never have been let out the hospital door with a discharge plan for home like this, that she (the in-hospital doctor) would never have approved the plan, and so newbie patient families are not put at risk of being taken in by and agreeing to this kind of case management behavior.

But it is unnecessary aggravation, in my opinion.

I can see that my challenge was to speak up and advocate on my mother’s behalf but keep an even keel.  I think I am getting better at it with all the practice I am (unfortunately) getting.

And I got nice phone calls this evening from the social worker on my mother’s team and from the hospitalist, after I got home.  They said they would provide feedback to the case manager.  That sort of resolution and such support are far better than what I’ve experienced in the past.





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