![]() ![]() That becomes a serious issue sometimes,” says Wayne Shelton, PhD, professor at the Alden March Bioethics Institute at Albany (NY) Medical College. In some cases, an elderly, frail patient is determined to go home alone, “and nobody thinks it’s a good idea. “Thereafter, clinicians must arrange post-discharge care with input from the proxy decision-maker,” says Sarzynski. If the patient has not previously appointed a durable power of attorney for healthcare, it is necessary to contact next of kin, or in some cases apply for a court-appointed guardian. “However, if the patient lacks capacity to make the decision to return home without a reliable caregiver, then the clinician must determine who is the proxy decision-maker,” says Sarzynski. This could include having family or friends check on the patient and arranging home healthcare services or sub-acute rehabilitation care, which may be a viable option for up to 30 days post-discharge if the patient was admitted for at least three nights under inpatient status. If Sarzynski is concerned about a patient’s welfare post-discharge, she works with case management to create a contingency plan. “If the patient does have capacity, then a clinician is challenged to facilitate the discharge against his or her better judgment,” Sarzynski says. In these cases, it’s necessary to determine if the patient has the capacity to make the decision, says Erin Sarzynski, MD, MS, an assistant professor of geriatric medicine at Michigan State University in East Lansing. It’s a difficult yet common scenario: A patient with complex care needs does not have a reliable caregiver at home to assist with implementing their post-discharge care needs. Contact nursing homes on behalf of clinicians if placement is especially difficult.Work with case management to create a post-discharge contingency plan.Determine if patients have capacity to make the decision to return home without a reliable caregiver.Ethicists recommend the following approaches: Ethically challenging hospital discharges include patients with inadequate at-home care and those who leave against medical advice. ![]()
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