Where Does Our Responsibility to Our Patients End?
I've been asking myself that question a lot lately. I've had a run of patients who seem to be reluctant to take responsibility for both themselves and their care. I'm not talking about patients who are emotionally needy or concerned about the future and need reassurance. Nor am I talking about those who smoke, are non-complaint with medicines and/or diet or don't lose weight. No, I refer to those who want "therapy" to take care of all of their discharge needs. Let me explain.
I work in one of the larger hospitals in Houston. It is also one of the two trauma centers and has its own Life Flight fleet of helicopters. As a result, a large percentage of patients are non-resource. Many of them find their way to rehab because it's cheaper for the hospital to lose the cost of the extra week of hospitalization and send them home than it is to pay for additional care at other levels. Since these patients are non-resource, when discharge rolls around they are reluctant to spend whatever funds they have toward DME and other equipment. That's where the problem arises. In therapy, we get them to the highest functional level we can. Many times that level requires DME such as walkers, w/cs and tub benches. Every day in therapy these patients use various DME. Then when discharge rolls around they seem surprised that "we" expect them to go out and buy the equipment.
In the last month I've had three patients who needed DME to DC home tell me the hospital needed to purchase the equipment. As far as I know none of their families made any attempt to locate any equipment. This puts the department in a bind because we can't discharge someone without a safe discharge plan. The lack of needed DME falls under unsafe plan. Yet, rehab doesn't have funds available to purchase these things. Nor do we have resources we can go to for such funds. The best we can do is charitable donations and those are limited to first come, first serve. Nonetheless, some patients feel it is our responsibility to provide equipment.
Sometimes our patients don't want what we have to offer. A few months ago I had a young man who needed a bariatric w/c and BSC. We were actually able to locate these for him but he refused them. He said they were uncomfortable. Last week I discharged a man with a donated w/c. He was angry because he wasn't given a WBQC as well. We'd been using the gait for therapy but he hadn't progressed enough to be safe without at home. He wanted a cane because he'd used one with me. Another patient needed a w/c so he took one of ours. He told his nurse he was going downstairs to smoke and never came back. Another patient who had some funds waited until the day of discharge to have his family purchase a w/c for him. He told us he thought the hospital would eventually get him one if he was ready to leave and didn't have one.
I understand patients have financial hardship. Nowadays everyone is having trouble getting by. That doesn't mean it is the responsibility of the hospital to provide equipment free of charge to every patient who discharges from the unit. It's our responsibility to make the patient functional and safe. It's also our responsibility to teach the family and family how to use the appropriate equipment. We provide instruction on measuring for correct fit. We demonstrate how to safely secure things. At some point the individual patient must take over responsibility for his or her care.
Tomorrow I am discharging a patient home with his wife. He had just enough funding to obtain a rental w/c but nothing else. He is angry that he will have to use a bedpan at home because he uses a BSC at the hospital. He is angry that he will have to take bed baths. He uses a tub bench during therapy. He refuses to admit his home is too small to accommodate those items. Instead he has spent the last few days taking it out on everyone else and refusing to participate with therapy. No one has been able to get through to him that all he is doing is hurting himself. Yes, he has a brain injury. He also has the ability to decide whether or not to participate. I feel sorry for his wife who had diligently come to family training and done everything in her power to make things work at home.
Maybe I expect too much. I try to put myself in the patient's place. I have trouble with that because I see things from the perspective of a therapist and of someone who wouldn't quit. I just don't understand why some patients do that. Correct that, I understand why patients might prefer not to spend the money on the equipment. I also understand that patients might not see the value of the equipment or even might think it won't be needed at home. What I don't understand is why they seem to think it is the responsibility of the hospital to provide it.