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Tom Sharon
The right to refuse the assignment of family nurse


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The Discharge Planner and Options to Relatives Providing Care

If you are unsure or feel any apprehension about your new assignment as the family nurse, you have the right to refuse. The discharge planner may talk to you about insurance coverage and may try to tell you that you are going to incur charges at $1,000 per day, but you do not have to give in to coercion. If you take yourself out of the equation, then the hospital owes you a duty to continue providing all the required care. The discharge planner will then have to discuss one of three options with you and your physician: (1) continue hospitalization, (2) transfer to a skilled nursing facility or rehabilitation hospital, or (3) transfer home with full home-care coverage.

In such a situation, there is no standard rule as to which choice is the best one. Your support system, home environment, and financial considerations will be the determining factors. Nonetheless, the hospital is responsible for your well-being regardless of what exists for you at home or in the community. If the hospital cannot guarantee that you will receive everything you need, it is not allowed to discharge you.
 
However, if the attending physician and discharge planner determine that an intermediate care facility will meet your needs, they can transfer you or charge you private pay rates if you refuse to allow them to move you. Additionally, the choice of discharge options is sometimes a matter of preference or convenience.
 
For example, when my mother was in the hospital for the fractured right hip, the physicians and discharge planner wanted to send her out on a certain date. The problem was that I had begun renovating her condominium. It needed a complete overhaul because she had not had any work done on it for about twenty years. We needed more time. The social worker said, "We need to transfer your mother to an intermediate care facility."
 
My mother refused to go because she knew it was just a fancy term for nursing home. I was afraid that such an atmosphere would be psychologically devastating, given that she was already depressed. I only needed ten days more to finish her apartment, after which time I knew she could go to her home with a home attendant.
 
I got nowhere with the social worker, so I approached the attending rehabilitation doctor and spoke to him about my mother's condition. I reminded him that she had a bedsore and a blood clot in her left leg. He agreed to extend her hospital stay for the additional ten days and then gave me another extension for an additional five. At the end of this final period, Mom's apartment was ready and her equipment, supplies, and home attendant were in place. A simple business negotiation went a long way to avoid subjecting an elderly woman to intense psychological trauma. But I had to be willing to speak up for her.

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