I take on-call with my job now and then. If a person is in an ER and not being admitted, who's responsibility?

Question

Often times we get stuck in situations where the person is not being admitted to the hospital, but they call the emergency after hours number and request placement for the consumer either in a personal care home or nursing facility. And this is sometimes before even fully evaluating the person or contacting family. Sometimes the person ends up being admitted and it turns into a waste of time anyway or a family member is willing to stay with the consumer until the next business day when a caseworker during the daytime is able to handle the situation. But sometimes not all of the proper resources are utilized before the after hours emergency number is used and it just seems like a dumping job. Who am I as an on-call caseworker to go into a hospital and place someone when the staff has all of the information they need right there to do it themselves and to pick up a phone? Regardless if the person is admitted or not, they are still in their hospital or is there something I am missing?

Answer 1

The individuals doing the referrals for placments after hours need to betold firmly and clearly that what they are asking is unreasonable. On-call services and avialblity need to be clearly defined. They are using on call services to do their job. Next, make sure you get double and tripple time for all of this activity. That solves the problem reallllllllllllllly fast.

Answer 2

Maybe I'm missing something, but generally, the job hospital staff (nurses, doctors, admitting clerks, aids, etc.) doesn't include making arrangement to get someone to a different facility. It seems to me that caseworkers are hired for just that purpose.

The doctors and nurses have a phone, so they could order pizza for the all-night gas station crew too; but they don't, because it isn't their job.

I'm guessing they hire on-call workers because this situation arises. I'm guessing that the role of the caseworker is to make sure the patient/client gets the right type of attention in this situation and that the family is talked with. I'm guessing there's some element of knowing what resources are available etc. I'm under the impression you see these "dumpings" as if they are a UPS package that simply require a quick phone call.

Generally, ER doctors are residents operating on very little sleep and usually having a really heavy load of patients to be dealing with. ERs have only a few nurses at any given time. The hospital probably feels it would be a disservice to the patients to ask hospital staff to make a simple phone call and hope all works out ok for the patient. Also, there are probably limitations on how much hospital staff is allowed to do beyond their job description both for reasons of possible liability if something goes wrong and a patient doesn't get the best attention in such a placement and because, possibly, the staff is so over-extended it could be considered a risk to just kind of add responsibilities. There could also be contractual agreement with regard to any job descriptions.

I'm assuming the patients could be people like my friend's mother who had increasingly severe Alzheimer's and who one night just got too difficult for her daughter to handle. I'm assuming there must be times when something like worsening breathing problems could scare family members into getting a patient brought in.

Doctors and nurses just don't have the time to devote to paying attention to that one patient's placement. That's why they have an on-call caseworker. I would imagine that for the patient (particularly a frightened elderly patient) and their family just having someone like a caseworker there to talk with them and reassure them is probably the very least the hospital thinks should be offered.

With all due respect, you seem to have a very cold opinion of the people who are in this awful situation. What a horrible, horrible, thing it is for someone to have to go to a nursing home and often know they won't go home again. What a difficult, difficult, thing it is for people when someone needs a personal care home. The patient is scared and/or in pain. The families are usually horrified and worried and sick.

Who are you to go into the hospital and place someone? You're the person they've put on call just for that purpose, probably so they can offer this type of assistance to people whenever they need it. In view of the fact that you've said they sometimes arrange to place someone even without the person's being evaluated fully or before contact family, I hope that part of your job is to make sure the patient later gets the appropriate evaluation and that all family members are contacted about the situation.

I'm guessing you could be the person who makes the difference between someone's not being "dumped" for too long.....