Unrealistic expectations
We had virtual Joint Commission survey last week. It was ridiculous with management having to walk around an iPad on wheels for days.
One day they were reviewing some charts and the director of SW asked for a few recent patients who went to SNF, HH, or needed DME set up so they could review the CM documentation. I gave them a SNF one I had done a few weeks ago that I was proud of the work I did.
The patient had been in our hospital for 2 weeks and refused SNF. We stabilized and sent home with family who had already been taking care of the pt in that state for over a year. Pt showed back up the next day. Underlying the medical reason for readmit, the family told me they just can’t take care of the pt until they can help a bit more. At this point they are total assist for transfers and the spouse is older and the daughter isn’t home all the time because of work. They wanted SNF. I explained I can’t force the pt to go and they need to be honest with the pt about why they want them to go and reassure them they can come back home when they get stronger (not an unrealistic expectation). After the family talked to the pt and they agreed to placement, I went in and asked if there was any preference. There was none other than not going back to 1 place they had been before and didn’t like. No problem. I told them I’d get the list of SNFs covered by the insurance and do my best to keep placement as close to home as possible. The pt was pleased with this. I documented all of it. In the end 2 SNFs accepted and so I went to the pt and told them this and let them choose. They picked the one that was closer to home. I documented all of this. Including on our preference form signed by the pt the first day where I wrote no preference other than not the one SNF.
After Joint Commission reviewed the chart they said it was good enough but in the future we really need to be printing a list of ALL county SNFs for pts/family to look at and make their choice and then a 2nd copy where we notate their preferences to keep as proof in the chart. If the pt has insurance why would I show them places not covered unless they specifically ask about a place. Then if they like one on the list I have to say oh isn’t covered it would be all you paying???? Why do they want me to waste paper and time. How out of touch (especially in the aftermaths of covid) to be thinking we have a plethora of options willing to take each patient.
I get there are places who ignore choice and try to force pt’s where they want them, but just fuck off with all of this.
