A Few More Health-Care Questions

. . . and some opinions

by Bob Buddemeier

Connie Kent’s article highlights a number of questions about health care requirements and procedures at RVM. Coincidentally, I underwent an experience that raised some different but closely related questions.

In late May, what had started out as pain in my right hip progressed to pain throughout the leg and weakness that required the use of a walker to get around safely. I had already signed up for an hour a day of help through the RVM Home Care office. On hearing about the latest symptom developments, my daughter Stacey drove up from Folsom on May 26 and had me taken to the Asante Emergency Department. Stacey is a retired firefighter-paramedic who has had several spinal surgeries. She knows the medical system from both the inside and the outside, and is an excellent patient representative.

After two days, we had been seen by five MDs, as well as other professionals such as therapists, and I had had an MRI, a CT scan, and multiple blood tests. No procedures were done and no treatments were initiated. There was no consensus on diagnosis, and my overall condition was little changed.

Discharge with follow-ups was the proposed action. However, late Friday afternoon we were told that the discharge might not occur because they could not get in touch with RVM to insure that I would be discharged to an appropriate level of care. At the time I did not learn whom they were trying to contact, or what the requirements would be.

[After the fact, we saw that the Asante medical report notes have a standard format including the requirement that the provider specify discharge conditions. All had recommended discharge to a “Skilled Nursing Facility,” and had noted Stacey’s presence.]

Friday evening (ahead of a 3-day weekend) it was decided to release me without RVM involvement on the grounds that Stacey would be able to look after me.

Questions:

Whom were they trying to contact at RVM, and why couldn’t they? (Security and Licensed Facilities are staffed 24/7)

What were they seeking? (Admission to the HC? Could they have gotten that off-hours even if they did make contact?)

How flexible are discharge care requirements? Is discharge to the care of another individual rather than a Skilled Nursing Facility generally an option?

Opinions:

If Asante and RVM need to communicate about the welfare of patients/residents, then the communication channels and procedures need to be robust, reliable, well-understood, and accessible to the patients/residents.

There needs to be better specification of the actual post-discharge care needs and how they might be met; admission to a skilled nursing facility is overkill in many cases (such as mine).

Well-intended requirements such as the one described can be counterproductive if they discourage people from going to the Emergency Department when they need to.