In our society today, people go to the emergency department for about anything they might need. If you look back through my blog postings, you will see stories of many ridiculous reasons people have come to see me.
One service we provide in the emergency department that most people wouldn’t think of is finding someone a place to stay. Sometimes, this is just a shelter for the night. Sometimes, people can’t be sent home. Because of social, physical or mental problems they really can’t return to wherever they came from. In such cases, we look for a reason to admit them to the hospital for medical care. If they are not in need of such care, we have to find them some place to go. We call this “placing” a patient.
Here is a revised memo sent from one of our social workers to the Medical Director of our hospital about a young man who was driving everyone crazy trying to “get placed.”
Hi Dr. T,
I wanted to update you on the patient I came to talk with you about 2 weeks ago. He is a 23-year-old man who is a paraplegic (paralyzed from the waist down) and absolutely functions independently. I have placed him in two boarding houses in the last few weeks, but he has been kicked out of each one. He refuses to stay in a shelter. He was asked to leave the Helpful Home Board and Care last week. He was supposed to pay his rent within 3 days of admission. He failed to do so, saying his social worker (me) told him Medicaid or our hospital would cover this expense.
This patient continues to lie about everything and has contacted Adult Protective Services (APS), the police department, and the fire department several times a day over the last week. He tells them I specifically told him he should call 911 and be taken to our emergency room. This is very frustrating for me, as I have received multiple phone calls from these agencies all day, every day about this patient, who continues to try to manipulate our system. The bottom line is that this patient was living independently for three years and then started going from skilled nursing faculty to skilled nursing facility, staying for 90 days, so his Social Security benefits would not be in jeopardy. He knows the system! He then presents to emergency rooms, wanting to be placed. I have placed him twice. He is non-compliant with independent living and is rude to staff. He is more independent than he appears to be and is severely lazy. It is his decision to be lazy.
He has a very dependent personality and believes this is our problem, not his. Several social workers from two hospitals in town have spoken with him about how he needs to take some responsibility for himself. We have given him resources for shelters, board and care homes and skilled nursing facilities. He has income from Social Security. The problem now is that he is not going to go away. He will continue to present himself to our emergency room, call APS, the police department and the fire department daily until he gets what he wants, which is to be placed. As mentioned above, I have placed him twice, but he has burned his bridges and I do not want to continue burning my bridges with the facilities I work with. The emergency room is informed that they should not admit him for placement reasons, but of course they will continue to see him for alleged medical complaints. My supervisor is well aware of this case and the problems the patient has been causing our staff, other hospitals and law enforcement agencies.
You may get a call as well from APS. Everyone who has assessed him here and at the other hospital agrees he functions independently, but he is very lazy, entitled and doesn’t want to take responsibility for himself.
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