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  • Communicating With Patient's Family Before Discharge
  • Dale Weir

When my father-in-law lay dying in a St. Louis hospital close to an hour drive from the family farm and his wife of over 50 years, we were suddenly told that the hospital felt it best to discharge him and send him to a nursing home closer to his rural home. No one had mentioned this as a possibility. It wasn't evenly remotely on our radar, and we were aghast.

While my mother-in-law was technically an hour away at the family farm, she had essentially been living at the hospital with him since he was admitted. My husband and I lived 20 minutes away from the hospital in question and 40 minutes away from the farm, but we had arranged our work schedules to ensure that between his mother, his siblings who had come to town, and the two of us, someone would always be with both him and with my mother-in-law.

The first thing that went through our minds was: as fragile as he had become, would he even survive the transfer to a nursing home? The second: now we needed to go find a nursing home and, quite frankly, there were no reputable nursing homes we knew of in the area he lived in. Taking time to search for one would take us away from his bedside. The third thing that went through our minds was that transferring him would kill him. [End Page 200]

We had absolutely no clue where this was coming from. Why was the hospital trying to discharge him when they had told us he had only days left to live?

When we finally got someone to talk to us, someone (we never knew who) on the hospital staff had made a decision, without talking to the family, that it would be easier on the family (not on my father-in-law, but on the family), to have him closer to home. They had initiated the actions to discharge him to an unknown nursing home in a rural community.

We didn't need it to be easier on us. He was getting excellent care in a facility that was easy to reach by highways and was actually between home and work for both my husband and myself. He was closer to where my husband and I lived than to the family farm, and, while it was further for my mother-in-law, she was only going back to the farm every few days to shower and change clothes (and we were driving her when she went back, since she was in no condition at the time to drive herself), so it didn't matter that he wasn't close to the farm.

As a side note, when he was initially admitted to another hospital that was marginally closer to our home and was probably 40 minutes from the family farm, then transferred to the final hospital in downtown St Louis, he was in denial and had repeatedly told the medical staff "that he wanted to go home and get back to his normal life." They had repeatedly told him that he would never be able to go "back to his normal life," so if this was in someone's notes at the hospital and they were acting on his earlier comments rather than the comments of the family surrounding him, I do not know.

We finally persuaded the hospital to leave him where he was until he died (which happened a few days later). Transferring him would have only hastened his death and caused the family more anguish, as they would have blamed themselves for allowing him to be transferred to a facility that wouldn't have taken as good of care of him as the hospital was. It would have also increased the stress on the family, as it would have required my husband and I to drive an hour and a half minimum on one-lane, horrible roads versus twenty minutes on a highway (provided that he would have actually survived the transfer in his frail condition).

While my mother-in-law was a retired registered...

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