Complicated Social History

When I was doing my gerontology placement, I had an interesting 78 year old male patient, Mr. O, who presented with fall and past medical history of bipolar affective disorder and cardiac diseases. The usual expected length of stay in the ward was around 10 days and patients who need more rehab were usually sent to transitional care or restorative unit. However, Mr. O exceptionally spent more than 3 weeks in the ward due to his difficult social history.

He normally lives at home with his wife and is highly dependent on his wife who does everything for him at home. He has a supportive daughter too. However, during his stay in the hospital, her wife was diagnosed with breast cancer and admitted to the same hospital in oncology ward for chemotherapy which delayed Mr. O’s discharge from hospital. His daughter at that time was also too busy taking care of her husband who was diabetic and was undergoing a leg amputation. The patient knew nothing neither about his wife’s nor daughter’s situations as the wife requested the doctors and all staff not to inform the patient. After having a team meeting, we discussed with the wife that it would be best for Mr O to transfer to Bentley’s restorative unit for longer rehab until she was discharged from hospital. However, Mrs. O strongly disagreed and warned that she would discharge herself from hospital and take her husband home if we did so. As there was a high possibility that she might not be able to take care of her husband as before, we offered a variety of discharge options including low-level care or home services but Mrs O strongly refused. She insisted that she would get better and continue to take care of her husband once she completed her chemotherapy treatment. Fortunately, Mrs O reacted well to her treatment and her doctor agreed that it might be possible for her to continue to provide assistance for her husband when they go home.

I attended the family meeting which involved two patients and two teams. Mr. O discovered his difficult situation however told us that he would do what his wife wanted to do. Finally, we discharged both of the patients with home physio and no other services. Obviously, care was the sole reason for the delay of Mr. O’s discharge from hospital and his difficult social history further hindered the process. Although we tried to suggest and provide what we thought were best for our patients, at the end of the day, it was still up to the patients to make the decision even though the discharge plan was not ideal for them. On reflection, I thought that the team should have put more effort in explaining to the patients in details regarding different kind of home services. Most importantly, Mr. O should be informed regarding his family situations from the beginning and treated fairly in making decision regarding his own discharge plan.