A Discharge Plan That Is Difficult To Understand

by Travis Mateer

Back in July, the USA today reported on the LACK of testing at nursing homes in Montana. Not testing meant not knowing what was circulating, and that was a bad thing. From the link:

Nursing homes became the first places with fatal outbreaks in the USA. Six of Montana’s earliest deaths were tied to infections acquired at a nursing home, but the state avoided the widespread early outbreaks seen elsewhere in the nation.

“My impression is that the facilities believed they had all protocols in place to keep their residents safe, were doing everything possible, and there was no need (to test) because of so few cases in their area,” said Rose Hughes, executive director of the Montana Health Care Association, which represents long-term care facilities.

Nursing homes have LOTS of protocols. When I was working at Missoula Aging Services, I had plenty of conversations with family members about the process known as discharge planning. If you’re not familiar with this process, here is a brief description:

Medicare states that discharge planning is “a process used to decide what a patient needs for a smooth move from one level of care to another.” Only a doctor can authorize a patientʼs release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager, or other person. Ideally, and especially for the most complicated medical conditions, discharge planning is done with a team approach.

When you take the concern about the community spread of Covid, and you combine that with the need of skilled nursing facilities to plan for the discharge of their patients, the story of how Mayor Engen got his Covid-positive mom OUT of a nursing home, getting himself infected in the process, makes no sense. From the link (my emphasis):

A week after announcing that he’d tested positive for COVID-19, Missoula Mayor John Engen on Monday said he was released from quarantine over the weekend and was feeling relatively well.

During last week’s City Council meeting, the mayor said he’d been infected with the virus, most likely after taking his mother into his home after she had contracted the virus.

Later in the article, we get this:

Engen’s mother, who is 91, contracted the virus in early December. Engen said he brought her home to ensure her care and suspects he contracted the virus from her.

Am I missing something here?

One of the issues early on in the pandemic was nursing homes TAKING IN Covid patients:

Coronavirus is particularly dangerous in elderly, vulnerable patients. This defines just about every nursing home resident in the United States. In nursing facilities, staff go from room to room caring for residents, passing out food, administering medications and cleaning patient rooms. Even with stringent infectious disease isolation policies, the spread of this highly contagious disease is possible among these weakened nursing home patients.While nursing homes must legally be prepared to handle existing cases of COVID-19 involving their own residents, it is obvious why a facility would not want to admit knowingly infected corona patients from the hospital.

Yes, this would seem like an obviously bad idea. Just like DISCHARGING a knowingly infected Covid patient to the home of the elected Mayor of a community seems like an obviously bad idea.

I must be missing something. Wouldn’t be the first time this week.

About Travis Mateer

I'm an artist and citizen journalist living and writing in Montana. You can contact me here: willskink at yahoo dot com
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2 Responses to A Discharge Plan That Is Difficult To Understand

  1. babble on says:

    Maybe John’s mommy wasn’t in a nursing place when he brought her home. Maybe she was in an apartment or independent living facility.

    • I would think your scenario would warrant language like “moved her in” instead of “brought her home”, but you’re right, it could be that, which is why I asked if I was missing something. thanks babble on.

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