Patient wants to go home, but social worker at hospital says no. What to do?

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My father is 56 years old. Has bilateral lymphedema and stage 4 kidney failure. He's on dialysis three days a week. He's been in the hospital for three months. He just wants to go home and go back and forth from home to the hospital to get dialysis. His social worker is saying he needs to be in a nursing home even though there are about seven hired people to help him at home when he needs it. Now the social worker is saying even the ambulance drivers who would be transporting him to dialysis are refusing to transport him if he goes home. His physical therapists at the hospital are barely helping him get his strength back. My brother and I are at lost of what to do. Our father is miserable and homesick.

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Is the social worker advocating for a nursing home so your dad can get PT? It's common for someone who's been in the hospital for so long to be discharged to a facility for physical therapy. A social worker would be the person who sets this up.

I would contact your dad's Dr. and see what he wants to do and then follow his instructions.
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I would really explore what the benefits are. Perhaps a trial period staying wouldn't hurt. From what I have read, there are many things to treat when in Stage 4 kidney disease. Does he have other things like hypertension, diabetes, obesity, etc? Do the ambulance workers have difficulty lifting him? Does it require special equipment or extra staff to move him?

Is he able to move around and to the bathroom, into shower, etc? How much care does he need? I know that lymphedema can be quite uncomfortable. The skin can bleed and get infected. It also needs daily treatment. Can someone come to the home to do that?

I would try to look at the big picture and do what's best for him. I'm not sure why, but it sounds like there is concern that with his needs, the home route is not a good option, in their opinion. I might ask them why.
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Thinking again....it's a doctor who signs the discharge instructions, not a social worker. I don't think she can hold your father against his will if a doctor will sign instructions to the contrary.
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Put aside the social worker for a moment and tell us what your father's doctor says.

Social workers have their own interpretation and perspectives. Although I've met a few who were as considerate and helpful as medical people, I generally wouldn't rate a social worker on as high a scale as I would someone with medical training, and would never take his/her advice over that of a doctor.

I suspect this social worker is a discharge planner?

I don't think the social worker can opine on whether ambulance drivers would or would not take your father to dialysis; they are governed by regulations and policies, not her interpretation.

I don't know how long stage 4 kidney failure can last, and with lymphedema, he has an extra complication. But given his complications, his long hospital stay, I think he's entitled to have some respite, regardless of how close he might be to a more terminal stage.

PT at a hospital can't compare to home PT or PT in a facility. He may be able to regain some strength if he's more comfortable at home.

I would check with the doctor who's treating him for either or both the lymphedema and kidney failure and if either agrees that he can go home, take him home. Just being in his own environment might be a real boost not only to his morale but his physical situation as well.
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