Written by Shelley Guy, Complex Discharge Coordinator, Langley Memorial Hospital

The importance of patients and clients being in the right place at the right time is often a moral struggle when care providers or family do not agree on where this 'place' should be.

As health care providers, we are in a position to assist patient, client and family journeys that are not always easy to follow.

Mr. M has a history of schizophrenia. He came to Langley Memorial Hospital because he was displaying worsening paranoia after his medication was suddenly stopped in the community. The family were in despair, wanting their father to go to residential care because his behaviour and care needs were too great for them to manage at home. But what did the patient want? He wanted to go home, not to a place with ‘old people’ (he is in his 80s).

Functionally, he was independent and able to direct his own care. Mr. M’s family did not agree. Even his family physician wrote a letter to the care team, stating that he felt his patient needed to go to residential care. It would have been easier to send Mr. M to residential care, but what was important to him? Mr. M wanted to go to Assisted Living.

The care team met with his family physician and weighed what was important to the patient against the assumed safest discharge destination. With more information provided by the care team, the family and physician were willing to try Assisted Living.

We are happy to report that Mr. M is thriving in Assisted Living. Having the right to choose a discharge destination is honouring a person’s right to autonomy. Care providers are often caught in this ethical dilemma, stalling care planning. It takes a team to shoulder these challenges. Using an ethical framework in care planning has helped guide the Langley care team in supporting this patient’s, and future patients'/clients', journeys.

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