Refusing to leave hospital?


Sir, – I wish to question the victim-blaming apparent in the article “Minister vows clamp-down on those refusing to leave hospital” (News, April 23rd), which makes it sound as if wicked malingering patients are the reason for bed shortages in acute hospitals. The article provided no analysis of why anyone might choose to stay on in hospital. Here are a few pointers.

Where are the beds in the “community hospital 30 or 40 minutes down the road” and does it really provide “adequate care”, the sort of care that respects the dignity of the patient and can deal with medical problems without either ignoring them or immediately shipping the person back to A&E? It seems to me that some illnesses are much more equal than others; and chronic progressive conditions are at the bottom of the pile, with community supports inadequate.

Second, there is the question of cost: a person without a medical card has a right to a bed in a public hospital at a fixed rate; but if he or she is decanted into a community hospital or nursing home, the situation becomes murkier. The HSE will pay for a certain amount of “convalescent” or “transitional” care but seems to set a limit of a fortnight. In my experience very little will happen in a fortnight. The HSE “Fair Deal” or care package bureaucracy will barely have cranked into action; house conversions cannot be done that fast; and once a person leaves the acute hospital the social work, occupational therapy and physiotherapy supports disappear.

I have a relative who last year went to A&E after her chronic condition led to complete immobility. She has been on a waiting list for two years for a complicated joint replacement. She spent about five days in hospital and was decanted into a community hospital (more than 30 minutes from her home) and later a nursing home by a hospital bed manager, without any full medical assessment or care-plan in place.

Nor were she or her family apprised of the nursing home costs or for how long the hospital and the HSE would pay, which is a pretty important point, given that nursing homes fees are over €1,000 per week. If you had that happen to you a couple of times, you might be just a little reluctant to leave hospital. My relative is still waiting for her operation and is back in the same hospital with a different (higher status) illness. – Yours, etc,


Dublin 13.

Sir, – Media outlets are awash with stories regarding the pressure on emergency departments throughout the country, with hundreds of patients awaiting beds for in-patient care on a daily basis.

Sligo University Hospital faces these same pressures.

On a daily basis I receive an email from our management asking me to do a ward round and discharge patients if possible, as there are patients in the emergency department. This email usually arrives during or just after I have completed this round and discharged all patients who are fit for discharge.

One particular patient highlights some of the difficulties clinicians encounter.

Mr X is a very nice man in his nineties who was admitted 65 days ago. His medical issues were sorted out in less than a week and he was ready for discharge. However, he was more frail than he had been pre-admission. He lives alone and now requires a home help if he is to be safely discharged. Our hospital-discharge planning team approached the home-care team with a view to organising a home help for Mr X over 50 days ago. The message keeps coming back that the is no funding available to provide a home help. All levels of management in the Saolta Health Care Group have been informed of this issue, but there has been no progress.

In the meantime, Mr X is becoming more and more institutionalised and likely to find it more and more difficult to cope if he ever gets home. At the same time patients pile up in our overstretched emergency department.

Is this the type of health service we should be offering to our frail elderly patients? – Yours, etc,


Consultant Physician

and Cardiologist,

Sligo University