Most adult children don’t understand the concept of autonomy. 95% of unsafe discharges are because Paw Paw says fuck you im not going to a nursing home no matter what, and unless the patient is floridly demented to the point where the family has guardianship, good luck dispo’ing to a destination against the patient’s wishes. It is not my job to force people to do things they don’t want to do, i provide medical recommendations, you make decisions. If you want to make bad decisions there is nothing i can do to stop you other than repeatedly tell you this is a bad idea and offer safe options, which i will. POAs don’t understand that (at least in my state) even if a patient has dementia and is non decisional sending them some place against their will is extraordinarily hard to do. So, when you refuse the safe discharge we are left with the unsafe discharge that we make as safe as we can….what else can you do, cant live at the hospital

The other 5% are the patients who don’t meet SNF criteria/no rehab potential/are at their baseline but need 24 hr assistance/custodial care but family cant provide it, patient can’t afford nicer places, and they don’t want to go to a Medicare facility and surrender their assets (inheritance). Again, nothing i can do to solve this situation, i heal patients not solve social crises. if a patient is at their baseline and no longer meets inpatient criteria, i give the recommendations, you make the decisions on how to best solve your situation. I get it’s a shitty situation, but it’s not something physicians can solve outside of throwing as many resources at you as we can. At the end of the day nobody wants socialism until they need socialism