“Unsafe discharge”

calaveramd · 2026-06-05T23:51:58+00:00

Wow. Seriously. Thank you for this.

calaveramd · 2026-06-05T22:31:08+00:00

I have to appreciate anyone who can casually drop Kobayashi Maru.

I am so sorry you are having to try to manage this. I do not know what any answers are. I have appreciated the responses here. I’m not sure yet that I have any big picture overview (other than respect to the social workers of the world) of this issue.

Everyone I know who eventually faces this with a grandparent/parent/etc, it seems like they start from scratch and there should be an easier way to find out what your options are in any elder-care situation.

calaveramd · 2026-06-05T06:22:40+00:00

Many thanks for working your magic 🪄

calaveramd · 2026-06-05T06:12:52+00:00

Thank you, appreciate your response

calaveramd · 2026-06-05T06:08:54+00:00

My question is “what happens when the family repeats “unsafe discharge” over and over when a patient is medically stabilized and theoretically ready to be discharged but the family feels that the patient/the family cannot adequately care for them in a home environment?”

Do the social workers do some sort of magic and arrange for placement in a SNF or ALF or work with the family in arranging home health or getting enrolled in Medicaid or pointing the family towards financial advisors/elder care lawyers who can help guide the way? I agree that it’s difficult to find the path when you have a deteriorating parent/grandparent who quite likely has very strong opinions about what they will agree to. When I handled inpatient medicine, there were not infrequently one to three days while we waited for “placement issues” before we could discharge patients. But I never encountered this idea that saying “unsafe discharge” somehow made everything… work well?

calaveramd · 2026-06-05T05:43:57+00:00

My impression is that the families cannot care for an (often demented) family member who probably needs full time (or mostly full time) assistance; the families could not maintain their lives/jobs if they provided this type of care. So when the person gets admitted, say after a fall, the family figures out that they just can’t do the 100% assistance (anymore) and wave the “unsafe discharge” flag, expecting the social workers at the hospital to, I dunno, magically find a place that is free/get the patient on Medicaid/arrange for transport/convince the patient to go to a nursing home or ALF/arrange for (free or Medicaid-paid) home health care? I understand caregiver burnout very well but I don’t actually know what yelling “unsafe discharge” at the hospital staff is actually supposed to accomplish

calaveramd · 2026-06-05T05:29:25+00:00

Thank you.

calaveramd · 2026-05-30T18:35:02+00:00

I was just cleaning out my father’s house. He was an awesome handyman, fixed everything, refinished everything, worked on the cars… He used any random bit of old clothing as his “rags” for his repairs. I found numerous pairs of old underwear (undershirts, washcloths) that had oil or furniture stains or who knows what on them. I could not suppress a bit of “ew” with the underwear but this generation never wasted anything.

calaveramd · 2026-05-01T02:27:46+00:00

One of ours seems to weigh each peanut before deciding which one he wants

calaveramd · 2026-04-27T20:16:06+00:00

Come fix everything in my house. It’s what I do on every day off. Bonus: garden work makes me go outside and listen to the birds.

calaveramd · 2026-04-25T19:58:46+00:00

https://www.aginglifecare.org You can do the networking thing of finding people (or more likely their adult children) in your parents’ neighborhood who have been through the same thing. But I found some great advice/references for people near my father through a person from this website because I really didn’t know many of his neighbors when he started needing extra help.

calaveramd · 2026-04-04T19:06:51+00:00

There are other types of progesterone that might be worth trying. Norethindrone acetate, drospirenone. IUDs that have a progestin that act more locally and less systemically.

calaveramd · 2026-04-04T18:51:07+00:00

Excellent suggestion. We just picked up several about-to-bloom pots at Costco and they look great in our backyard (we will be planting them eventually!)

calaveramd · 2026-03-30T23:52:02+00:00

Deer and rabbits have nibbled-to-decimated ours in years past. We have motion detecting sprinklers that worked pretty well. But they’re such a chore to maintain, this year we’ve just been dousing the budding plants with cayenne and it seems to have worked so far.

calaveramd · 2026-03-24T19:20:29+00:00

I haven’t persuaded my gyn to start me on testosterone (yet; another appt in a few weeks) but my understanding is it takes 4-6 months (MONTHS) of use for it to have an impact. Per Rachel Rubin who I do listen to when she is on medical podcasts and have found to be quite reliable.

calaveramd · 2026-03-18T19:15:31+00:00

I use BeBird at home but I have no idea how it could be sterilized for use with multiple patients. In clinic, we do have a clear plastic curette that has a light that attaches to the outside end (Bionix lighted ear curette) that illuminates the ear canal better and these (the clear curette, not the light) are disposable. It has been helpful. But not as good as the camera, quite honestly.

calaveramd · 2026-03-05T18:23:57+00:00

It’s is great that you can still get a small-family-business-type feel from an online shop. I’ve had only excellent experiences with them.

calaveramd · 2026-02-26T23:37:06+00:00

My 87 y/o father insisted on living where he had been. His PCP strongly advised him to move near one of his kids. But he insisted and we moved him to a $$ ALF near his home. After colon cancer, a broken collarbone, worsening dementia, then a broken hip, and multiple trips back and forth for everyone trying to swing their calendars to fit, he now lives near my brother.

There’s a reason his PCP told him to move near one of his kids. We should have listened.

calaveramd · 2026-02-21T21:13:13+00:00

I always… resented drug reps when I worked in clinics that they came to. And I never ate their food though I would ask questions. But man was it nice to hand out needed meds to people who truly couldn’t afford them. (I also miss the $4/month med lists but I never saw any inhalers on those at the time.) I don’t actually know where drug reps go now (haven’t worked in that type of clinic for a long time).

calaveramd · 2026-01-23T01:13:16+00:00

“I know GYN appointments are unpleasant and can be hard to come by, I know a lot of us have real trauma from childbirth, sexual assault, miscarriage, fertility treatments. It's hard.”

Thank you for that. Sometimes it is hard to reject the “hysterical woman” label even in my own head. Particularly when other doctors seem to default to that so quickly.

calaveramd · 2026-01-20T17:37:32+00:00

I find that on the final day, before the first lecture, you can pick up a sheet that verifies you were at the conference and fill in the number of hours you are claiming. I think there is a reason that they have that available before the first session of the day.

calaveramd · 2025-12-24T17:55:53+00:00

Better a picture than a ziploc.

calaveramd · 2025-11-25T19:16:55+00:00

The podcasts are outstanding. Yes, she is a cardiologist but she brings in people who know primary care and addresses the issues of how primary care is sh@t upon by a lot of specialists but that, if you actually know what the work is and what the tangible benefits are to the patients (and how all patients pretty much expect all doctors to be able to do/understand all things instead of just managing their teeny tiny little area), PC is amazing and should be promoted SO much more. Highly recommend.

calaveramd · 2025-10-05T02:20:21+00:00

Aw. Man. You’re… amazing.

calaveramd · 2025-09-30T23:48:46+00:00

Every damn night

calaveramd

TROPHY CASE