Mr. Roberts’ status improved after treatment
Zahra explains that after three weeks Mr. Roberts had improved substantially. He no longer had a urinary tract infection, and his delirium had cleared. He was working with physiotherapy to rebuild his muscle strength and stability before discharge.
Zahra explains that the health care team is not sure where “Mr. Roberts is at, cognitively.” She says that initial cognitive assessments had suggested mild impairment and memory loss, but since he started feeling better Mr. Roberts has refused to participate in any reassessments.
Mr. Roberts’ physician at that time, Dr. Patel, documented that because of the potential cognitive impairment, risk of wandering, and risks of falls, home is not a safe discharge destination for Mr. Roberts.
A family meeting about discharge
Zahra explains that challenges began to arise about the fourth week after Mr. Roberts’ admission. The healthcare team held a family meeting with David and his wife, Linda. The attending physician, Dr. Black, David and Linda, as well as some other members of the health care team agreed at that meeting that home would not be a safe option for Mr. Roberts. David and Linda had asked about long-term care, and the team had given them information so that they could arrange to visit. They agreed to make the decision the following week.
Before the meeting concluded David asked the team to avoid discussing the plan with Mr. Roberts until a home was selected so that he could personally speak to his father about it when he had all of the information.
Mr. Roberts asks to leave
Zahra tells you that last week Mr. Roberts informed his nurse that he wanted to go home. Mr. Roberts had become agitated and asked the nurse to help him call a taxi so that he can leave. The team was able to redirect him. Zahra does not believe Mr. Roberts knew about the plan for long-term care at that time.
The following morning Mr. Roberts dressed himself and left the unit. He was found outside the hospital, again with no coat, in the cold. On this occasion Mr. Roberts was put on a Form 1 under Ontario’s Mental Health Act, meaning that he could be held involuntarily to await psychiatric assessment. After a psychiatrist assessed Mr. Roberts and cleared the Form 1, Mr. Roberts was persuaded to return to the unit and wait to speak with his son.
The team did not hear from David about the long-term care home selection, as anticipated.