When Mr. Prince was admitted to the hospital, it seemed like it would be a short stay. Mr. Prince (his name has been changed for confidentiality) presented with a seizure. He had a history of seizures ever since he had a stroke about a year ago, but as long as he took the anti-epileptic medication phenytoin, his seizures were controlled. A blood test confirmed that his phenytoin levels were low. He was admitted so that he could receive an IV dose of the anti-epileptic medication, with a plan to discharge him if the levels came back within the correct limits in the morning.
Over three months later, Mr. Prince still sits in the hospital, despite having no active medical problems. The cost to the hospital, which is then indirectly passed on to other consumers, has been hundreds of dollars a day.
Despite the seeming oddness of Mr. Prince's situation, it is not uncommon, especially among patients with neurological problems that limit their independence. Hundreds of patients across the nation languish for months, even years, in hospitals, despite being well enough to live comfortably in a less expensive setting. Each patient is trapped in a kind of bureaucratic limbo for a variety of reasons. Many are illegal immigrants, homeless or uninsured with no friends or family. Mr. Prince is all of the above.
On this particular visit, Mr. Prince was noted to be more confused than usual, even after the post-ictal period of confusion had subsided. Concerned that his confusion could affect his ability to take his seizure medication, medical staff performed cognitive testing that confirmed a diagnosis of dementia. In fact, Mr. Prince was deemed incapable of making good, healthy, safe decisions independently.
At this point, a person with insurance and social connections has several options depending on their individual needs. Maybe they could move in with a friend or family. A nurse or caregiver could come visit at home. If they are significantly disabled, perhaps they could go to a care facility. As a homeless man with no insurance, friends, or family, none of these were options for Mr. Prince. Because he is an immigrant with no documentation, Medicaid or Medicare will not cover care outside of an acute setting. His stated country of origin did not recognize him as a citizen. So essentially, Mr. Prince has moved into the hospital, with nowhere else to go, despite less expensive options being more medically suitable.
Hundreds of similar patients exist throughout the United States, some staying in hospitals for years despite having no medical reason for that level of care, at a high cost to hospitals. These patients usually arrive to the emergency room with a severe illness, and the hospital is obligated ethically and often by law to provide the best possible care until the patient can be safely discharged. Staying within an inappropriate level of medical care may not be so safe, however. While in the hospital such "permanent patients" risk getting even more seriously ill due to the uniquely drug-resistant diseases that can grow in hospitals.
No easy solutions are forthcoming. Politicians generally don't want to change hospital reimbursement plans due to fear of being charged with encouraging illegal immigration. Hospitals generally don't want to appear callous by pressing the issue. In the meantime, however, hospitals cover the costs, even if it ultimately requires passing some costs along to others who require hospital services.