title: The "Permanent" Patient Problem.
abstract: Patients who enter the health care system for acute care may become "permanent" patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. Legal, professional, and ethical norms prohibit physician and acute care hospital "dumping" of these patients. However, limitless use of hospital resources for indefinite stays is untenable. In the absence of hospital policy addressing this specific issue, the availability of financial support will be determined by health care professionals' willingness to advocate for the patient and negotiate with hospital administrators and the ability and willingness of administrators to authorize the use of hospital resources. We propose five mid-level ethical principles to guide advocacy and administrative decision-making about provision of financial support for post-acute care for those patients who cannot afford it. We use two actual, de-identified cases to illustrate how these principles can be used to make reasoned, consistent decisions about the provision of post-acute financial support.
authors.affiliation: Received her doctorate of jurisprudence from University of Houston Law Center (Houston, Texas) and a Master's in Bioethics from Case Western Reserve University in Cleveland, Ohio.
authors.forename: Courtenay R
authors.initials: CR
authors.lastname: Bruce
authors.affiliation: Received her doctorate of jurisprudence from Yale Law School in New Haven, Connecticut and her doctorate in religious studies from Rice University in Houston, Texas.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Majumder
mesh_terms: D003266:Continuity of Patient Care; D015276:Health Care Rationing; D006801:Humans; D010351:Patient Discharge; D014481:United States