Top 10 List of Social Admits Defined!

What is a social admit to the hospital?   A social admission is generally accepted by healthcare professionals to be a patient with no acute medical needs that is brought into a hospital because no safe discharge arrangements could be made at the time they presented.

Most social admits involve elderly patients who present to an emergency room with weakness, have a thorough negative workup and are too weak to go home but have no where else to go. They might have a non surgical fracture limiting their mobility or a family refusing to take them home.

Most social admissions occur after-hours when community services are unavailable to assist with a safe discharge.  Most patients are admitted through the ER by a Hospitalist to observation status, which often causes the patient to be readmitted a month later with a stroke or a heart attack when they get a bill for thousands of dollars in uncovered Medicare services.

Most of the time, a social admit can be safely discharged within the next 48 hours, which happens to be the time Medicare will pay for observation status.  Occasionally, a weekend or a holiday throws a wrench in the plan and hospitals become default nursing homes until discharge can be arranged.

On rare occasion, social admits stay weeks, sometimes months, in a hospital because no long term care facility will accept them.  Some patients, and their families in particular, have burned all the bridges in their community nursing homes and patients have no where to go.  Occasionally patients are too dangerous for nursing home care and state psychiatric wards refuse to accept them because of other chronic medical needs they can't provide for.

Every now and then hospital medical teams ask adult protective services to start revocation proceedings to strip powers of attorney rights from families of patients they feel are neglected from failure to place into long term care.

What is the longest hospital stay ever?   That's a good question readers could shed some light on. Feel free to leave a comment with the longest hospital stay you've ever heard of.  This AHRQ graph presented here shows the two most common longest hospital stays are pediatric related with premature birth and infant respiratory distress syndrome.  However, neither comes  close social admit lore.  Some patients have reportedly spent months or years in a hospital waiting for discharge.

Readers have previously shed some light on the definition of a social admit (admit to the hospital to arrange for a nursing home placement) and the social admit marathon (when the admission and arrangement for placement happens twice a month for 3 years).  Make sure to update your vocabulary with all the funny medical slang.

What does the Top 10 List of Social Admits look like?  The Happy Hospitalist Facebook asked readers to help define The Social Admit and they didn't disappoint.   Here is the list of the top 10 social admits based on comment likes.
  1. Nobody, and I mean nobody,  wants to do incontinent grandma's colonoscopy bowel prep at home.
  2. I once worked for a cardiologist who was asked to admit an older physician's mom because her home was being painted.
  3. Family took mom off hospice and brought her in for the holidays so they could go out of town for Christmas and New Years.
  4. The family has been caring for grandma at home for a number of years but have suddenly decided on a Friday night at around 9 pm that they can no longer handle it.
  5. Once had a dead patient left in a wheelchair by family.
  6. "My mom hasn't been acting themselves (they are 80+yrs old) I think something is wrong" followed by "If you need to get ahold of us here is our cell number we will be down in the Caribbean for an already planned vacation" as they run out of the hospital leaving a smoke trail.
  7. Wife admitted with pneumonia.  She brought in alcoholic spouse because he was "unsafe at home without me."  He was admitted after wandering around the ER's seclusion area.  They had rooms down the hall from each other, but the man didn't want to allow her to see him because he was mad at her for bringing him in. Nicest drunk I've ever cared for.
  8. Patient was admitted for possible spider bite on arm. Patient only needed high doses of intravenous pain medication and cable TV because WWE was on.  Patient and family didn't have cable at home and the hospital was within walking distance for everyone.
  9. Caregiver no-showed and we couldn't get a SNF admit.  You know you can find a "UTI" or "pneumonia" on pretty much anyone!  Solid goto diagnosis for those social admits.
  10. I have had many a patient show up in the ER with suitcase in hand because they are just going to be admitted no matter what.

Here is the rest of the social admit list compiled by Facebook readers.  If you haven't joined, make sure to like the page and never miss another status update again.  You won't find this kind of important information anywhere else!
  • The family is going out of town for a state Basketball tournament and couldn't take grandma.
  • Long term dementia patient but the family swears there are new mental status changes, increased confusion.  Come on.  And the million dollar work up begins.
  • Altered mental status in Alzheimer's patient on a holiday weekend.
  • I had a patient admitted for "dementia".  When I called the hospitalist to notify him of her admission and arrival to the floor he asked what she was admitted for. I said "dementia." He said, "Is that even a diagnosis for admission?" I said listen, "She has dementia and the husband takes care of her but he was admitted for pneumonia and the family doesn't know what to do with her so they wanted to check her in too." So, apparently dementia is in fact an admission diagnosis.
  • When my great-grandmother had each of her (nine) kids, she stayed in the hospital with the newest baby for 6 weeks in a private room with her own private duty nurse. It's like the complete inverse of social admits now... Instead of being pawned off by a family not willing/able to provide care she was getting away from being the caregiver, and they just paid for it with no middle entity like you did back then. Back to today, my favorite is the social failure-to-discharge: when you discharge a patient yet they're still on your list the next day, and the next, and the next, just because of social/placement issues.
  • The VA.
  • Bringing grandma in so family could evacuate for hurricane.
  • My favorite is the demented John Doe dropped off at the ER entrance with no admission reason but no ID or contact info either. Thanks family.
  • "Confusion" at 3 a.m. after taking sleeping pills, from the Alzheimers/Dementia unit.  Baseline neuro: confusion.
  • Patient flown in from remote Alaska location for "skin infection" but discovered to be homeless, broke, and has a blister from 5 days of walking around without changing his socks or shoes after he spent time up to his knees in mud.
  • Family didn't want to take grandma on vacation with them.  Decided 90 year old grandma needed admission for ETOH detox.
  • Bringing grandma in so family could go on a cruise.
  • Grandma is demented and family was remodeling the house, thus rendering it an unsafe environment for her.
  • And don't leave out the extended stays! Grandma is ready to discharge Friday but the family can't pick her up until Monday because they're "out of town."
  • Friday night ER visit: loving son drops off demented mom for confusion but can't be reached until Monday because coincidentally he is out of town for a wedding and demands her discharge Monday morning at 0800.
  • 300+lb middle-aged female that "can't" walk (i.e. wont walk) and has urinary retention, has "servants" that help her in the home but family refused to take her back home with a foley leg bag despite extensive teaching of both patient and family.
  • How about admission for possible seizures because it was the middle of winter, snowing and the person was homeless.
  • Family brought grandma in because "it was time for that free nursing home" but demand the really nice one 'cause only the best when it's free!
  • Patient arrives from another country yesterday to stay with family but family quickly realizes they can't care for them. Patient receives dialysis but treatment hasn't been arranged and patient's insurance doesn't carry to the U.S!
  • Nursing home drop offs for weekends and holidays for "altered mental status" that have been going on for a week.
  • I was working at LA County Main admitting one night when a guy came in because he had been evicted at 11 o'clock at night. He knew there was a social worker there at night.
  • It's Saturday night and family wants to party, so they drop off the patient in the ED with a suitcase full of clothes and say they'll pick her up on Monday.
  • Currently trying to deal with a chronic lunger who wants to stay because they turned off her electricity. Still has enough cash to buy cigarettes though. Oh yeah, I do have to feed her too. Glad to see my tax money going to a good cause.
  • Most of the referrals to acute rehab are for social reasons. We are not your grandma's babysitters. * sigh*
  • When I worked during Hurricane Katrina, we had multiple admits from home because the family didn't want to take their loved ones with them, or they were on home oxygen. Extreme case, but true. Needless to say, our wall oxygen didn't work, we had no running water or electricity, and they were medivac'd out to God knows where.
  • Wealthy family in a small town has family come to visit.  Elderly aunt has a personal care giver with her but dear aunty is admitted to hospital for "HOSPITALITY" level of care! Out to family gatherings during the day but was brought back by 7 pm, put to bed by care giver who then went back to enjoy socializing with the family... the hospital tied up a 2 bed room in a critical access hospital for $10/night! We pottied her, changed her bed etc & were told to cater to her. We had to remind ourselves frequently that if you have the right name & position in the community you can get this service. No one else EVER got "HOSPITALITY " care.
  • Chicago. Old couple admitted because their heater broke last winter.
  • Had an ER patient brought by ambulance from another hospital ER because the wait was too long.
  • Daughter just can't do the dressing changes anymore (had home health for six days a week for a little foot wound) she had to do the dressing once a week (or could have let it go one day)
  • Constipated severely demented 98 year old whose wife couldn't get him to take laxatives (and would probably have broken both their hips getting to the bathroom if he had taken them).
  • Parents bring in child on medicaid for running fever all week on Friday night to ER. Leave and come back to take home Sunday afternoon. Can't call it neglect because they left in care of responsible people! Parents get free babysitter for weekend.
  • Brother and sister admitted for varicella because the family had plans to go to a water park for the weekend.
  • Because family planned a vacation and forgot to find someone to watch grandma.
  • Kicked out of assisted living home because of behaviors on continusou oxygen and 22% lung function with severe COPD.  Social worker drops him off at ER for "SOB".  No where to discharge to! Spent a week admitted walking halls and flirting, room service while someone found him a place to go!!
  • I thought you were referring to the patient using the phone the entire time with a room filled with company and relatives calling for an update q15m (every last one of them drunk and hungry). After all, the patient does need the sliver removed. My duh. I had to read the other posts. Gotcha.
  • 89 year-old grandma with Alzheimer's brought in by local fire rescue. She was found wandering in her night gown. Police got her address off of a ID necklace she was wearing. When they got to her house they found her husband dead. During the middle of the night he had passed from a massive MI and no one was around to take care of her.
  • Husband has been taking care of wife at home, who has advanced multiple sclerosis for 10+ years. Apparently no followup, no therapy, no home care. Decides on Monday that since he's having back surgery on Thursday, he can't care for her. (Sad thing is, she went skilled and will probably never go back home. She's 56.) Sad social admit, because she had no acute illness, but so preventable.
  • Why is it always grandma and never grandpa
    • Editor:  Good point!
"Ask your hospitalist today if mom is too old to hyperventilate and they'll work the system to get her free entry into the Nursing Home Marathon paid for by Medicare"

Ask your hospitalist today if mom is too old to hyperventilate and they'll work the system to get her a free entry into the Nursing Home Marathon paid for by Medicare ecard humor photo.

"Did you know 'too angry for discharge' and 'patient refuses to leave the ER' are now Medicare approved reasons for inpatient admission?"

Did you know 'too angry for discharge' and 'patient refuses to leave the ER' are now Medicare approved reasons for inpatient admission doctor ecard humor photo.

"Prepare yourself! Holiday admits are coming!"

Prepare Yourself.  Holiday Admits are Coming medical humor meme photo.

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