Health caretaker services for patients with dementia
I must say that I have not enough knowledge to use the correct words for what I am going to ask and describe. I hope I nevertheless can describe a situation in plain words and may be some of you have some answers.
In the German health care system, you
1. have to be health insured mandatorily (can't stay without it - premiums are calculated on the basis of your income). If you are sick, physicians have to treat you and make decisions of the care and medication you may need at no costs to the patient.
2. while being health insured you automatically also pay with your premium an insurance that provides caretaker services for patients, who need assistance with their daily chores, like bathing, eating, clothing, accompanying patients to any places outside their homes and bedrooms etc.
There are two forms to ask for those personal caretaker assistance services.
One provided by the government of your town, whereby you do not have the choice of who comes to the home as a caretaker of the patient and the patient also may have no control anymore over his finances.
The other one is to use the caretaker services provided by your health insurer. Here the person, who is applying for it, can name caretaker person of his choice and the health care insurance pays a certain amount of money to the patient dependent on how the insurer has measured the patient's needs for a caretaker person. There are five or sixs grades of needs.
And independent association sends out professionals to your house and who interview the patient thoroughly to get and idea how much care the patient needs. They also evaluate the mental health of the patient.
Now take a case where the patient has been evaluated as being dement and needing a personal caretaker of the grade three.
The patient has an awful skin disease with open lesions on legs and arms and pustulas, severly itching. A professional private dermatological service center has done thorough diagnostics to try to find out where that skin disease is coming from and it looks as if part of the cause is a reaction of a medication the patient had to take last year in late summer for a thrombosis. In addition it also was said that there are other potential causes and that a final diagnosis can't be made without further tests.
As the patient never went to any physician deliberately, very few things are known about other diseases the patient might have without knowing it. So, the physician asked the patient to get all further diagnostic tests done as a patient in the dermatological department of a well-known university hospital, of which he was the former chief physician and head of the department. He managed to get a free bed in the hospital for the patient.
The patient is brought (with difficulties and the help of two persons) into the hsopital. Arriving there the patient refused verbally vehementally to be taken into stationary care for further tests to be done. The caretaking accompanying persons and the physicians in the hospital were not successful in convincing the patient to stay in the hospital (be aware that all of it would have been paid for by the health insurance and at no cost to the patient). Helplessly the caretaking accompanying persons had to take the patient home.
Because the reaction of the patient was so irrational, the health insurance provider was asked to evaluate the patients needs for care. During the interview that followed (as decribed in 2. above), the patient was categorized with dementia.
Another incidence where the patient complained of strong pain in the legs, let the caretaking persons believe, the patient might have a thrombosis for the second time. Emergency physicians came to the house and said, no there is no new thrombosis in the legs. But that physician too said the patient needs to be brought into a hospital for further tests to find the causes of the severe skin lesions of arms and legs.
My question now is:
If the patient would again refuse (drama queen-style theater) to accept to be treated and tested out in a hospital, this time now with an official diagnosis of dementia, would the hospital be allowed to enforce a stay in the hospital as requested by the physician, against the will of the patient? As the patient is diagnosed with dementia what is the legal obligation of the hospital? Enforcing a hospital stay to the benefit of the patient or not being allowed to enforce it against the will of the patient?
Strangely enough, though I tried to find out the answer to that, nobody knew. They say that is a legal question and they don't know the answer to that.
In my opinion the physicians in the hospital, who don't treat her, would work against the oath they have taken, but if they enforce treatment, they would also abuse the will of the patient. In how far is that situation changed now, as the patient was diagnosed with dementia?
I don't know how that would be seen in the US health care providing systems, but some here know a lot about it, so I thought I take a chance and would ask you. Thanks for any feed back.
From what I see out of the answers I got from diverse persons, it seems the individual will of the patient is to be respected, even if that will is against the oath a physicans has taken to do no harm. Not treating the patient would though do harm. What is it now?