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Uptick in 'guardianship cases' leave Maryland patients in EDs for months

An increasing number of patients without guardians are staying in Maryland emergency departments for months, even though they don't require emergency care, according to The Capital Gazette.

The patients often lack a legal guardian and cannot care for themselves. Many have advanced dementia or a psychiatric illness. If case managers cannot find relatives to assign as guardians, the hospital must go through the county circuit court to appoint two people: one to make care decisions and the other to make financial decisions. 

In the meantime, hospitals such as Glen Burnie-based Baltimore Washington Medical Center are not allowed to discharge the patients to long-term care facilities. Patients who lack guardians spend an average of 90 days at BWMC. "This is taking up beds for acute needs," said Beth Tingo, RN, BWMC's director of population health.

BWMC had 14 guardianship cases in 2017, 16 in 2018 and 19 in 2019 so far. The patients have waited a combined 3,000 days for discharge since 2017. The hospital does not know why there has been an increase in guardianship cases, Ms. Tingo said.

Annapolis, Md.-based Anne Arundel Medical Center's ED has also seen an uptick in such cases, with 18 over the past two years, according to Barbara Jacobs, RN, the hospital's chief nursing officer. The issue may be due to the increase in families moving away and leaving behind aging relatives, Ms. Jacobs said. 

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