Many unrepresented patients have outlived their family members or are estranged from them, and sometimes they are dealing with substance use or homelessness. They are especially vulnerable if they have dementia or other disorders that make it difficult for them to communicate their wishes.
Here are four things to know:
1. Unrepresented patients are at risk of not getting treatment they need because in a nonemergency situation, the physician cannot offer treatment without consent, especially at the end of life.
2. Most states have provisions that allow a court to appoint a medical guardian and medical decision-maker, but it can be a long process. In the meantime, staff will try to find a family member, even distant relatives, or friend to take the role. However, in many cases they do not feel they know the patient well enough to make important decisions.
3. Unrepresented patients tend to stay in the hospital longer due to delays, which prolongs ICU care and end-of-life care. There can also be difficulty placing them in a facility without someone to sign them in. This can leave patients in limbo and put financial strain on hospitals. It can also distress providers who want to help patients but are unable to.
4. Cambridge, Mass.-based Beth Israel Lahey Health has started to address this issue by creating a matching program that places healthcare professional volunteers with unrepresented patients outside of their hospital system. All the healthcare volunteers train on how to ask patients what care they do and do not want to receive in serious situations. The key to the program is identifying them before a crisis situation arises, David Sontag, the health system’s director of ethics, told the news outlet. Identification generally happens during routine visits or appointments. Once identified, they can enroll in the program and have a volunteer assigned to them within one to two days. The program has been running for two years.
