Some social factors delaying the discharge to relatives of selected patients in a Veterans Administration neuropsychiatric hospital

117 Pages·06.65 MB·English

by  Robbin, Morton

SOME SOCIAL FACTORS DELAYING- THE DISCHARGE TO RELATIVES
OF SELECTED PATIENTS IN A VETERANS ADMINISTRATION
NEUROPSYCHIATRIC HOSPITAL
A Thesis
Presented to
the Faculty of the School of Social Work
The University of Southern California
In Partial Fulfillment
of the Requirements for the Degree
Master in Social Work
fey
Morton Robbin
June 1950
UMI Number: EP66361
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This thesis, written under the direction of the
candidate’s Faculty Committee and approved
by all its members, has been presented to and
accepted by the Faculty of the Graduate School
of Social W ork in partial fulfilment of the re­
quirements for the degree of
MASTER OF SOCIAL WORK
Dean
Dai
Thesis 0/....MQRTO$..I£QN HMBIN
Faculty Committee
Chairman/7
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TABLE OF CONTENTS
CHAPTER PAGE
I. INTRODUCTION^......... . . 1
The problem . . . . . ................... 1
The setting . . . . . . . . . . ......... 4
The discharge process ........ . . . . . . 7
Selection of cases..................... .. . 9
Collection of data .............. 10
Definition of terms . ♦ ............... .. . 12
Plan of the study . . . ................ 14
II. BACKGROUND DATA: INTERVIEWSW ITH RELATIVES
AND PATIENTS................... . 16
Case 1: Mr. Bishop..................... 16
Case: 2: Mr. Morgan ........... 24
Case 3: Mr. Gonzales • ............... 30
Case 4: Mr. Rosen........... 35
Case 5; Mr. Darrell ........... 41
Case 6: Mr. Cortez............. 47
Case 7: Mr. Vito ............... 53
III. ANALYSIS OF INDIVIDUAL CASE FINDINGS . . . . . 60
Mr. Bishop ................. ......... 62
Mr. Morgan ............................. 66
Mr. Gonzales ........... 70
Mr. R o s e n ............... 74
Mr. Darrell ........... 79
iv
CHAPTER PAGE
Mr* Cortez............................... @3
Mr* Vito........... 87
IV. SUMMARY OF FACTORS INTERFERING WITH DISCHARGE
OF PATIENTS TO RELATIVES . . . . . . . . . . 92
Inadequacy of the physical facilities
of the home . . . . . . 93
Inability of the relative to provide
recommended supervision......... . . « 94
Unwillingness of the relative to risk
loss of compensation............... 95
Attitude of the relative toward the
patient1s readiness for discharge . . . . 96
Attitude of the relative toward the
patient1 s illness......... 96
Attitude of the patient toward leaving
the hospital . • 99
Attitude of the relative toward the
hospital............................. * 100
V. CONCLUSIONS........................... 103
BIBLIOGRAPHY ......... 106
APPENDIX ............. 109
CHAPTER I
INTRODUCTION
I. THE PROBLEM
The problem of the neuropsychiatric patient who has
received the maximum benefit of hospitalization and then
is blocked from returning to the community, is the
concern of the present study. In a medical setting such
as that of the Neuropsychiatric Hospital, Veterans
Administration Center, Los Angeles, the care of the
patient is mobilized around a philosophy and practice of
treatment for discharge rather than around hospital
custodianship. The prolonged hospitalization of the
patient who is no longer acutely psychotic is not only
unnecessary but is also harmful because it does not deliver
him from his institutional dependency and fails to evoke
in him qualities of initiative and responsibility in the
world outside.
The primary objective in helping the patient
leave the hospital is the therapeutic value contained for
him in returning to the care of his family. The patient
responds to the individual attention he receives in the home
and may become a happier and more useful person. There are
2
studies'** which offer evidence that the long-time
hospitalized veteran responds to family care. This
does not mean that he recovers, for his illness may he
so deep-seated that he will never be well again* However,
a carefully worked _ou t_treatment ~program-wi-H-hasten~the*
period of convalescence for some* For long-term
hospitalized patients whose histories reveal difficulties
with interpersonal relationships since childhood, the
home may only serve to reactivate old conflicts unless
there is a carefully worked out therapeutic plan. The
patient*s return to his family, then, is not primarily
planned to relieve the congested wards of-a hospital as
the relative sometimes misconstrues, but to benefit the
patient*
Nevertheless, there is the immediate problem of a
static population of chronic patients in the Neuropsychiatric
p
Hospital, which is confronted with a lack of available bed^
^ Margene M* Shea, nAn Experiment in Planning for
Psychotic Patients at Home,” 1950. (Unpublished study writ­
ten under the Auspices, of the Veterans Administration by the
Chief Social Worker, Veterans Administration Hospital,
Murfreesboro, Tennessee*)
p
The social service staff at the Neuropsychiatric
Hospital, Veterans Administration Center at Los Angeles is
conducting a survey of patients who have been continuously
hospitalized for longer than one year to determine which
patients might benefit from care outside the hospital*
This survey was begun in January, 1950 and is a preliminary
to setting up a foster home program*
3
space. It is not known how many patients are no longer
in need of hospital treatment and might he returned to
a sheltered environment within the community, but the
number may be considerable. The fact that there is no
family care program (under the auspices of the Veterans
Administration) in this community gives the present
study value as a preliminary step in the examination of
the individual aspects of the problem.
The data of the study stress the need for a program
of placement in homes other than their own of some of
those patients whose relatives are unlikely ever to
accept their permanent disability. For still others the
data indicate need for development of hospital facilities
for chronic patients•
The following question was considered in this
study:: What were the social factors, extrinsic and
intrinsic, which imposed barriers to the movement of these
patients from the hospital into the community? Or,
conversely, what social factors were operative in keeping
this type of patient in the hospital? The writer!s
purpose was to review and analyze in terms of reality
situation and psychological aspects the refusal of
relatives to resume responsibility for care of the
patient at home.
4
II. THE SETTING
The present study was made at the Neuropsychiatric
Hospital, Veterans Administration Center, Los Angeles,
California in the spring of 1950* This is a teaching
hospital for the care and treatment of mentally ill
veterans. It provides a coordinated program of treatment
for all patients involving a team of psychiatrist, social
worker, psychologist, physical medicine therapist,
occupational therapist, nurse, and attendant, whose goals
include plans for the patient’s leaving the hospital at
some point in the future.
The hospital, one of the largest in the United
States, has a total bed capacity of 2,149 and a
population which currently is over two thousand patients.
Of this number, approximately half is made up of World
War I veterans and half is World War II veterans» Less
than five hundred of the two thousand patients are
classified as other than psychotic. There is a list of
1043.persons awaiting admission.®
The Neuropsychiatric Hospital is one of three units
which comprise the Veterans Administration Center and is
under the general administration of the manager of the
3
Heport of Admissi' ons Office, May 1, 1950
Center# The immediate administration of the hospital is by
the Chief Medical Officer* He is assisted by the Chief
of Professional Services, who assumes direct responsibility
for the total treatment program. Social fservice is a
section of the medical division and is under the general
supervision of the Chief Medical Officer or the Assistant
Chief of Professional Services, formerly known as the
Clinical Director.
The social service department consists of fourteen
staff social workers and five student social workers in
training from the University of Southern California.
Three of the fourteen staff workers are supervisors under
an administrator known as the head social worker.
Social workers are assigned to wards or services
which are classified under three headings:: admission
service, continued service, and predischarge service.
A patient who is transferred from one ward to another may
come in contact with several workers as it is not the
policy of the department for one worker to continue
offering a service to a patient who has been transferred
to another ward.
The social worker at the hospital is present
to help-the patient cope with the social and emotional
factors that are preventing maximum use of treatment as
well as to conserve gains made in the hospital. The