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Mom made the decision to leave today, I have to pick her up soon, and firstly the staff had no idea she was leaving, and secondly once they were told they treated me with quite the attitude. At this rate I'm over it so go ahead and have all the attitude they want.


They mentioned medicare might not pay for a readmission, and all that but is there anything else I should be prepared for? Other than my nerves to be completely done. I know she's going to think I'm the caregiver now, but that is not happening.


This is going to be a day.

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In general that used to be the "myth"; that insurance and such will not pay if you sign out AMA. In FACT you never need to even sign AMA forms. Hospitals and care places are not jails. You are free to leave. Clearly they thought the next 21 days of so they felt they were assured of is peeving them. But they may also have your Mom's best interests at heart. If she is leaving with no rehab she may be needing more help than would otherwise be the case. I would be clear you will not enable her in poor decision making. You seem determined not to be the caregiver, and I encourage you to make that crystal clear.
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BurntCaregiver May 2021
AlvaDeer,
Nursing home have their own best interests at heart, and what their interested in is the dollar sign. First, last, and always.
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Patient has the right to direct her care. Period. There's probably something in the admissions agreement which acknowledges that.

Your focus should be on what's in place of the NH care. If mom doesn't have a care manager, now would be a really, really good time.

Take the scenic route home💐🙏🏾💚
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I know that facilities would tell people that Medicare would not pay if it was AMA. But Medicare and insurances will pay up to the time the person was in the facility. Re-admission, though, maybe a problem and the facility can refuse to take her back.

You may have claimed "unsafe discharge" if Moms considered 24/7 care. That you are unable and unwilling to care for her. Even, her home is unsafe.

Keep us posted.
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BurntCaregiver May 2021
JoAnn29,

That's true the facility she was in can refuse to take her back, but they very rarely do.
What's nearest and dearest to the heart of any nursing home is the dollar sign. They don't let money pass them over.
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It's going to be a DAY for you indeed. Don't worry about the nursing home trying to tell you Medicare won't pay for re-admission into the nursing home if your mom needs it. That's not true.
Everyone gets up to 100 days a year nursing home care paid for by Medicare. If It's deemed medically necessary. If your mom has days left on Medicare and the doctor says it's necessary for her to go to a nursing home those days will be used as long as it's medically necessary.
If she has to go to the hospital and is admitted for three days or more and moved to a nursing home, Medicare will use the whatever is left of the 100 days too. The nursing home is copping an attitude with you because they want your mom to stay in there. Once the Medicare billing runs out, she has to start being paid for in cash every month, they start billing it to a long-term care policy if she has one, or if she's on Medicaid they start paying. Nursing homes never want to let someone go if they are soon to be paying in cash or through an insurance.
I sure hope for your sake you've told mom ahead of time that you have no intention of becoming her caregiver. God help you if she doesn't know you refuse.
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JoAnn29 May 2021
Medicare does not cover those 100 days completely. The first 20 are 100% the rest are 50%. Notvsure how that 20days work if you leave AMA and then return.
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Update: Got mom home and she was in seemingly good spirits. I got some grocery items for her and she was fine to cook/prepare them on her own. I talked to her about all the agencies I have phone messages in to and what I think they can/should help her with, and she agreed. I made it abundantly clear that there is more here than I alone can do, and won't it be nice to have someone come in when "you need them and not have to wait for me."

The SNF told me about the whole "medicare won't pay if she has to be readmitted," kind of thing and I told them, "really, that's not what THEY said." Crickets. Like you're gonna pass up medicare money, and my mom's secondary insurance. She is a signed check wherever she goes...

She did get a little quiet when I told her that people will be coming in and looking after things, and how glad I was to be able to get that kind of help that "I can no longer really do for you," like it was sinking in, and then I told her to have a good day and left. I came home and crashed on the sofa. I need space and time. A lot of it.
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jacobsonbob Jun 2021
"She is a signed check wherever she goes..." Very descriptive--I'll have to remember this one!

Hopedly, you'll be able to take the time to rest and relax, and the caregivers coming in will be accepted by your mother.
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Imho, make sure that your mother understands that just because SHE decided to leave the Skilled Nursing AMA that YOU will not be providing her care.
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MajorLeague Jun 2021
I have. She also knows people that have been her caregivers before that she wants to re-hire. I told her that was entirely up to her to manage and handle, and that I would not be the middle man as I had been before. She seems to be getting on pretty well and remains in good spirits, so I've set my boundary and that is that.
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She thinks you're going to be her caregiver now, you are firm that that is not happening. Then what on earth is telling you that you "have" to pick her up? You so don't. I hardly dare read down and see what happened... :/
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MajorLeague Jun 2021
Oh, I picked her up, and took her home. Got her belongings put in her room for her and that was that. So far she has been managing pretty well on her own, and I have been at home working and doing the things I need to do. I was extremely firm that I'm not the caregiver any longer but to ask an 85 year old to find her way home would have been extreme. Believe me, I know how to flex the "no" muscle and it's been staying strong.
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As long as mom is kept safe and healthy with whatever help she needs, she - and you - will be fine. Keep in mind that if she develops dementia issues, you will need to be her advocate.
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I am not sure what rehabilitation your mom needed before leaving, but usually a doctor can authorize home health care after rehab.
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