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My mother was brought to the hospital by ambulance with excruciating pain due to spinal compression fractures and PMR. She stayed three days under observation status, then released to go home after we expressed concerns for pain management and mobility issues. We were told that arrangements were being made for a visiting nurse and PT. Now five days later she is experiencing hallucinations (stopped the tramadol), is barely ambulatory and we just found out she was denied services because of a high risk home situation (Dad is 90). The hospital was aware of this at the time she was discharged. I have been in touch with her primary and was told the only thing we can do is bring her to the ER because it was unsafe for her to be at home. Because of Medicare guidelines we are in limbo. I initially requested mom be sent to palliative care, but with the observation status umbrella she did not qualify. I do not know where to turn going forward. Has anyone experienced something similar?


I should also add my sister and I share part time responsibility for her care to help out my dad ..... but we both have our own family commitments and jobs. Also mom has dementia.

Was Mom on Tramadol? This med causes hallucinations and should not be used on the elderly.
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Abby2018 Jan 15, 2019
Yes, JoAnn....she was taking 2 fifty mg. tablets three times per day. We stopped them on Sunday and brought her back to the ER on Monday. Did both CT and MRI scans that came back negative. Was released today because there is nothing “acute” to keep her there. She is now worse than ever.
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Someone dropped the ball. I think both Dad and Mom would be better in an AL until you can figure this all out. Hopefully they have money for a few months of care. That way Mom will have aides to help her and Dad will be there to help ease along the transition. Hopefully someone has POA on both of them. She can get PT while in AL.

Consider selling the home to help with their care. If you think Medicaid will be needed sooner than later talk to them about Dads money vs Moms money. If Dad wants to stay in their home then assets will be split so that Dad can still cover the bills but Moms portion will need to be spent down to receive Medicaid for LTC. Or hire a lawyer versed in elder care and Medicaid. Money spent can come out of Moms and Dads money. There are ways to get on Medicaid even if your a little over. Some states have a Miller trust which handles the overage and reverts back to Medicaid upon death.

Ur local Office of Aging may be able to help.
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The decision not to take the case because of questionable ability of your mother to safely remain at home was most likely made by the visiting nurse who assessed her at home. The hospital could not have assessed the home situation without being there to actually assess it. As a prior home care RN I had to make that call.

I can understand you may not agree with this decision but look at it another way....the home care nurse assessed through her/his professional judgement that once the HC staff leaves, who will continue to care for that patient? So the RN leaves, who will assist your mother to the bathroom, bathe her or feed her? Your father can’t. The nurse thinks 24/7 care, not just the limited time (hours) they (PT/OT) are there.

You and your sibling may take turns taking care of them, but to a home care nurse that’s not good enough. The HC is being an advocate for your parent in recognizing your mother needs more care & a part time situation won’t fit her needs for safety.

Most likely the home care nurse made this call as they assessed that no one could provide ongoing care to your mother, a vulnerable adult, because your father was assessed not to be able to care for your mother day to day.

Send her back to the ER and refuse to take her home- insist on NH placement. If your parents have the resources you may need to self pay until they apply for and get Medicaid. Or hire caregivers at her home for 24/7 care.

Its unfortunate no one spoke up at discharge time to say no, she needs more than Homecare, she needs 24/7 supervision and insisted she be changed to “admission” status for the 3 night stay requirement for consideration for nursing home placement. That was the time to inform hospital staff of her needs. But it’s not too late - once she is sent to the ER the process can be started over again but financially Medicare may not cover it but I am not sure how payment would work.
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Abby2018 Jan 15, 2019
Thank you for your insight. No one assessed the home, therein lies the problem. My mom does get along quite well with her walker and bathroom visits are not a problem.....when her pain is under control. She had a recent flare and that compounded with compression fractures made the hospital stay necessary. Once her pain was under control she was released with the stipulation both PT and a visiting nurse ( to monitor pain) would begin immediately. I have no idea what happened in the interim, but mom came home and the ball was dropped. I found out 4 days later from her primary services were denied. Now she is back in the hospital after experiencing hallucinations and in pain because she can’t keep her meds down. Observation status once again in the ER overnight. She had both CT scan and MRI’s done and both were unremarkable.....so not Alzheimer’s. They will probably release her today since I don’t know how much “observing”was done in a very busy ER. It’s sad really that at this stage in life you find loopholes in insurance contracts that limit the availability of your benefits. I was adamant at her last admission that she was not ready for discharge.....I was told they could no longer keep her and that home services would be provided. Mom wants to remain in her home and will not even discuss the possibility of moving to AL.
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It sounds like your mom needs more than just the home health service an elder gets after a qualifying hospital stay. That only involves a nurse coming maybe once a week & checking vitals, a health aid typically comes twice a week for bathing, and therapy comes once/twice a week. They are there for only a short time.

Depending on your state, if your parents are on Medicaid, more support services might be available free of charge. Check with your local council on aging.
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Abby2018 Jan 14, 2019
I agree. My parents do not qualify for Medicaid and the only way it seems to place her in skilled nursing is for her to hospitalized for a minimum of three days as inpatient. Otherwise it is out of pocket. Hoping with this turn of events she will be placed in the pysc ward for evaluation if this is not drug related.
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