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I just want to start this post off by saying thank you to everyone here. It's great to have the support of this caring community and to have this forum to share my questions in. My mom, who lives at home with my medicated schizophrenic sister, has stopped using her toilet and has taken to wearing Depends 24/7. She relieves herself in them all the time. She sits in them, urine soaked, all day. She was released from a nursing care facility last December after a 3-month stay and her behavior has gotten progressively worse since then. I cared for her for 6 years, I live 3 hours away in another state and got completely burned out, so now my other sister, who lives 4 hours away, has taken over as care-giver. My mother has a homemaker that comes in to help twice a week, but after a visit to her primary care doctor a couple of weeks ago after we thought she had a mild stroke (she was having difficulty swallowing and balancing, her doctor said she didn't have a stroke), we decided to try and get her additional in-home care had a VN Association in to evaluate her and they discovered her current state was not good. When they examined her they found bedsores and a fungus infection on her inner thighs due to sitting in the wet Depends. The VN who examined her at home was so alarmed by her lack of personal hygiene that she called Adult Protective Services and reported her as being neglected. I spoke to that VN for an extended period of time on Saturday and she told me that my mother either needs 24/7 homecare or she needs to move to assisted living. She said she’s non-compliant and lacks the ability to make her own health care decisions and therefore she determined that she’s too much of a risk to take on as a patient. My mother refuses to leave her home, she’s extremely combative -- so we’re kind of stuck right now. She’s going to her PC tomorrow with my sister and we are having a Physician’s Evaluation filled out. I'm not sure what I'm actually asking for here, but thanks for listening.

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I've been in your spot.
First acute care will call and threaten you and family to come and get mom. Once ur there they will tell you she needs 24/7 care.
Take it from me: DO NOT accept discharge to you or family.
They can't turn her out on street. If you go, they will force you to take care or arrange care and you'll be back to square one.
No one can accuse you of neglect if you refuse discharge.

Mom does need help. Unless dr signs incompetence and you have that with your POA you cant make health and do residential decisions. Sounds like dr is already kicking can down road.

It took me 8 yrs to finally get my POA invoked and a dr to finally sign. Mom is now in wonderful memory care and thriving. She was adamant to stay in house but finally got so bad and unsafe and bad hygiene that APS working with me helped get her placed.

I made a lot of missteps. Taking discharge of her twice and letting social workers bully me. Mom fired any help.

Good luck. Your best chance is this very moment. Tell facility you won't take mom until they sign a paper stating mom incompetent to manage herself; and they have to give you few days to find residential care. Start looking and asking for recommendations. If she is using depends full time and not caring for herself, AL might not be best choice, memory care might be better. Look for facility that only does memory care.
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I suspect that what is mainly wrong with the picture is a ferocious and combative little old lady who's got into this state because she wouldn't let anyone within ten feet of her until she didn't have any option! And whose mental state is probably aggravated, too, by one or more infections in one or more sites. Ooo boy.

And the trouble is that when things happen as emergency there is no joined up thinking or communication and it's all a right buggers' muddle, as we say.

And as the primary caregiver has troubles of her own, and the OP is long-distance and in any case long burned out, and no one has power of attorney or even instructions as to mother's wishes... basically, mother is reaping what she sowed. Which is very sad, but whose fault?

I should go for the "lead, follow or get out of the way" maxim and be ready to help if asked but not ready to become the scapegoat. Any updates, any clarity? Please keep in touch.
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Can you also go back to Adult Protective Services to keep them in the loop about the latest happenings and see what they recommend? I would think they could help point you in the right direction. And if you're concerned about possible neglect charges, it would show them you're doing everything you can for your mom.

Sounds like at some point you're going to have to go for guardianship or have her declared a ward of the state if she's so non-cooperative.

Also, maybe consider a geriatrician for her, if her regular doctor is just an internal medicine guy or family practitioner. A geriatrician should be more aware of her kinds of combative/paranoid behaviors, as they're very common with dementia. Good luck and please keep us posted.
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Well, mom is still in Acute Care. Since hiring the attorney they went from, "Her white blood cell count is not elevated so we're sending her home and if you refuse we will call the police" to: "Your mother has a urinary tract infection and is on IV antibiotics, she's severely dehydrated, and her blood sugar levels are really high." They also said she'll be there at least until the beginning of next week when they will move her to a rehab facility. She has Medicare as well as AARP gap insurance.
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Respectfully, why wasn't someone checking on her (and I mean examining her skin and backside) until the VN came in? OBVIOUSLY, HER NETWORK OF CAREGIVERS ARE OBLIVIOUS TO HER.

Who ordered the VN to come to the home? MY SISTER AND I.

Why didn't someone examine her backside a couple of weeks ago when you said she was evaluated for a stroke? GOOD QUESTION, HER PCP IS ON THE VERGE OF GETTING A MALPRACTICE SUIT AGAINST HER NOW OVER GROSS NEGLECT.

Sounds like at that time she could have very well had the beginnings of a UTI then and it wasn't picked up.
This does sound like senior neglect. AGREE. 

Your sister that lives with her doesn't assist her? Schizophrenics when properly medicated or even when they are not can help their mom to the bathroom. I know this from personal experience. YOU DON'T KNOW MY SISTER. NO TWO SCHIZOPHRENIC'S BEHAVIOR IS THE SAME. MY SISTER IS COMPLETELY APATHETIC. 

Schizophrenics also have a sense of smell; no one, not the homemaker nor your live in sister noted your mom was sitting in urine/feces soaked diapers? REALLY UNBELIEVABLE, RIGHT? MY MOTHER'S BEHAVIOR IS DETERIORATING RATHER RAPIDLY. 

There is enough blame here to go around. BLAME DOESN'T SOLVE PROBLEMS. ONLY ACTIONS DO, WE HAVE A PLAN NOW.

Are you sure her doctor's office didn't file a complaint and order the VN to go to her home to evaluate for neglect? NO, THE EVALUATING VN DID. I SPOKE TO THE VN FOR OVER AN HOUR AND SHE WAS REALLY INSIGHTFUL AND HELPFUL. I ALSO HAVE TALKED TO THE SOCIAL WORKER FROM APS, WHO HAS NOW GONE MIA AND WILL NOT RETURN CALLS TO THE ACCUTE CARE'S SOCIAL WORKER.

What is a "senior acute facility"? Free standing? Connected to a hospital? IT'S A HOSPITAL FACILITY CONNECTED TO THE MASONIC HOME SENIOR COMPLEX. 

The "absurd" part is it has to even get to this point. YES, YOU LEARN THE HARD WAY THAT 50% OF THE PEOPLE YOU PUT YOUR TRUST IN TO CARE FOR YOUR LOVED ONES ARE ONLY IN IT FOR THE MONEY.

Are you with your mother now or still at your home hours away? I AM AWAY, MY SISTER HAS BEEN THERE FOR THIS WHOLE ORDEAL BUT HAD TO GO HOME FOR A COUPLE OF DAYS TO TAKE CARE OF HER OWN LIFE. I TOOK CARE OF MY MOM FOR 7 YEARS AND AFTER BEING COMPLETELY BURNED OUT HANDED THE SITUATION OFF TO MY SISTER FOW AWHILE. I'M BASICALLY DOING ALL I CAN FROM FROM THE ADMINISTRATION SIDE NOW, I'VE HIRED THE ATTORNEY, I TALK TO THE INVOLVED PARTIES LIKE APS, VN ASSOCIATION, SOCIAL WORKER, PROBATE COURT, ON A DAILY BASIS. WHEN YOU WORK TRY TO WORK AS A TEAM WITH YOUR SIBLINGS IT SEEMS TO WORK BEST WHEN THE DUTIES ARE CLEARLY DEFINED AND EVERYONE COVERS WHAT THEY DO BEST. I'VE WORKED AS A PROJECT MANAGER MOSY OF MY ADULT LIFE AND THIS IS THE ROLE I"M MOST HELPFUL IN.

Did you hear the staff say that or is your source a third party, or the schizophrenic sister? ALL MY INFORMATION COMES FROM THE PRIMARY SOURCES LIKE THE SOCIAL WORKER AT MASONIC, THE DOCTOR IN CHARGE OF MY MOTHER AT ACUTE CARE, THE CLERKS AT PROBATE COURT, THE ATTORNEY. 

Why the need to get an attorney? Are you fearful of being charged with senior neglect? UNFORTUNATELY, THE ATTORNEY IS THE ONLY WAY TO DEAL WITH A SITUATION WHERE NO ONE HAS POA. THE ATTORNEY WAS HIRED TO PROTECT EVERYONE INVOLVED FROM MAKING MISTAKES. AGAIN, ASSIGNING BLAME ISN"T GOING TO SOLVE THE PROBLEM AT HAND. 

Hospital/acute care/whatever the facility is won't even speak with him about your mother without a signed HIPPA form giving them permission from your mother to allow them to discuss her care. Were you able to do this? THE ATTORNEY SEEMS TO BE DOING EVERYTHING ACCORDING TO THE LAW. SHE'S EXTREMELY WELL RESPECTED IN THE COMMUNITY. THE PROBATE COURT WAS VERY HAPPY WITH OUR CHOICE. EVERYONE IS ON BOARD WITH HER.

They had her there for evaluation and were probably in the process of running tests and examining her & hadn't even made the determination of her status yet. No way would anyone, after seeing a fungal skin infection, two pressure sores, dehydration, and a UTI not keep her. I don't believe that. WHETHER YOU BELIEVE IT OR NOT DOESN"T CHANGE THE REALITY. THEIR FIRST RESPONSE UNTIL WE HIRED AN ATTORNEY WAS TO GET HER OUT OF THE FACILITY ASAP. THEY DIDN'T WANT HER THERE AND TOLD ME THAT I HAD TO TAKE HER HOME EVEN BEFORE GETTING THE RESULTS OF ANY OF HER LAB WORK. THEY SAID WITHOUT AN ELEVATED WHITE BLOOD CELL COUNT HER CONDITIONS WERE NOT CONSIDERED ACUTE BUT RATHER CHRONIC. BOY, DID THEY SPEAK TOO SOON. THEY ALSO SAID THE REFERRAL FROM HER PCP STATED THAT SHE HAD CELLULITIS, WHICH IS A FALSE REFERRAL. AGAIN, HER PCP HAS A LOT OF EXPALINING TO DO. 

Two deep pressure sores? Again didn't you say she saw a doctor "a couple of weeks ago"? I am surprised whoever brought her there or the office staff/MD didn't notice this. AS STATED ABOVE HER PCP DIDN'T GIVE HER A PHYSICAL EXAM EXAM BEFORE THIS LAST VIST THAT RESULTED IN HER BEIG BROUGHT TO THE ACUTE CARE FACILTY. IT WAS ACTUALLY MY SCHIZOPHRENIC SISTER THAT BROUGHT HER TO THE APPOINTMENT 2 WEEKS PRIOR, WE WERE ON SPEAKER PHONE DURING THAT APPOINTMENT. PROOF THAT MY SCHIZO SISTER HAS NO CONCEPT OF WHAT IS AT STAKE.

Sorry for all the questions but something is wrong with this picture. YOU ARE TELLING ME! THIS IS WHAT HAPPENS WHEN A 93-YEAR-OLD SENIOR REFUSES TO GIVE ONE OF HER CHILDREN POA. 

I hope she gets the care she desperately needs. SHE IS NOW, SHE IS NO LONGER CAPABLE OF MAKING THE RESPONSIBLE DECISIONS. SHE IS A DANGER TO HERSELF.
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You need to get POA for mom in place. Is she seeing a geriatric specialist? Maybe dementia is developing. Call her doc before her appointment to make sure that they know about the VN visit and result. She needs 24/7 care which the doc can prescribe. Then POA can take control of the situation.

If you have the conversation with doc in front of mom she will deny anything said. If she is competent she has the legal right to make her own decisions regardless of how bad they are.
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Man, that is bizarre. Is there some reason the county isn't seeking Guardianship based on their findings? The attorney is a good idea. Perhaps, they can sort it out. I would think that releasing a person who is not able to care for themselves to return home to a place where no one is available to care for them, would be risky and a huge liability. I've never heard of that.
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Ruggles, somehow I didn't see this thread until now. Reading through the posts on the ordeal you and your family have endured, I have to credit you with the perseverance to see the situation through to a better solution, as well as to logically and calmly deal with a poster challenging your actions. Your responses were rational, well reasoned, and patient.

That's not to mention dealing with what I began to think after a few posts was a recalcitrant and not particularly responsible facility which sent her home when that seemed clearly to me was an inappropriate choice.

You might want to ask your attorney to order all your mother's medical records from that facility, since you raise the issue of addressing their negligence. That would be a first step, although I suspect that the records will be changed after a subpoena is issued. That shouldn't happen, but this facility doesn't sound very responsible, and it wouldn't surprise me if CYA suddenly became their driving motive.

As to filing an "official complaint", start with researching the state to determine if has oversight over the type of facility that Masonic is, if it's properly licensed, if there are other reports of noncompliance, etc.

If it accepts Medicare, Medicare used to publish results of inspections it conducts. I haven't checked recently, but you could always search the Medicare website or call it directly.

I also don't know if Medicare would take any action, but it might initiate an updated review after being notified of the problems that existed.

When I was searching for a facility over a decade ago, I first reviewed the Medicare rankings, selected potential candidates, then called them and specifically asked about the deficiencies (they loved that! Obviously I'm being facetious). I wanted to learn not only if they had addressed these issues, but also how they handled them as well as my inquiry. Some were defensive, others calmly explained.

Your attorney could probably help you on this, as to where and which issues to address in a state complaint to a licensing or oversight agency.


If you're considering a medical malpractice suit, she could also help you find a qualified and reputable medmal attorney. The first step after taking histories of the problems, issues, etc. would be to order a copy of your mother's records, not only from Masonic but from the hospital and the PCP treating her.

Med mal firms sometimes have nurses on staff to evaluate claims, or they'll send relevant data to doctors in comparable fields to determine if standards of care were breached. I.e., standard of care for a UTI or for pressure ulcers would be specific treatment. Failing to follow those standards MIGHT be grounds for a medmal claim. One aspect in consideration would also be what long lasting complications resulted from any negligence.

Be aware though that medmal attorneys, like any business, evaluate claims on a severity of injury, long lasting and/or permanent decompensation and results and similar issues. Sometimes medical issues which are resolved minimize or negate the value of a lawsuit.

However, that doesn't mean that a firm wouldn't necessary file, or at least initiate negotiations with Masonic's med mal carrier. There's still the pain and suffering aspect, and that can sometimes result in a nuisance value paid by the malpractice insurer just to close out the claim.
There's also the issue of bringing these failures to public attention, which certainly wouldn't be desired by Masonic, the PCP doctor or anyone else involved with lack of proper care.


The hospital discharge planner can offer suggestions as to other facilities, but I've found that there are often ones that are specifically chosen by hospitals, have representatives on staff, and that it's better to do my own review and analysis and choose the facility I want.

I would do the same for the home health care team. If you're satisfied with VN, go with them, but it's your right to choose an agency you want.
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Thanks so much for your helpful posts GardenArtist and Layyylah. So much to think about now that mom's in a safe place. We just heard that her blood sugar levels are through the roof and she probably has advanced vascular dementia. The short-term goal is to get her UTI under control and to try and stabilize the blood sugar levels. The long-term goal is to get her in a memory care facility. Her health seems to be deteriorating rather quickly now, but she's in a safe place, and the hospital isn't threatening to put her out which makes this whole thing a bit less stressful.
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I'm so glad for you and your family that you're getting some action. I'm sorry it had to come to you hiring an attorney. Did the attorney send a letter or call them?
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