My mom had a minor fall. She wasn’t injured at all. The AL facility insisted she be taken by ambulance to the ER to be checked out. When she got ready to leave, the ER doctor told me that the AL facility refused to have her return. Her behavior had declined. She was verbally aggressive and used profanity, but was never physically aggressive or abusive. I had her to her primary care doctor and he had just changed her medication a few days before. The hospital admitted her for safety reasons. After four days of evaluation by doctors and the psychiatric team, the moved her to a secure floor. Medically there’s nothing wrong with her. She has memory problems. The diagnosis that I received was Alzheimer’s/Dementia. I already knew that. Mom is ambulatory, can feed herself and use the bathroom without assistance. The Social Worker at the hospital is trying to find another AL facility. Mom makes too much money to qualify for Medicaid, which wouldn’t assist with AL anyway. Her diagnosis isn’t enough to qualify her for Skilled Nursing Care. My husband and I have tried having her live with us and I almost had a nervous breakdown. Her income is about $1600 a month before deductions. She’s in that wonderful place of making too much money and not having enough. My sisters and I aren’t in a financial situation to where we could pay very much, maybe an additional $400 a month, towards Mom’s care. Three of us are retired, and one has children in college. We’re at a loss as to where to go from here. My oldest sister is going blind, one sister is recovering from a bad marriage and can barely manage herself and the third is still working full time and isn’t able to. I’m sick at the thought of all this, and am wondering if there’s any solution. Anyone have suggestions?

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Wait it out and work with the discharge planner to provide a safe discharge. Do not take her home or financially pay for her.
Yes ALs can refuse admittance for behavioral issues to keep other residents safe. This may be an indicator for specialized nursing homes. Let the chips fall where they may
Helpful Answer (11)
Reply to MACinCT

You have to refuse to pick her up from the hospital. Ditto to your siblings. It will be as MACin CT posted, the hospital discharge planner will have to get involved and find her a place. It may be a facility over in the next county or adjacent city. She’s sounds like a tough placement, there may not be a lot of options.

Personally I think getting upset with or appealing to the old AL is a waste of time and energy. She’s likely toast for any AL cause if there’s an exchange of residency notes, there will be a history of issues that poses concerns for any other AL & they’ll pass on taking her as a resident. “Verbally abusive with profanity” is in the notes & I’ll bet there was filed complaints on her by name from other AL residents or their families. AL is private pay, familie$ expect decorum for their ca$h and will file a complaint. Usually in admissions applications there will be a sentence as to applicant allowing prior facilities to share residency notes. It’s not medical chart per se so not a HIPPA issue.

Your upset and failing about right right now and rightfully so.
Please reread your post aloud.
You know the answers, her care issues are NOT about her doing her ADLs or showing up on time for activity she signed up for but are serious behavioral issues. She was verbally aggressive at the AL and nearly brought you to a nervous breakdown while living in your home. You know what the problem is..... she needs to be where it’s geriatric psych care oversight. She not the usual skilled nursing care in a traditional NH resident. If I had to guess its a placement probably in a secure lock ward type of MC, rather than a NH. I directly never had to deal with MC (just IL, NH) but others on AC have posted that Medicaid did cover MC for their elder. If she can actually over time be reliably sociable due to a solid, consistent medication management, it may be that she moves from MC to a NH.

If she were to go into a NH or MC that take Medicaid, what would be the issue for her “at need” eligibility financially for Medicaid? If it’s too much monthly income, that can maybe dealt with via Miller Trust (if allowed in your state) or another type of pooled trust. It’s like RocketCat posted, there are ways around this but all $ goes to defray costs of care. OR are there gifting / transfer issues that will likely surface for the time she lived with you all? That is quite a different issue.....
Helpful Answer (10)
Reply to igloo572

Assisted Living Facilities have to follow discharge procedures. If your loved one has been in the ALF for more that 30-days they are required to issue them a written 30-day discharge notice. If they knew they were not going to take her back when she went to the hospital the notice should have been given to her right away, as she was leaving if possible. If they decided later not to take her back the discharge letter should have been given as soon as the decision was made.

A skilled home or assisted living cannot wait until the hospital wants to discharge and them simply say we won't take them back find another place for them. This is referred to as Hospital Dumping and it is not legal!

I would suggest that you tell the hospital social worker to call the ALF back and tell them to issue you a discharge notice. You will have 30 days to appeal the discharge. If you choose to appeal you have a right to remain in the facility until the discharge appeal is decided. The home would have to take you back during this process. If they don't agree to do this call the State and file a complaint against them!

The 30-day written discharge notice has to contain the following items in order to be legal;
1. The effective date of the discharge
2. The reason for the discharge: Note there are only 6 reason allowed by law
* The resident is a danger to themselves
* The resident is a danger to others
* The facility cannot meet their needs (They must prove that they did everything they could to meet the needs but could not AND they must show why another facility could meet the needs of the resident when they could not.)
* You health has improved and you no longer need the care (Medicare/Medicaid, if they are private pay they can stay as long as they want)
* Non-payment
* The facility is closing
3. Where the resident is being discharged to - the home must find a place for the resident and put the name of a home that will take them in the letter. The placement must be a safe place for the resident to go!
4. Your right to appeal and the name and address of where that appeal should be sent.
5. Your right to remain in the facility during the appeal process must be stated in the letter.
6. The name and number of your local Ombudsman Program. They can help you with the process.

If any of these six items are missing from the letter then it is an improper discharge notice. It will be kicked out by the hearing officer and the home will have to rewrite the notice with a new 30-day.

I often counseled families on this and told them to be sure they wanted their loved one to go back to a facility that was clearly saying they did not want them. There are some good reasons to send someone back, but if your only reason for wanting to file an appeal is to "get back" at the staff of the home this is NOT the way to go about that. During a discharge hearing only evidence related to the residents ability to remain in the home will be discussed. It is not the place nor will the hearing officer let you list all your complaints with the home.
Helpful Answer (7)
Reply to cjwilson

1600 is her monthly income? Well, she is under Medicaid requirements in my state. Does she have enough savings that you can private pay for a NH until Medicaid kicks in. This is what I did. Mom had enough for 2 months PP. She made 1700 a month. I let facility become her payee for SS and pension. Moms Depends and toiletries were provided. Once I saw that the residents were clean and smell free, I allowed them to do her laundry. All I did was visit.

Your Mom will only get worse as the Dementia increases.
Helpful Answer (5)
Reply to JoAnn29
Momasays Dec 4, 2018
That’s Moms income before deductions. We’re in NC and the Medicaid limit here is $1551 p/month. She has no medical issues that would qualify her for Medicaid. If she did, the limit for Skilled Nursing Care is about $2000 p/month and she would qualify for it then. She had no savings to draw on.
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I am pretty positive that it's against the law for a facility to refuse to take her back. Whatever you do, don't take her home. She will be considered homeless if she has no place to go and the AL can't refuse her return.
What they can do is say she is no longer a fit for this AL and they must help you find another place, while she is still living there.
I almost fell for it when an AL place tried to do the same thing with my aunt. Don't let them get away with it. Research the law and and then let them know you know what the law says. And hint lawsuit. Watch them back down quickly.
Helpful Answer (5)
Reply to mylittleZoey
shad250 Dec 6, 2018
They use the hospital for discharge.
Breathe deeply.

There will *be* a solution, because there has to be, but you have my total sympathy for the anxiety you must be feeling until it's found.

Your mother needs the support of a specialist dementia care or memory care unit. I expect that is what the Social Worker is trying to track down? I can't see what you can hope to do that s/he won't be able to do better, with so much more insider's knowledge of what facilities there are in your area. I know feeling helpless is horrible but surely you will just have to wait, and have faith.

Meanwhile, though. Granted that an ALF is no longer adequate for your mother's needs, the last ALF seems to have been pretty quick off the mark getting rid of their challenging resident and also they don't seem to have given the medication adjustment any time to have taken effect. Have they had anything to say for themselves in terms of how they have handled this situation? Not saying they've been wrong, but they haven't either been exactly wonderful.

How is your mother in herself? Are you able to visit her?
Helpful Answer (4)
Reply to Countrymouse

Momasays, I totally feel your pain! I was in a similar situation with my mom and I contacted A Place for Mom to find an affordable ALF for my mom after she was released from rehab. This is a free national service and I had an excellent representative that I worked with. Best wishes to you.
Helpful Answer (4)
Reply to NYC2015
Ricky6 Dec 6, 2018
Be careful what you tell "place for". If you say the wrong or unfavorable thing, it goes on their record for reference and could affect places available because of cherry picking residents.
The limits are determined by each state, but here in PA, your Mom would be well within the Medicaid limit of $2,250. You confirmed with the state that $1,600 exceeds the limit?

DO NOT allow the hospital to discharge her to you or another family member. They want to help you, but they are also looking for the path of least resistance. BE VERY CLEAR that you cannot care for her. They should be able to get your mom admitted to a SNF pending Medicaid.
Helpful Answer (4)
Reply to IsntEasy

Have you actually spoken to the Medicaid office in your state? Are you absolutely sure she doesn’t qualify? I know regulations vary from state-to-state, and some may have income limits, but Mom qualified in NY even with $3400/month pension and SS. It all goes to the NH.
Helpful Answer (3)
Reply to rocketjcat
rovana Dec 5, 2018
It's not just the money - there are medical qualifications for NH placement on Medicaid.
I don’t think people are reading your statement in that she doesn’t qualify for a NH. But it does sound like she needs a memory care AL. I’m sorry you are now in this predicament. Please let us know what ends up happening.
Helpful Answer (2)
Reply to Harpcat

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