AL facility refused readmittance after a hospital stay. Where do we go now?

Read the AL contract. They usually have to give 30days notice IN WRITING. The social worker at the hospital is responsible to find a place for her. Meet with them so they can't get out of doing their job. They will determine whether it is AL, memory care or nursing facility. They can deal with the current ALs bad behaviour. It is not unusual for a person who belongs in memory care to have behaviours that are unpleasant. Contact the government department in charge of regulating the AL. Talk to the doctor, since the behaviour change could be entirely due to medication.

Dear momsays; tough situation ..did you actually talk with the AL ADMINSTRATOR about options like maybe the family take turns sitting with mom until she goes to sleep at the AL because if the family participates more sometimes AL will work with you its called ageing in place this is what the AL that I worked at would do but it required the family to really participate to help keep feisty residents under control.or a private caregiver to put her to bed does she qualify for hospice? I wish I had more ideas for you, but sometimes the AL adminstrator will work with you the place I worked at Always helped the familys to keep their moms and dads at their home .

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.

I feel so sad for your Mom / I say that it is getting tough everywhere. If you make too much you can't get help / if you make too little the only thing you can get your loved ones in is a dump !!!!! I live on only $1000 a month ; 1/3 rd goes for rent and I need money for groceries and a phone and when it comes to TV very little ; and the left for Medical bills . Not hardly anything left of necessities. Where will I go when I get ill and cant take care of myself ; only God knows . The apt I live in is really only for 62 and older and to be able to take care of yourself but all the nice inexpensive places for people like your Mom are being put here because all the places with good care for a decent price are gone and the other ones that are nice cost a few thousand a month ; so who has that ? And then I see a lot of people getting everything for free ; I wont tell you what I think of that ! Call the Medicare for Seniors and ask for help maybe they will have a solution !

Consult with an elder law attorney.

The elder lawyer I consulted said it was legal for Mom’s AL to refuse to have her come back. Morally wrong, but legal. I appreciate all the advise and will visit the Social Security office tomorrow to hopefully gain some information. I called the hospital Social Worker today to get some additional information but she was out of the office. I’d like to get an official answer to my Mom’s diagnosis. I know she has Alzheimer’s/Dementia, but are there any other contributing issues? I’m afraid that if we’re forced into taking her into my our home, she won’t ever leave due to money and behavior issues. I worry about my mental state, my emotional state and even my marriage. Thanks to everyone for the information and suggestions. I really appreciate all the support.

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.

Talk to your elder-care attorney again, and consult again on the Medicaid rules in your state... My Mom made more than "acceptable", but it simply became necessary for the attorney to set up an "Income Trust" account, with me as the trustee, and arrangements to transfer her income (Fed. pension) to that trust, then issue payment according to Medicaid instructions (in her case, to cover the balance of the NH charges her money didn't cover.) Her income was about $3,500/month, but the facility charged $6,500 for "intermediate nursing care" (not sure what that actually amounted to, because they couldn't even treat a painful corn on her toe when instructed by her doc...) I agree with others not to let the hospital con you into taking her home if you're unable to care for her... It might seem harsh of you, but if she has nowhere else to go, they will HAVE to find placement for her. She obviously needs a higher level than AL, so there should be "official" assistance available.

P.S. I agree with Ricky6 that the AL facility should have made you aware of problems, and given you the chance to resolve the issues instead of being sneaky about it!

Reading this again, my only thought is that AL facility should have made you aware of your mom's behavioral problems and possible eviction before this situation occurred. If they did not, I would think a law suit would be considered by you.

I know that where she needs to be is Memory Care. Unfortunately these are few and far between. At least in NYS maybe others there is a program though Medicaid that they have an agreement with some MC facilities to only charge a certain rate for Medicaid recipients. In NY that amount is currently $1246/month.  I know you think her income is to high for Medicaid but again at least here in NYS they have what is known as a Medicaid Spend Down. She would be allowed to take the cost of her Medical insurance off her income as well as some other expenses. Then what is left would need to be paid to Medicaid or the facility along with the agreed upon rent. They usually allow about $200/month for personal expenses. Go to your local Office for Aging or dept. of Social services to help though this maze. Good luck!

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.

In the interim, maybe get her involved in a day facility where you can drop her off during the day and have her come home in the evening. Contact the office on aging in your community usually a county level. Keep calling all the assisted living facilities in your area. I’m so sorry, it’s a very difficult position you’re in. I prayed for you.

I agree with the person who said don’t fight with AL. Her needs are not AL they are MC. Many AL will allow borderline folks without behavioral issues, but not with. They are all private pay, so the community needs to offer calm.
My heart goes out to you, as this will be what I face with my own mom. She stays furious and I try to keep her calm bc I know this is coming. She wants to go home but there hasn’t been a way to keep help there, she either fires them or changes hours same day, or asks them to do things not within their job. Won’t allow any personal care which is key. It’s a tough situation I’ll be following your story.

I am going through this with my dad. Without going through the whole back story the memory care where my dad was living said that he could not come back from his hospital stay due to some of his behaviors. It is not easy to find a place especially when you need to relocate both parents. My dad is heavily medicated so at the end of the week he was sent for 21 days of physical, speech and occupational therapy. This bought me a little time. After visiting three facilities recommended by the hospital social worker I decided to stop by a different al/mc facility. The memory care at this facility offers a higher level of care but not quite sn. They assessed my dad for mc and my mom for al and agreed to take both. We will see how long this lasts for my dad. A friend whose wife died with early onset Alzheimer’s said she was combative. He had to keep moving her due to behavior issues. She had been in three different facilities before she died. I asked everyone I could think of for suggestions. Drs nurses emts friends facility directors. I freely admitted I was desperate. If you reach out to enough people someone will have a solution. I will be traveling on Sunday to move my dad next week. I pray he will be able to stay until the end. They are in that sweet spot of having too much to qualify for help but not enough for the long term. That’s what you get for working hard and saving you money.

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.

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.

Good luck finding a facility that will take her

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.

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.....

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.

What does her lease agreement state? It is my understanding that they are administered like apartments. Have you spoken to the executive director of the facility and asked them directly? If anything they might have recommendations.

good luck and prayers and hope.

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?