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AstridK Asked March 2015

How to get Mom out of nursing home?

My mother entered nursing home six months ago. She was in a dramatically altered mental state that I now believe was delirium. After she was there for a month, in a Gerry chair in the hallway yelling, it occurred to me that she may have an infection. I called the nursing home and asked that they do a urinalysis, which they did and found an infection. Within a week, she was back to herself again--talking normally and very lucid. I then realized that in the past two years, she has had three episodes like this with all three of them occuring while she had some kind of infection. I believe she does not have dementia because she is not showing symptoms of it and would certainly after two years with the illness. Since then she has improved with physical therapy (which I had to push hard to get them to do). She is no longer in a diaper, is getting around in a wheelchair and doing some walking. We are totally able to care for her at home and have also installed a ramp in the front of our house to aide in caring for her. I tried to sign her out a few weeks ago AMA and they said that she was "mentally incompetent" and unable to do so and that they would call the police on me if I tried to remove her. The way this nursing home operates, I had to push for the urinalysis, I had to push them to do physical therapy with her, I had to push them to give her something for depression because she was crying most of the time (she was in a depression but they didn't seem to have any intentions of doing anything about it) and now that she is doing very well partly due to my involvement they are saying how great she is doing but they still won't let her leave. I know that if I hadn't called them about the infection, she would still be in a Gerry chair babbling even now. They have labelled her with "dementia" or specifically her diagnosis is "mild cognitive impairment". I believe that their reason for keeping her there is because it is a facility that primarily cares for people who are on Medicare or Medicaid and they need to have a percentage of people there that they can collect their SS funds and have steady, dependable income to keep themselves in the black. Diagnosing her with dementia makes it possible to have total control over her. I feel like they have taken possession of her and she now has no rights. What do I need to do to get her out of there? I am working on getting Power of Attorney through legal aid but is that enough. Do I have to have legal guardianship because legal aid says they don't do that and I cannot afford a regular attorney. Is the phony diagnosis going to make it impossible for me to get the Power of Attorney? If the attorney went in there and talked to her, they would easily be able to tell that she has all her mental faculties. Please any info would help.

AstridK Jun 2015
Update June 2015: I took my mother to a neuropsychologist to have her re-evaluated for competency. The results of the re-evaluation state that she is not mentally incompetent and does not, "at present" have any signs or symptoms of dementia so, yes, it was a phony diagnosis. In the past month and a half, my mother has been working variety word puzzles (crosswords, word jumbles, anagrams) which is something she has always loved doing. No mentally incompetent person can do that. The nursing home directed their doctor into writing up a damning evaluation on my mother that rates her as being "severely impaired" on every single point on the evaluation. It makes her sound like she is a borderline vegetable. This is unethical. That doctor has spent no more than 15 minutes speaking directly to my mother in the past nine months. The doctor I had evaluate her, tested her for three hours. This nursing home tried to file for legal guardianship over her in order to take over her money. I had to take her to motion's court to file a motion to have legal counsel appointed for her and that lawyer got a continuance so that the new evaluation could be done. This was last May. The evaluation was submitted to the nursing home's attorney who recently withdrew his petition for guardianship because of the new evaluation and last Friday the nh informed me that my mother will now be discharged this Monday. Just because these people are in a position of authority, it does not mean that they are always right and that you have to do whatever they say. They tried to fraudulently label my mother legally mentally incompetent in order to take over her Social Security check upon her discharge. Imagine if she had real assets--owned her own home, had pension funds, an IRA, Stocks, Bonds--nursing homes currently file for guardianship over people and then siphon away all that that person spent decades acquiring through their own hard work. My mother only has her Social Security but she worked 40-80 hour work weeks when she was young to pay into that. These companies should not have the right to do this to old people. Nursing home should not be allowed to have this much power and should not have the right to abuse guardianship laws in order to take over their patient's lives. If my mother were truly severely impaired, I would not have a problem with this. She would need ongoing nursing home care. Because she is not, I find what they tried to do to her infuriating. It makes me wonder how many elderly people in their care they may be doing this to and many family caregivers would feel intimidated and defeated in trying to fight a company for guardianship of their elderly loved one and would just tolerate it because they would not know what to do. I was lucky. I happened to come in contact with people who helped and guided me in fighting them.

Nana2Nanny Mar 2015
PS- stop signing. You tell the NH that YOU ARE COMMITTING FRAUD FOR SIGNING WITHOUT LEGAL AUTHORITY. Some detail is missing- what is missing? They cannot have ss checks sent to them without legal authority from either mom or a legal poa, guardian. Tell them to show you how they justify you signimg for anything And collecting ss checks.

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Nana2Nanny Mar 2015
A lot of confusion here. You stated you are sure they are keeping her bcus of Medicare payments yet you are receiving bills? Aside from all the miscellaneous info- lets stick to facts. 1. Mom was admitted to NH. Who signed? If STATE admission- STATE is responsible and her GUARDIAN BUT had to deem her incompetent. 2. YOU say you are not her guardian so IF YOU ADMITTED HER, SIGNED- all contracts for mom are VOID, INVALID. 3. If mom signed- and she wasn't competent- all CONTRACTS are invalid.

So- ask the NH who is her legal guardian. IF they don't have anyone or any government entity they can PROVE and mom is seemingly if sound mind- call the police, ask for a stand by because the facility is keeping mom against her will. The BURDEN OF PROOF FALLS ON THE NH- AND EVEN A DOCTOR CANNOT STOP HER FROM LEAVING.

They have to go to court. That is another question for when the time comes.

If you choose to call the police, KEEP IT SIMPLE. TOO MUCH INFO confuses-

"Mom is being held against her will- I'm going to get her and I need an escort. I've already checked- no one has legal guardianship over her and she wants to go home".

AstridK Mar 2015
The nh has been sending me outrageous bills to pay--up in the thousands. I do not have the financial resources to pay them. My brother and I currently have enough to pay for what needs paid for within our own living situations. There's not money left over after that. I was reading info online and came across an article stating that you do not have to pay out-of-pocket bill for the nh. It said that many people do not know this and will pay on those bills thinking that they have to. I'm not avoiding paying because I don't want to. I'm not paying because I don't have it. They are currently taking her SS checks but in comparison to what they charge, it's a pretty small amount they are getting.

I have been signing forms whenever they give them to me. I don't want to make things difficult because I worry that if I make a problem or behave in a difficult manner, they may go and file for legal guardianship and if they do, my mom would be screwed. It would be like she has no rights at all if they did that. So I make sure I read thoroughly whatever they need me to sign to make sure I'm not signing over anything like a legal guardianship. I'm assuming that since they are still having me sign for things that they must not have filed for legal guardianship because they wouldn't need my signature (I assume) if they had it.

gladimhere Mar 2015
Astrid check with the probate court in your area. The court here has one afternoon a week where people can go in and talk to attorneys that volunteer their time for people without resources.

Also be careful of signing anything for your mother. If signing your name you could be held financially responsible. Many attorneys have staff that will do home/facility appointments to prepare POA's if appropriate. Has a guardian been appointed by the courts, only the courts can do it. And if you were not notified it was done as an emergency, as by law it is required to notify children and spouses. Is Mom married?

AstridK Mar 2015
fregflyer, The way my mother ended up in the nursing home was a bit complicated. She was doing well until about two months before going there. She started becoming confused and dopey. I contacted her doctor and said I couldn't tell if she was overmedicated, had a UTI or had dementia and he referred her to a neurologist. I got her to one appointment and then he set her up for another appointment for an EEG and a MRI and then she went to the ER and they admitted her and sent her to the nursing home. In that two month period, she went up to the ER about 7 or 8 times. It took that many visits for them to see something was wrong and admit her. I found an article recently in our local paper (The Pocono Record) that was saying that PMC (Pocono Medical Center) was being fined by I don't know who because their ER is severely understaffed. The article talked about how nurses are not able to even take a bathroom or lunch break, that they were sometimes just sitting at the desk crying because they are too overwhelmed and that because of the added stress more medical personnel in the ER keep quitting which makes the problem even worse for those who stay. I've lived in this area for 24 years and haven't really had any serious problems with PMC but I believe they acted poorly with regards to my mother when she kept going there and was mostly sloughed off and given discharge diagnosis like "anxiety attack". Anyway, she ended up in the nh before the tests at the neurologist could be done and when I told them that she had this appointment, they said they could not take her, that it was too short notice and that they would call and cancel it but that it would be rescheduled. It was never rescheduled. When she comes home, I want to get her back to that doctor to have her checked out. The thing with the UTIs is that I didn't connect the dots soon enough. This last admittance to the nh when I asked them to do the urinalysis and it came up positive and after she was put on Ciprofloxacin and came back to a normal mental state just made it all click together in my head that she has had three episodes like this. Each time she was tested for a UTI and each time an infection came up and each time after being on an antibiotic, she has recovered. This makes me doubt the dementia diagnosis because this started two years ago and if her now recovered mental state indicates where she really is at mentally, she should be in much worse shape a couple years into something like Alzheimer's but she isn't. My boyfriend's grandmother died from Alzheimer's about a year ago and I saw what happened to her over the space of a few years and it's not what I'm seeing from my mother. Still, I want her to be checked out by an neurologist to hopefully get a more definitive diagnosis.

freqflyer Mar 2015
AstridK, I forgot to ask, who recommended that your Mom be placed in a nursing home? Does she have a geriatric physician? Usually such a physician would be familiar with such cases and would have done a UTI test the first time your Mom had shown such symptoms two years ago. Thus, there would be a pattern.

freqflyer Mar 2015
Please note, that if anyone takes a patient out of the hospital or care facility AMA [against medical advise] there could be a fallout with the health insurance, be it Medicare or Medicaid... the insurance company could stop making any payments on the initial cause for why the patient was admitted or during said stay, or any future medical needs for the same issues. Your Mom might have to pay all cost out of her own pocket.

Continuing care facilities take care of dozens and dozens of people at all different stages of memory and health issues, thus they are familiar with such cases.... we, on the other hand, are only dealing with one or two people. We see the health decline for the first time... the continuing care facility sees it on a regular basis and know what to do immediately.

As for the nursing home wanting to keep a patient there to get more money, not of these places have a waiting list. If your Mom leaves, the next day that bed would have another patient.

AstridK Mar 2015
to jeannegibbs, She was admitted to the hospital first and then moved to the nursing home. She was in a delirium and like a zombie. I believe her doctor/s were over-medicating her which the nursing home has corrected. Her current mental state is nothing like it was when she went in.

AstridK Mar 2015
Well, they told me to get legal guardianship. They have been having me sign any paperwork with regards to her care so I'm assuming they don't have legal guardianship. I was looking into info on guardianship and it's expensive and a long process. I cannot afford an attorney so I have been using legal aid to get POA. Legal aid does not do legal guardianship. I asked. It's taking them a long time to get this moving. I did the intake on the phone over a month ago and they still haven't set anything up yet. I need to call them again.

BarbBrooklyn Mar 2015
Talk to the social worker at the nh to find out if a guardian was appointed. Boni Chak is a frequent poster on this site; you can look up her posts in the search box. Please come back with more information. We really all do learn from each other here.

jeannegibbs Mar 2015
I think the important question at this point is who is her guardian? Who has the authority to make decisions for her?

A nursing home isn't a prison, and they can't hold her there against her wishes unless someone with legal authority to make her decisions says she must stay there. So knowing who that is should be the next item you investigate.

Did you place her in the nursing home (when she was delirious)? If not, who did? That might be starting point.

Please update us with what you find out. We care!

pamstegma Mar 2015
Who is her Guardian?

AstridK Mar 2015
She hasn't been in there for two years. She has been there for six months. I was online today looking up info about Mild Cognitive Impairment and POAs. What I found is that MCI can either be the early stages of a dementia illness or it could also be a temporary issue. The only way to tell what it is is to let some time pass to see what happens. I also found out that if a person has MCI and is aware and mentally capable enough to understand the POA, what it does and what it is for, a Durable Power of Attorney can be drawn up. It is also possible to, if needed, get approval from the doctor for the patient to be permitted to sign a POA.

I'm sorry about your friend but I am not her. I know what is needed in taking care of my mother at home. I know how much time, focus and energy it requires and am able and willing to do it. I would not be doing it alone. My brother who lives with us would also be involved in caring for her. There is always someone home 24 hours a day. In addition, when she is brought home (depending on the circumstances of her discharge) she would have a temporary at-home nurse coming, a physical therapist and aides who would assist in such things as helping her bathe (although I have done that as well and would continue to). The Office on Aging in my county provides certain services to the elderly free of charge which I would take advantage. I could also use her SS check to hire more help if needed. I am not going into this in ignorance of what is required. Thank you for your input anyway.

pamstegma Mar 2015
No, it's not phony, she was likely declared a Ward of the State shortly after her admission. So you need to find out who was appointed Guardian and contact that person. You can no longer get a POA once a person is declared incompetent. Nor will you be given Guardianship unless you have good credit, and must pass fingerprinting and background check.
Please understand that at even a moderate level of dementia, moving her out of there will be totally confusing and upsetting. After two years, this is her home. Taking her out of there will only trigger anxiety and more crying. Talk to people who have done what you want to do. Most regret it.
Look at posts by BoniChak. She cared for her mom until it drove her to a heart attack. After a few months of recovery, she took her mom back home. It only lasted a week due to her mom's dementia.

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