Asking for a friend…Can a family member refuse discharge from hospital so she can be sent to a rehab or nursing home?

Dil56, thanks for the update.

Your friend is in the "waiting for another crisis" queue. There are lots of folks on it here: she'd be in good company.

Happened to an elderly man with Alzheimers in the hospital I was in. His daughter was his caregiver, but maybe she was in over her head, no pun. When it was his time to be discharged, she said she would be there to pick him up after work. She did not, so he stayed an extra night (the hospital did not want him to be out in the bitter cold). The following day she was to pick him up again, she did not. This time, the hospital arranged for transportation to take him home at 10 at night. He was readied to leave and he left. This was during another pretty cold night.

I could not blame the hospital, because it appeared the daughter was going to try to delay having him home as long as she could.

Pretty sad.

If the woman is competent and able to make decisions for herself when it comes time to discharge the hospital can discharge her.
If they will not discharge her unless there is a plan in place that she gets ongoing care, and there is no one to assume the role of caregiver then it would be an "unsafe discharge".
If this is the case and no family member wishes to take on the role of caregiver then other means of discharge will have to be looked at. But ALL family members have to agree that they can not be caregivers.
If she is not competent then whoever is POA or the "next of kin" and has been making decisions for her can ask that she be placed in rehab and then look for a Skilled Nursing facility that will fit her needs.
If no one is POA and no one wants to take this role and become her Guardian then the Courts will appoint a Guardian and that Guardian will make all medical and financial decisions for her

When a patient refuses to be discharged from a hospital, the patient or the family will be billed for the hospitalization. When the hospital discharges a patient, it means tha the insurance, Medicare or Medicaid have determined that in-patient treatment is no longer justified and stop paying. Somebody will have to pay after the discharge date and that somebody is the patient or the family. You can't black mail the hospital.

And the social worker WILL TRY to guilt and brow beat the family into agreeing to take her home, so tell your friend to expect this. They deal with this DAILY and yet they take the word of an elderly person saying family will be their caregivers, even when family members let it be known otherwise.

Medicaid is run independently by each state, therefore the advice given here will probably not be specific to the mom's state. For Medicaid, one has to meet 2 criteria:
1) financial
2) medical (most states will only pay for LTC and the doctor needs to make this assessment)

Medical care need is not the same as custodial care need. Is anyone the PoA for the mom? If so, this is the person who will have the authority to make decisions for when they meet the "trigger" requirement: usually 1 or 2 diagnosis of cognitive/memory impairment (or if they have a Durable PoA then it can kick in right away).

If no one is her PoA, the mom should be encouraged to create this legal protection now before she becomes further incapacitated (and the attorney will assess for this at the time of the appointment).

If she won't assign a PoA or no longer can, then the family has 2 options: they pursue guardianship through the courts or they call and get APS involved (reporting her as a vulnerable adult) and when things for the mom get "bad enough" the county will step in to acquire guardianship and then will call all the shots.

It sounds like your mom's friend may not qualify for Medicaid at the medical need part, but hopefully the family can consult with a doctor at the ER or rehab to get her assessed. Having impaired memory or just being a fall risk is usually not "enough".

Tell your friend that if the hospital allows her to make her own discharge decision, no one is to go pick her up, even if she calls and begs. This includes telling her friends and neighbors as well. My SFIL shouldn't have been able to come home (on one of his many falls-ER-rehab cycles and when I refused to go get him he called his church and got the name of someone to call and give him a ride home. He had Parkinsons and was an uncooperative disaster.

DIL56, it's MediCAID she is trying to qualify for. Medicare Part A is free if you're over 65 and have contributed to the system. Part B comes out of your SS.

Have they looked into PACE?

https://www.state.nj.us/humanservices/doas/services/pace/index.html

Also, the financial qualifications for Long Term Care MediCAID are different from those for Community MediCAID. Be sure your friend understands the difference.

Also, the hospital cannot force your friend to take the mom into her home, nor can it force her to provide care in the patient's home.

She needs to make it clear to the hospital that mom is going to her own home and that no one from the family is available to be gma's free caregiver. Gma's resources will need to be used to pay for care.

They are being told she makes too much money for assistance or Medicare at a whopping $3000 a month. I advised her to get an elder attorney to fill out Medicare paperwork. In the meantime I advised her do not accept the discharge to her home and maybe they will release to her own home with some care or best yet a rehab.

For your friend:
Skilled nursing is covered by medical as long as a SKILLED RN is needed. That won't last. A Nursing Home may be the answer. Or Board and Care. If Mom isn't able to function at home alone she should talk to the Social Worker and say that sending her home right now is "an unsafe discharge" because she cannot make it on her own for the following reasons. Then list them.
If they send her home unsafe, then she will have to call for an ambulance. The mere fact that she ends in ER in a number of days will get social workers working on a safe discharge plan.
It isn't enough to say "Mom can't live on her own." It is now to find the living facilities for her that are both affordable (or on a spend-down to medicaid program) and safe. My advice to you is not to consider a move to YOUR home even temporarily.
It is a bit late to discuss this only days before discharge. If it was clear Mom couldn't return home that was the time to get Discharge Planning to work on placement options. It's a huge job. They may be able to buy a bit of time in rehab for PT and OT evaluation to see just what kind of care Mom now needs. If so contact THEIR social workers and discharge planners day one there. Wishing you luck.

I think you meant can the family refuse to take her home. Thats sticky with a hospital. They are not under the same regulations as a Rehab or a LTC facility. What your friends can do is ask for a 24/7 evaluation. If found she needs 24/7 care, then thats when they tell the SW they cannot care for the person and she has no money to pay for 24/7 care. The SW may tell them there is help but that help has criteria that has to be met and there is no government resource that does 24/7 care in the home.

It would be nice if she went to Rehab. They can do a 24/7 eval and if found she needs it, and the facility has LTC onsite its just a matter of transferring her.

Whether they can themselves "refuse" discharge depends on whether it's their decision or hers. If it isn't theirs, no they can't - but they can state clearly that in their opinion it would be an unsafe discharge. The technical term for what the lady gets up to at home is "self neglect."

Was she injured? How long has she been in hospital?

Assure the patient the goal is to go home at a time that will be successful, but delay the discharge until there is improvement. Keep the home ready.

Yes, they can say that they are unable/unwilling to provide her the care that she needs and she can work with the hospital staff to find her an appropriate setting.

The discharge plan can *sound* safe.. if the patient says they have family living in/close by/on standby etc the staff take their word.

Does your friend suspects he/she has been 'volunteeted' as a named helper?

I have called & explained my honest level of assistance, to ensure it was not overblown.

Sometimes that indeed is enough to detail a discharge & change tracks direct to rehab instead.

Many patients will claim they have family help. Others will agree to accepting home services, which will enable them to go home with more support. (ie 2 X weekly shower assist, or 2 X weekly Nurse visit). However, once at home, they may choose differently! Leave the home helpers on the doorstep. Those staff report back.. but it is the person's right to refuse.

The patient will either thrive - or fail - falls are typical. Then 'boomerrang' back to ER for another cycle.

The magic words are "unsafe discharge". "She lives by herself and is non-compliant with doctor's instructions. This is an unsafe discharge as there is no one available to provide care for her".

Tell your friend NOT to sign the discharge papers and refuse to pick the person up. Let the hospital send her home in a cab if they think she is competent and safe to live alone.

Then you call Adult Protective Services to report her as a vulnerable adult.

BUT be aware that competent people are allowed to make bad choices for themselves.

Family members needs to resist getting sucked in to enabling a charade of independence.

My sister is a surgeon for Kaiser. In fact, she heads her department.

There was A lady who stayed there for eight months after the discharge plans. She simply refused to leave. I guess she didn’t have any adls that they had to help her with and or became so psychotic upon leaving that no no would take her.