Can I refuse to bring my Dad home from hospital and demand he go to a SNF?

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I've been trying to get my dad into a SNF since July. It's just been a lot of red tape and I've had to get guardianship (not cheap). The first SNF we were working with decided they didn't want to take him (after weeks of working with them) and basically blew me off, saying they didn't have a bed. I found another and have been working to get his medical eligibility from the doctor, but the doctor is apparently not sending the SNF what they need and so I've been acting as intermediary, trying to get what the SNF needs from the doctor. It's ridiculous that I need to do all this. The doctor agrees he needs to go, but there's no communication between the SNF and the doctor!

My dad fell twice over the weekend and I took him to the doctor this morning and practically BEGGED him to complete an evaluation form and send it to the SNF (which he agreed to do). The doctor said if he falls again to call an ambulance and have him taken to the ER and then refuse to allow him to be discharged to me - basically I tell them he needs to go to a SNF and there's no one to look after him of he is discharged. He said if they try to guilt me into taking him home, I have to refuse! I've heard this before, but since I have POA and Guardianship, can the hospital force me to take him? I've been practically living in his home for a couple of months while waiting for a bed in a SNF to open up but it can't go on - this isn't my home. My work is suffering as I'm constantly dealing with my dad. I know that this is how most people get into SNFs - 3 days inpatient hospital stay then 20 days Medicare then transition to Medicaid, but can I really refuse to bring him home and insist they keep him and then transition him to a SNF?

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My 87 yrs. old mom is currently in University of Tennessee Medical Center. We are from Indiana. She has dementia and had a stroke two weeks ago. They have refused to give her any kind of therapy. PT or speech. I can't get over to see her as we have 1 car down here as brother is working at Dollywood. They have been DEMANDING we pick her up. I thought I had a facility to work with her so she can swallow. They aren't even trying to feed her. Facility won't take her because they just know she won't improve. Social worker is pushing to get her out of there. I can't take care of a foley catheter, I can't lift her, and I can't get her into our Astro van using two running boards. Just because she has dementia, which was doing just fine, until the stroke, they don't want to help her or us. I've been trying to get through hospital administrator, but they are never around. We're in a pickle, not knowing who to turn to next. Been trying to connect with her Indiana cardiologist to see if he can help get her home again. Here they say she isn't medically necessary to be in hospital. What do you call it if you can't swallow, and they refuse treatment?
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People, falling parents does not necessarily mean a trip to the SNF, remember they need to qualify for placement (skilled need). Baby sitting (custodial care) to prevent falls does not qualify for placement. Family members need to stop thinking that the hospital is the end all for their parent problems. Families need to start taking responsibility and begin talking with their elders ahead of time to prevent a "social dump." This means placing the family's responsibility which should have been addressed way before the multiple falling issues become more frequent on an acute care hospital. There are so many programs and resources that a family can obtain to direct them regarding placement.
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Follow your doctors suggestions, do not be bullied; stand strong; take care of the caregiver.
No, the hospital cannot force him to go home unless there is a qualified 24/7 qualified caregiver. Yes, if he has been in hospital for 3 days, then Medicare will pay for him in
assisted living/other situation. I do not know Medicaid procedures
. If he continues to improve, Medicare will continue to pay. If not, perhaps Medicaid steps in now or he can be cared for at home with a nurse or other qualified caregiver.
However, this can represent a BIG out of pocket. Ask anyone you can think of for suggestions or referrals to a nurse/aide. Also remember that there are people who will care for individuals in their homes.
Always check references on caregivers - some states register some caregivers - check with State Board of Licencing to see if any complaints have been filed against someone you are to employ.

Good luck and remember to take care of the caregiver !
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Medicare has strict requirements and the main one is the 3 day inpatient stay. There are some other req. as well. Payments are only to a SNF. The first 20 days are 100% paid. The remaining 80 days are 80% with 20% co-pay. This is not for custodial care. If the patient does not show improving they will terminate the stay. Go on line and get the "Medicare coverage of skilled nursing facility care" document
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I do not agree with SWM. There are many court appointed guardians that are not required to provide care in the home. It is the job of the guardian to determine whather appropriate care is being provided in any location. If not appropriate then they are required to find the level of care necessary.

Just imagine if guardians were required to provide the care, there would not be nearly as many people working in the profession. If providing care was required since many guardians have many clients how in the world could they manage?

The guardians job is to identify appropriate placement and make it happen in collaboration with hospital social workers and other medical staff.
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Just so you know, since you are the guardian, you can be called is as adult abuse for refusing to take him home or care for him. By arranging to be his guardian, there are now more legal obligations on you (depends state to state as to the legal levels) but you agreed to more obligations when you were given the guardianship. You may want to talk to legal counsel before you refuse to take him home. You could be charged with abandonment or neglect. Sorry for the bad news, but thought you might want to check this out. The other thing no one tells is that not every facility has Medicaid beds so he could end up many miles from you. In addition, Obamacare is slated to dictate what is and is not acceptable starting in January, 2015 so all that has been standard procedure may not be standard procedure as our country adapts to national healthcare standards like other countries. Good luck.
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Not sure where you are located.In MA, most nursing homes no longer discriminate between private paying and medicaid patients; however, they do like to get those 90 days of medicare payments, which they can only seem to get when someone is discharged from a hospital with a medical order for skilled nursing care. ERs are notorious for discharging patients, especially those with dementia, because they cannot just admit them to the hospital, and are overwhelmed by the growing population. I once had to abandon a relative in an ER because I lived out of town, knew it was an accident waiting to happen, and could not care for him. I had been trying to get him services,unsuccessfully, for over three months and knew that he was in real danger. The ER doc called me several times the next day,trying to guilt trip me into taking him home. I just kept telling the doc that I could feel his pain, but could not, in good conscience, discharge him. He spent 3 days in the ER and was then admitted to the hospital. Once I was able to develop a relationship with the hospital social worker and reviewed allI had been through to get him services, she agreed that there was a gap in the system. In this case, the patient had a rare degenerative brain disease that was not well understood, was already on medicaid, but was under 60; therefore agencies like Elder Services had nothing to offer. He ended up spending about 30 days in the hospital while they helped me apply for guardianship in order to place him in a nursing home. Their system involved sending his profile out to their comprehensive list of nursing homes. Once they get three acceptances, the family must choose one. The hospital referred me to their lawyer to apply for guardianship and had prepared me to foot the the 3K fee; but fortunately, the attorney informed me that I was not responsible for this payment and that if the patient did not have means, the hospital would pay for it. I did not feel proud of abandoning my relative in the ER, or of letting the hospital pay for guardianship. However, I shudder to think of how things might have played out had he not been admitted to the hospital, and later the nursing home. I was working for very little money at the time, and trying to finance college tuition for my own children, so although I would have otherwise paid the fee for guardianship,it would have been a hardship. Hospitals are very quick to discharge people without suitable discharge plans, and often intimidate families with medical bills. Just recently,my mother's day care rightfully sent her to the ER because they thought she was having a stroke. They did the usual tests and concluded that the symptoms were caused by the antibiotics she was taking for a sinus infection. They wanted to discharge her immediately and in fact asked that she go right back to day care so that their nurses could keep an eye on her, just in she had had a TIA that didn't show up on the tests. The day care nurses, rightfully, resented the hospital's assumption that they could do this and didn't want her back until the following week. Since she can't stay alone, and the whole episode had disrupted her usual day care schedule, I was able to get her admitted into a SNH where she regularly goes for respite care. This particular discharge process should not have posed a huge problem for the hospital social worker; nevertheless, they would have been very willing to discharge her and let me pick up the pieces had the day care nurses and I not pushed back. The point I'm making here is that, with hospitals,admitting and discharging patients comes down to dollars and cents. Elderly people, especially those with dementia, are vulnerable because they often require nursing home services (medicaid) rather than skilled nursing home services (medicare). But you are not obligated to let them discharge a patient into your care if you can't take care of them, even if you are living in the same home. Nor can they make you financially responsible, even if you have POA or guardianship You must push back.
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Yes, have him taken to the hospital. . You can refuse to take him home
if there is no one to provide adequately for him there.
If it has been necessary for you to get guardianship, his condition sounds as if warranted it.
Social workers are of great help in finding a bed - this is their job.
Please explain clearly to your Father what is going on and that you love him
Stand your ground!.
Take care of yourself and of your husband.
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Please be sure to talk to your dad about what you're planning. Don't just put him somewhere without his being able to know what's happening and why. We will all (hopefully) be old someday, and wouldn't want to be handled like a house pet that needs ridding. I understand fully when you need round-the-clock care with an elderly parent....my dad was hospitalized after living with us for 7 years with pneumonia, sepsis, and once there, he needed breathing assistance and tube-feeding. Only skilled nursing could handle him in that condition. But love your dad and be very reassuring to him every step of the way. You're under stress, but please think of the stress he's under as well.
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Louise, ditto what Veronica just said, but another big thank you for telling us all in such detail how you did it. Maybe you should write an article for AC!
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