Hospitals and nursing homes are not prisons, if someone is mentally competent they are free to leave if they choose. If that person has the resources and wherewithal to arrange for a transportation and they have a home to go to there isn't much anyone can do to prevent their departure.
I think the question is - are they mentally competent? Early dementia is very difficult and many do not accept at all. Over medication at home, increasing falls. Living this right now.
Happened with my Dad. He just kept going back to his apartment until he was hospitalized 4 times in 6 weeks-with skilked nursing rehab.
We had to let him fail on his own. After a few years, he was judged in a hospital by psych to not have capacity to manage himself. Adult protective services had been called three times, but kept saying it was his right to make poor choices. He took taxis home, he refused all home health or anyone to clean his apartment. His neighbors and friends kept asking us why we didn’t do something. We could not until he lost his legal right to make poor choices. APS finally said he was vulnerable because of self-abuse, and that did affect the psych evaluation. The best thing we had was a POA that he signed last year when he was judged to be competent. That did not take away his right to make his own decisions until he was no longer competent. Please do not get your legal advice from anyone other than an elder care law attorney. Every state is different and every situation is different.
CWillie is spot on as to ability to leave. But there could be fallout later on by doing this. If they are in skilled nursing care aka a NH, there will be a series of codes associated with their care. These are ICD -10 codes & standard for how diagnosis & billing is done. If they leave and it’s recorded in their medical chart that they exited AMA / against medical advice, what could happen is IF they get hospitalized or seek medical care for anything with the same ICD codes that they were getting care for, that their insurer will not pay for any care associated with the same ICD codes for a period of time.
To avoid this they need to get discharged from the skilled care place and get a discharge report - or an aftercare document. It’ll have what their medications are & their schedule and if there’s PT or OT to continue or when a followup visit with their MD scheduled for or should be schedule by. Discharge report needs to be signed by resident or MPOA & facility keeps a copy. You need to keep your copy.
if you take them out, PLEASE be sure to get their medications. RXs for NH usually get ordered in 90-120 day supplies. A lot of these come in blister packs & are tagged with resident name on a hanger held in the locked medication closet at the nurses station. You NEED to get these. MediCARE, MedicAID or other insurance will not pay for duplicate meds. So it will be totally private pay out of pocket to get their meds & could be frightfully expensive plus you will need a new script to get any meds.....
In there a POA or guardian involved? If so, they should be contacted. Its their decision. A person found to be incompetent cannot sign legal papers. I would think a facility would need to make sure they were releasing this person to a safe place with someone to care for them.
This is what we are living through also. He shouldn’t be at home. The nursing home knows, his doctor knows, and we know it. But he is a stubborn old man. So, everyone’s hands are tied. He will remain at home, with us bringing his meals, doing his laundry, visiting once a day, etc. - until something happens to him at home that puts him back in the nursing home for good. It will happen, we expect it everyday, and we are amazed he has made it this long. He has Parkinson’s, with the early dementia that goes with it. He has to fail on his own terms.
You need ‘proof’ that your loved one is not mentally competent. This is very hard when the person has ‘show timers’ ie puts on an act for the short time of the doctor’s appointment, and the doctor never sees the living conditions. Particularly hard if you have no right to discuss the medical condition with the doctor, and the doctor sticks to all the ‘privacy’ rules. People on this site have recommended sending a letter to the doctor before the appointment (they are still allowed to read them!) with details of what is troubling you. You can suggest questions to ask (ie what do you eat every day). The best results come from also providing videos of the living conditions (eg what’s actually in the fridge), and also of incidents involving the person. For the latter, you may need to install a monitor system – if you ask, people here can make suggestions of what and how and the legalities. The contrast between the ‘stories’ and reality can provide the basis for a ‘not mentally competent’ verdict. If the doctor is unwilling to admit that they have been wrong all along, you may need another doctor. Before you do it, make sure that everything that needs to be signed before the verdict is all in order. The verdict will invalidate subsequent wills, POAs and all the other forms.
If you ask these specific questions, you can get a lot of help on this site.
If your loved one is indeed mentally competent, they can make decisions (even bad ones) for themselves. However they can’t make decisions for you about how you have to support them. One answer may be to stop propping up the situation. The challenge is to keep it reasonably safe. Tell the neighbours what you are doing and why, phone three times a day to check for falls, move yourselves out of your house so the taxi can’t find you. Or just do the minimum and live with ‘less than perfect’!
We had to let him fail on his own. After a few years, he was judged in a hospital by psych to not have capacity to manage himself. Adult protective services had been called three times, but kept saying it was his right to make poor choices.
He took taxis home, he refused all home health or anyone to clean his apartment. His neighbors and friends kept asking us why we didn’t do something. We could not until he lost his legal right to make poor choices. APS finally said he was vulnerable because of self-abuse, and that did affect the psych evaluation.
The best thing we had was a POA that he signed last year when he was judged to be competent. That did not take away his right to make his own decisions until he was no longer competent.
Please do not get your legal advice from anyone other than an elder care law attorney. Every state is different and every situation is different.
But there could be fallout later on by doing this. If they are in skilled nursing care aka a NH, there will be a series of codes associated with their care. These are ICD -10 codes & standard for how diagnosis & billing is done. If they leave and it’s recorded in their medical chart that they exited AMA / against medical advice, what could happen is IF they get hospitalized or seek medical care for anything with the same ICD codes that they were getting care for, that their insurer will not pay for any care associated with the same ICD codes for a period of time.
To avoid this they need to get discharged from the skilled care place and get a discharge report - or an aftercare document. It’ll have what their medications are & their schedule and if there’s PT or OT to continue or when a followup visit with their MD scheduled for or should be schedule by. Discharge report needs to be signed by resident or MPOA & facility keeps a copy. You need to keep your copy.
if you take them out, PLEASE be sure to get their medications.
RXs for NH usually get ordered in 90-120 day supplies. A lot of these come in blister packs & are tagged with resident name on a hanger held in the locked medication closet at the nurses station. You NEED to get these. MediCARE, MedicAID or other insurance will not pay for duplicate meds. So it will be totally private pay out of pocket to get their meds & could be frightfully expensive plus you will need a new script to get any meds.....
If you ask these specific questions, you can get a lot of help on this site.