My father just had a 2nd stroke and is in the hospital right now. He now needs help getting out of bed and walking. He is on Medi-Cal (California Medicaid), and his hospital discharge plan is to go to an SNF for rehab first, but after knowing he might need long-term care, there is almost no SNF that wants to accept him.
Now, the only SNF that might be able to accept him wants us to take him home afterward (but based on his situation right now, I don't think I can provide that support), and the hospital also called me and said they might start charging him while staying at the hospital because they can't find an SNF for him.
How should I respond to the hospital? Is it that difficult to find a LTC place in North Cal? The hospital has threatened to send bills and even transfer him somewhere out of state. Can they do that?
Your Dad is on Medical for health? Or in home? Does he have Medicare? My nephew is on for health and I was told that no Dr. can take cash from him if Medicaid is involved. I would call Dads caseworker and run by them what you have been told.
Has Dad been declared 24/7 care? Do the Drs feel Rehab will not help him? Because Rehab means physical therapy and Dad needs to be able to do it.
Maybe the SNFs don't except Medicaid? If they do, they may not take a person with Medicaid Pending. Medicaid for long-term care has to be applied for. If Dad is on "in home care" that may make it an easier transition. Just health coverage does not get you in LTC.
You need to completely understand what your being told. The hospital Social Worker can probably help there. Then call Dads caseworker and run things by them just to make sure u know where Medical stands in this. You make it clear to the SW that to release Dad would be an unsafe discharge. There is no one to care for him. Also, do not pick him up if released, because then you will be responsible for him.
The Social Services of the hospital need to find him placement. If they cannot find SNF then they need to find other placement.
If there is no skilled nursing center that will take him, and no rehab that will accept him there may be reasons for that. He may not fit the requirements for SNF as to be there one often must fulfill requirements that NEED skilled nursing. Same with rehab. If they feel your father cannot be rehabilitated, or if he was recently already in rehab, he may not meet requirements for entry. We can't know details of his own case. You will need to talk to the hospital's social services about just WHY they cannot find placement.
Now we are down to the hospital's threat to send bills. Does your father have great stores of money in savings to pay these bills? Because they cannot collect on his social security, and they can but ruin his credit. Sounds like your dad doesn't NEED credit at this point in his life, so a threat to bill someone who isn't quite wealthy is but a threat. And these bills are HIS, not yours. Never pay them or you are "assuming" the bill and can be collected against or have your credit ruined.
Hospitals do not keep patients who no longer need acute care. That's for certain.
A hospital can also not force FAMILY to assume care they cannot provide.
A hospital can also not collect on bills if a patient hasn't the money to pay them, so that's an empty threat; consider telling them (if this is true) "Dad hasn't any money; go ahead and send him bills; you can't collect on them ever".
A hospital is making empty threats now to your father's family. Tell the hospital that their social services department is responsible for finding your father suitable long term care, and you wish them luck, would be my advice. This is what their social workers are there to do.
Tell this hospital that if it continues to make empty threats to the family they will be reported to JCAHO for unsafe discharge. Use those exact words. JCAHO is the Joint Commission on accreditation of Hospitals. They can loose their licensure for threatening a family in order to get them to take a patient unsafely, and for not using their social services to find LTC placement.
Good luck. I hope you will update us.
Once dad gets to the rehab your battle is with them. In my experience the rehabs did advocate for as many days as they could get paid by Medicare. The kicker is that when dad is either improved or they deem him unable to improve, the next placement will be on you. It doesn’t have to be at your house (although they will push HARD for that and guilt trip you). But arrangements and payments will fall to you and dad. Sorry. I know how hard this is.
If dad is competent, now would be a good for him time to assign you POA (if you want that). That way you can use dad’s funds to pay for care if he continues to decline.
#1 Home is always first choice.
If that is not possible, then #2 home with new or more services. If not possible (not affordable, available, too hard) the next is #3 Care Home (skilled nursing, LTC, Aged Care Residential - names will differ).
Sadly, not every town has a decent care home with a empty bed 😔.
To discuss the *Home* option first..
He currently needs assistance of one person for mobiltiy. Is that right?
Pre-strokes, did he live with someone? If yes, is this person willing & physically able to provide this level of assistance?
'Home with Hope' of more recovery can be done... But hope can sadly turn to plateau & caregivers get overwhelmed & burnt out.
My immediate thought is that his care sounds difficult for someone to do at home. And that it would not be safe for him to be discharged. Do not go and pick him up, is usually the advice that is given in the situation where family would be unable to provide the care needed.