How can I get my wife out of the hospital and into acute-care or nursing care if she is on a 24hr. watch?

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She suffered seizures that are now controlled with anti-seizure medicine. The anti-seizure medication is slowly being decreased. Right now she suffers periods of restfulness followed by periods of extreme anxiety. She is not coherent but occasionally with recognize her spouse and children.

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Joannes, you said it all. This is a lot of information to follow, however, it needs to be followed. I am in the same boat with you. I have been a Caregiver and Healthcare Advocate for the past 6 years. There has been so very much I have had to learn on my own. I am so very thankful that Agingcare.com exist. When people are in need, not just searching, for answers in taking care of their loved one, I only hope that people like you and I can help them. Please keep doing the good work that you are doing in helping people.
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Absolutely do not take her out of the hospital until she is ready. You are lucky they are watching her 24/7 with emergency help right there. It is the safest place for her to be.

Do not take her straight home. Work with the social worker for an intermediate placement in a nursing or rehab facility. It sounds like her situation is quite severe and dangerous currently. It is just going to take some time.

I know that it feels very out of control for you both, and it is to some degree. But her health is beyond what you can manage right now. I know this is very frightening, but trust the hospital. Be ready for finding that your wife is a bit different than before, I really don't know what all the seizure activity might do to her.
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As a retired RN with lots of hospital management experience, let me summarize your options as all the above viewpoints need to be considered together as all are correct. First of all....get in touch with the hospital social worker or discharge planner assigned to your wife. Your wife's RNs will know how to do this for you. Let this person know your desired discharge goals. If you do not feel your wife can be cared for by you at home, or without support at home, then they can get started with finding a NH or other appropriate facility placement now...before time to go. Then, try to visit when her doctors are making rounds or get regular communications from her nurses about how she is doing and how the doctors are moving towards discharge. You WILL lose payment for her care and possibly her entire insurance coverage if you take her out against medical advice (AMA as it's referred to in the hospital). You do not want to do that. And, yes, a 24 hr watch is in place because, sounds like in her case, she is a 'danger to self'...likely due to having a seizure without staff present but also could be due to falling etc....and she will not be discharged until this is not the case. Sounds to me like, getting her new seizure meds working and in the proper dosage to prevent further seizures is a key point here that must happen. Then, consider the cause of the seizures as well. She needs to be stable enough all the time to be able to be left alone, because even going to a NH or other facility, she will NOT be under constant observation by staff. There is no way to do this without having her at home with a 24/7 caregiver plan of some kind, which is going to cost multiple thousands of dollars per week. You could be checking with your insurance company about coverage for home health care on your own. Most do not cover, or cover very little for only a short period of rehab time. Medicare does not cover HH care. Hospice covers very well, but the patient must be considered terminal within 6 months generally. The hospital social worker or discharge planner can help with all those options as far as knowing choices and answers that will apply to her medical condition. The special diet is good to research but you will not find it easy to get hospital or NH willingness to try natural health care options like this. If your wife is going to need continued care anywhere, even at home, after this hospitalization, then it's time for you to move into the role of health care advocate, get a POA if you do not have it and she is able to sign to do that, and to become a 'coordinator of care and advocate for all her care' going forward. It means you'll need to be able to fight for what she needs and be the one who monitors that she's being treated right and brings issues you are concerned about forward. If there IS an RN in your family or among your friends, they perhaps can greatly help you in this. Another option is to hire an eldercare case manager to help you with this new 'job' you will have.
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You can't...unless you sign her out AMA (Against Medical Advice) and you have MPOA (medical Power of Attorney). the moment you sign her out...the responsibility for her is yours...not the hospital. Also...since she is on 24 hour watch...I highly doubt you will be able to sign her out because a 24 hour watch is indicative of someone that will harm either themselves or others. Falls are included in harming themselves. A NH in no way is equipped for a 24 hour watch...if you are MPOA...and the hospital allows you to accept responsibility...you will be hard pressed to find a facility to take her. ALF are in place for independent patients...Memory Care Facilities are in place for those requiring minimal redirection...not total care. There are Total Care Homes but again...not for 24 hour watch...and yes...if you do this...your insurance carrier will be notified by the hospital and you may lose your benefits...and trying to pick up a new carrier in your position will be difficult to almost impossible without paying a large increase in premiums. Just not a smart idea all the way aroubd.
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Yep, social services. And don't be anxious to transfer her any faster than the hospital is.
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The ketogenic diet helps to prevent seizures. It is a low-carb, moderate (meaning on the low side) protein, and high fat diet. It is commonly used for children, because it is easier to control what a child eats. But it benefits adults too. Dr. Jeff Volek, professor and researcher at the University of Connecticut, has an excellent lecture about the keto diet on YouTube. Incidentally, the keto diet can also help with losing excess weight.
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Pam and Freqflyer have great points. Typically, we've found that if a patient requires 24/7 watcher who sits in the room due to aggitation or anxiety, that the hospital cannot discharge the patient. It would be an "unsafe discharge." The hospital should be working to reduce those symptoms so that she does not require the watch. NHs don't provide 24/7 eyes on, so she'll need to be in a better state of mind before being transferred anyway.
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I agree with Pam, if you want to move her from the hospital to some place else against doctor's orders, check with your health insurance first.... depending on your insurance they could refuse to pay for further care.
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The extreme activity could be a type of seizure activity. Don't move her before she is ready and cleared by the MD to be moved.
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Your wife is in the best position to be transferred to a nursing home: the hospital. Get ahold of Social Services at the hospital and let them know your wife is going to need skilled care. They can find her a facility.

But don't let the hospital discharge your wife to home. If talk of discharge comes up tell them that you can't care for her at home.
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