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I was told if I attempt to check my mom out of the nursing home it would be AMA. I don't understand that because they already said she didn't qualify for rehab because she wasn't going to get better. She was on Medicaid Waiver for home care then she was admitted to the hospital with a Pleural Effusion and Atrial Fibrillation. She was dismissed from the hospital and sent to the nursing home for 20 days of rehab, she didn't qualify for rehab because she wasn't expected to get better so she became a permanent resident from day 1. She has now been in the nursing home for about 3 weeks.


I told them 2 weeks ago that I intended to take my mom home but they cancelled her release plan because they said I didn't have adequate home care lined up.


They are telling me if I check my mom out AMA, my mom will lose her Hospice and Medicaid Waiver. I don't know why I would want to continue with her Hospice at home but she has new meds and an oxygen concentrator now.


I don't give much weight to "Medical Advice". Her doctor wrote out a prescription for a wheelchair. I take the prescription to a medical supply store, but the store said the prescription was worthless. I had to take a form back to the clinic and have them fax the requested information to the store then I had to run back to the store to pick up the wheelchair. Then they referred my mom to Hospice so now I have to return the wheelchair. After I get my mom home and fire her Hospice, I'm going to have to hope that I can get her another wheelchair. I'm a little upset that the hospital staff referred us to Hospice without understanding themselves what Hospice was. When I signed the papers, I was under the impression that I had to accept the Hospice company I was sent because that was "Medical Advice". I was under the impression that I was required to sign the papers for the nursing home because that was "Medical Advice". A lawyer set me straight on what "Medical Advice" was and now I need to fix my mistakes.

Hello SGeorge…so what did you decide to do with your mother? Leave her in SNF or take her home with hospice?
Have you found another facility?
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Reply to CaregiverL
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I still believe it would be a mistake to take her home. You were burnt out caregiving at home. Your mother didn’t qualify for rehab probably because she didn’t cooperate or do any of the exercises. Or maybe she was too weak to participate. Stop hitting your head against the wall. Visit her in the home…as I advised in a different post, look for a different facility if you don’t like that one. Hugs 🤗
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Reply to CaregiverL
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George, this is the time to get Mom into Longterm care with Medicaid footing the bill (SS will be used to offset care) and you can get your life back.

Hospice is probably being suggested because of Mom's condition. Hospice is not recommended unless a Doctor truly thinks its needed.

Just had this AMA discussion with my RN daughter who has worked rehabs/NHs as a nurse and a administrator. You can take Mom home AMA. But you will receive no medication prescriptions and no "in home" care referral. And, the rehab can refuse to take her the next time she may need it.

Yes, you can fire Hospice. And choose your own. No, you don't need to put ur Mom in LTC of their choice, you can pick your own. The wheelchair, its probably a rental thru Medicare and hospice will supply Mom one thru their vendor. I think rentals work once the cost of the item is met, then u own it. This means, if Mom passes, if wheelchair still considered a rental it goes back to where u got it from.

Be aware that Hospice, if u eventually choose it, means Mom will not be taken to a hospital. Things are allowed to progress naturally. Some of her meds will be stopped. She will be given Morphine for any pain and breathing issues. Its the end of her journey.

By taking her home you are now her caregiver 24/7 unless she can afford to hire help. I don't think Medicaid offers more than a few hours of care.

Not sure about the Medicaid waver, that you need to check with her caseworker. I don't see where Hospice has anything to do with going AMA thats a whole different entity. I also don't understand if Mom can't do the rehab why she must stay unless its an "unsafe" discharge. Maybe you really need to show them that Medicaid will be coming back and you will be there 24/7. Do what you need to get her released. Then u can do what you want when u get her home. But then you are paying a lawyer.
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Reply to JoAnn29
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You don't have to sign anything. When hospitals bring you the paper to sign you don't have to either. When they say AMA they mean that your Mother's physician is refusing to discharge her, and believes she needs too acute care to return home to your care alone. Also means they will in all likelihood not give you a care plan because to say you are not safe to leave and THEN providing a plan of care would not hold up well in court. Again, this isn't a jail. If you wish to pack up your Mom and leave no one will call the police. That doesn't mean that the nursing home will not tell your insurance companies that you left against the doctor's advice. I doubt they would share this information with someone off the street given they are so paranoid about sharing any medical information that they will often not tell you what room someone is in so you can send mail. (I recently had this experience.)
If you don't use hospice, yes, you have to return the w/c they provided. You don't have to return a w/c you yourself got with a MD prescription.
Medicaid has it's own rules. Check with them, as it may differ state to state.
Good luck. Be very certain this is what you want to do before you do it.
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Reply to AlvaDeer
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Why WOULDN'T you continue Hospice at home? Is there aggressive, curative treatment that you are going to pursue for your mom?

If you are displeased with the NH, have you tried finding another?

When you first started posting here, you were desperate to get your mom INTO a nursing home, because you were overwhelmed with her care and couldn't work.
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Reply to BarbBrooklyn
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Inside information that I'm not supposed to know, the nursing home has 5 empty Medicaid beds so they do what they have to do to fill the beds and keep them filled. My mom hasn't been in the nursing home 30 days but I'm supposed to give them a 30 day notice to take her out, it's all about keeping that bed filled for another 30 days and billing Medicaid for it. I took care of my mom in her home for over a year before she went into the hospital but now the nursing home is telling me that I can't? That's ridiculous.
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Reply to SGeorge24
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SG, why are you going to cancel Hospice? Are you going to seek aggressive curative treatment for your mom's afib and pleural effusions?

Your mother is in need of 24/7 care. When you first started posting here, it was to ask how to get your mother INTO a nursing home, because you couldn't manage her care any longer.

If you are displeased with the current placement, find her a better one.
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Reply to BarbBrooklyn
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Goodness this is a mess. I'd think it a reflection on the disjointed, competitive, commercial health care market in the US, except that Covid has done a number on every health services system that I know of - nobody's communicating, nobody's co-ordinating patients' plans. It's all a proper dog's dinner, and your poor mother in the middle of it.

Right. In hospital, is discovered to have pleural effusion (? cause ? treatment) and A Fib. Is discharged to nursing home for rehab. At nursing home, undergoes assessment and is deemed unsuitable for rehab, referred instead for hospice. "Sign here" they say to you. Understandably, you go along with it.

But who the heck is taking ownership of her diagnosis, treatment plan and care needs assessment? What are her requirements, and who has responsibility for covering (and especially in the US) and for funding them?

Assuming that you are her authorised proxy (I think you are, can't recollect the details), you make the decisions. Your aim is to have your mother discharged home with full support. You have her px sorted out and an oxygen concentrator available for use. What about other equipment? What about pairs of hands?

As for storage of and access to and sharing of her confidential medical information: there's a lot of law involved in this, and you'll need sight of the data protection regulations applicable in your state. Your discharging her from the NH against medical advice certainly has to remain on file at the NH - they are entitled to protect themselves should the discharge have any negative results for your mother (God forbid). Whether or not the NH can share that information with others will depend on the other party's reason for requesting it and authority to see it.

As a general rule, though, it just isn't sensible to conceal facts. Who do you think might be asking questions about her discharge?
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Reply to Countrymouse
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