The HCPOA acts as a proxy for the incapacitated person, to follow their wishes regarding the level of medical care they receive (for instance, DNR? Hospice? Palliative care?). Likely the DPOA would need to be on board, since it's the DPOA that signs all the intake paperwork.
There is a reason people are telling you not to do this. I think people don’t realize how detailed and hard it’ll be. Really think this through.
-Any sort of schedule you have now will be out the window.
-Can you lift her several times a day?
-Being male, you will need a female aide for things like bathing and toileting. And possibly a female aide to help her get dressed. Are you okay with workers (strangers) in your house?
-Can you handle pee or poop accidents on her bed or anywhere else in the house?
-Are your toilets, bathtubs, etc handicap-ready? Will her bed have safety rails? Are meds stored safely?
-If you have pets, will she adjust to them or the pets to her?
-There will be no more dinners out, no vacations. Friends and family will say to call if you need anything, but you'll find almost none will volunteer to stay with her if you want or need time out.
-When do you plan to get things like errands and grocery shopping done?
-If she worsens, how will you handle the medical needs? If she keeps you up at night, how do you plan to handle work the next day?
-If you get sick or hurt, what plan do you have for her care?
Finally, consider she is set in a routine at NH. Taking her out of that and into a whole new one is a rough transition on an elder. If you end up having to place her again, that's another round of transition and newness she'll have to adjust to.
I've said before that people think they can "love their way" through caregiving. That love will be enough to sustain their energy and will. It isn't. Most on here loved their elder dearly and wanted to care for them. They had to place their elder to save both of their lives.
Igloo572 here: You have been given very thoughtful insight from folks who have had parents, siblings & spouses in NH. If things at the NH actually at the point where MD / medical director has warned you against taking her out of the NH, tread carefully.
To replicate a NH oversight at a minimum in your home would need a skilled care team of 4 on 24/7 oversight plus ancillary providers (PT, OT, ST) either in-home or you / caregivers drive to/from or arrange for medical transport to rehab places. Plus backup staff for sick days & vacays. If mom has unique needs….. black box drugs, IV, bedfast, ESRD, obese, advanced diabetes etc …. may need a specific type of caregiver, durable medical equipment & costs will spiral. DME likely bought or rented; bathrooms retrofitted. So mom or you have solid 100K+ plus monthly income??? Because that’s imo what’s needed to have to be able to easily draw from to pay, buy, rent for a year of in-home skilled care. OR are you & other family members doing all basic custodial caregiving & to/from chauffeuring for “free” & always on call when 1 of you is not there in person and hiring skilled in-home as needed?
By & large health insurance does NOT pay for custodial care. MediCARE does not pay custodial costs. Medicaid, if eligible - would do some via community Medicaid programs like IHHS or PACE (day center) but narrow in scope, under 28/35 hrs a week. All the rest of the time is on you to basically provide 24/7 care & oversight. If you do this, whomever paying (mom, you, siblings) need to file & pay appropriately via IRS/ w-2 / FICA. They are household employees unless you are using an agency.
If you are thinking hospice will do this, that is not happening. MediCARE hospice is 100% Part A benefit. Hospice tends to be 2 - 3 visits a week for 3-5 hours per visit by the agency and with regular documentation to show need. Hospice expects someone capable to be there in the home all the other time unless hospice individual is themselves still capable. That type tends to be youngish over 65 retiree with end stage cancer. FWIW NH ask for hospice consult all the time as it provides for extra hands in chronically understaffed NH, so if this NH hasn’t done this, shes not qualifying for hospice. ((Hospice does 24/7 in a facility at end of life for those needing very complex care, which kinda are outliers.))
PLEASE NOTE: if you do this, her exit from the NH will be notated in her health chart & dovetail to health insurers. Should it be determined 100% unsafe by medical director / facility, exit will be notated as “AMA” aka Against Medical Advice. Likely detail how the resident (mom) & MPOA (you) were doing actions out of compliance for her care plan. Being AMA on a chart is big time bad as that info gets looked at by future providers & insurers. You go AMA and walk out amidst a care plan there will be fallout from the insurers on having claims for the same thing paid for. Big fallout will be that should her care become too overwhelming at home and now ya want to put her back into a NH, that AMA will be in her chart. AMA will surface. Having AMA exit in a chart tends to get a hard pass from better NHs for new admission; they can fill their beds easily without the bother of a AMA type.
! ! AMA details can also be used by APS in their investigation ! !
If you have serious hate on this NH & have shown this when you visit plus mom is a difficult resident, I wouldn’t worry too too much about her being there much longer. NH can & will find a totally legit reason to call EMS to have this type of resident go to ER/ ED, then when hospital discharge planner calls NH to arrange for return, NH will say “sorry but no, we cannot meet level of care or we have no open beds”. Next phone call from the planner will be to you to come and pickup your mom from the hospital. Good luck then…..
Think your last part depends on a case by case bases. When I spoke with the ombudsman regarding my mother's situation she is also considered an unruly patient.
The ombudsman informed me they cannot deny her re-entry back into the facility after the ER trip and quote they cannot handle the patient anymore. If the behaviors are documented prior to them taking the patient, or if new behaviors are shown but in lines with what is to be expected from their illness. They do not have the right to remove her without finding safe and suitable placement. The ER / hospital rarely meets that criteria.
I thought the something and was worried. When I reached out to the ombudsman on the suggestion from the forums that is what they informed me.
If that comes up OP reach out to your ombudsman. As they told me NH think they are all powerful, and many people buy into the hype. They really are not, they just get away with stuff because people just don't know. The information regarding what they can and cannot do is not widely known or shared.
I will say this as someone that strongly considered taking my mother home after her current facility threatened her removal. In theory I could have, and you don't understand I wanted to so bad. I know my mom would have loved it, and honestly so would I.
Here lays the issue our feelings blind us from the truth. Harsh truth our parents are placed for a reason. Please do not let emotions cloud your better judgment. Your mom is where she is for a reason. It may not be ideal and I 100% get that, but often when it comes to medical issues ideal is just not possible.
Think long and hard about this not only for your sake but also your moms.
Thought something similar until got food poisoning twice from facility I'm in less then a month apart.
Others must have caught something as well, since the kitchen was sanitized and now there is hand sanitizer at the front desk when there was none before
Grandma1954 August 2, 2023 7:31 am In theory they can. If you can not provide an environment that is safe. If you can not provide the help that is needed in order to safely care for mom then to discharge her to your care is not possible. If you can prove that you have the means to provide safe care then there should be no problem having her discharged to your care.
That out of the way I have to ask why do you want to do this? Caring for someone with dementia is not easy. It is a 'round the clock job. You will either have to hire someone to come in and help or you will be doing this all yourself and I can tell you that is an almost impossible task. Caregiver Burnout is real. If mom is eligible you might want to get Hospice involved. The Social Worker can help and if the facility/doctor knows that Hospice will be involved and you will get all the equipment and supplies you need and you will have Hospice Team in helping each week that may go far in showing that you can manage this.
But if this is what you want to do and the facility and the doctor is resistant you may have to get the Attorney involved that dealt with your mom when the papers for your POA were made.
I think you need to seriously reconsider this. Visit mom, spend time with her, be her son not her caregiver.
Actually, yes, in some cases they can. But it is not directly the Dr., but rather the Dr. referring the case to APS. If the Dr. (and nurses involved) believe that mother is not thriving at home and is possibly being neglected or kept at home for financial gain, they will call APS. APS does have the power to prevent family from taking LO into an environment they deem abusive or unsafe.
Naturally the answer is no - they can't force you to keep her in a nursing home.
But, the real question is - are you prepared for the realities of bringing her home?
A nursing home has multiple staff members 24/7 to cover her needs. The facility is designed to support her needs (large doors for wheelchairs and walkers, bathrooms designed with no thresholds and walk-in showers, no carpet, handrails, elevators, specialty beds, different therapies and doctors available to come to HER onsite.)
While response times may not be immediate - she can push a button 24 hours a day 7 days a week and get help without anyone having to schedule someone to take care of her while they leave for a few hours. Vacations are covered by other staff members - not by having to hire individual help to cover shifts. And people can actually TAKE vacations. Staff are trained to deal with things like changing incontinence underwear/diapers when they are soiled - SAFELY. They are trained to assist someone up from a fall - SAFELY and can quickly get more help if needed. They have hoyer lifts to pick residents up if needed.
So my first question is - is it just you? Are you intending to be your mother's 24/7 caregiver? Also, all due respect - if you are married - have you talked to your spouse about this? Are they onboard with this decision? Are they going to be able to help? Do you have backup care arranged? How will she be transported to doctor's appointments? How will you help her if she falls? What is her sleep schedule like?
Do you have children? If so, how will this impact them?
I completely understand the reaction to want to pull a loved one out of a NH if they aren't happy but a quick reaction to just bring them to live with you is often a bad idea and knee jerk at best. And once you do it, then you stop to think about it. And then it's too late to figure things out.
Stop and think about it now. If you are still working - you should not stop to be home 24/7 to become a caregiver. If you have a spouse they should NOT become the primary caregiver. If you have children, you should consider THEM and your own family first. Don't make this decision quickly or lightly.
The first sentence of your 3rd paragraph, When I couldn't get up out of bed to get water, I thought so too, until the nurse told me I'd have to wait because she was the only nurse on the floor and had to deal with several patients.
I didn't get water until much later that day. I'm so glad the only things the nurses do for me is bring the food, set up the shower and change the sheets on to the bed. If accesd to these were available, I wouldn't call the nurse at all
It’s very hard to replicate what a nursing home would do for mom. You’ve never done it before. They have professionally trained caregivers who know how to deal with every bump in the road. You don’t have that knowledge.
As far as family pitching in to help, that lasts for about 5 minutes. Don’t count on it. Scheduling caregivers around the clock in your home is a big hassle. If you’re planning for wife and daughters to care for her, think again. It’s your mom. You deal with her poop and pee.
You need to find a different facility if this one’s not working. Bringing her into your home is a terrible idea.
No a doctor cannot keep you from taking Mom out of a NH. But you may have to prove that someone will be with Mom 24/7. (She is in a NH because she needs 24/7 care) That the home your taking her to is handicap accessible. Like bars in the tub. A shower chair for bathing. Access to a bathroom on the same floor she will be living and have a bedroom, etc.
Is there someone with DPOA? If so, then they are in charge I would think. Medical POA is usually only used when doctors need to know the wishes of patient. You are the one doctors talk to. But you do not pay the bills and you are probably not the one who signed her in. So not sure if you have a right to remove her. May need the Financial POA in agreement.
If you give us more information (like, why you are thinking of removing your mom from a NH, if that's we here she is living right now), you'll get better answers.
Your profile says your mom has dementia. Think carefully about how you will provide her with care before you commit to taking her out of her current situation.
I would rather ask what is in the best interest of your Mother?
What are her care needs?
Can these be met in a home setting? (Either with family only or family + staff). Will she have supervision, assisitance, activities & socialisation at the level she needs?
Really think this through.
-Any sort of schedule you have now will be out the window.
-Can you lift her several times a day?
-Being male, you will need a female aide for things like bathing and toileting. And possibly a female aide to help her get dressed. Are you okay with workers (strangers) in your house?
-Can you handle pee or poop accidents on her bed or anywhere else in the house?
-Are your toilets, bathtubs, etc handicap-ready? Will her bed have safety rails? Are meds stored safely?
-If you have pets, will she adjust to them or the pets to her?
-There will be no more dinners out, no vacations. Friends and family will say to call if you need anything, but you'll find almost none will volunteer to stay with her if you want or need time out.
-When do you plan to get things like errands and grocery shopping done?
-If she worsens, how will you handle the medical needs? If she keeps you up at night, how do you plan to handle work the next day?
-If you get sick or hurt, what plan do you have for her care?
Finally, consider she is set in a routine at NH. Taking her out of that and into a whole new one is a rough transition on an elder. If you end up having to place her again, that's another round of transition and newness she'll have to adjust to.
I've said before that people think they can "love their way" through caregiving. That love will be enough to sustain their energy and will. It isn't. Most on here loved their elder dearly and wanted to care for them. They had to place their elder to save both of their lives.
If things at the NH actually at the point where MD / medical director has warned you against taking her out of the NH, tread carefully.
To replicate a NH oversight at a minimum in your home would need a skilled care team of 4 on 24/7 oversight plus ancillary providers (PT, OT, ST) either in-home or you / caregivers drive to/from or arrange for medical transport to rehab places. Plus backup staff for sick days & vacays. If mom has unique needs….. black box drugs, IV, bedfast, ESRD, obese, advanced diabetes etc …. may need a specific type of caregiver, durable medical equipment & costs will spiral. DME likely bought or rented; bathrooms retrofitted. So mom or you have solid 100K+ plus monthly income??? Because that’s imo what’s needed to have to be able to easily draw from to pay, buy, rent for a year of in-home skilled care. OR are you & other family members doing all basic custodial caregiving & to/from chauffeuring for “free” & always on call when 1 of you is not there in person and hiring skilled in-home as needed?
By & large health insurance does NOT pay for custodial care.
MediCARE does not pay custodial costs. Medicaid, if eligible - would do some via community Medicaid programs like IHHS or PACE (day center) but narrow in scope, under 28/35 hrs a week. All the rest of the time is on you to basically provide 24/7 care & oversight. If you do this, whomever paying (mom, you, siblings) need to file & pay appropriately via IRS/ w-2 / FICA. They are household employees unless you are using an agency.
If you are thinking hospice will do this, that is not happening.
MediCARE hospice is 100% Part A benefit. Hospice tends to be 2 - 3 visits a week for 3-5 hours per visit by the agency and with regular documentation to show need. Hospice expects someone capable to be there in the home all the other time unless hospice individual is themselves still capable. That type tends to be youngish over 65 retiree with end stage cancer. FWIW NH ask for hospice consult all the time as it provides for extra hands in chronically understaffed NH, so if this NH hasn’t done this, shes not qualifying for hospice. ((Hospice does 24/7 in a facility at end of life for those needing very complex care, which kinda are outliers.))
PLEASE NOTE: if you do this, her exit from the NH will be notated in her health chart & dovetail to health insurers. Should it be determined 100% unsafe by medical director / facility, exit will be notated as “AMA” aka Against Medical Advice. Likely detail how the resident (mom) & MPOA (you) were doing actions out of compliance for her care plan. Being AMA on a chart is big time bad as that info gets looked at by future providers & insurers. You go AMA and walk out amidst a care plan there will be fallout from the insurers on having claims for the same thing paid for. Big fallout will be that should her care become too overwhelming at home and now ya want to put her back into a NH, that AMA will be in her chart. AMA will surface. Having AMA exit in a chart tends to get a hard pass from better NHs for new admission; they can fill their beds easily without the bother of a AMA type.
! ! AMA details can also be used by APS in their investigation ! !
If you have serious hate on this NH & have shown this when you visit plus mom is a difficult resident, I wouldn’t worry too too much about her being there much longer. NH can & will find a totally legit reason to call EMS to have this type of resident go to ER/ ED, then when hospital discharge planner calls NH to arrange for return, NH will say “sorry but no, we cannot meet level of care or we have no open beds”. Next phone call from the planner will be to you to come and pickup your mom from the hospital. Good luck then…..
The ombudsman informed me they cannot deny her re-entry back into the facility after the ER trip and quote they cannot handle the patient anymore. If the behaviors are documented prior to them taking the patient, or if new behaviors are shown but in lines with what is to be expected from their illness. They do not have the right to remove her without finding safe and suitable placement. The ER / hospital rarely meets that criteria.
I thought the something and was worried. When I reached out to the ombudsman on the suggestion from the forums that is what they informed me.
If that comes up OP reach out to your ombudsman. As they told me NH think they are all powerful, and many people buy into the hype. They really are not, they just get away with stuff because people just don't know. The information regarding what they can and cannot do is not widely known or shared.
Learned a lot from this forum.
Here lays the issue our feelings blind us from the truth. Harsh truth our parents are placed for a reason. Please do not let emotions cloud your better judgment. Your mom is where she is for a reason. It may not be ideal and I 100% get that, but often when it comes to medical issues ideal is just not possible.
Think long and hard about this not only for your sake but also your moms.
Others must have caught something as well, since the kitchen was sanitized and now there is hand sanitizer at the front desk when there was none before
Cover909
In theory they can.
If you can not provide an environment that is safe. If you can not provide the help that is needed in order to safely care for mom then to discharge her to your care is not possible.
If you can prove that you have the means to provide safe care then there should be no problem having her discharged to your care.
That out of the way I have to ask why do you want to do this?
Caring for someone with dementia is not easy. It is a 'round the clock job.
You will either have to hire someone to come in and help or you will be doing this all yourself and I can tell you that is an almost impossible task. Caregiver Burnout is real.
If mom is eligible you might want to get Hospice involved. The Social Worker can help and if the facility/doctor knows that Hospice will be involved and you will get all the equipment and supplies you need and you will have Hospice Team in helping each week that may go far in showing that you can manage this.
But if this is what you want to do and the facility and the doctor is resistant you may have to get the Attorney involved that dealt with your mom when the papers for your POA were made.
I think you need to seriously reconsider this.
Visit mom, spend time with her, be her son not her caregiver.
But, the real question is - are you prepared for the realities of bringing her home?
A nursing home has multiple staff members 24/7 to cover her needs.
The facility is designed to support her needs (large doors for wheelchairs and walkers, bathrooms designed with no thresholds and walk-in showers, no carpet, handrails, elevators, specialty beds, different therapies and doctors available to come to HER onsite.)
While response times may not be immediate - she can push a button 24 hours a day 7 days a week and get help without anyone having to schedule someone to take care of her while they leave for a few hours. Vacations are covered by other staff members - not by having to hire individual help to cover shifts. And people can actually TAKE vacations. Staff are trained to deal with things like changing incontinence underwear/diapers when they are soiled - SAFELY. They are trained to assist someone up from a fall - SAFELY and can quickly get more help if needed. They have hoyer lifts to pick residents up if needed.
So my first question is - is it just you? Are you intending to be your mother's 24/7 caregiver? Also, all due respect - if you are married - have you talked to your spouse about this? Are they onboard with this decision? Are they going to be able to help? Do you have backup care arranged? How will she be transported to doctor's appointments? How will you help her if she falls? What is her sleep schedule like?
Do you have children? If so, how will this impact them?
I completely understand the reaction to want to pull a loved one out of a NH if they aren't happy but a quick reaction to just bring them to live with you is often a bad idea and knee jerk at best. And once you do it, then you stop to think about it. And then it's too late to figure things out.
Stop and think about it now. If you are still working - you should not stop to be home 24/7 to become a caregiver. If you have a spouse they should NOT become the primary caregiver. If you have children, you should consider THEM and your own family first. Don't make this decision quickly or lightly.
I didn't get water until much later that day. I'm so glad the only things the nurses do for me is bring the food, set up the shower and change the sheets on to the bed. If accesd to these were available, I wouldn't call the nurse at all
Cover909
As far as family pitching in to help, that lasts for about 5 minutes. Don’t count on it. Scheduling caregivers around the clock in your home is a big hassle. If you’re planning for wife and daughters to care for her, think again. It’s your mom. You deal with her poop and pee.
You need to find a different facility if this one’s not working. Bringing her into your home is a terrible idea.
Is there someone with DPOA? If so, then they are in charge I would think. Medical POA is usually only used when doctors need to know the wishes of patient. You are the one doctors talk to. But you do not pay the bills and you are probably not the one who signed her in. So not sure if you have a right to remove her. May need the Financial POA in agreement.
https://www.agingcare.com/discussions/if-you-are-going-to-become-a-caregiver-480769.htm?orderby=recent&page=1�
If you give us more information (like, why you are thinking of removing your mom from a NH, if that's we here she is living right now), you'll get better answers.
Your profile says your mom has dementia. Think carefully about how you will provide her with care before you commit to taking her out of her current situation.
What are her care needs?
Can these be met in a home setting? (Either with family only or family + staff).
Will she have supervision, assisitance, activities & socialisation at the level she needs?