Leaving Skilled Nursing AMA, what should I be prepared for?

Update: Got mom home and she was in seemingly good spirits. I got some grocery items for her and she was fine to cook/prepare them on her own. I talked to her about all the agencies I have phone messages in to and what I think they can/should help her with, and she agreed. I made it abundantly clear that there is more here than I alone can do, and won't it be nice to have someone come in when "you need them and not have to wait for me."

The SNF told me about the whole "medicare won't pay if she has to be readmitted," kind of thing and I told them, "really, that's not what THEY said." Crickets. Like you're gonna pass up medicare money, and my mom's secondary insurance. She is a signed check wherever she goes...

She did get a little quiet when I told her that people will be coming in and looking after things, and how glad I was to be able to get that kind of help that "I can no longer really do for you," like it was sinking in, and then I told her to have a good day and left. I came home and crashed on the sofa. I need space and time. A lot of it.

She thinks you're going to be her caregiver now, you are firm that that is not happening. Then what on earth is telling you that you "have" to pick her up? You so don't. I hardly dare read down and see what happened... :/

Imho, make sure that your mother understands that just because SHE decided to leave the Skilled Nursing AMA that YOU will not be providing her care.

In general that used to be the "myth"; that insurance and such will not pay if you sign out AMA. In FACT you never need to even sign AMA forms. Hospitals and care places are not jails. You are free to leave. Clearly they thought the next 21 days of so they felt they were assured of is peeving them. But they may also have your Mom's best interests at heart. If she is leaving with no rehab she may be needing more help than would otherwise be the case. I would be clear you will not enable her in poor decision making. You seem determined not to be the caregiver, and I encourage you to make that crystal clear.

Patient has the right to direct her care. Period. There's probably something in the admissions agreement which acknowledges that.

Your focus should be on what's in place of the NH care. If mom doesn't have a care manager, now would be a really, really good time.

Take the scenic route home💐🙏🏾💚

I know that facilities would tell people that Medicare would not pay if it was AMA. But Medicare and insurances will pay up to the time the person was in the facility. Re-admission, though, maybe a problem and the facility can refuse to take her back.

You may have claimed "unsafe discharge" if Moms considered 24/7 care. That you are unable and unwilling to care for her. Even, her home is unsafe.

Keep us posted.

It's going to be a DAY for you indeed. Don't worry about the nursing home trying to tell you Medicare won't pay for re-admission into the nursing home if your mom needs it. That's not true.
Everyone gets up to 100 days a year nursing home care paid for by Medicare. If It's deemed medically necessary. If your mom has days left on Medicare and the doctor says it's necessary for her to go to a nursing home those days will be used as long as it's medically necessary.
If she has to go to the hospital and is admitted for three days or more and moved to a nursing home, Medicare will use the whatever is left of the 100 days too. The nursing home is copping an attitude with you because they want your mom to stay in there. Once the Medicare billing runs out, she has to start being paid for in cash every month, they start billing it to a long-term care policy if she has one, or if she's on Medicaid they start paying. Nursing homes never want to let someone go if they are soon to be paying in cash or through an insurance.
I sure hope for your sake you've told mom ahead of time that you have no intention of becoming her caregiver. God help you if she doesn't know you refuse.

As long as mom is kept safe and healthy with whatever help she needs, she - and you - will be fine. Keep in mind that if she develops dementia issues, you will need to be her advocate.

I am not sure what rehabilitation your mom needed before leaving, but usually a doctor can authorize home health care after rehab.