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They think she had a seizure but can find no issues. She has dementia and is part paralyzed on left side. The hospital wants to send her home with pt only. There's no one there to care for her during the day. I want to refuse to take her home but the hospital said that it was abandonment. I don't no what to do from here. She is declining fast and needs more care than I can provide. What can I do?

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Have you applied for Medicaid for her? Is Hospice an appropriate level of care? Can hospital assist you with getting her into a nursing home "medicaid pending"?
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Do not let the hospital bully you. Unless you are your mothers legal guardian, you can not be legally held responsible. Tell the hospital you have to work - that your mother would be left alone all day if in your home. Ask them to put you in touch with their social worker who deals with elder care issues and ask them to help you find a placement for your mother where she will receive the appropriate level of care - that you can not provide. The pressure that hospitals and rehabs put on family to take the sick, elderly into their homes is really starting to chap my hide!
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Be professional, sweet, and turn the tables on them. One thing you can do is ask if their recommendations meet with the standard of care for someone who is partially paralyzed. I.e., do they routinely recommend that someone in that condition return home with no one to care for her?

Be prepared for a change of attitude, preceded by some quickly changing facial expressions. Standard of care is a legal standard considered in medical malpractice cases. Just the hint might cause them to be more realistic about the situation.

And don't let them bully you. Like RM, I'm really getting fed up with the manipulative tactics of hospital discharge planners and rehab social workers to shove off all the care planning on the family, and engage in a CYA move themselves.

I don't know the specific legal qualifications for abandonment, but I think your best option at this point is to state that you can't care for her, you need advice on how to get that care professionally, and ask for their recommendations. I.e., what can and will they do to help get 24/7 care, recognizing the fact that you cannot provide it. Turn the tables on them.

If they insist you take her home, ask if they'll pay you to stay home as you can't afford to quit work! (Sometimes you really have to be adamant in dealing with these people.)

And DON'T sign anything in the Discharge Instructions that commits you to provide care. I discovered that someone at the last rehab facility snuck in an "acknowledgment" in the discharge instructions that I agreed to provide 24/7 care for my father. That was never even discussed! And I read them before leaving - I'm still not sure how that into the instructions.

Of course I didn't sign them so it's not a valid assumption or commitment. But still, it really irked me, and it's on the list of issues to raise if we ever need care again.

Fortunately or unfortunately, the rehab facility is great except for the somewhat manipulative social workers. In the past I've been able to raise these issues prior to admission when the staff wants the patient and the Medicare dollars, so they've been worked out.


On the issue of having been unconscious, has anyone mentioned a syncopatic episode? She could have passed out, there might not have been any obvious cause, and that could be their assessment. Syncope was the cause of my father's falls. Despite cardiac and other post fall assessment, no determination was ever made what caused the blackouts.
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To clarify Rainmom's post, that's a court appointed Guardian, not to be confused with POA. And they are trying to do the same things here in Canada too even though they know full well it isn't right, it is all about preserving the hospital's bottom line.
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I know it's tough but it's perfectly fine to say no, you can't take care of her. Make the hospital find alternate arrangments for her. You have the right to say no, it's not happening and not doable for you to do. Don't put you long term financial well being at risk nor, if you have one, family's at risk.
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It's a long story for another time but one of the worst 24 hours of my life was when an ER pulled that crap on me six years ago. Left me and my brother frantically looking for an appropriate place for my sick dad. H3ll - we were so clueless at that time we didn't even know what appropriate was! If I'd only known then what I know now! And not in terms of appropriate but in terms of the BS hospital discharge people try to pull.
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Sometimes I think hospital staff work at opposite purposes. Nurses, aids and doctors try to provide good, quality and concerned care, but the discharge planners seem anxious to just boot the patient out the door and move on to the next football...or rather patient.
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We had a similar experience with my mom. She became incoherent while on the phone with me and fell. The hospital wanted to discharge her to AL, which wasn't able to handle the 24/7 care she needed. My sister (nurse in NH) kept using the words "unsafe discharge" to the discharge planner. We steadfastly refused to take her home, as we couldn't provide the needed care. She was a pretty snippy, unhelpful woman about it and thought we should be taking care of her personally. Ultimately, she gave us a list of NH, a friend in healthcare crossed off places she didn't think would work. We took two days and visited facilities. She went directly from the hospital to the NH, where they did rehab, then transitioned her to long term care.

You have to put on your body armor and say "that's not possible" a lot. GA is right - the doctors and therapists were terrific, but the discharge planner was a piece of work. Network with friends and family for feedback on NH - that helped us speed the selection process.
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I see from your profile that your mother is living at your home. So does that mean that your home is also her home? So that, if the hospital were to discharge her home, they would be able to demonstrate that they are discharging her to a home environment where she lives with other adults, yes?

I don't know, and I don't want to depress you, but I wonder if that complicates things for you. You can certainly still refuse to collect her. But can you prevent their sending her home, I wonder?

Who found her unconscious, by the way, and what was that person doing in your house?

How long has she been living with you? Does she have another home of her own, or is this a permanent arrangement?

If it were me, I think I would:

take a brief leave of absence from work
take mother to see her GP
get an assessment of care needs done
find out what the options are
pick one.

Your mother has dementia, she is declining rapidly, you work (quite right too, no reason why you should have to give that up) and there is no one around during the day... Something's going to have to change anyway. Might as well make it sooner rather than later, don't you think?

And meanwhile, hospital is not a good place for a frail elderly lady with dementia. All things being equal you'd want her out of there as soon as possible in any case.
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We've all had bad ER to hospital experiences and until you know the rules of engagement it is a frightening time

If your mom has Medicare then ask for a copy of the Medicare bill of rights which loosely states that your mom cannot be discharged prematurely

Very important point here - Medicare will only pay for a rehab short term stay in a nursing home if your mom has been in the hospital for 72 hours - do you have a regular doctor who will oversee her care in the hospital ? If so, call him or her

You need the ER to admit her to a bed first and then you may have to avoid the discharged planner for awhile - they will contact you immediately for your plan and if you don't have one they will send her to any facility with a bed available - you want to look at any facility before that happens - do you have any relative to help you ? 72 hours goes by quickly

Above all - health care is a business which depends upon the reimbursement of expenses by the government or private insurance - neither cares about what's best for the family but how to contain costs

If you are lucky you will come across kind individuals who will offer some good advice but you need to verify anything they recommend - just because a facility is nearby doesn't mean it is good

Start by looking on the Medicare website for nursing home ratings - any facility taking Medicare has a public rating - but know that even 5-star facilities are far from ideal and some 2-star facilities are okay but at least you'll be forearmed with some info

Good luck
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I had an experience where a hospital did it's best to send me for rehab and I was refusing. After 2 months in the hospital I was far too ill for rehab They were refusing to let me go home and I was refusing rehab. In the end when I demonstrated that I could walk to the bathroom and manage a couple of steps they reluctantly agreed. Three days later I was admitted to another hospital for another month.
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Madge raises an issue about which I'd forgotten. If your mother was admitted, she should have been given a Notice of Medicare rights regarding discharge, indicating that you can challenge a decision for discharge but must do it within a specified time.

If you do, make notes and document all the way - who you spoke with, time, etc.

Remind yourself as well that you're in a challenging and potentially emotional volatile situation now, especially if the discharge staff keeps up the pressure to take your mother home. Give yourself a lot of space, take a day off if you can, and make sure to include some downtime as your emotional equilibrium and patience could be pushed to the limit.


I'd like to elaborate also on Madge's comment that neither the government or private insurance which focus on cost containment rather than what's best for the family care that much about those families and patients.

The acquisition by private companies of medical facilities has resulted in many changes at our preferred hospital, some of them good, others of questionable merit.

Scuttlebutt was that some undesirable marginal staff were weeded out. I did see that when I was hospitalized briefly - service was top notch, as if I was at a 5 star hotel.

Some floors were upgraded significantly and made much more accommodating for patients and staff. Other floors were not; it's as if the revolution bypassed these outposts of antiquity. Those are the areas which I've found to be less accommodating.

But I also found that some of the higher performing staff could be caught in the midst of the changes, assigned more patients, and challenged to provide the high level of service they felt appropriate. They, like patients and their families, are also feeling the effects of the narrowed corporate focus of financial issues vs. total healing care and issues. We're both victims of the increased pressure to maximize profits.

I often wonder if the charitable hospitals will eventually be ones to which patients turn for more caring and compassionate care.
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Veronica, did you end up going to a long term specialty hospital for that third month of care?
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GA's comment reminded me of something else. The first time my mom was in the hospital, she was admitted "under observation", not "in-patient". We learned later that we/she didn't have the same rights to fight the discharge as we would've had she been "in patient". Also, the lack of diagnosis made things sticky. She was discharged that time, only to end up back there two days later. That time, her doc made sure that she was designated as "in patient" and had a diagnosis. These were important for Medicare reasons. It gave us more to work with with the discharge planner.
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It does not sound ike Mom can be left home alone any more. And it does sound like she needs more care than one person can give her.

If you cannot get SW or d/c planner at the hospital to listen, ask for a patient-family representative and go through their greivance procedures if you have to. You can call your Area Agency on Aging or the equivalent yourself and find out what options for additional care you might have, even though the hospital should be trying to help instead of just dump that all on you.
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Linda raises another issue. If a person hasn't been admitted, but has been kept overnight or longer for observation, Medicare does not have to pay for any meds administered.

This happened to us one time; I fought it, filed appeals with Medicare, battled with the hospital over rampant overcharges. Medicare dropped the ball and didn't follow up after I challenged their appeal decision, and the hospital eventually gave up after trying to convince me they were justified in charging $14 for a tube of chapstick that couldn't be used b/c Dad was on oxygen and the chapstick contained petrolatum. There were other outrageous charges as well, something like $4 for one aspirin.

On the other hand, our preferred hospital just absorbs the charges; we've never been billed for observational stays.
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:O $14 for lip salve???

Reminds me of a line from Martin Amis about a woman having a baby in a big private hospital and the comfort she takes from the huge rolls of invoices "... with every Kleenex lovingly itemised - not for her the bargain basements and Crazy Eddies of the NHS..."

But that! Do you have consumer law that would allow you to return the chapstick for a refund on the grounds that it is 'not of merchantable quality' being not fit for its intended purpose?
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I got charged my med co-pay for a "test" my ob/gyn gave me. Her nurse put a paper chuk on the floor, I was told to stand over it, legs wide and cough. Now - my part was $20, I shudder to think of the total cost of this billing!
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Perhaps the paper was hand rolled from specially cultivated organic tree pulp...????

Unbelievable, the nerve of it. I suppose these bills get run through a computer and the people who set the charges assume (correctly, apparently) that hardly anyone is ever going to look at the individual items?

But on the other hand I expect there are cost accountants at the back of it somewhere, and it'll be to do with subsidising the cost of other tests that would be so expensive otherwise that nobody would use them. That's the charitable explanation, anyway!
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I think you should consider a hospice group home referral with a palliative care option. Talk to the discharger about this. Where we live, patients can get physical therapy under the palliative care option.

The biggest reason why the hospital discharger goes ape sh*t while pushing the patient out door is because of insurance's refusal to pay more than medically required. Once the doctor determines the patient is stable and no longer needs hospital-based services, the race is on to get the patient out the door ASAP. Just imagine if a hospital allowed all of their patients to stay in their rooms for an unlimited number of days but the patients no longer need hospital-based services? The hospital would go broke. If you don't find a place for your mother - then the discharger will pick one for you because they're under the gun from their managers. The discharger should provide you with a list of of places to review. I'm not saying you should give in immediately to his/her intimidation but healthcare is a for-profit business.
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Garden Artist the best advise when the hospital wants to admit a parent is to ask if it is for "Observation"? If they say "Yes" then insist on a full admission or as you found out they can charge you for all sorts of things.
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CM, yes $14 for a small tube of Chapstick, with petrolatum. Even organic chapstick is cheaper (and smells delightful as well).

Your comments are quite amusing; it's nice to be able to laugh at these peculiar (but grossly overpriced) billing practices. The hospital's roving ambassador told me that there are charges for each department, but couldn't elaborate.

So I imagined: $2.00 or so for the cost of the tube; open it in Receiving, add another $2. Send it to Inventory, another $2. Send it to the specific floor, another $2. Inventory it on the specific floor another $2. Who knows where the other $4 would come from? Retrieving it from inventory, perhaps, and delivery perhaps to the specific room? Unwrapping it and recycling the wrapping paper?

Costly business, this moving chapstick from one place to another. And after all that it couldn't even be used. They probably would have billed another $14 to dispose of it!


I never thought of the merchantable for specific purpose application in that sense. I believe there are laws to that effect, and recall vaguely some involvement with them when I worked in products liability firms.

I'm adding that suggestion to my various medical files in case it ever happens again. I could add that the hospital represents itself to be competent to provide specific care for specific conditions, but the chapstick doesn't meet that standard. I can imagine the blank stares if I raised a legalese argument like that.
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Charges for each department. I ask you. [what's the emoticon for head shaking?]
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My hubby had been in ICU for 33 days. Open heart surgery went FINE, but the complications of it where HORRIFYING.

When he was in Post-ICU, weak as could be, sitting up on a chair, holding on to a pillow for dear life, could not feed himself, could not stand up, much less walk.............................THREE people from the financial office came up to the room one Thursday morning and li-te-ra-lly cornered me against a wall.......ok ok , a corner, and told me that I HAD TO TAKE HIM OUTTA THERE, because he no longer qualified to stay in. Ok, I said to them what I wrote just above here. I told them I understand their predicament, but understand mine. When you wheel him to the parking lot, HE CANNOT STAND UP AND WALK AND GET INTO A VEHICLEEEEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

No, you must take him before noon, or else we will charge YOU for another day.................................................

I said: "Thank you for letting me know, that you are going above and beyond the NINE DOCTORS my husband has. You are taking upon yourself his discharge, and whatever happens to HIM as I take him OUT, will be your fault". They handed me a stack of paperwork, WHO KNOWS WHAT IT WAS..............I folded it in three sections *why do I remember that*............and said: I will get to this, when I get to it.

And yes, we were 4 hours drive away, I had to get a rental van, drove him to the Rehab Hospital in our area, and they had him walking, eating, writing, everything in 2 weeks time.

I felt bullied, corralled, evicted, thrown out. Once they had their limit, they were not kind at all.

The most informed we are, the better off we shall be. I do thank GA, CM, BabaLou, Veronica, and forgive me for not noting all the names of you guys, that know THE LAW, and the convoluted stuff we must endure. HOOPS, yeah, it is insane. Oh, RainMom, love to you all.
We
are
in
this
TOGETHER.
Knowledge IS POWER!!!

M 8 8
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Every hospital has a Social Worker. Talk to them about getting your Mom in Rehab. NO hospital wants a readmission and I fear that is what might happen if she were to fall again or have another seizure.
Since this question is about a week old I am guessing your Mom is either at home with you or in rehab.
Hope all is well with her.
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GA, besides the inventory charges, here is what typically happens to run up the bill for that chapstick. First, patient complains (or nurse notices) dry lips. Nurse puts in a call to doctor asking for authorization to order chapstick. Doctor calls back with OK. Nurse calls down to pharmacy to order. Pharmacy tech locates, labels, logs chapstick and sends up to patient floor. Nurse receives chapstick, logs onto patient chart (and bill) and delivers chapstick to patient room. Total staff time spent - probably close to an hour.
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AK, thanks for the explanation. I guess chapstick is an example of "value added" pricing that hasn't really been addressed.
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Thank you for all of these helpful answers in this discussion. Can anyone say more about the "medicaid pending" and what it means? My sister is in a long term care facility and there is an application in to medicaid for her. Should she be able to stay there permanently? Or is this only for a future move?
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Medicaid pending means they will cover from the date of application once approved. Some facilities will accept this, at least for a while. So yes, she will probably be staying.
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