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My mom's (92) discharge date is in a few days. She is in the behavioral wing because of aggressive outbursts and hallucinations (she hit and scratched my dad 92) due to dementia. Since she's been there she refuses her meds periodically which is frustrating because they can't get a good baseline as to what dosage (risperidone) will be of most benefit. Since she will be staying past her designated discharge date, her Social worker advised me that they would have to appeal to the state for an extension. She is not on Medicaid, but Medicare with a top tier supplement plan. Has anyone else experienced this?

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Abby, how are things with your mom?
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There is time limit in the stay in an acute psychiatric unit. When patients need additional care, they are referred to a long term facility. An appeal to the state for an extension is not going to work. Acute psychiatric units are supposed to provide short term hospitalizations to get patients stabilized on medications and out. The social worker can help you find an appropriate facility that provides long-term care. Incidentally, medications are of little use, because of non-compliance and also because of severe side effects. Most of all, your mother needs to be in a facility that provides a controlled environment. Furthermore, antipsychotic medications can cause strokes in the elderly.
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Hmmm, it occured to me overnight that if mom is in this facility as an "involuntary hold" it means that there might need to be state approval to hold her longer.

Abby, hope all is well and that they come up with a plan soon.
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Could it be that the social worker assumed she was on Medicaid instead of Medicare? That's the only reason I could think of for her bringing up "getting the state's approval".

And I wish you all the luck in the world trying to get an answer to anything.

I wish you the best.
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Abby, I think you need to find either the SW's supervisor, the patient advocate (which I believe every hospital has by law) or the legal department.

Ask "why does the State need to approve a longer stay? Is my mother under State guardianship at this time?"

Insist on an answer to THAT specific question.

I would be very cautious about bringing your mom home to be cared for by sis and dad. Especially if you are thinking about discharging her against mefical advice.

Are there other caregivers lined up for home?
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Abby, is the State involved because the facility was granted emergency guardianship?
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Abby2018 Dec 2021
Barb....she was transferred from our local hospital as an emergency involuntary patient. Although the hallucinations are under control and she has not shown aggression in the past 10 days, she is not med compliant. More hit or mis depending on her mood. Her physical health is deteriorating since she eats sparingly and is not taking fluids consistency (not to mention meds sparingly for her heart and hypertension). At this point we would like to take her home where she is familiar with her surroundings and family. Although a challenge, we were able to eventually encourage her to take her meds. She enjoyed her food and we made sure she was getting enough fluids. She IS moody, demanding, and controlling, but we had our way of working around it. They have been vague as to why they are holding her, and really don't have a goal plan moving forward. Social worker has not been helpful in explaining details and I have yet to speak with the dr. My only conversation has been with the APRN and the nurses who work with mom on their shifts.
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Medicare will not cover this past a certain specified time without applying for an appeal. It sounds as though Mom is going to need placement. Has that been started in the discharge planning? I would trust and put yourself in the hands of the Social Worker who is likely your best bet to get this done, hopefully with an extension. So sorry you are going through this.
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Abby2018 Dec 2021
Thanks for your concern Alva. Dad wants mom home as she isn't doing well under their care. I guess I'm confused as to why the state has to be involved and go to court with the additional expense of an attorney if her stay needs to be extended. Can they keep her there without family consent? The social worker is not very clear with explanations, and being an hour and a half away it's difficult to get there for the limited visiting hours. Plus they were in lockdown for two weeks and just yesterday re-opened. I will call again tomorrow to plan discharge, I just fear resistance. My sister will be taking care of her in my parents home, so dad won't be alone with her.
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