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You tell him what I tell my friend (of 19 years who is 88). I am his POA.
NOTE:
-----Care facilities by law cannot release a patient IF they do not have the care needed at home. Double check this 'fact' -
-----It is true for my friend. Until I get a room ready for a live-in; until I get a live-in; until I get the new bed, and insure there is room for a wheel chair everywhere, caregivers lined up for the 16 hours of care he needs, he cannot be released.

* If he checks himself out, he will NOT be able to get any medical services again (at the facility he is currently at); he loses all his rights to that care. For how long, I do not know. Ask the facility.
* "If you check yourself out, I will not be here to take care of you. You will be on your own."
- While this is your spouse and I'm helping my friend, this may not 'sound' right - telling a spouse you won't be there to 'pick up the pieces,' - however it is critically important that you stand your ground and NOT be the 24/7 caregiver who is not equipped to do what is needed. You WILL burn yourself out. Period.
* Husband is unable - due to brain chemistry - to think beyond "I want to go home" - it is fear and anxiety, and dementia talking.
* Do not argue.
* Agree; learn what he feels and address his feelings, not the situation. "I know this is difficult for you." "I hear you that you feel . . . "
* Of course he wants to come home. Are there ANY patients / people with dementia needing 24/7 care in a facility that do not want to come home?

Depending on his memory, tell him "I'm working on it." Stop the argument before it starts.

Gena / Touch Matters
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Is he competent? That is probably the most important question.
If the answer is YES then he can make decisions and he can leave the Nursing Home.
If the answer is NO then he can not check himself out.
If the answer is no you need to have a doctor complete paperwork indicating that he is not decisional or is not competent. Once that is done then your husband can not check himself out.

If with the Parkinson's you are fearful that he may become violent you need to tell the doctor as well as the Nursing Home that you are afraid for your safety and that to discharge him would be unsafe for you.
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Taarna Jul 2021
Thanks for your well thought out reply. This is exactly what I would say as an RN.
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I had a friend who was competent to make her own decisions. During a rehab stay it was determined she needed 24/7 care probably because of her Parkinson's. She could not afford aides and had no family willing to take on the responsibility. She was an "unsafe" discharge and the rehab could not release her. She was transferred to the NH side. My daughter worked in rehabs/NHs for 20 yrs and says this is how it works.

OPs husband is in a NH because he is 24/7 care. Thats part of the criteria. If she can't guarantee 24/7 care in the home and she is unwilling to do that care, he can't be released no matter how competent he is.

And she shouldn't believe a SW when they say they can get her help. That "help" may only be a few hours a day. Then its the help showing up on time.
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help2day Jul 2021
Nursing homes are not prisons. There is nothing to stop a competent person from leaving a nursing home IF they have the means and wherewithal to do it. That said, the OP's husband, I doubt, has this option. If he has Parkinsons severe enough to require 24/7 nursing home care, he's probably beyond "checking himself out anytime". Her husband can say whatever he wants, but in reality, he's probably not going to walk out the door.

It's so hard to discuss a spouse or parents' diminishing health and capabilities. Perhaps a meeting with the NH's physician will help to convince her husband to stay. Many times, it takes a "person of authority" to convince someone. His Parkinsons is only going to get worse, so will his cognitive abilities. My Mom insisted on "coming home" even though she had a broken leg. It was heartbreaking but I would keep saying when she is healed or when the doctor said so. I knew it would never happen. It seemed to placate her at that moment. She passed 3 months into "rehab".
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If your husband is not mentally competent, then you need to make sure it is documented by a doctor and copies must be in his files. In that case, all decisions about his care and disposition should be directed to you, not him.

If he is mentally competent, then he legally could check himself out - any time he wishes. Make sure that social services knows that you will not take him back home because you do not possess the ability to care for him. Let him also know that you love him but do not have the ability to care for him at home. If he "checks himself out," he will most likely be dropped at a shelter who will most likely call EMS since they don't have the ability to care for him, and he will be placed into another residential facility.

All that being said, usually there is a reason he is threatening to check himself out. Gently and kindly probe into what is the problem(s). Let the charge nurse know about his concerns - some may be justified and others may be misperceptions based on his disease process. If it is the latter, then his doctor can be consulted for adjustments in his medications. He might need a mild anti-anxiety agent to help him relax in the face of a world that increasingly looks threatening to him.
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Educ8r Jul 2021
Taarna, yes, yes, and yes! Excellent advice. Thank you for sharing your knowledge and experience.
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My husband was diagnosed with Parkinson's in 2003 ( @50yrs old). About 4 years ago the hallucinations became severe such that all senses were involved and he was acting out in response. also he became psychotic. He was eventually prescribed Nuplazid a medication specifically designed for people with Parkinson's dealing with this issue. It has been a game changer. A night and day difference. He is more himself (with mild dementia-like issues) but no more hallucinations or acting out. He sometime thinks he is more able than he is but I can usually get him to realize that that is not the case. We also occasionally use CBD with a 8:1 CBD/THC ratio to address his anxiety issues. With his mental health issues addressed his physical needs are more manageable. I am fortunate in that I was able to retire 3 yrs. ago as his physical needs have increased. We have yet to address when it will be time to move him to a facility.
All that being said I fully understand that the time has come that your husband needs to be where he is. You may want to talk to his doctors about addressing the mental health issues that are contributing to his requests to go home. Perhaps a change in meds as someone else mentioned would make a difference.
Best wishes for a good solution
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Have you tried just being honest with him, by letting him know that you don't believe he is able to come home, as you can no longer care for him, and also letting him know what a burden that will be for you? Most folks in any nursing facility usually go through periods where they want to go home. It's up to you to remind him that he's where he needs to be for his safety and care, and that as much as you would love for him to be able to return home, you're just not able to provide the 24/7 care that he now requires. It might not hurt to have the Dr. at his facility share that sentiment with him as well.
Has he been diagnosed with any dementia along with his Parkinson's? If he has, your POA would have the final and only say about whether or not he could return home.
I wish you well as I know this has to be very stressful for you.
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My DH insists almost daily that I am treating him wrong by my assessment that we cannot at home provide the care he needs. Medicaid in a nursing home is the only safe option for the two of us. Caregiving for him at home would require 24/7/365 assistance for me, to provide for him. One person cannot survive his controlling, demanding behaviors.

Sometimes he is able to seem “normal,” and that could be why he cannot accept the reality. Which is … diagnosis, prognosis, and recommendations must be made by taking into account the *other* normal for him: dangerous combativeness, destructive demands, etc.
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You have No recourse. If he wants to come home, he should be able to.
You switch places with him for even a week and you'd want to come home too.

Just line up Care Giving Help and try to work it out.

If your husband has been in the Military, you can call the VA and get Caregiving help, up to 30 hrs a week.

Dexpending on his illness, you can get some Care that his Insurance Co will pay for Like Home Health, where a Nurse comes and checks on him once or twice a month, where an Aide comes to help him bathe or shower 3 times a week and will even send Therapists 2 - 4 times a week.

It will be an adjustment having him home but he will be a much Happier Camper.
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Imho, this would be considered an unsafe discharge from the nursing home. He should not be any deciding factor since he's in the nursing home for a reason.
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If his care needs are too high for your home, there are many good replies below how to deflect, avoid or prevent that from happening.

The first hurdle can be mental/emotional though..(IMHO).

Some get caught because deep down they think they should obey their spouse. They think they must make them happy. Do what they want or wish for.

I am not saying that is you!!

Just that sometimes that is the big hurdle. I've seen it over & over with my family & friends. Someone *wants* to come home & so it is done to please them, to avoid conflict, to obey - despite contrary medical advice or just common sense.

If you truly think he should not come home, you will be much able to follow that course without guilt.
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