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Father in law is in skilled care nursing home from a fall at home. Rehab staff recommends LTC upon DC and family agrees as just before his fall we were noticing several instances with dementia like behavior. He was never one to spend anytime with family so awareness of this by family was limited. On the surface he can carry on pleasant conversation and can recall recent events but is lacking in very many other areas to be independent and care for himself or make decisions. Awaiting to get a diagnosis as the mini mental exams do not capture all his deficits. He is Medicaid pending awaiting approval. My husband is his POA as we realized quickly that things were a mess recently after his fall. The skilled facility he is at states that upon his DC day they cannot keep him if he doesn’t want to stay, which of course he will say because naturally wants to return home but has no insight to his inability to walk and care for himself. No one in family are able to take him in to their home and that has been made clear to social services. We and rest of family are extremely distressed when DC day comes what will happen and he wants to leave. He of course has been very difficult and argumentative as we have tried not to upset him but plan accordingly for his best interest. We are extremely stressed dealing with all his affairs. And concerned that facility will dump him on us to care for if he states he doesn’t want to stay. Can they do that? Especially since he has not been diagnosed with dementia officially. He hasn’t been able to be assessed by a neurologist. Soonest appointment is made for September.

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If he wants to be discharged, it will be to his home. You then wait for him to be hospitalized again.

Point out to discharge staff that it would be an "unsafe discharge". They are obliged to get a plan in place. YOU are not the plan

You are under no obligation to provide care or housing.
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Do not let him stay with you, no matter what. "Temporarily" taking him in will quickly turn into a permanent arrangement. Last resort is to let him return to his home and await the next crisis.
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In my state you are entitled to have his mental status assessed by a professional psychiatrist, psychologist, or social worker with training and experience in geriatric behavioral issues. This can be done before the neuro exam and can serve the same purpose as far as behavior. It may or may not be covered by insurance he has currently.

Don’t discuss this with him, just do it. If you need to tell him that he needs “an assessment” before deciding the kind of help he needs, tell him that, without getting into specifics about his behaviors.

As stated by others, all family members must be on the same page that no one can take him home. At worst case, you will need to have an aide with him 24/7 in his previous housing until you can get a documented report indicating that he’s incapable of managing for himself.

If the assessment has been scheduled, be like water on stone- say you cannot plan appropriately for him until it is done, prepare a list of the questionable behaviors you have observed, determine objectively what would be needed to make his house safe for him.

You stress is totally understandable, but the fact is that HIS WELFARE depends on full time care, so therefore his future depends on being declared cognitively incompetent.

Final thought- you need to accept the fact that there will be no good, successful, comfortable solution for himself or for you. Dementia is a capricious, vicious, brutal enemy, forcing us all to make choices from the best of the terrible solutions.

Good Luck.
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mstrbill Apr 2020
Just want to input here regarding your stated "worse case scenario" of full time aid. Full time Aids are very expensive and family does not have to pay for that out of their own pockets. That is not their responsibility. If Medicaid covers that, then fine, but family does not have to put that in place out of their funds.
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I'm sorry, I understand the stress level. Keep trying (or your husband) to gently convince father that the Nursing home is really the best place for him now. He'll get 3 meals a day and people to look after him to make sure he's safe. If living with you comes up (don't bring It up) explain to him it is not possible because you can't be there all the time. As far as the working with the Nursing Home, DO NOT sign any release papers (your husband needs to know this). Doing so would not be in father's best interests. Let us know how it goes.
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This is what I did...
Find a facility I was comfortable with and explained that this is a rehab hospital and when you can do ABC and three of your doctors release you then you can go home. Mine accepted that after a bit of a fuss, but it worked.
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Alicew234 May 2020
We did this too. Once he's placed, the facility will have a duty to make sure any discharge is a safe discharge. The facility keeps reiterating that he needs to do XYZ before they can consider him for discharge. And he can't do any of those things.

He is really unhappy about it but we are hopeful that he will accept this new normal eventually. He also was not doing well at home but the extent of his decline wasn't apparent until he went into the hospital.
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If it is an unsafe discharge then I have advised my families that the person needs to be able to organize and arrange his own discharge, including a ride home etc. with the understanding that the discharge is against medical advise. Many times this ends it since cognitively that person may not be able to pull it off. I also tell them to not agree to take them home without the doctor saying it’s safe. It takes more complex problem-solving to work out a way home that often is beyond current ability. If they do manage the discharge I tell families to keep an eye, the person will likely be hospitalized again.
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Where was his home before he was in LTC? Was he living with you or on his own? If he was living on his own they can't make you take him into your home. If he was living with you, you need to make it clear it is not safe for him anymore there, you do not have the resources and ability to be his caregiver. They cannot discharge him to an unsafe environment.
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MKM533 Apr 2020
Thank you for you response. He was living on his own prior to his fall. As we learned more. He wasn’t doing very well at all. Since his interactions with family were limited by he’s own choosing, it was easy to hide or compensate for a lot of his deficits. We are extremely stressed and appreciate your input. Thank you.
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Your husband needs to talk to current facility and ask for a social worker. Explain to social worker that a discharge home would be an unsafe discharge.
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Read your husbands POA. Is it "immediate" or "springing", which means he has to be incompetent for the POA. If immediate, I think your husband can make the decision to have Dad transfer to SN. If springing, then DH can ask for Dad to be evaluated and declared incompetent to make his own decisions. If found Dad cannot make informed decisions, then the POA kicks in. Our rehabs also have SN attached. If Dads is set up like this, you can transfer him over to the other section. Then you tell him a little white lie that he is needs to stay a little longer. If Dad has no money, then u apply for Medicaid. Thats a whole other thread. If you need more info about that, come back. Right now getting him to stay is the main thing.
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Don’t accept him into your home or you will regret it for the rest of your life . Hugs 🤗
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