Rehab center is making all kinds of excuses why he should not go home. What right does my sister have to take her husband home?

If you have all that he needs at home, and you can get home therapy thru his insurance, if you can watch him or have aides watching him when he is awake, well maybe they just want money, but make double sure with his doctor, not the rehab place but his main doctor before you make any decisions. His primary care dr. will know what is best.

This is what I found in reference to Medicare paying Against Medical Advice.

"Several sources, including a representative from Medicare, have confirmed that Medicare has no policy to deny payment of hospital charges to patients who leave AMA. Payments are made based on a determination of whether care was medically necessary, regardless of how the patient is discharged."

An article about insurance companies. It was found that Insurance Companies do not pay is bunk. Drs use it to keep patients in the hospital. It also says that some people who leave AMA are usually back in 30 days. But, that is a very low percentage.

www.uchicagomedicine.org/forefront/news/2012/february/do-patients-pay-when-they-leave-against-medical-advice

So it comes down to...you can leave a hospital or rehab facility if you want to with no repercussions from Medicare or Insurances.

I would talk to his primary. If facility feels he needs more therapy or speech therapy homecare maybe able to be set up for that.

TG I have never had to be in rehab. After dealing with Mom I swore she would never go again just to get her strength back. Therapy is just a fraction of their day. The rest of the time they are ignored. Activity time is a joke. I only saw one rehab that went out of their way to have something going on all afternoon. Thats the NH Mom was in. I think the elderly with Dementia just decline. I have seen them look so much better when they are home or in familiar surroundings.

Rehab facility owners obviously want to keep their beds full. Staff at rehab facilities want to keep the beds full of EASY patients. Make no mistake. Staff manipulates discharge dates ALL THE TIME. Your sister is there doing all the work. Easy for them. They're going to hang on to him as long as they can - regardless of who is paying the bill. The doctors who service rehab facilities "pop in" once in awhile, and rely heavily (if not entirely) on staff reports. They know what to say to keep someone and they know what to say to have someone discharged. There is only one reason patients would be discharged too soon - it's because they are too high maintenance, or they have a bad disposition. (Mean and grumpy.) It has nothing to do with "the level rehab it is" or if it is a "good one that is in high demand ... so they want to move patients out as soon as they can". That's nonsense. It doesn't generate more revenue to move patients in and out quicker. If the bed is full, it's full. There's a finite number of beds. It's not the number of patients served, it's the number of nights the beds were full. Demand is not an incentive to discharge too soon. (Unless someone is staying for free. (Ha ha.) Like I said, an easy patient will be kept longer, high maintenance and nasty people will be cut loose asap.

Two Questions:
1. Is your brother-in-law able to make his own decisions? If so he can leave anytime he wants.
2. Do you have POA, if he is unable to make his own decisions? If so, you can make a decision when he leaves.

The home cannot keep a resident against their wishes. A resident has a right to refuse care and can leave anytime they choose.

Things to watch out for:
1. If the home feels like a resident is going back to an unsafe environment then they still cannot refuse to let them leave but upon leaving they may call Adult Protective Services to make a visit to ensure the individual is safe.

2. If the doctor refuses to write a discharge order the home may not give you the individual's medication when they leave. They can refuse to do this. If this happens call his doctor and get new prescriptions.

Summary
It sounds like there is a plan for your bother-in-law has a good plan for him when he gets home, he has a caregiver and his home is "set up" for him. There should be NO reason the home does not allow him to go home.

If the home continues to refuse to let him leave you can call the Ombudsman Office, they can help you with this.

Good Luck!

Leaving against medical advice can leave a bad mark on the insurance.
Talk with primary doctor - could make order for in-home care so its not going against medical advice.
If you have not received a return call from a doctor after twice calling - physically go in.
Blessings
hgn

A couple observations and least compared to our experience with rehab, I don't know what level rehab it is but good ones that are high demand in my mom's area want to move patients out as soon as they can and often the opposite problem can exist where they are sending people home before family thinks they are ready. But the other big guideline here is insurance, assuming he is on Medicare (and I imagine its the same for all insurance) they require reevaluations frequently and have very specific requirements for covering rehab so he would need to be meeting those unless they are being paid like a NH, I'm not clear on those differences and the parameters I know are different for intensive rehab and then the next step down too. Seems to me the two questions to get answered are, why do the feel he shouldn't go home yet, what is he getting there now that he can't get at home and if he still meets Medicare's levels for in patient rehab how much longer will that be the case? Have a meeting with his care team to get a clear picture on their reasons for feeling it's better for him to say there and see if the reasons make sense, if the PT, OT and or ST are all on board with that still being best for him. His personal doctors would be worth contacting too, see what info they are getting in updates and from his records maybe they can shed better light on it. My guess is if she is going about it the right way, asking questions of multiple professionals involved she will either decide he should stay a bi longer or they will back off and suddenly feel he's ready to go home, not wanting to raise any red flags about why they are keeping him longer than really necessary if that's the case. But ultimately he can refuse care and decide to go home and she can probably do that for him as well if he isn't able, though home might not be the best choice if he isn't... If he does still need care or will benefit from care he can't get at home there is always the option of moving him which might not be easy but I think can be done if they are that unhappy with his current situation. Again his PC or private specialist would be helpful advocates here.

Your sister should talk to the Ombudsman and state her claims; additonally, it would be a good idea to back them up in writing,

As long as they are getting paid, Of course this Rehab place is going to make all kinds of lame Duck Excuses.
Complain to Adult Protective Services and get him Out, ASAP. They have no right to Hold him there, You have a Right to Sign him Out.

A person has a legal right to refuse medical care. You can always sign yourself out of a medical facility by signing a form saying you are leaving "againist medical advice". They have you sign this form so that they are not liable for what happens to you if leaving was a bad idea. A person also has a right to be treated in the facility of their choice (as long as the insurance is ok with the choice). What does the family doctor say about the situation?

Your sister has every right to take him home. And she can file a complaint with the state's ombudsman too. Legally, the rehab center cannot hold him against his will. Talk with APS and see what can be done. Also, talk with an attorney. Good luck.

My sister (dementia) lives in a nearby Assisted Living. She suddenly developed pseudo-gout in her knee and had surgery for irrigation/drainage. Was in hospital
5 days then off to local rehab. She sat in bed nearly 24/7 except for 45" of PT/rehab each morning in their gym. Her dementia seriously increased along with decreased physical strength. The Rehab Dr. (different than her primary Dr.) wouldn't return my calls/messages nor was available @ rehab to meet with me.
After several days of being ignored I announced I was returning her to Assisted Living where she actually had a life, using her walker to go to dining room 3xday,
walking to her bathroom, visiting with residents, etc. = much more physical, mental, emotional activity. The Dr., whom I NEVER met, apparently ordered the discharge minutes before we left. Rehab services are paid for 21 days and we left on day 15. She did beautifully after returning to her home.(AL) Home Health
evaluated her for PT but my snarky sister declined. "Get the Hell out of here. I know how to walk." Bottom line, Rehab wants to bill for 21 days if allowed. Ethics have disappeared from the equation.

Talk to the doctor who is involved in his care. Tell him that BIL wants to be released. Ask if PT, OT can be done at home. Your SIL is now paying for his care. If paying will be hard on them, tell the facility there is no money. You can also call Medicare and see if they feel he can be discharged.

In what way is he not being taken care of? Is he not being bathed or changed? Are they not feeding him? His calls for assistance being ignored? Not receiving therapy? Wearing dirty clothes?

My husband was in a rehab facility for 4 1/2 months. It was not like home. Each aide had 10-15 patients to care for. Immediately before, during and immediately after meals, requests to be put back in bed or into a chair had to wait. It’s a different world there. No one patient is any more important than another.

If you feel he suffered true neglect, find the ombudsman in your area and fill out a report.

I’m not sure, but I’d check with his insurances to make sure you aren’t endangering his coverage if you pull him out against medical advice. Call his doctor and find out if he/she knows what’s going on.