Any options if a senior is “unable to make medical decisions” and has mobility and home environment concerns? Does the hospital have to present viable options?

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Living with a family member is an option but senior rejects and wants to go home anyway? Senior has memory loss and wants to be discharged and go home. No POA, medical or guardianship. Senior has Medicare. Can hospital force a discharge or are they required to present viable options?

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(Blushing). Helpingson, thank you for your kind words!

I learned EVERYTHING I know about eldercare HERE. "Safe dischare,"" I can't possibly do that", and "won't there be a Medicare penalty on the hospital if she's readmitted within 30 days for the same dx?"

Stick with us! I'm sure there will be a round two.
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BarbBrooklyn

You replied to my original post within minutes. I remembered your comment "Hospital is required to make a "safe discharge". Safe discharge became my theme when talking to her physicians.

Thank you very much for your prompt response when I needed timely advice.

helpingson
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I know it's not much consolation but imagine I'm patting you gently on the back. You made the best of an impossible situation. Well done.
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So sad, Helping. (((((((Hugs)))))))
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Thank you all for your responses to my question ending with "Can hospital force a discharge or are they required to present viable options?" The saga continues, but I'll share some background; maybe it will help others in a similar situation. Your responses have helped me.

My mother spent a week in one hospital and transferred to another hospital for another week preparing for a surgical procedure. As doctors determined she was "unable to make a medical decision", I became actively involved (i.e., doctors would call me for procedure approval). Mom is a private person and didn't want me to know about her more serious ailments (i.e., surgery). The hospital rescheduled the surgery from Friday to Monday and said there was no medical reason for her to stay the weekend and would have to return to the hospital for surgery. So, I'm sitting in the hospital waiting room, it became clear the hospital prepared to discharge her and it was my understanding I would be involved in a discussion with nurses and case manager. Also, knowing the condition of her house (i.e., hoarding, won't let anyone inside EVER), her physical limitations to include moderate-high fall risk and progressing dementia/memory loss, I was uncomfortable with her going home and still believe her house is unsafe. So, I made arrangements for my mother to stay long-term with her “willing” sister, who lives an hour away in another state; however, my mother adamantly doesn’t want to stay with her (anybody) and prefers to go home.

I wasn’t included in a discharge meeting and called the hospital for an update Friday afternoon. The nurse who provided me the most detail about my mom's health said "your mom made it very clear she doesn't want to share her medical information with family and friends."

Before visiting my mom Saturday morning and not knowing the status of her surgery, my wife suggested I call the hospital to make sure she is still there. The nurse said my mom was discharged on Friday. Confused, I didn't think they could discharge her without my consent. So, I drove to her house Saturday morning, saw her walking around outside her house and noticed her odd behavior (dementia-like state, 1,000-mile stare) and inappropriate clothing (i.e., bathrobe, hospital gown). She gets in my car and I offer to buy groceries since she hasn't been home in two weeks. Honestly, it was a stalling effort until I could figure out what to do since I didn't want her to be in her house (unsafe). Then she wanted to get some breakfast, inside the restaurant and go shopping in a store, but she was inappropriately dressed. I called my sister (lives out-of-state) who reached out to several adult services organizations (most closed on Saturdays) and Adult Protective Services hotline said to “take back to ER and request a capacity assessment.”

So I drove her back to the hospital for a capacity assessment, but told her I was taking her somewhere to pick up some literature on her condition that she wanted to read. I left her in the car in the ER parking lot and discussed the situation with a kind woman who worked at the registration desk and understood why I brought my mother back to the hospital. Nevertheless my mother registered herself, a requirement for entry, and was examined by an ER doctor who confirmed her memory or dementia-like issues (i.e., she told the doctor I was her husband and said my sister was OUR child). The hospital admitted her for 24 hours for further assessment and later I learned it was by court order/magistrate.

Although I felt guilty for returning my mother to the hospital and knew my choice could cause my mother not to trust me again, observing her mental/physical conditions over the 24-hour period confirmed I made the right choice. I stayed with my mom overnight and observed multiple doctors, nurses, and case managers assess her. Her primary doctor (hospitalist) and case manager recommended two options: 1) assisted living or in-home care 24/7 or 2) live with a family member. This is when the real drama started.

My mother insisted discharge and wanted to go home, but I continued to try to convince her she should spend some time with her sister. She told me to leave the hospital and she would make arrangements to go home.

I prepared to go home when the doctor and case manager found me in the waiting room. I called my Aunt and the doctor, case manager, my Aunt and I had a conversation on the speaker phone and I agreed to have another conversation with my mother about spending some time with her sister. The doctor encouraged me to be firm with my mom and said that since she lacked the ability to make a medical decision and with the hospital, I was the “Responsible Adult”, it would be within my rights to put her in my car and drive her to my Aunt’s house. So I gathered myself, told the nurse what I was planning to do, and told her not to be surprised if it got “loud” in my mom’s room.

I firmly talked to my mom, told her I was taking her to her sister’s house, but of course she got offended and thought a son should never talk to his mother in the way I did. I believe we both started yelling. Not screaming, but I knew I was louder. She told me she would call 911 and I told her to go ahead and they would escort her to my car.

Upon discharge, she made a BIG scene. The hospital administrator, multiple nurses/staff, and two security officers escorted her from her room to the main lobby. Throughout the commotion, my mom said “a nephew was picking her up.” Eventually, my cousin pulled up behind my car in front of the hospital and said he was taking my mom to his mother’s house (another sister, not the Aunt who offered to care for my mom). He told me he would take her to his mother’s house first and then would take her to our other Aunt’s house to stay for a few days.

As of today, my mother never made it to my preferred Aunt’s house today. Collectively, my Aunts don’t want to force her to live with my Aunt but believe staying with my Aunt is the best option (younger, retired, loving, and financially secure). Her sister whom she is staying with is incapable of providing for my mom. My mom continues to ask all family members to drive her back to her house.

I saw my mom yesterday at a family gathering, three days after leaving the hospital, and physically/mentally she appeared to be doing better. However, returning to live in her house alone is against doctors’ orders, we lack financial resources for in-home care, she doesn’t let anyone in her house anyway due to hoarding, isolation isn’t good for her mental state and her health condition will deteriorate since she continues to cancel her doctors appointments/reject medial advice. I imagine a family member will eventually take home.

Although my mom and I were cordial yesterday our relationship has forever changed and I believe her quest for independence will never stop.

helpingson
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debdaughter: That is actually quite shocking.
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Llamalover47, unless, possibly with home health, like with my dad
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The Hospitalist will not discharge the patient to the home. That is not  the protocol-safety of the patient is. It is usually the rehab unit of the NH once a Medicare bed is deemed available.
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so your dad's back home again? did they get his uti taken care of?
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He was for 2 Days this time, 7 Days three weeks ago. Both times discharged to a rehab. The rehab discharged him to his apartment where he lives alone.
He was in the hospital last summer and discharged to rehab then home. He was admitted to the ER 3 or 4 times in the past 6 months for falls in public, but he was not admitted to the hospital because he was not injured. The falls were from
Standing up too fast after walking for a few miles.
So now he is in rehab again, and we are recycling this drama once again. This is very very difficult-there are six of us siblings and all six are totally burned out. He will not allow anything-not home health, not a cleaning service, none of his kids are allowed to clean or throw away food.
We could not have him live with any of us, everyone works, and more than one hour with him will suck all the energy out of you.
I feel deeply sympathetic for every person posting on here. It is so difficult.
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