What are the rights of a patient when a Skilled Nursing Facility (SNF) refuses to discharge them to an acute care inpatient hospital, even though the facility admits it cannot provide the medically necessary care the patient requires? The patient is experiencing worsening symptoms, including orthostatic hypotension and circulatory issues, due to delays in presurgical orthopedic neurorehabilitation, which are critical within the neuroplasticity time window for recovery.
The facility claims it is providing care within its scope but acknowledges its inability to treat conditions such as dehydration and stercoral colitis. Additionally, they refuse to discharge the patient unless a home address is provided or the patient signs out Against Medical Advice (AMA), despite requiring 24/7 ADLs and bowel/bladder care. The patient has reported medical neglect and abuse, and the facility has stated it will only send the patient to the ER if his condition worsens.
How can the patient advocate for their health and safety, ensure access to appropriate care, and hold the facility accountable? They have no access to a treating provider since he requires inpatient acute care interdisciplinary team and this has been documented by outpatient specialists, yet because they are out of network and outpatient they cannot initiate a transfer for a patient already authorized at custodial care level which was never actually appropriate for him.
You might also address the out-of-network issue. Is the person in a Medicare HMO or a PPO? (If he had Medicare + Supplement, he would not have a network at all.) In a Medicare PPO, you can use an out-of-network provider, but at a higher cost. It can sometimes be worth it, so please double-check. In the worst-case scenario, if this problem is not settled until the end of the year, he should choose a PPO option for 2026, even though doctors' services, except for primary care, will usually have a co-pay even in-network.
Sandy- Private Patient Advocate
Similarly, a SNF should be able to provide assistance with ADLs. Again, it's not possible that they can't do this.
Of course, what they can do and what they will do may be two entirely different things.
How complex are the bowel and bladder care needs that the SNF can't do this?
If impaction has occurred, due to the stercoral colitis, then an ER visit may be necessary. However, if the patient has stercoral colitis, but doesn't have a current impaction, then hospital intervention isn't necessary.
Stercoral colitis doesn't mean that the patient will always be impacted, but that this could be a complication of the disease.
Orthostatic hypertension sounds scary, but it's not. I've had it for years. It just means that you get dizzy when moving from a prone to an upright position. It accompanies conditions to do with the circulatory system. In my case, it's varicose veins that I've had since I was a teenager. The patient should move slowly and gradually into an upright position before attempting to stand up.
What's the presurgical orthopedic neurorehabilitation? I had to do exercises post spinal surgery to help the nerves to recover, not beforehand. I'm interested in how this works before surgery, especially with the neuroplasticity window of recovery mentioned. That was something that was important after surgery for me.
The exercises I had to do were very small and gentle stretches which help the nerves to move freely within the sheath that protects them. I was taught how to do this by the physiotherapist, then I had to do this several times a day by myself. Nobody watching me would have known that I was doing my therapy exercises to help repair the nerves.
I'm interested to learn of other types of neurorehabilitation, as it seems that I may have developed another problem with the vertebrae above the one that has the bone graft - I couldn't get up from the teacher's desk and walk the couple of feet to the board the other day. My back just "went" and my legs with it. I hope I don't need further surgery!
How old is this patient?
What underlying illness has led to the patient being so bedridden as to have stercoral colitis?
Is this patient well and competent enough to advocate for himself?
If not, who is POA for this person?
As you can imagine, the colitis is going to be an ongoing problem with someone this ill and debilitated. It is not something normally addressed in an ER unless there is an obstruction and disimpaction is needed. That may be an ER procedure with immedicate return to LTC.
You mention a need of stablizing this patient for surgery. WHAT surgery?
The person you are describing sounds as though he is now suffering from both chronic and acute debility. But the acute isn't in need of hospitalization. Hospitals now only keep patients with acute needs. So an ER would address an electrolyte imbalance, a dehydration problem, and etc. But would not keep a patient stable enough for SNF.
This is truly an individual situation with one very ill patients with needs for surgery who cannot apparently be stablized enough to qualify for said surgery. This is a medical issue that can only be handled by the patient, the medical team and the care facility. And some issues simply cannot BE handled, dependent on illness, age, infirmity and etc.
Sorry, but we can only guess at all that's involved in this apparently very complex situation, and can only wish you the very best of luck. So sorry for all you're going through, but there can be no other ways to intervene here other than those you are already attempting.
The stercoral colitis is a diagnosis that needs immediate treatment, you should be calling the ambulance for transport to the ER.
What happened to your dad that he needs neurological rehab? A Stroke and injury?
What kind of facility lacks the ability to treat dehydration? Most SNFs have an acute care unit with their own doctors and nurses. If a treatment is beyond their scope of practice, they will send a resident to a hospital.
I'm with others here. Contact your Ombudsman for that county where this facility is located. It sounds fishy.
Your scientific terms about his conditions look like a doctor's descriptions and are hard or impossible to comprehend. Can you please convert your scientific descriptions to general our readers can understand what they are to enable us to help you better? Thank you.
Patathome01
The question in my mind is...is the SNF waiting for you to make provisions at another facility for the patient? Is it an insurance (or lack thereof) issue? Someone has to finance the patient's transfer and care in the new facility or the patient can't move. Either insurance has to cover, or patient's money, or you pay out of pocket.
There IS an answer to the problem. We just have to find it. Hopefully, an Ombudsman can help sort things out.
Yes, call an Umbudsman. The facility should have the number posted or in admitting papers. They have to give you the number.
Does the patient have the cognitive ability to make decisions in their best interests?
How old is the patient? Important to know because the "out of network" thing will come into play depending on what health insurance they have.
If you work at this facility maybe suggest to the patient to talk to an ombudsman. If the patient never assigned a PoA and now is in need of an advocate, then perhaps social services needs to get involved. Call social services for their county.