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He has been in this facility since last October. He is 61 with early onset dementia and he is difficult to care for. He is ambulatory and he wanders into other peoples rooms, and has gotten combative a few times. They sent him into the next state 45 minutes away to a hospital to help with the behavior, said they would take him back, but then refused to do so. The hospital says his behavior is controlled.


Now the hospital is trying to send him to a substandard nursing home 45 minutes away from home. (Substandard as defined and documented by the state of Michigan).


I’m trying to get the state to force them to take him back, since this is clearly a violation of the law. So far I’m not getting much traction.


Has anyone else successfully fought and won in a case like this? Any suggestions welcome.

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What does the contract say? Many NH can (and do) "evict" residents they feel would be a harm to themselves and others. This is oftentimes spelled out in the contract that is supposed to be gone over, by the admission office.

What probably has happened, the NH has used the Hospital to "dump" him, and as far as they're concerned, he has been "discharged" from their facility. Don't look for much if any help from the Hospital. If the NH paid the Hospital a "referral fee", the Hospital is going to look out for the NH first and foremost.
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"The hospital says his behavior is controlled." Wasn't that the purpose of the hospital stay? To adjust his treatment plan to change his behavior?
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Do they have a legal obligation? Presumably their promise to take him back was conditional on the hospital's evaluation and a reassessment of his care needs after the initial 2-3 month period. If he now met the first facility's admission criteria and the facility was just trying to weasel out of it, wouldn't the hospital be arguing? They must know what the law is and, you'd have thought, would be better placed than a family member to insist on its being applied.

The OP, I think, refers to Medicare and Medicaid as authoritative sources of information about admission criteria and codes of practice rather than because either is actually funding her husband at this facility? So it doesn't sound as if money is the key issue. If he's self-funding, he may be extremely lucrative - but not lucrative enough to compensate for the risk to other residents from his wandering and combativeness. Where is the line between "difficult" and "not possible"?

It's a living nightmare.

Would it be possible to negotiate his readmission on condition that additional dedicated support staff are hired? Would that be affordable/doable? Are you still in communication with the facility? What has the state had to say so far?
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If he's ambulatory why not bring him back home? How bad off is his dementia? I know there's services for people to stay out of nursing homes, even if they have dementia. I'm in NYS, so I'm not familiar with your state's organizations.

When I still lived in NHs, the "problem" resident's usually required what they called one-on-one. 1st they need the staff to provide that service though. We had resident's that wandered. They were given wander guards. It was a bracelet put on their wrist and if they left their unit an alarm would go off. For the more difficult resident's, they were put on a lockdown unit and then the most difficult were shipped out to other facilities.

I can't imagine how frustrating this must be for you. Good luck and try to keep your head up. One person CAN make a change! Always remember that!
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But they are offering him care, just not in the NH you prefer?
If he is a wanderer & goes into other resident’s room and disruptive, the NH can use these facts to refuse him. They may require family provide sitters in addition to the NH staff.
I think, while it may not be what you want, if your husband’s behaviors cause other residents safety to be at risk, they can use that as a reason not to accept him.
And I don’t know of anyone fighting the NH decision & having them reverse it.
Such a sad situation. I hope it works out for you two.
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Have you been in touch with the Michigan Elder Justice Initiative, Tboosrn?
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CM -- I think there is an acceptable alternative -- the NH that promised to take him back and has a legal obligation to do so. States have been very lax in holding care centers accountable, and it is high time that they start!
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Tboosrn, what a sad situation! I think it is fairly common for a care center to send a resident with problematic behavior to a psych facility for evaluation and medication adjustment. I wonder how often the care centers then refuse to accept the resident back. What a horrible situation.

Did the NH continue to charge for his bed that they presumably were holding for him?

What excuse does the NH give for going back on their word about taking him back? Have you talked to the Ombudsman? The real reason is probably financial. An NH would love replacing their Medicaid residents with private-pay, and with a high rating that is often feasible. This is not only unfair to the residents, but also to other nursing homes. Surely it is easier to maintain a high rating at a profit if you do not have residents who require extra care and attention. So the "dumping" NH keeps their 5 rating while the NH who receives all these difficult cases struggles not to have their ratings slip even further.

I wish you success with your crusade. I know that AARP has a lawsuit about NH dumping in CA. Have you tried contacting ACLU? This is certainly a violation of your husband's civil liberties.

If you have the time and resources to pursue this, please do, on behalf of all the nh residents who don't have an advocate.

Keep us informed! (I hope someone here has experience to share with you.)
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To clarify: Nursing home compare.gov clearly outlines how every nursing home performs. It’s not a secret. And since this is a 5 star facility where he has been and I want him placed, I am not concerned about their ability to care for him. They are not refusing him because they can’t meet his needs. They are trying to dump him because he’s difficult.

This is against the law. Medicare and Medicaid conditions of participation clearly state being difficult is not a reason for discharge. What I’m finding is that states do not often enforce the CoPs. I am wondering if anyone has ever successfully forced a facility to adhere to the law.
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The facility is refusing to readmit your husband because they are unable to provide the level of care he needs.

What sort of care do you suppose he would get if the facility were forced to readmit him under protest? - even if that were a legal possibility, and I really can't imagine how it could be made so. How can you force a facility to provide a service they're not competent to provide? The hospital has succeeded in stabilising him, which must be a great relief for the time being; but they have resources in terms of staff training, prescribing authorities and probably deprivation of liberty as well which the facility simply doesn't.

This doesn't alter my enormous sympathy for him and for you, and my agreement that there is a terrible dearth of services for people who are comparatively young, fit and well but living with dementia. It is a desperate situation.

Since the NH the hospital is trying to transfer him to has been inspected and found wanting... have you tried asking anybody at the state's offices what facilities are performing better? Maybe there's an acceptable alternative.

I'm so sorry for what you're going through.
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