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All the thoughtful answers in this forum have helped. They also raise a question: Where are these doctors who decide when or whether a loved one can return home to live independently? Right now I would LOVE to have anyone say something definitive. After a severe brain injury several years ago, my brother (now 65) lived successfully in his own condo. Last week he fell repeatedly and developed sudden-onset confusion (hallucinating & unsure where he is). MRI shows decreased “white matter” but no new injuries. A hospital nurse told me (unofficially since I don’t have POA) that he needs 24 hr care “from now on.” I live an hour away and work during the day. Today the hospital transferred him to a SNF for transitional rehab. He alternates between thinking he IS home vs. being angry that he’s somewhere else. Today he said “some lady” visited & said he can’t live alone anymore. Who, if anyone, is making decisions? Insights appreciated.

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It's possible that the NH has applied for Guardianship, or that your brother has become a ward of the state.

The social services department at the nursing home will know.
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SisterMoox Nov 2019
Many thanks for your calm advice. The facility social worker said this: (1) They’re not allowed to release my brother to an unsafe environment, BUT he can self-discharge to his home “against medical advice” if he so wishes. (Contradiction?) They won’t transport or arrange for transportation. Given that he can’t walk/transfer/think clearly, this would be a disaster. (2) This facility is for rehab, not long-term care, but they can start looking for a Medicaid LTC placement if he or a POA so authorizes. (3) She advises me to get POA immediately, even if I must lie to him about his need for 24-hr care and my plan to authorize it in his best interest. I’ve never lied to him and don’t feel capable of it now.
Sorry for lengthy reply. I’m usually good at decision making, but right now I’m heartsick and see no acceptable option. Again, thank you for your common sense in the face of my bewilderment.
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It sounds like the Social Worker has explained it now. The lady *telling him he can't live alone* is likely advising him in a health & safety way - not a legal way.

As an 'unsafe discharge' he was transferred to rehab. If 'unsafe discharge' from rehab he will stay in nursing home environment unless he is able to leave himself. It's not holding people like prisioners as such, but even when very stubborn, if an older frail person literally can't walk out the door or call a taxi, they are effectively stuck there.

Your brother is younger & may improve his walking & indeed walk out the door. I have heard of this happening in my area recently. The man had recent surgery (brain tumor) but not deemed incapable at that stage legally so he had the right to discharge himself. The neighbour actually alerted the hospital that the man was back in his house. I think Police were informed & asked to do welfare checks. His Sister (in another state) was then as you are, thrown into this & was advised to get Guardianship. The poor man would not have been able to obtain cash for food or any self care/pay bills etc. Don't know the ending but I believe the Police/Ambulance services were going to transport him back to a hospital - maybe under mental health act if required. His Sister was quickly findng a permanent nursing home & planned to move his things in & hoped evetually he adjusted to his new home. I think she was being helped by a Social Worker as to what she could do within thelaw / as next of kin / health ethics.

Only natural to sit down & have a huge cry - like mourning the brother you had before this. (((Hugs)))

Then continue to reach out for advice (that Social Worker sounded ok) to look at the facts & what needs to be done.
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Thanks! Excellent information about the "unsafe discharge" status. That certainly applies to my brother. Despite daily sessions with speech/physical/occupational therapists, he remains confused and barely responsive, with inadequate signals from brain to body. Yesterday the facility's Social Work Director gave me further info that might be useful to others in this situation: If he reaches the end of the authorized rehab period without enough improvement to go home, she suggests that we present the move to an LTC facility as simply another necessary step in keeping him safe 24/7, "until he's well enough to go back home." He'll hate this, of course (with reason), but at least it preserves some hope for improvement. I'll consult an elder-care attorney for the fine points of keeping my brother's condo (no mortgage) available for as long as possible---in case he really DOES "snap out of this" and regain some of his former independence. My next concern is finding a Medicaid-certified LTC facility that's not just a warehouse. Thanks again.
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Beatty Nov 2019
It sounds like you have an excellent path mapped out. Your brother is certainly lucky to have you! Take care of you too!
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In a rehab or nursing facility, an ombudsman has to be present to witness signing a power of attorney.
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Have an attorney draw up a HIPAA release that doesn't expire and then you can get all the information about his medical conditions and what is going on.

The ones that are provided by the hospital or doctors expire every 12 months.

He may be able to understand and sign for you to become his POA, but this is a fudiciary responsibility and you should understand exactly what you would be taking on before you do that. He would need to have his signature notarized and they may ask if he understands what he is signing.

Check with the homeowners insurance company to ensure that his insurance will cover if the home is empty because of long hospitalization/SNF stay. Most do not and you only find out if something happens. He probably has HOA fees as well that you want to find out if he can pay those, SNF is expensive and he may need Medicaid that will say he can't pay anything towards his home, no property tax, insurance, utilities or anything.

It is a tremendous amount to understand and deal with. He is blessed to have you.
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Hi Sister, maybe you could get your brother to agree to give you POA without lying to him. Explain that you are going to help and that your involvement will be in his best interests. It would be a start and possibly open the door for you to get more information about his condition and options for care. Best of luck.
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