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In the case of a spouse 350lbs, (knee down) amputee who is bound and determined to return from SKN (4+ person assist) to his home that is not suitable for his disability and the added situation that his wife is both unwilling and unable psychologically and physically unable to provide for his care.

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The facility by law cannot release him if he is 24/7 care. He would need to prove that he will get 24/7 care at home. If he can't prove that, then its an "unsafe discharge". You need to talk to the SW at the facility and tell her you are not his option or his solution. That there is no way you can take care of him nor can you afford 24/7 care. Do not let them say there is help out there. Once you walk him out of that facility, he is totally your responsibility. Ask that a doctor or a DON explain to him that he cannot go home.

For you, see an elder lawyer. If Medicare is paying for Rehab, they won't after 100 days and they aren't a given. He will end up in Long-term care. An Assisted living will not care for someone whobis a 4 person assist. You need to have whatever assets you have split. His split goes to his care and when almost gone, he applies for Medicaid. Once on Medicaid, you remain in the home, are allowed a car and get part or all of the monthly income (Social Security and any pension) to live on. There is more to this but an Elder Lawyer will explain it better. An Elder Lawyer is needed because they are versed in Medicaid.
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GAinPA Jul 16, 2023
From my conversation with his wife, the SW is saying "he can take care of himself"(!) and added that he has been abusive to the staff and disruptive in general and the Director of Admissions wants him out. So it sounds like the SW is not on the wife's side.
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GA, if he is capable of getting himself home with no help, I would advise his wife to leave the premises before he arrives.

She needs to take a vacation, stay with a relative, whatever.

The discharge folks need to know that there is no help at home. If they are happy to send him home as a "safe discharge" under those conditions. she can return and have nothing to do with his care.
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yes, he is capable
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I would ask the SW at the Nursing Facility to call APS and ask that they start the process of getting a public guardian appointed.

Is this person capable of arranging his own transport back home?
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