What do you do if your parent is non-compliant with OT and PT in rehab?

RB, I am glad you have a pathway.

This one may be called Plan A: 'care at home trial'. I hope you get enough support to make it work & Mom improves.

Keep in mind a Plan B can be formulated at any time.

"It wasn't feasible to send her out of town".

Sometimes we have to sort out what we DON'T want to help us decide what we DO want.

No to out of town.
No to home.
No to you being the caregiver.

It's starting to shape the plan.

Well done.

So, she didn't get discharged to the rehab today?

Rbuser1, I’m confused as to what going on Medicaid or Medicaid pending has to do with drinking water or complying with therapy? One had to do with business and the other physical therapy. You have to be prepared to show 5 years worth of bank statements. If you’re unable to or need help with that, seek elder law attorney. Hugs 🤗

I just read some of your posts concerning your brothers estate. Your Mom should no longer be Administrator, she is not capable. And yes, lawyer fees can be taken out of the estate. My lawyer got his when the house sold. Get a lawyer who can become Administrator and hopefully knows Medicaid law. Administrators do not pay out of pocket. The estate pays.

IMO, nothing can be done with brothers house, other than selling it, until Probate is complete. Did Mom inherit? If so, eventually the house can be sold for her care at Market Value. If Medicaid is in her future, Medicaid has a lot to say about a house. And did Mom ever live in it, no, then it will probably not be exempt. She has to have resided in it. There is just too much going on here for lay people to understand. I would have Mom sign nothing in the state she is. And you shouldn't even as her POA in some instances. Admission papers, do not take on any responsibility for payment and everything is signed by you with POA behind ur name.

If Mom is beneficiary to brothers estate, I would not have the NH help with filing for Medicaid. I would get an elder lawyer. Too involved for an average office worker to handle.

RB, I think that's a wise decision. Wishing you peace and clarity going forward.

RB, is mom being recommended for REHAB (paid for by Medicare) or is she being placed for Long Term Care (private pay or Medicaid)?

If she's going for Medicare-covered rehab, I would ask if this is a place she can be placed in for LTC afterwards.

I can't imagine why they would want money upfront. In your shoes, I would talk to the SW this AM about the fact that mom has inherited funds, which may change the situation.

Remembering back to when my mom was placed for rehab (but we all knew it was permanent), the discharge planners at the hospital asked very plainly how much mom had in resources. My brother and I were taken back, but my SIL, the MBA who understands much better how businesses work, gave them a full accounting on the spot.

I recall the discharge planner saying "good, so if she needs to stay after Medicare-covered rehab, she's got a couple of years worth of private pay before she needs to go on Medicaid.". This clearly got us referred to a better tier of facilities--ones that had Medicaid beds but weren't exclusively Medicaid facilities.

All nursing homes want a person to pay up front and in cash. This does not mean that someone has to. It is not a "risk" for them to take your mother or any other person like her. They know they will bill and get paid by Medicare and secondary insurance for up to 100 days. Their "risk" is that they may not get paid double in cash by the new resident.

My friend, when dealing with nursing homes and and their social work staff it is a test of endurance. Don't sign any paperwork that you haven't gone over with a fine-tooth comb or a lawyer. Don't give them any access to any of your mother's banking information either. You also don't have to take all of their calls.

I'm going to tell you what the nursing home or rehab is trying to pull here. Your mother is going to be covered by her insurance (Medicare and secondary) for up to 100 days of skilled care. The NH is going to bill them and collect every penny. They are also going to try to collect it from you and your mother as well. You deal with Medicare personally. You speak with them and ask them to send you proof of how much they're paying. Never take the nursing home's word for anything because they will lie about everything. The business practices of NH's are absolutely disgusting. Robbing, lying, and swindling are the business practices of nursing homes.

The hospital will get your mother placed in a NH if she needs one. If the intention is she goes for rehab and will then be going home, you don't blindly pay anything. Demand a written bill from them every week of her stay. Stay in touch with Medicare like I said. It is tedious, but think in dollar terms. As in you and your mom are saving $10 or $15 thousand dollars because they paid already.

As for this lawyer person who said you should have rented the house to pay for your mothers needs. Fire that a**hole because he's not acting in anyone's best interests but his own.

If the plan is your mother is not being permanently placed in care, demand a written bill weekly for her stay and check it with Medicare. Pay only that which is owed and not a penny more.

Remember, just because a NH says money is owed doesn't mean it actually is.

You can handle this. No one says you have to take every call or go every day. You can tell a vulture from the NH's business office to 'F-off' and hang up if you need to.

Stay strong and hard and do not be intimidated by these people. They don't own you and your mother and they are not entitled to every asset and cent she has.

RB, what a sh!t show! I'm so sorry all of this is happening with such awful timing!

You ARE mom's POA, yes?

How much of an estate are we talking about? What is the house worth?

If mom now has "resources", might it be better for mom to private pay (with monies she's inheriting) to a closer NH that will accept Medicaid down the road when she has run through those funds?

ETA, as long as you can visit once a week. Having her at a distance might be what you need right now.

After I replied to AlvaDeer yesterday, I got urgent calls from lady who works for lawyer saying she had to have Mom sign documents for filing what he owns. I had talked to her previously about how Mom was stubborn and she says well these are legal documents and if she doesn't do what the court requires the sheriff will come find her..
So, she repeated that to me today while I was trying explain Mom's health issues. And I caught attitude. She said she needed a check for X amount to lawyer for filing fees. I said can we pay with his estate account.
Just long as you give me a check. She then says that those monies and the house became Mom's as soon as my brother passed away. Was shocked. Then I really felt like hey, will Mom even get Medicaid since this is going through so fast. Sorry if too much info.
She asked my Mom a couple of questions. Did she remember the lawyers name and something else. So that cya that Mom was competent to sign documents that day.

RB, I'm very confused on a couple of points.

Didn't you WANT a Medicaid pending bed?

Is mom going to inherit a substantial sum from brother?

Why was the sheriff going to come to mom's doorstep?

Are you mom's POA? Mom should sign the admission papers, not you. She doesn't sound incompetent.

You "take back" that mom is manipulating you?

If you reneged on placement, what's Plan B? Take her back to your house?

I'm really struggling to understand what the issues are.

To clarify , I don’t know how easy it would be to get Mom admitted to a different Medicaid facility once she’s already in one. I’ve never done that . Maybe someone else can answer that question . Hopefully they will post .

Some rehab/snf will only admit mornings. Some not over weekends. So try for a stall over the weekend if you feel that's best.

Edit: I see transfer is set for Sunday am.

Mom will need to be medically stable prior to transport. Probably free of IV therapy? Any new flare up of symptoms, brown urine, new confusion etc may stall the process.

PS People arrive in rehab/snf & get bounced back to the hospital quick smart if they are not stable. (Saw it myself a fortnight ago. Rehab, no fluids, cystitis flare up, back to ER).

update: mistakes were made again today. I did not hold firm and took a medicaid pending bed for my Mama in rehab/snf an hour and probably 45 minutes on a good day.
During the meantime my/our lawyer's assistant came to hospital to have my Mom sign papers that were post dated for 9 days from now and we paid with the estate of my brothers (as Mom is the administrator)She then 'explained to Mom all these things and told my Mom how nice she was and just before that had threatened my again that if my Mom didn't sign the sheriffs dept would come to her doorstep when I tried to explain how stubborn my Mom was. And so on, but to my Mom who is really sweet and actually can be to most other people.
Next comes in the case manager who had already called and I agreed and again Mom just was awesome and wonderful.
I drove over to the town where this medicaid pending bed is. It's a semi private room and bathrooms down the hall, like in a lot of places. The admissions lady was there and very nice.
I started getting a bad feeling.
Mind you this is all Friday afternoon evening.
Mom is to be transported up there Sunday morning.
I am losing my mind because things happened suddenly and fast.
Talking with my Mom as I came back by to see her in the hospital and she thinks things are going to be fine and that she is going to get herself better and for me not to worry (Ha) and I'm still kicking myself in the a**.
So, here is another question? Can I reneg on this discharge that was set up under duress?
The lady at the facility asked me if I wanted to sign the papers of admission tonight. I said no.
What are my legal rights. Why do they wait til Friday evening to do this kind of thing.
You would think I'd be happy with this arrangement.
I'm trying to be brave about this. I know I've shared a lot about our dysfunctional relationship, and I know things won't change with the way she is...this feels wrong to me. All of it. I take back what I said about her having me come see her every day to hear complaints and being manipulative if she is close by. I am damned if I do and damned if I don't.

Alva,

You’re right, igloo is a knowledgeable poster who gives detailed information about these things. I hope that she sees this post and weighs in.

When a person is stressed out from dealing with difficult situations they don’t always know what to do in these situations.

You have been dealing with all of this for a long long time.
I would bet we have already suggested, if the nursing home cannot be paid for, that you go to an elder law attorney? If not it is time to. You don't remind us of mom's age. What is her income and is it social security with no assets only? She can get medicaid even if she does need to put her own current funds toward her nursing home costs.
You CAN get her placed, tho, as Igloo observes, with how complicated it is these days it is not DIY.
WHAT have you already tried to get Mom in placement.

You bring up that she will not cooperate to get better.
Yes, perhaps she cannot and perhaps she will not, but whichever it is, it won't change.
So accept that now.
Mom will get weaker. Will sustain falls and infections. Will eventually need palliative care and hospice. You may be looking at the beginning of a slow slide to the end.
And it is likely to be slow and with complications, so I suggest placement lest you predeceed her from the stress and anxiety.

As to the stress incontinence story? Stress incontinence with sneezing, coughing, laughing is exceptionally common in the elderly. I suggest a pad.
Elders lose any normal "drive" to take in fluids. They are not thirsty. They almost always present with blood work showing dehydration. But brown urine is VERY concentrated if this is a healthy live. So again, this is some sign that this may be progressing past point of repair. Your continuing to try to "change mom" is going to be frustrating to you both.

I am so sorry. This is what aging in the USA is about. It surely isn't about quality of life. Only about quantity that isn't a blessing to the elder or to anyone else other than the medical industry.
Speak with the social workers at hospital. Need is correct that a lot of placements are made at time of hospitalization because family simply cannot "do it" anymore. Sounds like you are close to that, or already there.
I am so sorry for all you're going through.

Reading through this post brings a few questions to my mind.

I have seen situations where a person stays in the hospital until they are placed. I have also seen situations where the hospital sends people home in a taxi.

What happens if a person has no one to apply for Medicaid for them?

I also wonder if cases are determined based on if the hospital is thinking about a lawsuit. I was listening to a report somewhere, probably NPR and autopsies were being discussed.

Apparently, it is becoming increasingly difficult to get an autopsy done in questionable circumstances because the hospital doesn’t want to be sued.

So, some people are paying high fees to private companies to conduct an autopsy.

There have been posters who have said that they told the hospital that releasing their family member would be an unsafe discharge and they sent them home in a taxi. What can someone do when this happens?

RB, please remember that if they find you a place that will accept her "Medicaid pending" you can move her later to a different place once she's on Medicaid.

Deep breaths!

So the NH will not take her Medicaid Pending? My Mom had 20k so she was able to pay 2 months towards her care. I applied in April, she was placed in care May 1st and paid May and June. June I confirmed with the caseworker Mom was spent down and they had all the info they needed. July 1st Medicaid started.

Sounds like Mom has Dementia. Have you tried talking to Medicaid caseworker?

This may not be helpful, but just in case..

It's fortunate that your mother is willing to advocate for herself. For example:

'Yes, this is Ms ____ and I need someone to come in and help me go for a walk'

This is amazing. If my mother during past hospitalizations would have been able to use the call button and formulate a request in this way--a request to *move* no less--she would not have been on her back with atrophying muscles for the duration of each stay. 

(In retrospect I understand that I should have gotten her up myself, but each time there was someone telling me it was "not safe" for this or that reason. If my mother had made the request, it might have actually happened.)

Maybe try to stress less knowing that mom is able and willing to speak up for herself (even if you experience these requests as kind of cringey)? Definitely support her in all requests to get out of bed!

That's all from me. Others are providing much better and more specific recommendations. Good luck to you and take care.

I think your answer to the SW or case manager is that mom is destitute and will simply have to stay in the hospital until Medicaid comes through.

Have you confirmed with the NHs that they will not accept a Medicaid Pending patient?

When my father was in the hospital I told the social worker and case manager I could not take care of him any longer at home because I couldn't be there 24/7 because I had to work. The SW with my help started the Medicaid application and they found a NH that would take him while pending for Medicaid. It took about a week but they kept him until they found a NH bed. I didn't have any money nor did my father to pay $14000 upfront (although one of the nurses almost took pleasure telling me that they want their money upfront). I suggest you do the same. Let them find a NH bed and help them get the Medicaid application going, but DO NOT take her home with you from the hospital.

RB, another thought. Keep your eye on the prize here; in order for mom to get the care she needs, she needs Medicaid. Leave the hospital to do it's job and ignore your mother's demands and manipulation. Just get the Medicaid application completed and work from there.

Sounds like your mother is ready to go. You and the doctors need to start listening to her. It's her body, her life, her choice.

RB, you ask "what do you do if".

I think I would step back and let the nurses handle her.

If you don't want to be at her back and call, don't be. Say "no, I can't do that, mom".

If she needs to stay hydrated and she won't drink, let them give IVs. It's not up to YOU to sit there are force her to drink.

I'm sorry if this sounds cold, but you can't care more about someone else's health than they do

I'm so sorry that you're going through this. It must feel like Groundhog Day.

I really like Beatty's list of non-committal responses-I see, let me get back to you.

They allow you to think through if a plan is actually a good idea, and what the expectations will be of you if that plan is implemented.

My nephew recently had a “system is broken “ situation with his mother ,( my sister ) . She had bad delerium after surgery . ( she has had delerium previously this year as well ) .

Case manager at the hospital said Medicare would not pay for rehab , and she would get OT and PT at home . She lives at my nephews house . They kept pressuring my nephew to take her home and telling him that being in familiar surroundings will help. Nephew wasn’t comfortable taking her home when she was acting crazy and they said she needed 24/7 supervision but he works . So then , they suggested my nephew put sis in respite care but there is no money so he could not .

While this was going on , sis had good and bad days. Also while this was going on it was different people all the time that would call my nephew . He ended up stalling by not answering his phone , letting it go to voice mail . Waiting until the end of day to call them back . It gave him time to get a break and it gave my sister time to improve before going home .
So sometimes , stalling , acting alittle dumb buys you some time when needed. Letting the phone go to voicemail can also be done with Moms phone calls. You can listen to the message and call later if it’s not urgent .

Your Mom may bounce back and forth . It is exhausting but she’s safe in a facility and not home with you that way . You can’t force her to drink . Let this play out , it’s buying you time until Medicaid comes through , hopefully Medicaid comes through soon .

The old saying "You can lead a horse to water, but...". Right?

As hard as it is.. does it help or change things if you ask or tell Mom to drink? Nurses & Doctors can ask her, warn her of the consequences, order a swallow assessment if needed, set up IV fluids if needed.

I tried to encourage drinks, warn etc. No change. Now I merely put a glass in view & within reach. I draw attention to it with a gesture (my words are pointless - reply most nearly always NO)

Then I shrug. Oh well. 😶


Mom is refusing drinks, refusing PT/OT. *refusing care*

She may continue to travel the healthcare circuit: hospital - rehab (or if not participating, respite) - hospital - rehab etc - until a new bed is located. One in permanent care.

In your shoes I would speak to the case manager or social worker. Ask how they stop this circuit.

I certainly hope that you are able to sort this out. It sounds terribly difficult.

Poster's previous question, for background:

https://www.agingcare.com/questions/why-is-the-health-and-rehab-so-eager-to-discharge-mom-because-pt-ot-and-st-say-she-doesnt-need-any-m-484250.htm?orderby=recent&page=1�