My dad has been in NH for 2 years, after having privately paid all the money from sale of his house and is now on Medicaid. He is now in process of being discharged due to an undesirable dementia behavior. NH claims (1) dad is a danger to other residents (he is not violent, he says inappropriate things - very common dementia behavior; (2) NH can no longer meet his needs (no idea how this is so). Trying desperately to find an attorney to help me fight this but apparently it is a very "niche" area, very specialized. I have read everything I can find on the subject myself, but do not feel confident appealing by myself. They mentioned discharging to two of the lowest rated homes on the Medicare website. He is currently in a 4/5 star rated home. Have not received written discharge as of yet.
I am single and work full time and live with constant guilt. No one believes it would be a good idea for me to quit my job, rent an aptmt for the two of us and try to care for him by myself, but I cannot let him be placed somewhere that is actually known for abuse of its residents. Currently NH is 15 mins away from my home and his elderly brother and sister and nephew and I are able to visit him weekly, but if they move him far enough away, he will have no more visitors.
You need to find a new place for him and soon.
“Winning” an appeal, won’t imo resolve the problem, as facility can find yet another reason as to why they cannot provide level of care he needs so your back at same situation few weeks or months from now
OR
the NH can get creative & does a call to EMS as he presents an issue that needs ER evaluation, do he goes off to the ER. & then NH refuse to take him back once he’s stabilized in the ER.... and so he then becomes a problem for the hospital discharge planner (usually a SW) and they will likely be on robo call to you to come & pick him up like tomorrow.
If the NH has sent him & you as his DPOA a “30 Day Notice”, the NH will do something & soon. Has a “30 Day Notice” been sent?
If so NH maybe will do the ER dump, to get him out. If that happens You’ll have to get to the old NH like ASAP to get his things too. Look at the admissions agreement to see what the “bed & property hold” policy is. Could be 72 hours or discarded or placed in storage for 30/60 days but within a fee.
But more likely imo will be if 30 Day done that APS gets contacted.
A “30 day Notice” can be done by facilities. I had them for my mom as her Medicaid application went passed usual 120 day review; application approved at 5.5 mo, so ok. If you get a 30 Day Notice, it’s pretty terse and implies they will do whatever what’s needed to resolve the issue for his health, safety & security. Will likely be CC’d to Medicaid program, perhaps caseworker name or unit #, APS and whatever pro-bono clinic for your area. Your put on legal notice by this letter that they can do something if you don’t. For us it was 2 Notices sent abt 3 weeks apart & certified. You have to respond by writing (I did by fax as well) otherwise they can go hardline & contact APS.
If APS is contacted, likely will be to do an emergency ward of the state placement for him so he gets an temporary guardianship done. Probate court is where these are heard & most have a list of already vetted guardians that are appointed. If this happens, that guardian determines what’s next; family is not necessarily involved at all. If current NH likes the resident, guardian can arrange for them to stay there. Otherwise the guardian can do a lateral move to a facility wherever the guardian has prior relationships that can do the level of care needed & has an open bed. The CC to probono legal clinic is there so you can’t say but but but the elder didn’t know they needed legal advice on this.
So really & objectively, just what is the issue with him?
or is it an issue with family?
So knowing he had dementia going in, and knowing what possible behaviors could develop, they are allowed to take all his money and toss him out when they feel like it? Would have been nice if they had informed me of this upon admission. So families be warned....just because you find your loved one a "good" home, doesn't mean they can't be evicted from the "good" home.
Not sure what you mean by family issues....other than me asking questions about what meds they have him on and possible side effects, also mentioning the possibility of calling in hospice since I was told by his heart doctor that, his best guess was my dad would have 6 months-1year left because he was not med compliant at the time (he did not want to take any meds anymore, but has since been possibly coerced into taking them, so they could get him on some mood stabilizing med I had to sign off on), I don't see how I upset the applecart. Everyone says you have to be their advocate, but I now feel like you have to keep your mouth shut good and tight no matter what.
The staff at sisters 126 bed facility are for the most part always smiling and working hard. My visits are a few times a week, at different times of the day so I see different shifts, and I spend anywhere from 2 to 4 hours at a time so I do see a lot.
Also, I never see NH that accept medi-cal/medicaid patients ever rate beyond a 2.5
Way beyond tweaking a care plan. This is superserious stuff.
Please realize NH did not ”take” his money. Take by definition implies seizure or capture. That is not the situation btw the NH & your dad.
NH provided skilled nursing care services and room&board that he was fully expected to pay for whether it was on a private pay contract or by Medicaid and it’s required copay of his income. But the current issue is not imo about $. Deflecting to $ is just avoidance of the bigger issues.
Your dad has exhibited inappropriate sexual behavior (ISB) & has posed a threat to residents. Its significant enough that NH has determined they can no longer meet his level of care needed & it’s a security issue for them. This is all about health, safety & security for dad & other residents.
NH is being proactive. They are not going to wait till an assault or rape happens to do something. His behavior is beyond the level of care this facility can do. They have to think about other residents & staff safety.
NH has not “tossed” him out; they have not evicted him. They want him to do a lateral move to another NH that can do care he needs. As per your post, you wrote that they have suggested 2 different places to you. You apparently do not like either based on ratings you have read. NH is trying to get something worked out for his placement. If you have not yet gotten a written 30 day notice but just one told to you, they -in my experience - really are trying to work with you to get him moved. Once it’s typed Notice / letter there will be details in his chart to substantiate why facility can not longer provide the level of care needed. If it’s about his ISB that is notated for actions or threats to safety & security of residents & staff, I don’t think another traditional NH will take him ever. If as you’ve posted, the NH has already tried a mood-stability drug with him & issues not resolved, the NH has tried stuff. They really cannot meet the level of care needed. He may need a locked ward male only psych unit. Maybe not long term but until he has the right medication management.
You as dpoa can request an emergency care plan meeting to do a chart review to discuss best options; I’d suggest that you have 2 other family members go with 1 of them only there to take notes.
A ? for you, you posted that there is or were compliance issue for his heart medications. Was this since he has been in the NH? If so, just how was the cardiologist & the MD medical director of the NH dealing with his care plan? If he’s non-compliant for care and continues to be that, a facility can use that as a legitimate reason - just on its own - as why they cannot provide the level of care needed.
The NH is going to run out of nice in all this. They are trying to get things done and give you options. It is in your dads best interest for you to work with them to find a resolution for his new placement in another facility and ASAP.
And you may want to have difficult conversations with your family as to if there were issues in the past with inappropriate behavior by your dad. Happened unbeknownst to you but happened. There are a couple of folks on this site who are caregivers to parents who were abusive. They are incredible people to be doing this imo. Beyond platinum stars to them.
All that was said to me about his not taking his meds was that they cannot force him. He is offered them every day, but whether he takes them or not is another story. Mainly because they have him on high dose of diuretics and he just doesn't want to live that way any more, having to change 4 times a day because of accidents. Believe me I had hard time accepting his choice, but I finally made my peace with it and was going to try to enjoy the time we had left together. But now he is back on meds, so.....
Yes I had suggested 2 or 3 other nursing homes but all refused. I was not aware there are all male facilities, so I will start searching.
We did already have a family meeting with the home, but nothing was resolved.
Thank you for your suggestions.