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My mom is in the hospital ready for discharge ( which I disagree , already filed appealed it was denied. She has a collapsed lung and on iv antibiotics for Mrsa blood infection) she needs to go to a nursing home that offers long term care, the one the social worker found is 45 mins from me and the reviews are terrible, I don’t want her to go there I won’t be able to see her often. Do I have to accept this place?

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Nature, I’m not sure that most of the responses are so different from what you heard before. If the SW found the only bed available, then if OP turns it down, there is no NH admission and Medicare isn’t available full stop. Most SWs are better informed to find a place, and it’s really difficult for OP to do it at short notice. The Hospital couldn’t be forced to keep the bed occupied, just because the daughter is ‘picky’ - and there is probably no definition or limit to ‘picky’! But you are right, best to move on with a bit more time to go on waiting lists and check regularly for vacancies.
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Theses responses are very helpful, but different from what I thought. When I worked in Utilization Management (probably called something else now) I heard from the social workers that if there was only one nursing home bed available anywhere & the patient was ready for discharge, they had to go to that bed or Medicare wouldn't pay. Once in that first facility however, then you could investigate & move to another place once a bed was available.
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I believe hospitals contract with agencies and long term health care facilities. They want and like to make arrangements without asking the family or POA. While I do not know, hospitals may have $ contractual arrangements with facilities or simply (not so simple) have built relationships with facilities' personnel and know who to call, who they like). It may also depend on which facilities are available and money / insurance issues/concerns.

* If they make arrangements or tell you where your mom 'should go,' ask the social worker WHY THERE?

* Hospital personnel shouldn't have any legal right to make these determinations, without first consulting with family. It is my understanding that you (or certainly the POA) makes these decisions.

* Some social workers may be very helpful. They should discuss the options with you / the family to come to a mutual decision - or the decision the family wants. They provide input based on what they know being in the field.

* In addition to writing us asking, you need to consult with:

1. The social worker. S/he 'may' believe s/he is helping you or doing you a favor setting all this up. Regardless of what they believe, they should consult with you / family before making any arrangements. They SHOULD go over all the alternatives with you / the family. This is the respectful way to proceed and some/many hospital personnel do not do this from my experience.

2. Contact the County on Aging; or if necessary
3. Consult an attorney specializing in elder law.
4. Get your POA documentation in order asap.

Gena / Touch Matters
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My only comment is that some of people here on the forum think you can just send her to any of the NHs that you choose. It is a two way street. The NH has to be willing to accept the patient!
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Tell discharge planner...not acceptable...check out others and send her one you want.
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No you don't. You can take her home with you provided you can care for her. Ask dr to order some home health (nursing, etc) to manage meds or IV (if that goes with her). You also have the option of finding your own nursing home closer to you and reviews you agree with.
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Here is how you get her closer to you:
1 - Rehab unit must be able to take MRSA patient (not so easy to find) and be able to do IV medications (most can do this)
2 - Rehab unit must take your mom's insurance
3 - Rehab unit must have an opening now

If you can find a place that meets those criteria, then let the hospital know and they will send her there.
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TaylorUK Dec 2021
I don't know whether the hospital with definitely send her there, but the principle of finding a unit and one that fits the criteria given by Taarna seems to be a very good starting place. If you can find a place that suits you then they are much more likely to be helpful than if you just say you won't accept what they have found.
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The social worker at the hospital with my husband's illness responded when I offered some other names. Medicare rates nursing homes. Look in your area, right down the best ones and give her the list. In addition, after was there, and it was for rehab, I wasn't happy with it. Another hospital's manager told me I could switch him to their hospital. It was perfectly acceptable. So do disagree but politely and asking for her help. They are swamped, and OFTEN don't really know about the places. Perhaps, they can address that problem first and then choose long-term care facilities (often they are the same place). Good luck.
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The social worker at the hospital with my husband's illness responded when I offered some other names. Medicare rates nursing homes. Look in your area, right down the best ones and give her the list. In addition, after was there, and it was for rehab, I wasn't happy with it. Another hospital's manager told me I could switch him to their hospital. It was perfectly acceptable. So do disagree but politely and asking for her help. They are swamped, and OFTEN don't really know about the places.
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Monika001: Unfortunately, hospitals are a business and as such, they no doubt need the bed that your mother was occupying for another patient. However, you should speak to the social worker; as a discharge planner, that is the individual's job.
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If you can self pay.. you can place her in a NH of your choice. If she is on medicaid you can still place her in a NH of your choice that acceps Medicaid. In my case my mom was going to have to APPLY for medicaid. My elder attorney advised me to at least be able to self pay a NH for 3 months. ...that way once my mom applied for medicaid...she would be able to stay in that NH ..Medicaid pending..I was able to place her in a NH of my choice... she was able to self pay for 3 months...on Oct 1 I applied for medicaid for my mom...her file still has not been reviewed. So she has been staying at the NH just be paying them her SS check. If she is approved then...Medicaid will back pay the NH. If you CAN'T self pay several months ...GOOD LUCK in finding placement. She will need to be placed in a Medicaid Pending NH and it may not be good. NH where my mom is costs $8000 mo.
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‘Can I refuse’? My guess is that you can certainly refuse, but if so you are probably on your own. If the hospital staff member (whether or not a qualified SW) has found a licensed place with a bed, they have done their job. That’s why accepting it and then looking further may be the best option.
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First Social Workers are College educated in SW. They aren't SWs if they don't have a degree. They are office workers. I applied for a job at a NH where it was going to be my job to fill empty beds. When a bed became empty, I was to call every Hospital to tell them I had a bed open. I am not a SW. So this SW is calling around to see what beds are available. The one she found is 45 min away. May be the only one with a bed available. You tell her no, too far away and rating is lousy. Then ask that she continue to look. In the meantime, you can look too but it is her job to find a suitable place for Mom.
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It makes sense that a less attractive NH is more likely to have a bed free. Like the previous posters said, you may have to accept this as a temporary placement, while you do the leg work of checking others and getting your mother on waiting lists.

My MIL had a fantastic NH, the problem being that it was over 2 hours away, and a visit took most of a day. DH spent an hour a day on the phone talking to her, which was better for her than trying to move her.

One advantage of ‘temporary’ is that you won’t be trying to buck the system, and your failed appeal has probably taught you already how difficult that is. ‘Compromise’ happens more often than ‘perfect’. Good luck!
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Unfortunately, for whatever the reason, the hospital social workers are not willing to do the work. There may be a representative from her medical plan that might help you otherwise you are on your own to find a suitable place - think of it as a temporary full-time job. If she's on Medicaid and a facility tells you they don't take Medicaid what that means is they haven't applied for Medicaid. Maybe contact the local ombudsman. They know which facilities are good or bad because they take the complaints. But they cannot assist you with an application. Good luck!
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First, hospitals are under great pressure to discharge patients who could be cared for in a nursing home.
Secondly, are there other options for nursing homes in your area? It is not acceptable to agree to a placement that you believe would not provide good care. It would appear that the hospital social worker is unwilling to do the needed research into options. Unfortunately it is up to you. Often hospital social workers are basically ordered to act quickly. The pandemic has left hospital bed use at a premium. You may be forced to accept a brief placement with which you disagree while you can research better options. Your county social service or the Internet should be able to steer you to options. Wishing you good luck. You are clearly wanting what’s best for your mom. I had to move my mom from an unacceptable nursing home to a great one.
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Go and get the discharge plannner and she or He will help you.
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No! You don’t have to go with the one the social worker found. Do your own research. If you haven’t done so already, look up nursing/rehab facilities on the Medicare website. Resident care is probably the most important criteria, so look for places that have a high overall rating as well as a high resident care rating. Find ones that interest you and ask the social worker to contact them. The first two my brother was in lived up to their one star ratings—we had no control over the placements. The one my brother is in now has a 4/5 overall rating and a 5/5 resident care rating. I had asked the hospice social worker to call my selections. If your mom is in Medicaid the number of beds available will be smaller and some places don’t take Medicaid people at all.

You may have to decide which is more important—the distance or the quality of care. I live 1500 miles away but my brother’s daughter lives a half hour away from the facility he’s in. A full time job and the distance have limited the number of times she visits him. There are facilities closer to her but they were poorly rated. She said she would much rather drive farther away knowing he’s in good hands. You have every right to find a place you’re more comfortable with.
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I think if she is on Medicaid, it depends on AVAILABILITY. If she pays, then you can go anywhere with her you want if there is room. They can't just put her on the street and i do NOT think it is wise to bring her home - the burdens on you would be overwhelming and she needs special care. Speak to those in charge and look for other options - do not give up. You may have to move her later if you find a better place. And just so you know, I have never (I am 88) heard of a good nursing home - just think of why they exist - how can they be good or nice. To me they would be hell on earth and I will do whatever it takes, so I do NOT ever enter one. Keep asking and looking and checking.
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Daughterof1930 Dec 2021
We are grateful to have found a good nursing home for my mother. Her care was competent and compassionate throughout. And yes, I’m sure it was hell on earth for her. It’s not what anyone would choose, but sometimes life removes our choices
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No you do Not have to accept that Place. Keep looking . You May have to make the phone calls yourself or continue searching .
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It may be too late since you asked a few days ago but I wouldn’t start with refusing or demanding, I would start with telling the social worker what your concerns are and asking about other options. Be willing to help with the leg work even but hold off on the demands until you’ve exhausted other avenues. At the same time I would question her doctors and nurses about the reasons ing and safety of sending her to another facility with the collapsed lung and active MRSA infection, they may be able to help ease your mind and or guide you on how to handle this.
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I went through this weeks ago. The social worker sent me a list of all the nursing homes within a 10 to 20 mile radius of my location and said she would call me in two days. I said no I will call you at the end of the week because I’m going to tour all of my favorite pics. I’m not rushing this process I’m not sticking my mom in a hell hole. I toured five different places some had opening some did not long story short my top pic became available and we placed her in long-term care last week. We found out she is not a candidate for memory care and she is sadly a skilled nursing patient. We were really hoping for memory care. Some of the skilled nursing facilities were not locked down because she has advanced dementia and roams so they were off of my list. I think you can say no but you can’t keep her in the hospital for another month you need to be actively looking and sometimes you just have to pick your battles and try and select the best option. It suck’s all of it! I agree with fellow commenters wherever you end up you need to actively be showing up and asking questions because the care Will not be to your complete satisfaction wherever you go. You just have to learn what to accept and what to be an advocate for. It’s not going to be perfect because every place is understaffed and there’s too many sick patients who need to much attention. I don’t know how people can pay for long-term care and a sitter on top of it. The elderly healthcare system is just so poor it makes me so sad
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Monika001 avatar
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Monika001 Dec 2021
It’s so sad he told me he can’t find any place that can take my mom since she is on dialysis also.he said the nursing homes don’t like to pay for travel he is suggesting I put my mom on hospice he said she would get i easier somewhere probably because without dialysis she would die in a week. The elderly are treated badly
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YES. There are many contracted facilities. Tell the social worker you would like the ENTIRE list and do your homework. Most, not all of these facilities are awful.
I would suggest once your Mother is placed, go all the time- or as often as you can.
The "Covid" restriction's guidelines is another way the facility will try to keep you away. I went anyway! They need to know you and your family care. I also asked for a Care conference. I met with the entire team.. all caregivers and the physician that is contracted with the facility. Mom became infected and back to the hospital she went. Unfortunately, my Mother passed 12.22.21. I will be naming the facility in my negligence lawsuit. Best to you and your family. STAY ON TOP OF THEM!
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Bronish Jan 2022
My heart breaks for you, ddsandiego....I just prayed for your situation, asking the Lord to be with you and that this lawsuit will be a real bombshell for the NH/hospital, and, even tho it won't bring back your sweet mom, at least, I prayed that you'd get a Hefty Sum that may be helpful to you where you need it most.
May the Lord Jesus Christ be with your spirit. Shalom. 💜🕊💜
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You do not have to accept and DON'T.
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Monika001 avatar
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Monika001 Dec 2021
the social worker said he can’t find one now. Either no staff or they can’t take her because she is on dialysis. They are suggesting hospice he said she could get into a home quicker mostly likely because she will only love a week with out dialysis
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Since this is time sensitive, I doubt our responses will help. The bottom line is availability and suitability. Unfortunately, nursing/rehab facilities are understaffed. Unless, you can find another suitable placement, Mom will have to go there. Be her best advocate. Get to know the staff, meet with the nursing supervisor. Be visible and vocal .Visit as often as you can, especially at the beginning .
My Mom was over an hour away. I just had to push myself to go. There are 3 of us, so we took turns. Are you able to hire a "sitter " for Mom when you can't go?
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Good that you appealed. I did that with my dad and he was able to stay longer in the hospital. There were still no good options. In his case we brought him home with caregivers in the house. But it was never a great situation.
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Just make sure you do NOT accept placement with YOU as a "temporary" solution.
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Accept what has been found because it is so hard to find now. You can keep looking. The hospital needs to discharge her to open up beds for those that need hospital care.
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In my experience, you can if you have a better or adequate substitute.
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No, you don't have to except it. You can say its too far away and the ratings are lousy.

Is it Rehab or Skilled nursing? I would wonder about Rehab being able to handle a collapsed lung and IVs. My daughter has worked both rehab and Skilled nursing as an intake nurse and sent patients back to the hospital because the person is not ready for Rehab.

You can call the places suggested and talk to the DON and ask her/him if they are capable of caring for your Mom. You are her advocate. Don't go with what discharge tells you, research.
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