My mom has been in assisted living (AL) for 3 months, over the last month she has been very vocal about returning home, which is not possible. She walked out the door at her AL on Tuesday and required the AL staff to try redirection to get her back which didn't work. Police, fire, paramedics, and finally psych team called to help. psych team determined she lacked a suitable plan to return home and had her transported to a local hospital for a 72-hour psych hold. An evaluation occurred the next day and they determined she lacked capacity and elevated her status to dementia and a UTI....... the reason for the behavior.
Meds were prescribed and 72 psych hold was lifted though I don't believe they have the meds under control yet. Her AL home can't take her in and they had a shared room for memory care (MC) that required someone to watch her for 72 hours due to aggressive behavior costing $2,500 for her to reenter their MC population. I did not feel this was a good fit and have been working with placement to find a new MC for her needs and meet financial requirements. Every day they call to harass and want her out and say there is no reason for her to be there. It's taken 3 days to find a place that has a room and meets needs, she's still stuck in the hospital emergency department and they refuse to admit her due to dementia and UTI.
The new MC facility still requires they evaluate and approve her before accepting her which I feel will be fine, but not until 8 days after leaving her AL. She's now been stuck in the Emergency department with nowhere to go, can't go to AL nor family or old home due to care requirements and she insists she returns home. The hospital emergency discharge planner and manager have suggested we are abandoning my mother and might call APS, I said fine, do it! Then I called APS and reported the hospital situation to them. I've stated we have nowhere to take her and this is an unfortunate situation that I've never encountered before, so why hasn't the hospital prepared to admit her into a bed until a suitable MC home that we approve can take her? They certainly been in this situation before and offer no help.
If a family cannot take a parent and there are no suitable MC residences open and the Hospital requires she needs MC, what does one do when you have no control?
What to do?
My mom is in a similar situation with a medical condition that requires a higher level of care than where she was living, so I have been searching for a new place. I've been polite, but firm with the discharge planner and we've come to an understanding that I am doing my best to get Mom situated. The discharge planner actually called me several times to get the discharge going before I ever heard from the doctor. I told her I would make no plans for my mother until I had the opportunity to discuss my mother's situation with the doctor and had a chance to see my mother.
I think it would be to your advantage to insist on being with your mother in the ER. The quality of care she receives is based on the perception of the person who is treating her. Some of the nurses see my mom as a whiney old lady, while others see her as a charming woman who is in excruciating pain. The latter is accurate. I've had to intercede on her behalf numerous times and it is amazing how cooperative my mother is when the caregivers are properly apprised of the situation.
Your mother is trying to advocate for herself, but no longer has the skills. Someone needs to be in there with her and advocate for her. They are telling you what is happening, but what do you (your family) see? With her dementia she is unable to give them the information they need to properly diagnose. You know your mother--how she acts when ill, how she responds to medical personnel, what upsets and her calms her down, etc. Her agitation could be from the UTI and it could be from strangers poking and prodding her, unfamiliar surroundings, another medical condition, and many other reasons. Your mother is scared and she is in fight or flight mode with no one to protect her. This is cruel to her. These doctors don't know her baseline behaviors and they should be working in tandem with you. I would absolutely insist on being in the ER with her. If they say no, then tell them you will be reporting them to the state licensing board and send a written and certified letter to the hospital documenting the insufficient care she is receiving. Also insist on working with the hospital ombudsman. Best wishes for you.
It stinks that Kaiser is NOT addressing the need for her to receive medication for her UTI, even in the ER. Kaiser is a great plan for everyone - expect frail elders with dementia or complicated conditions.
The state department of public health regulates all care facilities, and Medicare also regulated skilled care settings.
Kaiser is managing her Medicare benefit, call the Medicare quality assurance number and see if they can help.
What a mess...feeling badly for your mom, and for you.
I think you should continue to say she isn't safe for discharge but you also need to either accept any open bed or self-pay.
Are you in contact with the hospital Ombudsman yet?
You have three choices here:
Give up guardianship or POA and if you have these already for a person with dementia this will require an attorney to do; give over guardianship to the state. I seem to remember that you hold guardianship over Mom.
Or
Get Mom into the placement that already existed. She uses then, her funds, with you as guardian or POA keeping careful records of every penny in and every penny out of her estate/trust until all is spent. Then Mom is on Medicaid and medicaid placement (again, won't be pretty)
Or
Take Mom home.
If someone else has another option I don't know what it is. If Mom is not admitted her supplemental insurance may not be paying for her care outside of medicare coverage; I don't know how that will work.
You are between a rock and a hard place and I don't envy you one single bit, buit do NOT be bullied into someone convincing you that you HAVE TO take Mom into your home. They simply want to be shed of her and are willing the THREATEN you to do so. Were you not ever born they would come up with something else.
Do know, however, if you are POA, or guardian, you are expected to come up with care for Mom. Good luck on that. I can't imagine where you will find even minimally decent care for her, or at what cost.
Your answer to their threats, by the way, was stellar. The answer is absolutely, "GO AHEAD AND CALL: I will call FOR YOU. But she isn't coming to my home.:' Good luck. Hope you will update us.
By the way, guess what APS and the entire state's last answer will be to all this. Taking her away from your guardianship or POA. Which would be heaven I am supposing. Let them place her, spend her money on her and then place her when she is on medicaid.
Her AL home can't take her in and they had a shared room for memory care (MC) that required someone to watch her for 72 hours due to aggressive behavior costing $2500 for her to re-enter their MC population.
Aggressive behavior requires 24/7 supervision.
This is provided in a Behavioral Unit.
Okay. What care requirements can be met in hospital that can't be met at home?
I'm not arguing that the family can take her. I'm just asking what it is that you can't do that she needs.
In the E.R. for UTI and behavior problems on a 72 hr. psychiatric hold.
Even though the 72 hr. hold was lifted, she should have been admitted to the Behavioral Unit the minute the psych hold was placed. She should be in the behavioral unit until meds are stabilized, seen by a psychiatrist. The E.R. is not equipped to hold a patient. What is wrong with that hospital?
If they have no Behavioral Unit demand her transferred, admitted, and evaluated by a psychiatrist there. One does not get over the behaviors caused by a UTI in 72 hours. Call the hospital Ombudsman at this point.
Have you been there, boots on the ground, to see this all happen?
Patients with an advocate present will do better, be treated better.
Beware of the unsafe discharge, the hospital may try that next.
The unsafe discharge is exactly what we've been experiencing and they have threatened us numerous ways be I have stood firmly that she has nowhere else to go until accepted by her MC we selected is ready. I expect more calls today saying we are abandoning or dumping her, which cannot be true as I didn't take her there, I'm just the POA and her son trying to keep her safe.