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This is a doozy. My mom is 77 and live in an low income independent senior apartment complex. She has stage 4 cancer and has chosen to refuse treatment because the Dr's said she'd be worse off with chemo. Her legs are very weak from being in the hospital for so long from a 911 call because she was throwing up daily and felt awful from her cancer so they placed her in rehab to by pass some time.


She has Medicare part A and blue cross govt insurance. She's legally married but separated for a decade+, I am all she has. An only child and I have young kids of my own and no safe place for her here on top of working and also children and my own health issues. My life is already stressful enough.


I'm not sure how long she has to live. She's starting throwing up again daily at rehab and she's not making much progress with walking. The social worker is a bitch to say the least and said once she's ready for discharge she has 3 days to find somewhere. I'm not taking her in my home. We are hoping she'd pass away in this rehab facility before anything else. She needs to be on Medicaid for any long term care facility but she's married like I said and they deny her until she gets a divorce. I'm trying to get all the paperwork required for her divorce but it takes time and she's very unorganized and her ex husband is a POS and can't find half the paperwork required.


I guess my thing is I'm not taking her in my house. The social worker just said "good luck " we have no other family or friends. We can't afford private pay anything for her without it affecting my own family. What if I refuse to pick her up? My mom made a lot of bad decisions in her life and I shouldn't have to try to pickup her mess. It's affecting my anxiety and stress level. I'm missing work and my house and family are being affected already and she doesn't even live here. Hospice is monitoring her progress at the rehab center btw but not allowed to have hospice and rehab at the same time and her insurance cover 2x a week hospice care for about an hr each at her house. Thanks for reading.

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Hospice had facilities back in the 1990's and 2000's. Now most of them have closed and only a few are around. They only accept comatose people within two weeks of death. There are a few rare exceptions. One near me is run by a church for the very poor. 99 times out of a 100, hospice is not going to be the residential solution. They will provide services at the residence once it's found (apartment, nursing home, assisted living, etc.), but hospice does not provide daily care. This mom needs to get into a nursing home one way or another. I would personally start calling the non-profit religiously affiliated nursing homes looking for one that will take her out of compassion while everyone works on Medicaid.
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Yes u can refuse.

I think all her ex needs to do is sign a ""Spousal refusal form" that he is not responsible for Moms care.

If the Rehab has LTC unit, have her transferred there. Check out what I said about the refusal form. Have the SW start the Medicaid application or ask the elder lawyer. You will probably need to hand over Moms SS and any pension she receives. You can get Hospice in when in LTC.

You tell the SW that you cannot have Mom in your home because you cannot care for her. That it would be an "unsafe discharge" to send her home.
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I think the key for payment and access is the prognosis at the time of inpatient placement. It’s not the six month window to qualify for hospice services which can be provided almost anywhere. More like 14 days for inpatient OR until symptoms are controlled. In your mom’s case get the vomiting to stop but now it’s back so they may be unwilling to take someone whose symptoms they think can be controlled. They would need some documentation of her condition I am thinking. Hospice is not a government entity but rather a service, a benefit. Hospice companies may be private or nonprofit but they receive payment for their services from Medicare and while I can understand the need to be divorced to go on Medicaid for LTC it’s not needed for hospice. It sounds like your mom has good insurance. She’s just trying to use it for something this facility can’t get compensated for in the rehab. Or doesn’t know how or finds it too burdensome. Some excuse or the other. About them discharging her to your home. Were you asked for your address? Since her address is for her apartment, I can’t see her being dropped off there alone. Here is a link where you can find hospice information for your state. They have a phone number for each state. https://hospicefoundation.org/Hospice-DirectoryThe rehab social worker should know how to go about doing this but I don’t find social workers always that well informed outside their primary duties. They are being churned out and learn on the job it sometimes seems. she may see her duty as get your mom discharged and you seem the easier choice. Look for a hospice facility in your area. Call them. Tell them she has uncontrolled symptoms with the vomiting and no place to go. They know if they can get paid for the two weeks to board her. Since she is NOT currently on hospice (right?) then they might take a chance they can get reimbursed for her stay. There is a big bonus for signing her up for home hospice. Not sure how that works for inpatient. The rehab wants her on Medicaid but An inpatient hospice facility might prefer Medicare??At the end of the day, it is a business for them. I’m sorry for you and your mom and please do let us know how you manage.

Burnout,
As I understand it,
There is no LTC hospice. The LTC is why you are needing Medicaid for a place for her to live. The hospice is a service she can utilize in the NH, in an ALF, In her home etc.

The inpatient hospice facilities are only for about two weeks. My DH aunt is in LTC and is on hospice. She was on hospice at home for a couple of years before going into LTC
Of course there could be private pay hospice facilities but they wouldn’t be accepting Medicaid.
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Does she not qualify for hospice? Or LTC with Medicaid pending?

She can consult with a Medicaid Planner for her state of residence (which you did not list) if she hasn't already applied and was denied. Don't make any assumptions about whether she'll qualify or not.

I'm so sorry for these circumstances. I hope things can work out.
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BurnOut2024 Jan 19, 2024
She qualifies for hospice but not long term care hospice. Only in her home 2 days a.week for about and hr. I contacted a Medicaid planner and a Elder law attorney and talked with them for half an hr each they are stumped and referred me to a lawyer for a free consultation about a quick divorce. But the elder law attorney said it might not even be worth it at this point because divorce can take months and we'd need a lot of information from her husband which he isn't cognitively in the best shape either. She was already denied last year for Medicaid. We will contact another medicaid planner for another opinion
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I hope you don’t have POA. If you do , go to a lawyer to give up POA. Then the county/ state will have to figure out where to put Mom.
Do not pick her up . Tell the social worker you can not care for your mother .
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BurnOut2024 Jan 19, 2024
Thankfully no I don't have POA.
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If you need some more days in rehab just to get all this sorted out, you can appeal the discharge to Medicare. It buys you and extra few days in rehab, even if the appeal gets denied. If the appeal is accepted, then could be extra rehab weeks allowed.
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This social worker is trying the usual line of getting you to take mother. She is pushing it quite a bit harder than normal – usually it’s more like promising help that isn’t going to eventuate, rather than ‘good luck’ because you 'have no option'. All likely to be lies, however.

I’d go for the social worker, in writing. First to her saying ‘unsafe discharge’, that you refuse to take M into your home, and that you will not provide support to M in her own home. Copy to Admin at the rehab, copy to the Ombudsman with a covering letter actually complaining about the social worker and the rehab facility. You are being threatened illegally.

If M turns up in a taxi or ambulance, refuse to open the door. Make sure that everyone in the family (including children) knows that they MUST NOT ACCEPT HER. Children need a line, like "Mummy says I'm not allowed to open the door when she's not home". Make sure that it is possible to see who is at the door before it is opened.
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Relieved she isn't in your home.
Do not pick her up.
Take care that they aren't delivering her to her home and husband by ambulance. Use the term "unsafe discharge" as he isn't capable of caring for her.
Social worker wants mom off her hands and on yours. She/he is trying to fork Mom off of her plate and on to your own. Do not allow that.
Unless she HAS BEEN LIVING WITH YOU (in which case YOUR HOME is HER HOME) no one can EVER force you to take your mother into your home.
Hospice no longer provides 24 hour care. It's a couple of baths weekly, a call from clergy and social worker, and a magic morphine bottle. RN visit once a week. Hospices are currently cleaning up with medicare funds for very little provided in terms of care.
No one can force anyone to let another person into their home.
She may require placement.
She cannot stay in rehab.
Tell your Social Worker at Rehab, who is likely in charge of discharge planning that Mom cannot afford 24/7 care while on hospice and that you cannot do it, and that your Mom cannot be discharged to your home.
Good luck? If she isn't living with you, then good luck right back to that social worker, whose job it is to find placement for her.
Now if you are POA this is a mixed bag kind of thing.
Go into the facility and discuss discharge planning with them.
They cannot force you to accept someone you are incapable of caring for into your home.
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sp196902 Jan 19, 2024
Alva I think the mother and husband have been separated for 10 years and don't live together. Mom lives in her own apartment.

I thought hospice had facilities around the country. They also offer hospice in the hospital (that's where my sister is doing her hospice). I wonder if that would be covered and the mother could stay at the hospital or go into a skilled nursing facility.

Sounds like until the OP's mother gets on medicaid once the divorce is finalized she falls into that limbo period where she can't afford to go into a facility and her current insurance won't cover the facility either.
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