If an assisted living patient has to go to the hospital for surgery, will they lose their bed?

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If an assisted living patient has to go to the hospital for surgery, will they lose their bed?

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My BIL was in ALF and had 2 stay in the hospital for surgery. Once discharged he had to take rehab in SNF. Now, ALF says he can not return, he know longer has a bed.

If this is protocol, it needs to change. No vulnerable senior should have to go through that. thanks

Assisted Living Hospital Discharge Rehabilitation Center

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How long has he been gone, what does his contract with the AL say and was his bill at the AL paid up while he’s been in the hospital?

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As Worried said, read the contract. I know with Mom, after 2 weeks they didn't charge for the care part but I did pay for her rent and board.

As long as rent was being paid, I don't see the problem. Was ur Dads surgery such that they don't feel they can give him proper care? Call your State Ombudsman and ask about this. The facility has to provide you the info.

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There’s probably couple of things going on for this:
- if he’s currently in a skilled nursing facility, his chart is showing he needs that level of care...... he’s getting & needing “skilled”. AL is not that & AL cannot readmit him unless he can clearly show to totally be able to do his ADLs with very minimal assistance.

He would need to have a needs assessment done & it shows in detail he’s ok on ADLs. The needs assessment usually done by a RN & SW duo - the current place will know of an independent firm who does these. In my experience it’s rare for elderly to go from a SNF to AL. Younger in their 50’s & 60’s who are stroke or accident victims might can do enough rehab in a SNF to transition back to AL, IL or even return to their home.

- AL cannot hold a unoccupied room or a bed indefinitely UNLESS its being paid for. If he’s been private pay & he can continue to pay the AL & the Rehab/NH at the same time, the AL will gladly take the $ & upkeep his vacant room.
But I'm guessing that is not within your BIL financial ability. If so, then whatever the terms of his AL admissions paperwork will state what happens to the room due to a vacancy. You or your SIL do have the admissions contract, right?

This isn't just an issue for AL. NH have this issue as well. It’s referred to as a “bed hold”. Usually it’s a 72 Hr hold that’s placed on a Medicare & Medicaid bed in a NH. (It can be actually closer to 90 hrs if the place wants to make it that cause they want the resident back). Observation status at a hospital or ER can’t run more than 72 hrs..... they have to be either admitted to the hospital or discharged from “observation” by then. If they are on LTC NH Medicaid, Medicaid will pay the daily room & board charge for 3 days so the NH can & will put a “bed hold” on their space as $ still coming in.

But if looking like gonna be a week or 2,, then in my experience it really is going to be interdependent on the elders & your relationship with the facility on “bed holds”. If they are a easy care resident, pay their bill or copay on time, have a good SS monthly income, family is helpful, and the place has several other empty beds, well in that scenario, they can extend the bed hold. Family will need to private pay as Medicaid will not be paying. The $$$ amount kinda depends, it could be daily private pay rate, the reduced Medicaid daily room & board reimbursement rate or whatever you can quietly negotiate with the NH. The “devil that you know is better than the one you do not know” comes into play......

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Thanks igloo for the helpful information. Years ago LO went from NH to DR to Hospital for 3 days of testing...events that were being ignored or underdressed in NH. NH Committee met and decided they were 'cured' so LO was sent home from hospital. No home services at all. 6 steps to enter or exit home. In PT they had her get up step with on PT holding her and one holding weight of walker...a basic one..not Rolator she used. She never did 3 steps independently but because no $$ to pay daily ( plus mortgage) she was graduated out of Skilled Care while they confirmed she had been having seizure type events!

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They are held for a certain length of time. Check with AL facility.

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I have heard of that - but the friend whose mother was denied the bed still got back, she just had to wait for a free bed again. Sometimes it's only a matter of days. Sometimes when the patient is actually ready to be moved, their bed is available again. That is what happened with my friend and her mother.

Yes, it is extremely scary to be told the bed is no longer available.

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Sadly many have these Rules when it Involves Possibly Lengthy Rehab. Hopefully, They can Go back to the same Place but with a Different bed.

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Thanks everyone for all of the great responses.

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In order for the ALF to keep his bed open he would have to pay "bed hold." This simply means he pays for his room while he is in rehab. The bed hold rate is usually the daily rate of any community. If he went in the hospital in the middle of the month and had paid for the whole month the room his until the end of the month.

Question; You mentioned your B-I-L was only in the hospital two days and then went to rehab. How old is your B-I-L? I asked because if he is 65 plus and on Traditional Medicare, Medicare requires a three midnight stay as an inpatient (not observation) in a hospital before they will pay for rehab in a skilled rehab. If he was not in the hospital as an inpatient for three midnight's, Medicare will not pay the cost of his rehab!

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That's good for all of us to know. Thank you.

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Apparently it is true. My mom was sent back to a hospital from a rehab bed. I called to find out how to handle her bed the next day and was told they had already boxed up all of her belongings and we needed to come and get them. It would have been nice to have been called and allowed us to pack her things to ensure we really got everything she had left behind. The social worker at the hospital gave us a list of places to check out prior to her release so we could send her somewhere else.

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How rude!

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How long was BIL in SNF? That’s the real question here.

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I am in IA and this question is very helpful. Not long ago had IL manager pressuring/ bothering me about how I should really be in AL. Once after multiple falls and TIAs. I had no home care, no family nearby. PCP took 5 months to follow up 2 weeks of PT/OT/RN with outpatient services! Yes I am filling a report with State Licencing Board.
After about 6 months I finally got homemaker services, and medical alert system from the state. I was qualified for Medicaid Waiver, but there was no funding! So I had to wait..then took 3+ months from approval to start services.
My IL says you Only have to pay for 2 months more on lease if you have to leave for higher level of care..AL or LNH. Very scary to think that if I had gone to AL last year I could have been homeless after complcations of 'same day orthopedic surgery' this year.
Thanks for making me aware of what to ask!!

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If someone has to leave an Assisted Living (ALF) because they need a "higher level of care / skilled care" the ALF cannot charge the resident the 7, 15, or 30 days prior notice that a resident agreed to when they sign the admission papers.

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As a medical social worker in Pennsylvania, I can honestly say that the only scenario where a resident could not return to assisted living was when the resident required more care than the assisted living could provide. Typically those residents went to skilled nursing or acute rehab in order to attempt to achieve their prior level of functioning to return to assisted living. As assisted living usually is private pay with rent paid monthly, I'm having difficulty understanding why your BIL couldn't return. Did he owe the facility rent? If it was a Medicaid sponsored facility, there still should have been a bed hold. My suggestion is that either he (If he is competent) or his POA should arrange an appointment to speak with the administrator if the facility.

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Peanuts56

Thank you so much for responding. I had contacted the long term care ombudsman about helping to get my BIL transferred to a facility closer to home. (he was in a MC 4 hours away from all family). The long term care ombudsman stated to me that the administrator what my BIL out of her MC facility just as bad as we wanted him closer to home.

Long story short …. That same weekend, BIL ended up in the hospital for surgery and discharged to SNF for rehabilitation. SNF said he recovered well and is ready to go back to the same level of care, however, administrator says she no longer has a room at her facility.

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How is the AL being paid for? It certainly sounds wrong and was not the case for my mother although her rehab stay was for 3 days in the neighboring facility. I think you need to get more information from administration. Is the AL for or not for profit? Is she on Medicaid? I have been told by financial advisers that an AL facility is not allowed to discharge a resident when there is not an option in place for further placement. I wish you the best and hope you speak personally to those in administration.

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I can only answer from experience and this would be for an SNF. My late mother had a stroke at the SNF, was transferred to a hospital. The SNF called me and asked me if I would like to do a "bed hold." Of course, IF I had said 'YES,' that would have cost me $410 per day and that was in January of 2014.

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I would talk to lawyer. It sounds like the ALF just does not want your relative back. Has the rent been paid at the ALF?

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Ricky6

Thank you for responding. I believe you are 100% correct. The ombudsman had just stated to me 3 days prior to my BIL that the administrator said she wanted him out of her facility just as bad as we wanted him closer to home. Sad times.

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To the best of my knowledge if someone in assisted living has to be in rehab or the hospital, the room at the assisted living must be paid in full as normally is done. Then they must take the patient back.

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Lockett2166

Thanks for responding. That is what I thought as well.

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During the last year my father was private pay at an MC, he had several hospitals stays from 3-10 days and always returned to his MC. The MC did reduce the bill for the "care" component of the full days he spent in the hospital but we still paid "rent" on his room. They also required additional care for the first 24 hours he returned to help Dad re-integrate and to re-access his needs.

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Thanks for all the responses. This what happened to my BIL was not a surprise. The administrator at the MC unit stated she wanted him out of her facility as bad as we wanted him closer to home.

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This has been so complicated for you haileybug. I admire your persistence.
However your BIL has established and documented episodes of abuse toward staff as well as disruptive behavior and unfortunately his behaviors are following him.

The administrator of your BIL facility is within their rights to give up the bed if BIL was admitted. You and your family will lose this battle. It sounds like BIL had an extended period of time out of his memory care. A center won’t hold a memory care bed in limbo forever. Memory care beds can be hard to come by and there are many folks on a waiting list for MC. For instance, what if the admin is aware of someone needing that MC bed and while that person’s loved ones are waiting for the MC bed, that family may be paying for extra CG to watch over the person waiting for MC. In a case such as your BIL, how long would be appropriate saving an empty bed? No one could really say as no one knows how long BIL would be gone. The admin is certainly within their scope of responsibilities in deciding to not hold BIL bed & give it to someone who needs it now.

The administrator is most likely thinking of the safety of everyone else in the facility - patients and staff. If the admin can make a case for this with proper documentation their decision will prevail.

However, now they won’t need to as BIL is in the hospital getting care. That admission cost him his bed. The center has their “out”. They don’t need much else. The hospital/SNF will now have to keep him until the DC planner finds him placement.

You can always to file a complaint against BIL’s MC facility using the complaint process which should be posted somewhere easily visible in the center. As far as payment, I don’t believe your BIL is private pay so he is subject to CMS Guidelines for MC conditions of coverage.
I will bet the administrator of BIL’s MC is quite familiar with these regs and will cite the need to keep all in the MC safe if all else fails.

Given his present situation, he IS receiving care where he is so you can’t use that as ammo to help your claim.

Medicare/Medicaid will not allow for discharges for non compliance anymore but a patient can be discharged forcibly for jeopardizing the safety of all in a MC unit. There is a process for this but it does not apply here because he is no longer at that MC.

Between a a rock and a hard place again for you HB. You certainly get an “A” for effort as I know you are essentially trying to look out for your hubby who has to travel so far to see his brother. I am sorry for you & your family.

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Shane1124

Thank you for responding. I appreciate your feedback.

Dear, I have a question for you. Now what I am about to say/ask is coming from the deep depths of my heart.

Are you saying to me that if a person (ANYBODY) with some type of mental issues (dementia or whatever) that they are accountable for their actions??? If so, we a living in a SAD time.

Are you telling me these Memory Care Units claim that they are specialized in caring for patients with Dementia and Alhz. and that they know how to deal with the behaviors but really they do not?

I have always been raised that there is always 2 sides to a story.

With that being said, I wonder how I would feel or even act if I had was placed in a facility 4 hours away from home never getting to see my family. Or perhaps, how would I respond with someone who has a nasty attitude with me on top of everything else. Sick or hurting and not knowing how to communicate.

I have had my experience going into Nursing homes doing my clinicals and visiting and I have witnessed rude, unlovable staff.

Have spoken with 2 executive directors over the phone that had nasty attitudes with me. If they had nasty attitudes with me, wonder how they are at the facilities? Someone with this high position should never act in this manner.

There is a whole lot more to it than pointing fingers a person who can not help themselves.

By, the way. Thank you so much for acknowledging my persistence. If more people on the other side of the fence has some persistence, my family would not be facing this situation. Someone would be looking at what would be causing all these problems for BIL and trying to fix it.

FIX IT + Get him closer to home. Thank you

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Thanks to everyone for all the useful feedback. I appreciate it so much.

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If an assisted living patient has to go to the hospital for surgery, will they lose their bed?

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