They think she had a seizure but can find no issues. She has dementia and is part paralyzed on left side. The hospital wants to send her home with pt only. There's no one there to care for her during the day. I want to refuse to take her home but the hospital said that it was abandonment. I don't no what to do from here. She is declining fast and needs more care than I can provide. What can I do?
Be prepared for a change of attitude, preceded by some quickly changing facial expressions. Standard of care is a legal standard considered in medical malpractice cases. Just the hint might cause them to be more realistic about the situation.
And don't let them bully you. Like RM, I'm really getting fed up with the manipulative tactics of hospital discharge planners and rehab social workers to shove off all the care planning on the family, and engage in a CYA move themselves.
I don't know the specific legal qualifications for abandonment, but I think your best option at this point is to state that you can't care for her, you need advice on how to get that care professionally, and ask for their recommendations. I.e., what can and will they do to help get 24/7 care, recognizing the fact that you cannot provide it. Turn the tables on them.
If they insist you take her home, ask if they'll pay you to stay home as you can't afford to quit work! (Sometimes you really have to be adamant in dealing with these people.)
And DON'T sign anything in the Discharge Instructions that commits you to provide care. I discovered that someone at the last rehab facility snuck in an "acknowledgment" in the discharge instructions that I agreed to provide 24/7 care for my father. That was never even discussed! And I read them before leaving - I'm still not sure how that into the instructions.
Of course I didn't sign them so it's not a valid assumption or commitment. But still, it really irked me, and it's on the list of issues to raise if we ever need care again.
Fortunately or unfortunately, the rehab facility is great except for the somewhat manipulative social workers. In the past I've been able to raise these issues prior to admission when the staff wants the patient and the Medicare dollars, so they've been worked out.
On the issue of having been unconscious, has anyone mentioned a syncopatic episode? She could have passed out, there might not have been any obvious cause, and that could be their assessment. Syncope was the cause of my father's falls. Despite cardiac and other post fall assessment, no determination was ever made what caused the blackouts.
You have to put on your body armor and say "that's not possible" a lot. GA is right - the doctors and therapists were terrific, but the discharge planner was a piece of work. Network with friends and family for feedback on NH - that helped us speed the selection process.
I don't know, and I don't want to depress you, but I wonder if that complicates things for you. You can certainly still refuse to collect her. But can you prevent their sending her home, I wonder?
Who found her unconscious, by the way, and what was that person doing in your house?
How long has she been living with you? Does she have another home of her own, or is this a permanent arrangement?
If it were me, I think I would:
take a brief leave of absence from work
take mother to see her GP
get an assessment of care needs done
find out what the options are
pick one.
Your mother has dementia, she is declining rapidly, you work (quite right too, no reason why you should have to give that up) and there is no one around during the day... Something's going to have to change anyway. Might as well make it sooner rather than later, don't you think?
And meanwhile, hospital is not a good place for a frail elderly lady with dementia. All things being equal you'd want her out of there as soon as possible in any case.
If your mom has Medicare then ask for a copy of the Medicare bill of rights which loosely states that your mom cannot be discharged prematurely
Very important point here - Medicare will only pay for a rehab short term stay in a nursing home if your mom has been in the hospital for 72 hours - do you have a regular doctor who will oversee her care in the hospital ? If so, call him or her
You need the ER to admit her to a bed first and then you may have to avoid the discharged planner for awhile - they will contact you immediately for your plan and if you don't have one they will send her to any facility with a bed available - you want to look at any facility before that happens - do you have any relative to help you ? 72 hours goes by quickly
Above all - health care is a business which depends upon the reimbursement of expenses by the government or private insurance - neither cares about what's best for the family but how to contain costs
If you are lucky you will come across kind individuals who will offer some good advice but you need to verify anything they recommend - just because a facility is nearby doesn't mean it is good
Start by looking on the Medicare website for nursing home ratings - any facility taking Medicare has a public rating - but know that even 5-star facilities are far from ideal and some 2-star facilities are okay but at least you'll be forearmed with some info
Good luck
If you do, make notes and document all the way - who you spoke with, time, etc.
Remind yourself as well that you're in a challenging and potentially emotional volatile situation now, especially if the discharge staff keeps up the pressure to take your mother home. Give yourself a lot of space, take a day off if you can, and make sure to include some downtime as your emotional equilibrium and patience could be pushed to the limit.
I'd like to elaborate also on Madge's comment that neither the government or private insurance which focus on cost containment rather than what's best for the family care that much about those families and patients.
The acquisition by private companies of medical facilities has resulted in many changes at our preferred hospital, some of them good, others of questionable merit.
Scuttlebutt was that some undesirable marginal staff were weeded out. I did see that when I was hospitalized briefly - service was top notch, as if I was at a 5 star hotel.
Some floors were upgraded significantly and made much more accommodating for patients and staff. Other floors were not; it's as if the revolution bypassed these outposts of antiquity. Those are the areas which I've found to be less accommodating.
But I also found that some of the higher performing staff could be caught in the midst of the changes, assigned more patients, and challenged to provide the high level of service they felt appropriate. They, like patients and their families, are also feeling the effects of the narrowed corporate focus of financial issues vs. total healing care and issues. We're both victims of the increased pressure to maximize profits.
I often wonder if the charitable hospitals will eventually be ones to which patients turn for more caring and compassionate care.
If you cannot get SW or d/c planner at the hospital to listen, ask for a patient-family representative and go through their greivance procedures if you have to. You can call your Area Agency on Aging or the equivalent yourself and find out what options for additional care you might have, even though the hospital should be trying to help instead of just dump that all on you.
This happened to us one time; I fought it, filed appeals with Medicare, battled with the hospital over rampant overcharges. Medicare dropped the ball and didn't follow up after I challenged their appeal decision, and the hospital eventually gave up after trying to convince me they were justified in charging $14 for a tube of chapstick that couldn't be used b/c Dad was on oxygen and the chapstick contained petrolatum. There were other outrageous charges as well, something like $4 for one aspirin.
On the other hand, our preferred hospital just absorbs the charges; we've never been billed for observational stays.
Reminds me of a line from Martin Amis about a woman having a baby in a big private hospital and the comfort she takes from the huge rolls of invoices "... with every Kleenex lovingly itemised - not for her the bargain basements and Crazy Eddies of the NHS..."
But that! Do you have consumer law that would allow you to return the chapstick for a refund on the grounds that it is 'not of merchantable quality' being not fit for its intended purpose?
Unbelievable, the nerve of it. I suppose these bills get run through a computer and the people who set the charges assume (correctly, apparently) that hardly anyone is ever going to look at the individual items?
But on the other hand I expect there are cost accountants at the back of it somewhere, and it'll be to do with subsidising the cost of other tests that would be so expensive otherwise that nobody would use them. That's the charitable explanation, anyway!
The biggest reason why the hospital discharger goes ape sh*t while pushing the patient out door is because of insurance's refusal to pay more than medically required. Once the doctor determines the patient is stable and no longer needs hospital-based services, the race is on to get the patient out the door ASAP. Just imagine if a hospital allowed all of their patients to stay in their rooms for an unlimited number of days but the patients no longer need hospital-based services? The hospital would go broke. If you don't find a place for your mother - then the discharger will pick one for you because they're under the gun from their managers. The discharger should provide you with a list of of places to review. I'm not saying you should give in immediately to his/her intimidation but healthcare is a for-profit business.
Your comments are quite amusing; it's nice to be able to laugh at these peculiar (but grossly overpriced) billing practices. The hospital's roving ambassador told me that there are charges for each department, but couldn't elaborate.
So I imagined: $2.00 or so for the cost of the tube; open it in Receiving, add another $2. Send it to Inventory, another $2. Send it to the specific floor, another $2. Inventory it on the specific floor another $2. Who knows where the other $4 would come from? Retrieving it from inventory, perhaps, and delivery perhaps to the specific room? Unwrapping it and recycling the wrapping paper?
Costly business, this moving chapstick from one place to another. And after all that it couldn't even be used. They probably would have billed another $14 to dispose of it!
I never thought of the merchantable for specific purpose application in that sense. I believe there are laws to that effect, and recall vaguely some involvement with them when I worked in products liability firms.
I'm adding that suggestion to my various medical files in case it ever happens again. I could add that the hospital represents itself to be competent to provide specific care for specific conditions, but the chapstick doesn't meet that standard. I can imagine the blank stares if I raised a legalese argument like that.
When he was in Post-ICU, weak as could be, sitting up on a chair, holding on to a pillow for dear life, could not feed himself, could not stand up, much less walk.............................THREE people from the financial office came up to the room one Thursday morning and li-te-ra-lly cornered me against a wall.......ok ok , a corner, and told me that I HAD TO TAKE HIM OUTTA THERE, because he no longer qualified to stay in. Ok, I said to them what I wrote just above here. I told them I understand their predicament, but understand mine. When you wheel him to the parking lot, HE CANNOT STAND UP AND WALK AND GET INTO A VEHICLEEEEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
No, you must take him before noon, or else we will charge YOU for another day.................................................
I said: "Thank you for letting me know, that you are going above and beyond the NINE DOCTORS my husband has. You are taking upon yourself his discharge, and whatever happens to HIM as I take him OUT, will be your fault". They handed me a stack of paperwork, WHO KNOWS WHAT IT WAS..............I folded it in three sections *why do I remember that*............and said: I will get to this, when I get to it.
And yes, we were 4 hours drive away, I had to get a rental van, drove him to the Rehab Hospital in our area, and they had him walking, eating, writing, everything in 2 weeks time.
I felt bullied, corralled, evicted, thrown out. Once they had their limit, they were not kind at all.
The most informed we are, the better off we shall be. I do thank GA, CM, BabaLou, Veronica, and forgive me for not noting all the names of you guys, that know THE LAW, and the convoluted stuff we must endure. HOOPS, yeah, it is insane. Oh, RainMom, love to you all.
We
are
in
this
TOGETHER.
Knowledge IS POWER!!!
M 8 8
Since this question is about a week old I am guessing your Mom is either at home with you or in rehab.
Hope all is well with her.