So what happens?

Question

So what happens?

Follow

Share

I'll try to be as brief as possible.

My uncle, age 94, is nearing the end of his life. Along with diabetes, neuropathy, and on his second pacemaker, he was recently hospitalized for pneumonia. The resulting coughing left him with a stress fracture in his back. He was hospitalized again this morning as he is in excruciating pain from the fracture, which cannot be treated with anything buy Tylenol due to his limited kidney function.

Uncle's wife is in her late 70s, with Stage 7 Alzheimer's. She and my uncle are still in their home, with home care providers. My aunt has been approved for Memory Care, but is Medicaid pending. No nursing home in this area will admit pending Medicaid, Even if they did, there is nowhere for her to go. There is a waiting list of over 100 people. AND she has become aggressive, and unless that can be controlled, the nursing home would not take her even if they have an opening.

My uncle cannot return home if his wife is still there. She is unable to control her violent outbursts, even with Seroquel. Several aides have quit due to her attacking them. It is too dangerous for my uncle to be at home with her. He has never said she has attacked him, but we are sure she has. My uncle would never tell anyone this, or admit it if asked.

What if anything can be done to get one or both of them into a nursing home if there is no Medicaid (they can pay privately while waiting for Medicaid approval) and no room, they are unable to be safe at home, and there are not enough aids to cover them 24/7? They have one daughter who is married, has a three year old, and both she and her husband work full time. They live nearby, but still 35 minutes away. I know some will say "well the daughter just has to quit her job, abandon her family and move in with them". NOT happening. Even it she could quit her job and let her husband fully support the family, she cannot and will not abandon her toddler. She cannot take her daughter with her, as she cannot trust her mother not to hurt her. And separating the child from her father to care for grandma and grandpa is also not happening.

What does an elderly person who cannot care for themselves do when the nursing home says "no room, go home"?

Alzheimer's & Dementia Senior Housing Violent Behavior

This question has been closed for answers. Ask a New Question.

27 Answers

Most
Helpful Newest
First Oldest
First

Their needs are different.

It sounds like the wife needs to be admitted to a psych facility. Caregiver should call 911 the next time she lashes out.

Placement for Dad is the responsibility of the hospital Social Worker. Refuse to accept discharge.

The daughter should under NO circumstances try to care for them herself.

Helpful Answer (15)

Report

A few weeks ago my MIL was stuck on the toilet. She had a UTI, and was confused and sat there for 7 hours. I called the telehealth line and spoke to a nurse. She asked if I could physically get her up, and I explained that she would attack me if I tried. The RN told me to call 911, as she is a danger to herself and others.

If you are her caregiver, and she can no longer look after herself, when she is in one of her fighting moods, you call 911 and ask for help. Then when they want you to pick her up from the hospital, you say NO.

Helpful Answer (9)

Report

Don't be shy about reporting violence to you or others. Call the cops. It may well be the thing that gets her help.

(1)

Report

Is it time for Hospice to be considered for the Dad?

Helpful Answer (3)

Report

He does not have a life-ending diagnosis or "end date". Unfortunately excruciating pain is not a hospice condition.

(3)

Report

See 2 more replies

Thank you Barb. It's a very small community, and the hospital social worker is of no help. The hospitalist discharged him the last time he was taken to the hospital, about a week before Thanksgiving. He could not walk he was in such pain, and his daughter fought against discharge. All the staff would say is administration is "breathing down their necks" to discharge, and Medicare would not pay for another night, as discharge was recommended, even though he wasn't ready.

Helpful Answer (2)

Report

Boll, has anyone asked for a Palliative care or Hospice evaluation?

The criteria has changed.

I was driving before but wanted to get you an answer quickly.

Please tell the daughter to hang tough, especially if the discharge department is telling her that it's her job to solve this problem.

As long as dad is "in a bed" leave him there. I was told that many years ago by a wise and compassionate discharge planner. If someone says they are discharging him, ask if it meets the criteria for a "safe discharge". It won't.

Make sure dad does not sign himself out.

And make sure dad is admitted, not under observation.

Getting mom into a psych hospital might be a good solution to DAD's problem.

Helpful Answer (6)

Report

While Uncle is in the hospital the daughter needs to tell the Social Worker that he cannot return home because her mother cannot care for him. Either can she because of working and having a small child. They will place him in a NH with Medicaid pending. They cannot safely release him. Then she needs to ask the SW about Mom explaining that Medicaid is pending for her but there is a waiting list for NHs. In my State u have 90days to spend down, get Medicaid info, and find a place. Not sure if Okd for Medicaid they will wait indefinitely for daughter to find a place for Mom. Again, she cannot care for Mom.

This is all should be done by the daughter. Especially if she is the POA. If Social Worker can't help, then she needs to call Adult Protection Services because Mom should not be left alone.

Helpful Answer (3)

Report

Thank you JoAnn. APS in that area is a joke. My friend's mom had dementia. She was walking around outside naked and using her living room floor as a toilet. Her daughters were told "she has to be allowed to live how she wants".

(1)

Report

See 1 more reply

It seems that the hospital has to find a place him. Home is unsafe. Isn't the low kidney function enough to get him on Hospice? I'm not a medical professional but it seems, from what I've experienced, anyone with that diagnosis has a limited time to live.

Helpful Answer (5)

Report

Kidney failure isn't good enough for hospice. CKD comes in many stages and changes with hydration levels. SEVERE PAIN, you know, doesn't cut it either. My Dr tried to get me on hospice for both of those reasons plus 49 years of TYPE 1 insulin dep. Diabetes and all that goes with it. The pain level is from birth defect (causes flow voids in spinal fluid with activity to nerve damage in private areas feeling like a brillo pad in gasoline, lit on fire scraping me 24/7 except when I can drug myself to sleep. Hospice said, I'm not dying fast enough. Pain meds? With Trump's war on drugs making Dr's afraid to give a scrip. I was on hospice once for med malpractice. 850mg morphine, 240 mg oxy, up to 48 mg dilaudid. I obviously didn't die. Result? They yank that out from under you so, ??? Street drugs??? The only problem I have found in the war on drugs is that the ones TRULY in need of pain control CAN'T GET ANY! I want to give you my experience with that issue not for "shock value" but to say your uncle is not alone. Had a few ER Docs, one who cried when he told me that I was one, like your uncle, that caz of the 'war', we "fell through the cracks". He couldn't admit me but the infection from the 2 open foot wounds looked very painful so he referred me urgently to podiatry, gave me a courtesy shot of morph, 15 oxy to hold me til appt & he told me that it hurt HIM so badly that too often, good people fall through cracks & we wonder how suicides are up?? Now, being released. My dad is 91 and fits somewhere in between your uncle and your aunt. Dad admitted. A combo of your aunt, dimensia but also cerifiable for 60+ years when he had a "vision" that God made him a prophet. In the hospital, he yelled at all nurses, dr's, janitorial staff, anyone to leave him alone, thewere ALL going to hell, refused meds... they could not send him to nursing home NOR to psych hospital. The Dr TRIED to keep him there but was forced to release him when he could no longer prove there was a medical need to keep him. HE TRIED!! No money for private pay. We live together and I will not put myself into Medicaid readiness, lose MY home we share financial responsibility for. Your uncle sounds like he CAN get by with a caregiver. Your aunt is the challenge. You may very well have to bite the bullet, call 911 and have her com/ADmitted to a psych facility. This is heartbreaking to hear. No one's in the same boat, but many are on the white water. You. I got very personal with my answer but I know from experience that you will all feel better when y9aunt is happy getting the attention she needs to express her unique personality and believe it or not, they do enjoy the attention. I have worked in the levels from ER to n.h. to psych facility. Worked it, been a pt and living with it. All sides. Rich and poor. Don't let your sister feel anything but that she's doing the best for HER child, her marriage. Maybe not making any sense. This is a tough one but seems to all come down to proper place for auntie. U'll be surprised how much of the rest will fall into place and bring peace. Good luck. Prayers.

(4)

Report

Take Auntie to the E.R., or transport by calling 911.

1) Get her checked and treated for a UTI, which we know presents with behavior problems.
2) E.R. will arrange to have her evaluated and treated in a behavioral unit.
After being stabilized on medications that may help, they will discharge her to an approved facility. Easier if the discharge planning finds the facility for you.

Helpful Answer (7)

Report

Take him to a different hospital if needs be.

The story you tell does NOT mean APS is a joke. There are criteria for taking away a person's right of self determination.

The naked lady isn't hurting anyone.

The person in your story is a danger to others. There IS a difference.

Helpful Answer (5)

Report

It is not safe for him to go home. Stand firm on that: unsafe discharge. Unless they can get the violent one out of the house into an appropriate setting. But it sounds like he needs too much care to go home either. Rough. Good luck.

Helpful Answer (3)

Report

State social worker (APS) needs to be called. APS needs to intervene on behalf of 2 vulnerable adults, and possibly take guardianship of both. Uncle must not be discharged to an unsafe environment, and family or anyone else for that matter is under no obligation (nor should they in this case) to take either one into their home or care for them. Make sure this time hospital does not release uncle this time, first call APS if hospital social worker or hospital administration pushes to release uncle back home, that should make a difference but if it doesn't, I would strongly suggest consulting an attorney for possible lawsuit against the hospital.

Helpful Answer (5)

Report

You wrote, "(they can pay privately while waiting for Medicaid approval) ..."

How many month's worth can they afford (for her to go into MC)? Someplace should be willing to take her on private pay, just make sure it is a facility that accepts Medicaid. Have the hospital discharge her directly to the care facility if at all possible. You don't need to be her FPoA to apply for Medicaid for her. Is their daughter the PoA for either of them? If not she should absolutely refuse to go get t

If your uncle does not have cognitive impairment then he gets to make his own care decisions. It is very possible the pneumonia will take him out... I'm so sorry this is such a hot mess. I wish you all the best.

Helpful Answer (1)

Report

Is your aunt and uncle's daughter the POA? She or you should get connected with a local social worker to explore your aunt and uncle's options. A social worker may be able to help expedite the Medicaid. Perhaps hospice is an option for your uncle, if his doctor or hospital will certify that he is nearing the end of his life. Many hospice services are covered by Medicare. Hospice is supposed to be for the last 6 months of life, but my mother, who has advanced dementia has been on hospice care for more than a year. Hospice has been recertified every 6 months. You or your aunt's daughter must talk to her doctor about her aggression. Calming medications may help. And you should also consider placing her in an assisted living/memory care/skilled nursing home where professional staff know how to care for people with aggressive behavior. An attorney specializing in elder matters might also help. The socal worker may give you some names of pro bono attorneys if your aunt and uncle have a low income. There is nothing that you can do about the waiting lists for assisted living in your area. But perhaps medications can help your aunt in the meantime. All the best to all of you!

Helpful Answer (5)

Report

I think in this case the big issue is that uncle and aunt are living in an isolated, rural area, with few services for elders. And they don't want to leave that area. I live in a small town and facts are facts: at some point I will not be able to manage here. But my wanting to stay here should not burden family.

(1)

Report

Have Dr put mom on something to calm/mellow her out and hire more Caregivers.
INasrallah Cameras to be able to watch her 24 7.

Onice Dad is in the Hospital, the Hospital can not legally discharge him to an unsafe environment.

Tall with him and let it be his decision rather to go home or to a Nursing Home.

Beleven me when I sat Nursing Homes are Horrible! They are all understaffed and you don't get much care much less good care.

I have 1st hand experience and I would rather take my chances in my own home.

Prayers

Helpful Answer (0)

Report

Bev, I can appreciate that you want to "take your chances." That is your privilege. The problem comes when having an elder stay at home means, realistically, if not absolutely legally, that family member or members have to give up their lives to make it happen. People will say that daughter has to sacrifice her family - why is this? Are they not important? I suspect that this couple refused to move from what sounds like an isolated rural area with very limited elderly services and because of their stubborn refusal, others are "obligated" to fix the problem? It is one thing if you want to take your chances at home and not rope in anyone to enable, but that does not seem to be the situation in this. As for elders refusing to leave their homes etc. - look at it this way, why would this be the deciding factor when others are impacted? I would like to ride to work in a limousine but it is not going to happen and no one owes me that. I take the bus. We all have to put up with stuff we do not want, but that is life. And no one "ages" out of having to accept unpleasant necessity.

(1)

Report

Give APS a call.Or the daughter can call, asking for help.They will do an assessment of the situation, and determine level of risk. Risk is high for each elder, and higher for both of them together.
Neither of these 2 elders can live alone in the house, safely and independently. And they can't both live there, as you have clearly explained. Getting each of them into appropriate care settings now, before the funds are all spent down, is the best plan.
As another commenter said, 'unsafe discharge' is the mantra when dealing with hospital social workers.

Helpful Answer (4)

Report

The hospital social worker is able to help you get uncle and maybe aunt placed.

Uncle is 94 and in poor health. Let him have morphine or whatever will relieve his pain. It is what it is. Allow him to begin his end of life journey. Do not allow him to suffer. Get palliative care involved also and possibly send him to a brick and mortar hospice facility.

Aunt may need to be evaluated for medication changes. Since the nursing home has no beds home care is needed. Get palliative care involved for her also.
Ask her primary care's social worker for help finding care.

This is what I suggest having cared for my dad and now mom and an aunt both with alzheimer's.

Good luck and God bless.

Helpful Answer (3)

Report

The daughter needs to try to get to this hospital to speak with the drs and case manager and yes state this is an “unsafe discharge” - she can also call Medicare now and report the same if they hospital is not working with her on finding him a safe place - by calling Medicare (their current insurance) it will automatically place the hospital discharge on “a hold” while they investigate it (it will at least give time to speak with the correct people to help her find a better place for her parents). After my moms stroke they were trying to discharge my mom when DME place hadn’t delivered moms bed and chair etc the equipment needed to get her home so it was the DME girl who taught me about “unsafe discharge” and told me to call Medicare - they immediately told me to stay put and the hospital couldn’t make us leave - they were very helpful. She could also call hospice and speak to the hospital case manager about a hospice house - if there are bed available (maybe while they await their Medicaid approval he could go to a hospice house).

Someone mentioned here calling 911 for her mom - having her checked for UTI and psych eval - I agree. Local paramedics are not new to this - they will take her in and at least someone will be able to review her medications and check for uti - bloodwork etc. I understand she cannot give up her life and has a child to care for but she should try to get there to speak with her dads drs - refuse discharge - report the unsafe discharge to Medicare if the hospital isn’t working with her and think about calling 911 to get her mom admitted so they can help her mom get a better medication balance now before entering a memory care (as I have seen/heard many people get their parents into Memory care and then are called and told either their parent or too much work and cannot stay or that they are required to hire an aide at their cost to keep the parent in memory care) - so finding a medication balance for her mom now will also help them both before memory care. Best wishes

Helpful Answer (4)

Report

Daughter was there every day. Constant contact with doctors. She repeated "unsafe discharge" like a broken robot. THEY. DO. NOT. CARE. Sent him home. She could have opted to leave him on the street, but other than that, taking him home was the only option.

(1)

Report

Newbie to this forum. Are different states different Medicaid? In my state if "they can afford to private pay," they will not qualify for Medcaid until such monies are spent.

Most Nursing Homes limit the number of Medicaid beds because the payments are quite low.

IF you request a "self-pay" bed, you will pay MUCH more but will have a better chance of "getting in." Then, when the funds run out & you qualify for Medicaid, you are already "in."

Also, UTI's are (in my experience) way more likely to be the "cause" of anger, meaness in Alz than the Doctor's seem to realize. & tests are so simple.

Helpful Answer (6)

Report

Yes, that was unfortunately written into the Medicaid amendment to the Social Security Act in the 1960s-allowing state discretion on their contributions to this shared- cost program with the feds. Some states are notoriously low in their contributions and reimbursemnts-and believe it or not elder care is better than many other areas (well- woman care, midwives, etc.) Many but not all are in the South. So yes there is a fair amount of variation in Medicaid eligibility rules. A great resource here is the Kaiser Family Foundation, kff.org.

(3)

Report

If they can pay for a nursing home while Medicaid is pending as you say, they why can't they pay for extra in-home care from private agencies for his wife? As someone else stated, get her tested for uti, and also medication for calming her.

If uncle is nearing the end of his life and in hospital, he stays there (state emphatically there is no one to care for him at home, get Patient Advocate involved if needed) or have him sent into hospice facility where he can live out the rest of his days without pain and in peace.

Helpful Answer (4)

Report

Maybe nursing home is less expensive. My FIL was on 24/7 in-home agency care and it ran through $25,000 of their savings for that one month. The found him a board-and-care for $4500/month. Now he's back home after heart valve surgery and no longer in need of 24/7 care. But OMG, $25,000/month? Who can pay that on an extended basis??

(2)

Report

See 1 more reply

I would get the wife involuntarily admitted to an inpatient psych ward for evaluation and treatment. Call 911 when she has one of her outbursts so the authorities can bring her in and have her admitted.

While she is spending time getting her behavior medications sorted out on the unit, allow uncle to move back home with round the clock home health care. He probably qualifies for hospice with his multiple health issues.

Get a social worker consult for wife to place her into a memory care unit that can provide care for her through Medicaid - even if it is "quite a drive" from home. This way they can both be cared for safely.

Helpful Answer (6)

Report

bolliveb: Imho, your uncle needs to be transported to a different hospital and possibly be administered morphine for the extreme pain (I do not profess to be, nor am I a medical professional). However, he should not have to suffer especially since he is nearing EOL. Refuse discharge from the Hospitalist. Private pay for his wife as long as the financials allow.

Helpful Answer (2)

Report

I don't know if it needs a different hospital but I agree he should be tried on morphine (it doesn't work for about 25% of people but it has to be tried). If it damages his kidneys as he is EOL one has to think it doesn't really matter - his being out of pain is more important than a few extra weeks in agony. I totally agree with the refusing discharge.

(5)

Report

See 4 more replies

You have to put the burden on the State. Discharge of husband should be refused making the hospital have to sort out a nursing home, and mother should be either taken to A&E and left there so the same applies or 911 called for a violent event and then there is no one for them to send her home to so it has to be sorted between court and social care. It sounds horrible and is not the type of situation one wants anyone to get into. But sometimes one has to play the system to get it to take on responsibility one should just be able to ask for. I hope you manage to find a way to get them both settled in the care facilities they need.

Helpful Answer (5)

Report

I don't exactly know but you must contact Adult Protective Services in your county - Office on Aging can help you get this number. They must be contacted at once and they step in and do what they need to do when you can't. And if someone is in a hospital, and are ready to go home, NEVER, EVER ALLOW YOURSELF TO BE FORCED TO TAKE THE PATIENT HOME. The hospital must and will find a place to put them - do not take them home or you are dead in the water. Also seek out a social worker in the hospital and state the fears of having someone in your home who is violent and abusive. Someone must step up to the plate and that is the state's responsibility. You can also call the police and place a call about violence and safety and the person must be removed. Don't give up.

Helpful Answer (3)

Report

Also every state and county has what are known as OMBUDSMAN - People who work for the state and who are called in for senior issues when there is no help. You can find them via the Office on Aging. DO NOT LET THESE PEOPLE INTO YOUR HOME - EVER.

(1)

Report

Is there are pain management doctor in the area?

Has topical pain relief (BioFreeze, Pennsaid) been tried?

Did the daughter sign for the discharge or did the patient? How was he transported home?

Helpful Answer (3)

Report

This is horrific - I feel for this daughter. Your update is they released him to his home?

I can only say keep trying. Call 911 for him - for the mom staying she is a harm to herself and to him. Call Medicare - Call local APS again an ombudsman is a good idea - call hospice - Local Counsel on Aging. You can request 911 EMT to take him to a different hospital. How does a hospital case worker not even send him home with home health? The daughter needs a social worker out there now. Where are you located? This is so not okay that elders just keep getting sent home - I would call a local news channel (email them for her). This type of care for elders has stop happening in this country. I’m sorry for this whole family. 🙏🏼

Helpful Answer (4)

Report

Are you saying now that the hospital sent uncle home without adequate care? Was APS called? Has hiring an attorney been considered?

Helpful Answer (3)

Report

"Daughter was there every day. Constant contact with doctors. She repeated "unsafe discharge" like a broken robot. THEY. DO. NOT. CARE. Sent him home. She could have opted to leave him on the street, but other than that, taking him home was the only option."

Boll, you and the daughter need to understand this "game" of chicken.

She needs to say "no" and walk away.

If they send him home in a cab in a nightshirt, she calls 911, APS, the cops and the press.

Helpful Answer (6)

Report

Yup. Friend's G'Ma was wheeled out front (near midnight) to await a taxi home. Except staff forgot to call one...

Eventually a passerby wheeled her back into the hospital, half frozen.. Made the news. Got a BIG apology for her trouble but hopefully safer discharge for all!

So what happens?

27 Answers

Recent Questions

Popular Questions

Related Questions