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A new wrinkle on Dad, who after a fall (he is 91, alcoholic, blind) was hospitalized then brought to a rehab facility where he has been for just over a month. Now that he is no longer heavily medicated and has regained his mental capacities he JUST WANTS OUT. He's still progressing, no longer in a wheelchair and able to walk a little with a walker, but no longer in any shape to live on his own. I've been frantically researching assisted living facilities in his area (I'm in a different state) close to his friends, and figuring out how to pay for this. His frequent visitors report that he is improving but all agree that he is in no shape to return to his small apartment. The elephant in the room is that at home, he will start drinking to excess again, fall and repeat this cycle. An in-home aide is out of the question due to expense and limited space. Yesterday was a bit of a show down on the phone with him and his doctor who is extremely difficult to reach, and only called because of this crisis. Dad insists he just wants to get back to his apartment. I talked him down, telling him he needs to stay there for at least another week to regain his strength. My plan is to move him into an assisted living facility that offers respite care, so we can test the waters and I can have time to pack up his apartment and take care of logistics for a permanent move. I guess I'm looking for reassurance that I'm doing the right thing, but also wondering if he decides and somehow finds the capacity to simply walk out of the rehab facility what would happen? On a recent visit he showed up with a bag of belongings insisting that his visitor drive him home. The rehab aide didn't seem concerned and someone must have packed the bag for him? I can't even describe the frustration of rarely being able to speak to anyone with any kind of answers at the rehab - I'm constantly given the run around and after a month (and a week being there daily in person after he was first admitted) I have only JUST been able to get updates after their weekly assessments, but even this requires a huge commitment of calling, leaving messages again. My mom (also in assisted living and doing very well) says that possibly he could be kept in a restricted facility if he manages to leave, as the state would decide that his safety was at stake but that doesn't seem right. I was quite shocked that the doctor would call me - but without suggestions or recommendations, only saying that it was not a good idea for him to live alone. What if Dad insists they call him a cab and just "goes home"? How deep does the responsibility of the rehab facility go?

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Rovana, by law a rehab/NH cannot release a person unsafely. Even though there is no Dementia he cannot physically care for himself. You can be deemed 24/7 care and not have Dementia. He must show that he has 24/7 care in his home. My daughter has worked rehabs/NHs for 20 years and new exactly why my friend was told she could not go home. My friend had no cognitive problems. Just didn't have the money to pay for an AL. If she could have afforded an AL, there would have been no problem.
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Lisa….for YOUR own peace of mind and your physical safety, take some of the advice that will work for you. You cannot help someone (your dad)that doesn’t want your help. This is such a hard place for you to be in. If he is as stubborn as you say, best thing you can do is get off the runaway train and when it crashes, call APS and let them deal with him. And most importantly, please take care of you!!!! Love and blessings to you….Liz
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Just noticed post was from Aug 2021. Hopefully resolved well.
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Unless dad is declared incompetent, then he decides what he wants to do. I don't believe the rehab can keep him against his will and if he can figure out how to leave, then I don't see them stopping him. All you can do is what you are doing but you may not be able to save him from his own bad decisions.
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Does the assisted living have a bar? Does it serve alcohol in the restaurant or allow residents to bring alcohol to meals? Some do.

If your Dad was detoxed with librium he sounds hard core. Believe me when I say it my Dad was hardcore.

I don't believe there a lot of supports for seniors with alcoholism.

Hang on for the ride. Take care of yourself first. Dad is gonna do what Dad is gonna do particularly if alcoholism is involved.

I'd recommend Alanon for you. It helped me. I remember being petrified Dad would call a cab to leave the rehabilitation place when he hurt his shoulder. As it was when he was in the hospital he told them he would stay a couple of extra days so that he would not have to go to the rehabilitation place.
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I'd recommend Alanon for you.

It sounds like Dad wants to leave to drink.

It is not illegal to drink yourself to death.

Even in assisted living he is going to want to get out (unless he has someone supplying him with a steady stream of alcohol.

We went through this with Dad. Good luck. I found Alanon helpful.
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It sounds like the rehab. is very aware that he should not go home alone....pretty rare for the MD to actually call a family member. They will not help him leave AMA, big liability if they do.
IF your dad manages to get it together enough to find a phone, call a cab company, and take some belongings with him when he leaves, then he has managed to discharge himself AMA (against medical advice.) Seems doubtful he can manage that all by himself.....but if he does, call APS.
He is likely to repeat the same cycle - get all 'buffed and polished' in a rehab stay, clear up mentally and improve physically enough for discharge. (which he has NOT accomplished!) and then go home and rapidly deteriorate. And end up in the ER again.....
He is not likely to cooperate with any plans you make...
Once he has completed rehab (determined by the rehab staff), and there is no safe discharge plan, he will need to pay privately for the nursing home. An elder law attorney in HIS state can help you with dividing up assets so that your mother gets a fair share for her care, and he uses up his share of resources, and then goes onto Medicaid. That will pay for a long term care residential bed.
Your mother's comment about him being in a locked facility tells me she realizes he will likely get into trouble in assisted living with that level of independence...and maybe she does not wish to live with him again.....
Do the best you can, don't beat yourself up, there is no clear path here and sometimes it all falls apart....try not to feel guilty....
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The rehab cannot release him if he is 24/7 care unless he will have 24/7 care at his home. If he cannot supply proof of care, by law he will have to stay in the NH.

This happened to a friend of mine. She had overdosed on oxy living on her own. She had Parkinson's and wheelchair bound. She needed 24/7 care and no one willing to do it. She also had stomach cancer. After a hospital stay and rehab she was told she could not go home.
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rovana Jan 2022
Are you saying that a person not declared incompetent can be held a prisoner?
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Very helpful. Today I finally got a written report from the facility and it shows that he has no signs of dementia, cognitive impairment etc. I do not want him on meds - he was given librium while first admitted (as a precaution while he was detoxing) and it reduced him to a drooling mess. I insisted that he be taken off it and now I'm kind of dealing with stubborn Dad who has almost all his faculties. My plan has been to move him to respite while I'm preparing the paperwork and setting up (his) finances to pay for assisted living at the same facility - should I be cautious about that? My hope is that once in the assisted living he will adjust and actually enjoy being in a social setting and no longer having to fuss with dealing with the difficult tasks of daily living. Am I living in a dream world of optimism? I have a POA but did not go through a lawyer, I just drew it up from a standard form and had him sign it and a couple of friends witness. It's notarized. That doesn't give me any clout with the rehab? My head is spinning because their lack of communication with me has just contributed to my stress.
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MJ1929 Aug 2021
What kind of POA do you have -- medical or financial? Durable or springing?

If you don't have medical POA, no, you don't have any clout with the rehab place.
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talk to the social worker at rehab as well, and what annreid suggested below. If your father goes home, it will be rinse, repeat… contact your local age and disability office in your county for guidance. If funds are limited you need to be educated about Medicaid.
I wish you luck, it’s a difficult road…
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You desire good things for your dad however if you are not his PoA AND he doesn't have a medical diagnosis of cognitive impairment -- you are powerless to make him do anything or see the benefit of your plan.

Even if you ARE his PoA you have no authority until he is diagnosed as impaired. The facilities do not respond to you because you currently have no legal authority.

When he goes back to his apartment contact APS to do wellness checks on him (this gets him on their radar). At some point his train will leave the tracks completely and then the county will come in and pursue guardianship of him and they will manage his medical and financial affairs, and place him in a facility (and in his alcoholic and uncooperative case, probably a locked MC wing). You can relay this info to him but I doubt it will change any of the choices he makes.

You should absolutely NOT be paying for anything for him, no matter how badly you think he needs it. This is enabling, and unsustainable at your end. You are robbing yourself to help someone who does not want to be helped.

For your own sake, you should reserve your energies and put up boundaries so that you don't go down with the sinking ship. You aren't responsible for his happiness. You can't have his recovery for him. He's an addict and you are co-dependent. Maybe going to an AlAnon meeting would help give you a better perspective of it all. Many on this forum have been in your shoes so please take their advice. May you gain clarity and wisdom and have peace in your heart no matter the turn of events.
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LisaTorres Aug 2021
This is incredibly helpful, reassuring and in a strange way - comforting. Thank you so much.
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ASAP- TODAY IF POSSIBLE, contact the facility and request a neuropsychiatric evaluation INCLUDING A COGNITIVE ASSESSMENT, AND IN ADDITION, a functional assessment by OT and PT. Adding a current visual assessment including BOTH visual acuity testing AND FUNCTIONAL performance for Activities of Daily Living and ability to manage personal needs.

Hopefully, failures in needed skill areas will be revealed and you will be able to request that he might be given medication on a trial basis that will allow you a little more time to get a structure in place for him.

Obviously your mother, who probably knows him best, is right on track.

If there is ANY possibility that he somehow passes tests that can indicate that his decision making abilities are not impaired, you may have no other alternative than to let him be released.

IF there is a POA in place, contact the lawyer who drafted it and determine if the holder of his POA is able to participate now in deciding what he should be doing.

Be careful with the idea of a “respite” placement unless it will include observation and continuing assessment. If you know he NEEDS safe comfortable 24/7/365 care, stick to your own compassionate goal setting.

Tough, tough situation. Remember, against NO COOPERATION there are limits to what you can expect yourself to do.
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