My brother has a home with a live in caregiver. My brother is a triple stroke survivor, and an alcoholic since he was 15. He is now 65.
He got sick with pneumonia from aspirating on food. He ended up in ICU 2 weeks ago. He was in ICU a week, than transferred to a nursing rehabilitation facilty, as he cannot walk and was having problems swallowing. We wanted him transferred to a better hospital in the city as we live in rural TN and the hospital here is nicknamed "death hospital" because of the neglect patients receive. I had to have my brother life flighted to the city 3 times in the past because hospital here neglected him so badly. The city hospital filed a complaint against the hospital here due to severe neglect of my brother in one instance.
Fast forward to now. They refused to transfer him to city hospital, saying he just needed to recover from pneumonia, get physical therapy and speech therapy and it would be the same treatment he would receive at the hospital. I very hesitantly agreed to sign admission form after discusing it with family. He wasscheduled to go home Saturday the 14th.
Yesterday I called nursing home to discuss his going home, and they informed me my brother has decided to stay in the nursing home. They said that he needs 2 people to lift him to potty chair and to bathe him, and if he went home, they would call adult protective services because there is only one person there. I said that he would have never agreed to staying here. They said they told him if he signed up for Choices and stayed in the nursing home 30 days, than Choices would pay for him to have in home care 40 hours a week. I know that was the sales pitch that got my brother to agree. When I asked who would take care of him outside the 40 hours since he only has 1 caregiver, they said "Well, than he can never go home".
She was on his way to his room to have him sign the agreement when my call interrupted her. I told her "Do not let him sign any papers until I talk to him. I want to make sure he understands what he is signing". I am going there this morning.
My brother not only is detoxing from alcohol and cigarettes, he suffers from severe depression and anxiety and is on a multitude of medications and I have no idea what meds he is on at the nursing home.
In my opinion, he is not of sound mind and should not be signing legal documents.
Also, his home is paid off and I have been receiving notices from Medicaid that when my brother dies, they will take his home. It is worth about 70k. Those came as soon as he was admitted to nursing home. 1 from Choices and one from TN Medicaid. His caregiver is also one of his best friends from back home in Michigan. He moved here 15 years ago to take care of my brother in exchange for room and board, and to get away from the snowy winters. He has no place to go if they take the house.
But my main concern is that they are having my brother sign papers when he is not mentally competant to understand what he is signing, and are threatening to call Adult Protective Services if he goes home because there is only 1 person there to lift him.
I am disabled and cannot help him physically and do not have the means to hire another caregiver. They feel that because he had a cut on his heel and a sore on his toe he was neglected.
His caregiver has been going thru Proton cancer treatment and wasn't able to care for my brother as well the last 2 months. He had a friend come in to help take care of my brother, but the friend worked full time and couldn't do much. His caregiver is finished with treatment and will be back to normal in 2 weeks.
Does the nursing home have the right to not release my brother without discussing it with family? Can they have him sign his life away with empty promises when he is not mentally competant? Can they threaten and/or call Adult Protective Services if we take him home because only 1 caregiver is living with him.
We are in SE TN and have no family here. It's all on me. Thankyou.
Was the staff made aware that your brother has some cognitive issues? If so, they should not have talked to him. He is not capable of signing a contract. I too am not big on SWs. I have had only one who really helped. I find the others I dealt with don't think out of the box. I had one tell me I should put a ramp at the door my Mom used. She was in the lowest level of my house were half the room is underground. I tried to explain to her she comes up out of the ground. No way a ramp would work. She lived 30 min from me and didn't know what a split level was.
I cannot thankyou enough for all your advice, and for sharing your knowledge and experiences about what you went thru and what you learned/know about NH laws.
I am sorry it took so long for me to reply. I had a dentist appt. Thursday and I was there for hours!!
OK.
UPDATE:
My brother came home from NH yesterday. He is so happy and doing very well. I haven't had a chance to discuss what the SS women told him, but I will find out. I want to know what they told him. He did mention that they told him his caregiver could no longer care for him at the house, and it would be best for the caregiver if my brother stayed 30 days, than had in home healthcare for up to 40 hours per week. He said that is why he agreed.
I did some research on TN Medicaids program "Choices". Apparently, the laws changed regarding in home health care July 1st, 2021.
The law that changed was...when someone gets in home healthcare thru Choices, they have to be qualified as "at risk of needing permanent NH care". The patient receiving in home health care thru Choices will be evaluated every 30 days. If it is found that they would do better in a nursing home, the patient will be placed in a NH permanently. And that could be any nursing home that takes Choices and has a bed available. Because we live in a rural area, he could end up an hour or more away in a horrible place.
So, I am glad that he is home but I will need to talk with him and his caregiver about the living situation, the alcohol and where we go from here.
The NH arranged for Amedysis home health care to come out thru the Choices program. So, we are not out of the woods yet.
I asked the NH what would happen to my brother if he did agree to the 40 hour in home care thru Choices, and once he got home he stayed up all night drinking, and when they come knocking at the door at 8:00 am, he screamed at them to get out of his house, (which has happened before with physical therapists coming out).
Their answer was "I don't know. Once he leaves here, we have nothing to do with what Choices does. They have their own rules and we don't know what they are.".
I'm guessing they would probably put him in a psych ward or 7 day detox at Focus, and than place him in a NH or psych institution.
So, I am going to keep this conversation because it has so much information that I need to go thru and check in to.
I need to be prepared.
I wish my other family members would do something. I am disabled and have an unknown illness that is keeping me in bed 21/7 or more. I believe it is ME/CFS, a crippling post viral disease I probably got after the flu/bronchitis in 2017. I was hospitalized, came home on oxygen for 2 months, and my life was forever changed. I ended up with something that has kept me in bed for close to 4 years. Plus I have untreated hyperhomocystienemia, a rare hereditary type of anemia.
I have begged my family to help me find housing in MI so I can sell my home here, move home and get diagnosed and treatment for whatever I got in 2017. They tell me I'm going to have to figure it out myself.
I have never asked my family for help. Everyone always came to me. I was always the "1st Responder" of the family. Now, I need help and they blow me off. It hurts but I'm a tough cookie. I will figure it out, and take my brother with me. It doesn't have to be MI. As long as they have expanded Medicaid and a good hospital/medical campus, that is what is important.
I must go but again, I can't thank you enough for your knowledge, support and encouragement.
He is home, for now. Amedysis is thru Choices so it'll be the "30 day evaluation" again. Gotta go talk to caregiver about that.
Thankyou everyone. I will check back in a day or two.
Most important, I think you should record conversations with your brother so it's very clear what HIS wishes are. Once he gets out of the hospital, he should be making those wishes clear in an advance medical directive that appoints you as his medical Power of Attorney.
As to whether they can refuse to release him, I can't speak to that, but you need to document, document, document. I always took copious notes whenever I was dealing with doctors and nursing homes, and I referred back to them frequently. It's always good to have that stuff written down to jog your own memory, too.
You wrote in part and in response:
"They never told him if he didn't have 2 adults to care for him on weekends and evenings he couldn't leave the nursing home. I felt he needed to know that before signing legal documents that would undoubtedly keep him in the nursing home. "
Ostensibly this makes sense, as his current level of care may in fact require that. And it may that his condition changed.
However, and this is important, I'm unclear, what documents he was asked/encouraged/forced to sign beyond the admission papers. Other than segueing from rehab into palliative care, I never once signed subsequent documents after admission, but my father's experiences were completely rehab and nothing else.
There was one blatant and ineffective attempt to encourage Dad to agree to AL, but I stopped that by asking that they give their brochures to me, I would do any necessary investigation, and Dad and I would make the decision together. That stopped the SW from pushing Dad any more.
(I also documented everything relevant every time I visited. One of the staff whispered to someone else "she's writing everything down." I think that put them "on their guard."
Usually the documentation was as to progress, conditions, and other data that I could either rely on for future care and/or incorporate into Dad's medical record synopsis which I kept in a notebook that accompanied me every time something medical was involved, sometimes even to a DME shop, although I usually just had notes and not the full notebook for that kind of activity. At that time, it was getting hard to keep details straight.)
Right now I can't recall the details of legal "informed consent", although I do recall that a person deprived of reading something before execution is NOT signing with informed consent. I don't recall the level of invalidation of the document though, whether it's specific clauses or the document entirely.
But it seems to me this could come into play in terms of his signing various documents. However, I would anticipate that NH staff would claim they told him, or asked him if he had questions. This is one of those tricky areas of law, i.e., proving he did not have "informed consent."
If you have data documenting his situation before entering the NH, especially being in detox, that would help, as it would bring into question his state of mind at the time of document execution.
(It's a bit hard for me to follow everything that has happened, so please feel free to correct me if I've made inaccurate assumptions.)
One thing I might do is start documenting them, and letting them now it. E.g., I would summarize (in detail) what the NH staff feels is required, with the goal of ensuring the best outcome for your brother but secretly documenting their conditions. Ask someone with rank to review and agree, so that you're both "on the same page" as to what you need to focus on in terms of discharge.
Then work to accomplish those conditions (easier said than done!) w/o telling the NH staff. You can then approach them again, stating the conditions are in place, and requesting (or demanding, if necessary), a discharge date.
This is a complex situation with multiple moving parts and other parts that are unfortunately not flexible. I apologize if I'm not addressing the entire situation; I'm still trying to sort it out, and not getting angry as I read of how this group is treating you.
Another thought: are there any Ombudspeople in the area who might be able to help?
As I see it, he did not have access to information required to make an "informed decision", b/c the nursing home staff failed (or declined or refused) to provide him with, or allow him, to read the governing documentation.
The SW's are unreal. They remind me of prosecuting attorney's. My father was a PI attorney, so I was always being "subpeoned" to the kitchen for a "cross examination" when I was a crazy teenager.
I went yesterday and spoke with my brother. I asked him "What did you verbally agree to?" He said "To stay 30 days so I get free stuff at home". I asked "Did you agree to stay here forever?" He yelled "No!! I said 30 days and thats it. I want to go home! That's my house!" I than asked him "Did they make you sign anything?" He said he thinks he signed one paper, but can't remember. I told him not to sign anything. Tell them I want a copy of anything they want you to sign emailed to me." (I doubt he will remember the 'email me a copy"but I know he won't sign anything. I told him that they told me if you don't have 2 people to lift you at home when you go home, they will call adult protective services and you can't go home. I also told him not to worry about that because they cannot force you to stay. I asked if they are treating you good, is the food good, just regular questions. He looked good and talked about things that happened 40 years ago, so his long term memory is still sharp. He doesn't have his glasses though, so to sign papers without glasses is like being blindfolded.
The SW called me after I got home and said "You obviously talked him out of everything he previously agreed to". I said "I didn't talk him out of anything. I just asked him 3 questions. He said you said if he stays 30 more days, he will get free stuff" and 2 other questions. I didn't talk him out of staying." I than said "I don't know if you get kickbacks or what, but my brother has rights, but he also gets confused easily and I want to make sure he understands what you have told me.". They later called me and said "Your brother needs to be picked up Friday morning bc thats all Medicare will only pay thru Thursday so will you be picking him up?" real sarcastically. I said "Yes".
I mean, there is no talking "with" me. Just talking "at" me. They have not answered my questions or concerns. They talk over me and change the subject. They deny things they previously told me. I feel like an outsider in this process.
I have never heard of an Ombudsman. Are they volunteers? I need someone. They are still going to try and get him to agree to stay. She told me that today. I need to go make some calls. Specifically Choices and the nursing home again. I will get vack to you. Thanks so much.
In your post you state that your brother decided to stay.
You also state that you do not think he is competent.
If this is the case you need to talk to a lawyer about getting Guardianship. Once that is done you can have him released to home IF he will be cared for properly and safely. YOU will be responsible to see that this is done.
As for getting you both (or perhaps all three of you if we include brother's friend) back to MI) let's do it one step at a time. Let's get him the care he needs in the current environment. That will give you and brother time and energy to clean one or both houses. And it is possible, although it takes a bit of work to transfer a person from a NH in one state to another. You would need to be in MI to visit NHs and, if financially necessary, to discuss the requirements of Medicaid with the officials in MI.
Please be easy on yourself. In fact, you can pat yourself on the back while the rest of us applaud you for being a loving and concerning sibling! Well done!!!
Was he on Medicaid prior to this admittance? Has he been in rehab the 100 days allowed by Medicare? If so, then he has been in over the 100. If he has no money then the NH will apply for Medicaid. Medicaid will ask that his SS and any pension go to offset the cost of his care.
Medicaid DOES NOT TAKE YOUR HOUSE. Under Medicaid its an exempt asset. No, he will not be able to keep it up if he remains in the facility so it will need to be sold for Market Value. The proceeds will be used for his care in the facility. If the house is not sold, when he passes, Medicaid will put a lean on the house. When it sells, the lean will be satisfied. Medicaid does not get involved with the process. Its left up to family or Executor to sell the house. If there is a Caregiver that lives in and this is her permanent address foe st least 2 yrs, she is residing there, she maybe allowed to stay in the home but will need to prove they can pay the bills and upkeep. This depends on the State u live in.
If your brother is competent, no the rehab/NH does not need to talk to family. You need to be placed on his Hippa paperwork as someone who can talk to Nurses, Doctor's and staff. He can request that someone be there when he is given information. Or that they call and talk to you.
What I would do is ask for a meeting with brother present. Asking that this all be explained again. Your brother is now a 2 person assist. A CNA is not required to do this on her own. Your brother is aspirating his food. This is not good. His stroke maybe causing the problem. My opinion, he needs skilled nursing. Maybe for good or for a longer period of time.
The person you talked to was on the way to have him sign admission papers. You were right to doubt the 40 hours of in home care, because it was not going to happen. What he would be signing is to be in the NH probably for the rest of his life.
It sounds like a hot mess for sure, but the bottom line is, your brother is an alcoholic, and just had aspiration pneumonia, which I'm sure almost killed him, and now requires more care than his friend or you can provide. So why wouldn't you want him to stay in a place where you at least know he's safe, can't drink, and will get the 24/7 care he now needs?
My husband had aspiration pneumonia in Nov. 2018, and almost died because of it. He also developed sepsis, and septic shock then and when he was able to come home, he was completely bedridden and under hospice care. I was fortunate to be able to stay home and care for him, but I also had to hire an aide to come in the mornings. My husband never recovered and died in Sept. 2020.
It was very hard work to look after him, but I was his wife, and was going to do whatever it took.
Your brother needs more help than any of you can provide, so if you don't like the nursing home he is in now, you can always look around for one you might like better, but I will tell you that there are no perfect nursing homes. Period. And that is what your brother needs right now, and perhaps for the rest of his life. I wish you all the best.
Maybe I'm having difficulty accepting the fact that this is it for him. I promised him 3 years ago I would find a way for both of us to get back to Michigan. He had attempted suicide. When I went to the hospital, I asked him what I could do to help him want to live. He said "I just want to go home to MI". I promised him I'de find a way to get us both home bc I am so unhappy here. But, I got sick. I still tried but the housing market got too expensive with Covid. I'de have to sell both of our houses and I am too sick to even clean most days. I feel like I failed both of us. I didn't want to let go of my promise to him. And I can't bear going home without him.
Thankyou for your reply. I am very sorry about the loss of your husband. ⚘
I am so sorry
I think the treatment of what may be dysphagia suggests that he's not getting proper medical treatment. And I think those giving you "advice" are attempting to intimidate you, if not threaten you.
As to release, read the agreements that were signed when he entered the facility. Notwithstanding those conditions, however, he does have the right to be treated with respect, and properly.
I think the complication of issues really does dictate involvement of an attorney who can stand up to them and recommend to you other courses of action.
(You've mentioned both a "home" with live-in caregiver and nursing home. I'm not clear on where your brother has been and is now. Is he in a nursing home, with a caregiver who actually is specifically assigned to him and resides in his room? I'm not familiar with a situation like this. Could you help?)
Right now he is in a nursing home. Has been for 2 weeks. I think they have his best interest at heart, but were very unethical in the way they have pressured him to make decisions and sign papers that he is not capable of making. They never told me any of these decisions till after he agreed to something he didn't completely understand. I went to see him today and he had no clue of what he had agreed to. When I explained it to him, he said "No! I want to go home! I only agreed to stay 30 days because they said they would give me free stuff at home!". (In home health care up to 40 hours a week). In a perfect world that would be wonderful. When I asked "Who is going to take care of him at night and on weekends?" They said "I don't know. Than he won't be able to go home." But they never told him that. They never told him if he didn't have 2 adults to care for him on weekends and evenings he couldn't leave the nursing home. I felt he needed to know that before signing legal documents that would undoubtedly keep him in the nursing home. And his caregiver that has sacrificed so much to care for him without pay for like 11 years will end up homeless after a certain amount of time. When I said I felt Robert should know that he may never go home again, they got short with me and dropped the subject and had to go.
I am so upset right now. Thankyou for your comment. ⚘