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My mom is currently in the Rehab facility in New Jersey after the surgery. She is somewhat weak, but not to the point where she can't stand up an use the wheelchair or some assistant to move around. I had a meeting today with the rehab nurse, the social worker and the doctor who said that she is not strong enough to go home. And, if I take her home, I will have to sign that I am taking her against the medical advice and the insurance Medicare would not pay for her medical services once she is at home. This is nightmare and i feel powerless that I can't do anything about it. The rehab is telling me she might need another two to 4 weeks to get stronger, but after that they might say she is still not well enough and can continue to hold her there against her and my will. Is there any law that I can use to force them to discharge my mother and assign her for a home medical care. Do you think i need an attorney to resolve this matter.


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my mother has been in a rehab center for a couple months now and is not happy with where she is and would like to come home is it possible that she could sign herself out of rehab and go home
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You don't say how old your mother is, what type of surgery it was, and if she has dementia. As a nurse and social worker I can tell you if staff is all in agreement it will take longer for her to gain strength to manage at home, then listen to them unless you are a doctor and can care for her at your home. All they are saying about Medicare is that perhaps the level of care she needs (i.e. IVs, wound care, intubation, etc.) need to be done in a hospital/care facility in order for Medicare to pay for them. Isn't it better to have her cared for by professionals just in case she gets an infection or some other untoward event? When she is stronger, I see no reason why the facility would not discharge her. Believe me, there are not enough beds for all the sick people to fill, so relax and let the staff get her better. Best wishes to your mother for a speedy recovery!
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I would suggest calling Medicare directly and relaying the information the Rehab people gave you,and what you desire to do. In general Medicare will pay for a brief period of skilled nursing home care after release from rehab, but I am not sure what their policy is if you take someone out of rehab before the professionals think the patient is sufficiently rehabilitated. Personally, if your Mom just recently had surgery, it may really be too soon for her to go home, especially if she is still weak. You could turn your head for a minute and she might fall down and end up back in the hospital. A facility is not the most comfortable place to be, but for the 24/7 supervision and care, it may be the best place for a while longer. Give it some more thought. To put it in a bit of perspective, my Uncle just came out of a 4 week rehab stay, subsequent to a one week hospital stay for a cellulitis infection in his leg. He did great with PT and his legs were strong at the end of 4 weeks. Although he is legally blind, he lives alone and gets around his apt with no trouble. I do not live with him. I took him home on Wednesday, on Friday a nurse came to evaluate him for PT home care and a Nurse for wound care (bed sore), and sometime btween Friday night and Saturday morning, he lost his balance getting up from having fallen asleep on the sofa, and fell down in the living room, and I found him on the floor when I went to check on him /saturday morning because he had not been answering the phone. He is now back in the hospital, and I don't yet know what the next step is going to be for him.
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tsoj2001 - leaving a facility AMA - whether you are a parent taking a child out of the hospital, or you self-discharge yourself from a facility - can come back to be a big issue for future care. You will be viewed as non-compliant for care and some insurers will not pay for later services.

Sunflo2 has given some really 5 star advice. You have to have a detailed plan for your AMA action not to be a problem in the future. Keeping her there with 24/7 care and continued therapy may be the best thing as it gives you time to change your home to make it suitable for her changed needs & ability.

Not to be totally rude but could there be something about you personally that has the facility concerned? Do you have any health issues (physical or mental) that has them concerned about your ability to handle caregiving? Often for the elderly, it's the "blind leading the blind" in care in that you have an 88 yr old being discharged to go home to an equally frail 88 year old. In some areas, if a person leaves AMA, an automatic report goes to the state for a protective services inquiry. If your's does that, you can expect adult protective services to pay you an unannounced visit and speak to your neighbors. If there is anything amiss in your personal life that is a red flag (like you are in foreclosure or you have a child with a juvee record or someone in your household has a felony) then mom could be forcibly removed from the home. Not pretty.
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Above the age of 85 yrs, the elderly are often sent to a rehab for some building up/healing so they are stronger when they arrive home. If the rehab is part of an existing nursing home, you can benefit from the existing skilled nursing care (RNs) but there is a tendency to keep the elder as a nursing home resident after the medicare rehab dollars dry up. They normally get more medicare dollars for new rehab patients (ie the first 30 days) and are very willing to either admit them to a nursing home on day 31 or demand that you immediately take them away to free up the rehab bed. This happened to me when caring for my 90 yr old father in New Jersey. Was told on a Tuesday afternoon to have my father discharged on Saturday or Sunday. I was working in overdrive to set up his room with proper medical equipment, get the doctors help to order out home health nurses to check on him, PTs to continue his work on walking and hiring a full time private paid home health aide so I could continue working the following week. I managed to get it done but as the sole/primary caregiver except for the paid home health care aide, but it is difficult.
So if you plan to take an elderly woman home after surgery you will need to purchase the equipment she needs and the doctor will need to set up the home health nurse and perhaps a pt to improve her walking. You need to consider getting a full time caregiver so she does not fall and create a bigger problem in the future. She will undoubtedly say she will be fine--they all say that but you can't afford for her to injure herself and then she will land in a nursing home for life. Good luck but remember, just bundling her up and bringing her home without everything thing and one she needs in place --isn't a workable plan.

My father had to go to 2 rehabs at age 90 because he was too weak to be home. He wanted to be home from day one, but I reassured him if he could
continue on developing his strength and walking skills, I would bring him home.
I visited him every day and he did get home after a 2 month (combined hospital and rehab stay). He was very happy to be home.

Good luck but consider all options. You will need Medicare to provide some home health services so do nothing to harm that ability. Medicare will not cover all the things she needs or services but it is a Godsend for all it does provide.
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Could you clarify your mother's situation? Has she completed her total regiment of rehab that is paid for by Medicare?
I tell my clients it is important to understand the reasoning behind a decision before reacting to it. Sometimes, but not always, there is a good reason for their decision.
Medicare pays for 100% of rehab for up to 20 days in a facility and 80% up to 100 days if the rehab facility and Medicare decide it is necessary. After that it will not pay.
However a facility is not permitted to have a person leave a facility without "a safe discharge plan." This means they cannot legally permit someone to leave a facility until a plan is in place that will keep the person safe once they leave. That is why Medicare will not pay if you go against their advice.
Ask the staff what would be needed to make it possible for your mother to return safely to her home. Maybe all she needs an aid to be with her, or maybe you need to make some adjustments to the home--like expanding the door ways so a wheelchair to get through.
You can still take you mom out of the facility against their advice, but they are required to let you know that they and Medicare can not be held responsible for her safety.
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To add to the great advice/resources already expressed above; I would say you need to request a personal meeting with her care team at the facility making sure the physician is present as well. You should (again) listen to their side and then present your side with a clear written "care plan" for her continued rehab at home. This would include skilled in-home care, appropriate provisions (hospital bed, portable potty, walker, bathing safety (grab bars, etc.); stairs safety, whatever is required to help her navigate the home); possibly even someone staying with her for X days, in home assisted care, etc. This is exhaustive; but you have to "demonstrate" that you are not endangering her care by pre-maturely discharging her back home before medical experts think she is ready. So please, make sure you have done your research and have a clear well-thought care plan for your mom.
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We get so attached to our parents that we just want to take them home where they are "safe". All too often I see postings here of people who are burned out after only a few weeks and can no longer keep up the pace. Try to put that emotion aside and accept that she needs a LOT of care for now. Take it one day at a time, work with the staff and MD. If push comes to shove and you both go to court, don't be surprised to see the judge appoint an independent guardian, leaving you on the outside looking in. Stay connected, but put your hero cape aside for a bit.
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Short answer - generaly it is a myth that AMA discharge results in bills to the family; generally planning to keep someone in order to maximize using all their benefits is wrong and should not be done; generally it should NEVER be AMA unless the person is really unsafe.

Long answer - As a rehab doc, I have done exactly two AMAs in my entire career. I had witnessed the scandal of a TBI facility practicing what was not-so-lovingly termed "fundsucking" by a disability rights activist I was honored to work with. That bascially meant they were keeping people until funds ran out, being dishonest with caregivers and claiming people were a danger to themselves or others, but then set them up for immediate d/c regardless of needs I was able to assist in a small way in putting an end to it, and after that I made it a point to write into our policies that rehab was elective and AMA was used only under extreme and unusual cricumstances.

In the eldercare arena, I have seen more people just want to quit rehab and go home who are not thinking real clearly about safety or maximizing their function, and it is important to be objective about that. I like the idea of using a third party like an ombudsman to negotiate and help decide, if speaking with d/c planners and maybe getting a team-family meeting to address specific discharge goals and what the person really needs to be able to do to return home safely. These are not cookie-cutter decisions but should fit the individual and their needs and desires first and foremost.
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My Grandmother is in a nursing home her Medicare is running out Thursday. I have a meeting today. She's been begging to come home can i discharge her even if the social worker and doctors disagree.
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