What happens if I refuse to take my 90-year-old parent home and the hospital wants to discharge her?

Hi GMS:
You wrote us on the 11th about the hospital attempting an unsafe discharge on your loved one.
Lots of us wrote to suggest you have control here.
I am so curious about what happened here. Do you use the accusations of "unsafe discharge" and see a social worker?
Did anything here help you or help prevent this unsafe discharge.
You post was such a good one, one we see all the time, and folks truly don't know what to do about it, but there ARE things that can be done, and your post brought that info back up front on the Forum.

Can you tell us how it is going for you now? We would love an update.

When I lived in CT my father was discharged to a nursing home from a hospital. He was slowly dying. of prostate cancer. He was 86 years old, very frail due to weight loss, illness and a high fall risk. He was too large of a person for me to take care of at home even with hospice help. The social workers at the hospital set up the transfer to the nursing home. He had to spend down the money in his bank account and then the nursing home social workers helped us apply for Medicaid. He was allowed to keep some money in his bank account. For memory’s sake I will say 5K. Once Medicare/ Medicaid was approved the whole nursing home expensive was 100% paid for.

Gms575: That would be deemed an unsafe discharge and a social worker would get involved.

I agree with the comments here. Let them know that you are not physically or mentally able to care for her. I told the hospital this the first time my dad was in the swing bed so they sent him to a care facility to finish out therapy. Long story short, when his time was up there he went home. We had someone to stay at night and he ran them off the first week. He did ok the first couple of months with my help and another person helping, but he declined again and is now back in the swing bed. He will be discharged to a facility. He can not walk well even with a walker, get in and out of bed, dress himself or tend to hygiene needs plus he has medical issues that need 24/7 monitoring.

Tell the hospital exactly what Alva wrote and say it exactly as she said. Hospitals need to move people out to free up beds but they need to move to them to safe environments. Not sure why your Mom is in hospital or where your are located but if she was somewhat mobile prior to the hospital but is bedridden now, she may qualify for short term rehabilitation (STR) to see if she can gain strength and some mobility back. I was the admissions director at a local facility which did both short and long term care and we accepted many patients to help them see if they could regain strength. If your Mom has traditional Medicare it will pay for 20 days needed skilled nursing (SN) or STR. If the team at that facility determines that more nursing/rehab is needed, Mom can get an additional 80 days but Medicare will only pay 80% of the bill; the remaining 20% will need to be paid by Mom's assets or hopefully, her supplemental insurance if she has one. Be aware that the team can not "force" her to participate in PT and in order to qualify for continued PT she must be making progress. Also be aware, that in spite of all efforts she might not come fully back to her pre hospitalization state.
The scenario changes a bit if she has a Medicare Advantage program. These programs are owned by private insurance companies and although they are required by law to off the same services as traditional Medicare, the time limits on those services are very different. I have had to discharge patients after 10 days if they were not deemed to be "making progress" by the Advantage program.
Tell the hospital social worker you can not take Mom home (and don't be fooled by the " well, it you take her home tonight, we will get in touch with you tomorrow and help you out" line. It's not going to happen and once she leaves the hospital, she will be your problem. Before you pick up the list, jump on the computer and check out the ratings for the nursing/rehab homes near you on the www.medicare.gov site. They have star ratings for nursing homes from inspections submitted by the various states but remember, the state only visits about 5 days every 18 months so that the star rating with a grain of salt. Pick out a few you like and then check them against the list you get from the hospital. Call first to find out if they have vacancies and if they do... visit, visit, visit!! I recommend two visits if possible and if you can take someone along with you that's great.... two sets of eyes. Not going to bore the rest of the forum with visit details but find out if the facility can guarantee you a Medicaid bed should it be needed in the future. How many minutes of PT do residents get per day. You can ask about the nursing staff to patient ratio but what they have listed is rarely what is real; that's what happens when you don't pay people well or are short staffed to begin with. Get a sample of both the month's menu and the activity schedule. The National Institute of health: https://www.nia.nih.gov/ has a great list of questions you should ask. But remember on your visit, use your eyes, ears and nose to see how patients look, are dressed and interact with staff.
Wishing you good luck on this part of your journey.

Same scenario happened to us. My mom is wheelchair bound amputee living with us previously before her hospitalization. She was discharged even though we fought it, from the hospital into a skilled nursing facility. She was completely bed ridden, and prior to hospitalization, she was mobile, could make transfers to her wheelchair with ease. Not after the hospital. The hospital is not the place for your mom now, and you might be able to get a few extra days, but she will eventually be discharged. You should be given a list of skilled nursing facilities in your area by the case worker at the hospital. Do your research on the list of facilities, visit them, look at reviews, do your research. Pick one, the hospital will make the arrangements for transport to the skilled nursing facility. She'll have 20 days at the facility EVEN though Medicare pays for up to 120, it changes over to a secondary coverage with an 80/20 coverage with the supplemental insurance and the SNFs don't like to deal with that. I'm just telling you what happened to us, you might not have Medicare and plan F supplemental. We fought this whole way to get my mom the care she needed, and yet this is what happened. Discharged from hospital, then discharged from skilled nursing after 20 days - then what? She was still bed bound, refusing the PT offered, and a higher level of assistance needed than what the SNF offered on their assisted living side, so no place to live and no way could she come back home to us. Luckily for us, one of the PT people at the SNF whispered to me about a health rehabilitation hospital. It's different from skilled nursing. We got her transferred to a place near us, out of the SNF into a rehabilitation hospital. I had no idea rehab hospitals existed. I call it boot camp PT. My mom would not be with us today without that rehab hospital. There, she couldn't refuse PT, they really encouraged her, didn't give her the chance to say "no" and got her involved with group PT (they played corn-hole ha ha, she loved it) and got her back to making transfers with help. She wanted to come home, but the doctor there said no, not a good idea. She needed more assistance than we could provide at home. So after 14 days at the rehab hospital, she's discharged again, now what? They had a list of brokers that helped me find an assisted living place. We picked a broker, she came and interviewed my mom, and matched her with a facility. I toured the places with the broker, but the first place we saw I knew was the match. It is a little hidden gem in our area and I never would have found it without the broker assistance. It's been 6 months now with my mom at assisted living, she is thriving. I haven't seen her like this in years, plays bingo daily, puts her make-up on, socializing with new friends. We used Care Patrol as the broker to find an assisted living place, and I can't say enough good things about them. This is a long story, and obviously my experience is different from others. Maybe you can glean some info from my story. We fought the system the entire way, the hospital, the insurance, to skilled nursing, to the rehab hospital, to finally a place she is happy and healthy. It took about 2 months of her living there to realize she is actually likes it better there than our house, it's a big adjustment.

This was Great information, I was wondering this for myself, since my kids have dropped out of my Life

If you aren't a POA, you will have to get Guardianship. The hospital files a petition to declare your mom incapacitated. If she is under Medicare, her hospitalization will be covered. They kept my mom for over 2 months. Sell the house and spend down her assets. It's tedious work, but very necessary.

Sorry to learn about your mother's condition. Yes, Unsafe Discharge.

A social worker needs to send her to a nursing home, if necessary, a rehab facility before permanent placement.

Say “unsafe discharge”.. hold your ground..

You need to tell the hospital THESE WORDS EXACTLY:
"I cannot accept my mother into her home. If you discharge my mother it is an UNSAFE DISCHARGE and I will call the Joint Commission (JCAHO) to relieve your hospital of its license to practice medicine. My mother is bedridden. I am physically, mentally and emotionally unable to care for her at this time. Whether you send her to placement or to rehab you need to have your social workers work on finding her safe placement now".

That's it.
They key phrases here are "I am physically unable", "JCAHO", "Your license to practice medicine" and those magic words UNSAFE DISCHARGE.
You will be seeing a social worker shortly. Get it together and decide what placement is right for your mother now.

I agree with telling them she's an unsafe discharge, that you are not her caregiver (and cannot be under any circumstances) and to ask to speak with a hospital social worker about transitioning her directly into LTC (which is covered by Medicaid if she qualifies financially).

Are you her PoA?

She needs to go to a nursing home now. Tell the case manager that and tell them that you are unable to safely care for her at home. She will have to pay for the nursing home though, so see if Medicare will pay for short term rehab. If they don't, whatever money mom has needs to go to the NH, and if it is not enough, she needs to apply for LTC Medicaid with the state. The social worker at the hospital should be helping you with all of this.

Tell the hospital oocial worker that she’s an unsafe discharge as no one’s available to care for her.