We are going through a very difficult situation with my 80 yr old father. He is a heart failure patient who became too weak to stand and transfer. After a hospital stay for afib, he was transferred to a NF for rehab and made no progress. This is a high quality private pay only NF. It accepts Medicare for short term rehab stays, but not Medicaid for long term stays. All long term stays are private pay only.
My dad was pretty normal mentally before this. But, he relied on the family for so much, that I think being alone and isolated from us caused him a great deal of mental stress. I think he got confused and scared and we weren't able to explain the situation to him over the phone. The facility said he screams most of the day "Get me out of here." It was bad enough they had to give him sedatives (Ativan.) We got calls that the yelling was disturbing other patients and affecting their rehab stays. It's a very difficult situation, because he is now so weak that I don't think we can handle him at home ever again. He is someone who can't even get out of bed and is too weak to stand. I don't think he understands that, though and won't accept it. The NF doctor has called us a couple times about it. It must have been pretty bad, because she actually said we should consider putting him on hospice, because it would allow her to prescribe an anti-psychotic like Haldol.
Well, things came to a head in late July when the medical director called our elder care attorney and said they were ready to evict him because the yelling was affecting the welfare of other residents. They said they were going to move him to another skilled nursing facility that had a dedicated memory care unit and could better handle patients like my dad who they believed had developed dementia. They were actually going to do it within a few days. The lawyer told them to put their concerns in writing and that bought us some time. We spoke to the NF doctor and she examined my dad and found out he was in a great deal of back pain from arthritis. She prescribed a narcotic-like pain reliever and that made a huge difference. He calmed down dramatically and stopped most yelling. The back pain was a huge source of his problems. I can now have normal phone calls with him and the nursing facility never put anything in writing and stopped threatening eviction.
My question regards what would have happened if they really evicted him. So, first, they would have had to find a place that would accept a yelling patient, right? What kind of facility would take him voluntarily? Then, what would they do if we objected because we said it was too far away or we didn't like their Medicare ratings or we said we were worried about their Covid case problems? If we objected to a facility, could they still transfer him? If they did transfer him, how could the new facility expect us to pay for his care? We would never have signed an agreement with them and objected to his transfer and told them up front we would not pay. How could they collect care fees under those circumstances? Really curious about this.
It is a relief that it was discovered that pain was so bad, and that is now being addressed, but if Dad still cannot cooperate with rehab then placement will be needed. Because rehab facility is the wrong placement for someone who cannot do the hard work of rehab with PT and OT. You say your father is "bedridden". Then why is he in rehab? Why not SNF (skilled nursing facility).
First of all there IS no ideal placement for our elders suffering from dementia and all other end of life issues. And I know that you must understand that no facility wants a patient that is acting out in a way that disturbs all other residents. That is definitely not fair to other residents. So yes, it comes down to which facility will accept a senior in need of medication to stay calm. And no, in Covid 19 times there is no ideal for certain, and the facility may not be in easy reach.
The more adversarial any relationship becomes with family and facility, Lawyers and such? Sorry, but ultimately that sabotages any hope the senior has. While facilities will say they don't share information because of privacy there ARE questions that can be asked and answered. If they are going to have trouble with the seniors, their own resident's complaints AND family and Lawyer? Put yourself in their place. Is that the senior you would choose?
All of my and my partner's grown children are in teaching. It seems to me that one half their time is spent dealing with problem families; I don't lie. With Lawyers and family around special education. In cases with little hope the Lawyers and families drain an already troubled system of the time and energy of the teacher and the system, as well as of its funds. It is a vicious cycle in which no one wins and everyone is frustrated and unable ultimately to give any sympathy whatsoever to the child. And yet it goes on and on and on in an endless stir that is circular.
I am so sorry about all this, but if pain is the reason, then medications are the answer. And I am with whomever can give any hope, with drug cocktails that give relief. There is so much grief and loss in the end of life for ourselves and our families.
I personally saw my mother tank after 24 hours in a rehab facility with 'screamers' and while I understood the illnesses that caused them to act out, it was not without a lot of stress--you'd be sitting in a room, trying to talk or, in our case, get mother settled in her room and sudddenly, w/o warning, a scream would tear through the bldg. It was jarring and upsetting and far from being OK in any way shape or form. I inquired of the director what the heck was going on--and she said "oh we have some screamers. you get used to them". No, ma'am we didn't!
Mom was miserable and refused to even get in her bed. She sat in the wheelchair they brought her in from the hospital in and refused to move.
OS stepped in, found a better facility and paid the cost difference. (About $25 per day for the 12 weeks stay--mom didn't have the $$ but OS will throw money at any and all problems).
In the better facility, mom didn't get the socialization or activities, but the place was lovely, clean and quiet and the food was decent. Her PT went well.
We didn't even need to ask one of the several lawyers in the family for help. OS simply stepped up and threw money at the problem.
Once your LO enters a facility--they become part of that 'family' and shouldn't have to deal with extra stress.
Mother now lives in dear she will wind up in a 'home' as she is slowly getting worse. We can't promise her she won't. We can only promise we'll make it as nice as possible.
This means they can put him on hospice and drug him into compliance, they can move him to the end of the state and no obligation to inform the family.
I have to say that I think families should do whatever they need to so that their loved one isn't screaming all day. My dad was in a rehab with a screamer and it was pure hell, he couldn't rest because this person screamed all the time and it destroys your nerves. The patient was not getting good care because all she did was scream not matter what anyone did for her, so they ignored her because they couldn't stop her. Please encourage whomever is treating him to do what is needed to keep him calm, it really will be more beneficial for him.
Good luck on THAT ONE!
The bill is to your elder for his care, and his assets will be made to stand good for his bills. And it will be collected. How much money do you want to sink into lawyers? How much of everyone's time are you willing to take, to use, at the expense of all when your own words say your father is bedridden and uncooperative? If your father cannot participate in rehab he is not an appropriate patient for rehab. Period. Full Stop. I understand your pain and worry over his care, but your adversarial relationship with all, your willingness to pay your father's money (I assume) to Lawyers? I question that. I really do.
Not ONLY will he pay costs over medicare, but your next letter will be from Medicare saying he is not covered. And yup. He will pay. You could be looking at upwards from 650.00 a day he will pay; that would have been the bill had my brother stayed in rehab longer than they thought he could benefit from their care. And nope, I would not be sinking his money into a Lawyer to buck THAT system. Not on your life.
You have quite honestly made a lot of posts in the last few days and they all prove that you all are terrified and overwhelmed for the future of your father. You are understandably afraid. We ALL understand that, and we have ALL been there. The end of life is often without a fix it. Without an answer. And I assure you that I very much doubt that your lawyer will get you much but a bit of a delay, a bigger bill, and the same outcome, no matter how much you pay him. That is only my guess. I will hope you keep us posted and tell me that this Lawyer has found an answer to this for you, for your Dad, and for all the Seniors now attempting to live with you Dad. I am so sorry for the "tough love" talk. But it's what I do. I truly feel for you, for your terror, for your pain, for your helplessness. There isn't a soul answering on this site who doesn't understand this pain.
The lawyer we hired was actually pretty necessary for a lot of reasons. We really should have hired him a long time ago. My father needed a will, estate plan, POA, Trusts, LTC application and we never got in done in the past. The bulk of the lawyers fees goes to that necessary document creation. I definitely understand what you are saying about the rehab stay. My father probably doesn't belong there anymore. But, the lawyer checked and the cost per day to stay in the rehab center is the same as if he went over to the long term care nursing center. It does seem unusual to me to handle things this way, but at this point I don't know what else to do. I'm just basically letting the lawyer tell me what to do. The lawyer told me to not worry that he doesn't belong in a rehab facility. He said that if you move him now, it will almost certainly be to a facility that gives him worse care and you will be paying roughly the same amount. He said that my dad's care level is high enough that he will need to be in nursing home the rest of his life. Given that he has issues with yelling, the choice of homes that will accept him is small and we won't like the choices. He also said that moving him now could actually be bad for his health. Getting readjusted to a new facility for someone in his condition is hard on the patient. It could even hasten death he said.
It seems that we only have bad options in front of us, unfortunately.