Can a hospital discharge force one to go to Board & Care home for LTC if insurance denied SNF placement? What to do if we can't afford BCH?

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Can a hospital discharge force one to go to Board & Care home for LTC if insurance denied SNF placement? What to do if we can't afford BCH?

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Thank you all for your helpful previous responses regarding my dad who was refusing food, liquids & meds and was in psych facility where their plan was to transfer him to SNF temporarily. He ended up being dehydrated there & had to go to ER for pneumonia as well from not moving enough. He has been in the hospital since and combative with refusing an IV, still doesn't have a good appetite but they are trying to discharge him and pressure me into agreeing to Board & Care Home placement since his insurance denied SNF placement. He doesn't sleep well, has dementia & mental issues where he would require 24/7 care, also has mobility issues and needs help using a walker. The social workers claim it is a challenge to try to find SNF or BCH that will accept him because of his mental needs. They are trying to get me to agreee to any BCH that will accept him without even checking it out first or taking into consideration income and my mom's expenses who relies on his income as well. I feel rushed trying to make a fast decision with such financial and emotional
impact. I wish we could take him in at home but will put too much stress on my mom who also has dementia. The dehydration will probably be an issue again at a BCH as well as needing a hospital type bed with rails that he can't fall out as he had trouble falling out of bed at home and felt most comfortable using a floor mattress without rails.

Care Decisions Hospital Discharge Senior Housing

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Just need to say that Medicare may pay for a hospital bed. But I doubt if a B &C will allow him to use the railings. I would think the State oversees them. As such, its against the rules to use railings. I think they could be used on one side but the other has to be open so they can get out. Check his supplimental too. Some pay for durable equipment. You can rent to own too.

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Don't give into them no matter how much the pressure you. All nursing homes, skilled nursing facilities, whatever you want to call them they're nursing homes, have a downgraded care as well. Sometimes they call it Board and Care sometimes they call it Custodial Care. Regardless of what they call it, they all have it. They're counting on you making an emotional decision because they know you're under pressure. You don't have to though. He can go to any nursing home and if he's in such a condition they will not put him into custodial care. Talk to Medicare and his secondary insurance yourself. They won't lie to you. The hospital and nursing home will about who's paying for what. When my father had to be downgraded from skilled nursing care to custodial care we had to start paying in cash. Then I found out that they were still billing Medicare and his private insurance for skilled care and they were paying it. I didn't stand long for that and neither did Medicare. You talk to them directly. It is very possible and even likely that the social workers you're talking to are lying to you. That is what social workers do. They promote the agenda their facility tells them too or they're out of a job. You can't trust them and don't. Talk to Medicare first and his primary care doctor. I can't even tell you the illegal things the social workers expected me to do in order for the facility to get a hold of my father's assets. Talk to Medicare and his doctor.

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This is exactly correct. I was always under the assumption that Social Workers are there to look out for the well being of the family and people in need. Boy was I Wrong! The social workers and case managers at the NH (and likely many hospitals) seem to be in reality working for the best interest of the facility, not the patients. I experienced it, and felt its presence, but thankfully ( I think partially due to my and my father's demeanor) , it ultimately worked out in my favor.

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They are pressuring me again this morning to discharge him to the only BCH that would accept him, what to do?That BCH doesn't have a hospital bed or rails which he needs, the social worker says we would need to rent one (more costs). They were trying to downplay the unsafe situation the other night saying he freaked out when he got downstairs but I said if that was the case why was security escorting the nurse to begin with? They said the psychiatrist says he is fine to go and that he is ambulatory with a walker yet he could barely take a few steps holding on to me to get in my car. I think he still needs rehab to help walk,will a BCH provide that? Do I have enough time to get a lawyer in the meantime?

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Janine, I'm sorry I missed this yesterday. Please update, and yes, hire a lawyer for the financials involved. Make sure you are not paying out of your own pocket.

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My mom was kicked out of memory care because of her behaviors. A board and care did accept her and would have been much better for her from the very beginning. All residents in this board and care had been kicked out of previous memory care. Some do accept residents with impossible behaviors.

My mom was on hospice at the time and it was they that recommended the board and care facility. Try calling a hospice, see if dad is eligible, and if they have any recommendations on facilities.

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I so agree with your advice below, and esp Mstrbill who says that under no circumstances should you take him home. You observe the "Social Workers refuse to help in appeal and only want him discharges". I am afraid they have decided and they are likely right that he is going to be very very difficult to place with the problems he has. However, taking him home isn't an option. I have forgot how old your father is, or how ongoing and torturous has been the path so far. If so has palliative care and hospice been discussed. So far no one has helped him; he is being kept alive only to suffer more.
You are in such a tough position. You may need to consult to find a way to get Dad on medicaid while preserving Mom's assets for her own needs. So sorry. I cannot myself imagine what I would do in your position. Nor even in the position of facility trying to place him. I agree that B&C won't work. He is too mentally ill to be able to be in a small setting with say 5 or 6 other seniors, who lives would be thrown into chaos that is non stop.

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When you mean insurance do you mean LTC insurance or Health insurance? If you mean heath, I know of no health insurance, including Medicare, that pays for LTC. Rehab, yes, but its been shown that Dad is not capable of rehab.

To be honest, with his mental state I doubt if a Board and Care would take him. From what I understand they are small taking only a few people. I doubt if the staff could deal with Dad's mental problems.

What did the Psych eval do for him in way of medication? Just my opinion here. You are not going to get him placed anywhere if he has aggressive tendencies. He may need to go to a Psych hospital to have medication adjusted if he can become combative.

To protect Mom you need to talk to a lawyer well versed in Medicaid. Any assets they have, other than SS and pensions, will be split with Dads being spent down for his care in a LTC facility. Once he starts running out of money, you will need to apply for Medicaid. Better u apply than rely on the NH to apply and follow thru. Once he is excepted by Medicaid, it will then be determined how much of his SS/pension will be used for Mom to be able to live. She will remain in the home and be allowed a car. She will not become impoverished. If this is the way you want to go. If not, Mom still needs to be protected so a lawyer is a good idea.

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Yup, I did mean Health insurance. This is all new to me, thanks for all the helpful info.

The denial said he was incapable of the rehab but as of the last few days he has been cooperating with physical therapy in the hospital which should help support an appeal? He could barely take a few steps to get in my car without assistance (when I tried picking him up) so he definitely needs help walking. There was one BCH who agreed to take him but he was acting fine when they did an assessment to see if they could accept him so they didn't witness this kind of behavior. He was on Abilify in the Psych Facility, then got switched to 25 mg of Quetiapine in the hospital.

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PHEW, you dodged that bullet. DO NOT offer to bring him home. He needs psych hospital placement. He is not a safe discharge.

Get hospital social worker to assist with Medicaid application. You will have to spend 50% of parents assets by paying for dad's needs and care. Medicaid will not leave mom impoverished.

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Janine, from what you've described your father needs to be in a SNF or a psychiatric facility. Do not under any circumstances take him home. DO NOT cave to any pressure to pick him up from the hospital. If he can't afford the SNF, then it will have to paid for by Medicaid. This is the mindset you have to have, and it is up to the hospital and their case managers and social workers to ensure his safety, and they must not release him to an unsafe environment. That would be an unsafe discharge and would violate the hospital's code of conduct. You must be strong and adamant, and if you don't feel you have the strength to do it yourself, then hire a lawyer to advocate for you and your father.

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Thanks for all your help. I definitely plan to appeal - the social workers would not give me the reasons and not assist with an appeal, they said I could do that myself as they just want him discharged!
He needs rehab using a walker to help him walk and also has advanced dementia, schizophrenic related delirium which makes him need help with daily activities. They told me he was recently cooperating with physical therapy in the hospital. I just got it in the mail & it states "Currently you are not able to participate in therapy due to confusion." & Also "No daily skilled nursing needs noted" which is inaccurate on the doctor's part?! It makes no mention of his mental needs. He is still in the hospital and only because I tried picking him up after being pressured by them for discharge to either a BCH or to try to take care of him at home in the meantime until we figure out finances for BCH but it was not safe for me to take him - he was not mentally stable to go home even though they claim he is always pleasant (which is his true personality but not with this psychosis). He had to be escorted out with security to a nurse to the car since he was yelling about being forced to leave then started pounding on my car window and would not be compliant. Now that they hopefully see it won't be safe going home, they are probably going to push the BCH again but I think he needs somewhere that can also handle his mental needs. This is the behavior he had at home to begin with which led us to get an ER Psych Evaluation where he was transferred from to Psych Facility then back to ER again which is why he is in hospital.
What to do now?

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Appeal the insurance company's decision and get him placed in a SNF, rehab, or wherever his doctor says he will receive adequate care. Including keeping him in the hospital longer. Another decision requiring the doctor's orders.

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What were the insurer's grounds for denying SNF placement? (apart from not wanting to pay for it, obviously)

If it's your decision, and you don't agree that the placement meets your father's properly assessed care needs, then don't agree to it and state your reasons. Be a wall!

Is he still at the hospital for now?

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Income and expenses must be taken into consideration, you cannot let your mother become impoverished. It may be advisable to retain an elder attorney who knows how to deal with these situations. Can you be a little more specific on what the cost of these facilities are and the assets/income your parents have?

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Can a hospital discharge force one to go to Board & Care home for LTC if insurance denied SNF placement? What to do if we can't afford BCH?

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