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.
Thank you
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.
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.
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.
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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