Can rehab facility refuse to let my mom go home if she wants to?

I am sorry, I should have reviewed my post for errors. What I meant is that the lawyer said that Medicare not paying for the SNF stay if the parent leaves AMA is a myth.

I contacted a Elder Law attorney and I was told that Medicare not paying if someone leaves skilled nursing is a medical myth. They wanted to keep my mother until a specific date, which was 6 weeks away. The date was in alignment with the exact number of days Medicare and my mother's insurance would pay. There was no way for them to know that the exact date they proposed would be the day she would be better... She was better this weekend. They did not want to discharge but my mother is functioning just fine. She has a caregiver at home to help her with things and is safe. She does not have long to be on this earth - she should have as much quality of life as she can get. And she is not getting that is SNF - where she has to wait to eat, wait for coffee, not get coffee, listen to others moan in pain or due to delirium. She wants to be home with her dog, her coffee, her things, her food, etc., so I want to honor that wish while it is possible. Sorry for my tangent - point is - I was told by a lawyer that the threat Medicare will not pay is not true at all.

lots of little mistakes but I need to clarify

DODGED a bullet

Each time my mom had one of her joint fixating or replacement surgeries, she was in nursing home for rehabilitation for quite some time. The Medicare rule is as long as they're showing progress up to the allowable number of days limit, which is somewhere over 100. My mom did NOT have dementia during those surgeries but she was chomping at the bit to get me to take her home. No wat was she ready to function at home alone in any of those instances. Her second surgery was her first hip replacement, and even when THEY said she was ready and put her out, I still had to be with her 24 /7 for 6 weeks. On the third week, she still had so much pain but she had to use a combination of strong vicodin and xanax. Sadly she was so determined to be independent, she would get up without calling to go to the bathroom in the middle of the night because she "didn't want to bother" me, when night is falling on the floor in a groggy state, thinking she was sitting on a chair that wasn't there. We spent 6 hours in the ER, her on the gurney sleeping, me sitting in a chair with my legs swelling up, waiting for her ortho doc to come view the xrays and release her. Although she hurt herself many times and falls before and after, this time the doc said that she died to bullet, but please don't do it again.

That's only one story of I'm sure many about bringing people home too soon. If they are willing to keep her longer, they have justified it to Medicare. Is SHE pressuring YOU to get her home? Unless you truly believe they are keeping her an unreasonable amount of time, I would not get Medicare or legal involved. When you go before a judge, things can quickly get out of your hands and they don't always turn out the way you like them too. The judge could set aside your POA, a point of Public Guardian, and it may turn out depending on your moms condition that you would have no say over her health care for the rest of her life. Be cautious!

As far as I can tell there is no reason, except the money on the rehab's part, as long as you have the services for her when she gets home, they can't keep her. I am sure that you can get the services needed through home health care agencies. The rehab my mom was in did the same to me and they had her an extra two days that I had to pay for out of my pockey. Medicare will not pay for a companion, but will cover the other services provided she is home-bound. For services not covered by medicare, check out what the state has to offer, we have programs in CT that cover most of mom's companions (45 hours/week and a home health aide to come in a couple of times a week) My mom did lousy in the rehab and as good as the staff was, she slept alot. At least at home she gets up and watches tv and goes out occasionally. I have been there and so haven't others. Stand your ground but make sure you have the services lined up. Call her doctor and have him make the referral for you. I work for a home care agency

Are you receiving aid and attendance funding? Are you worried you might lose it?

I have not read all of the responses, and don't know what type of surgery your mother had, how old she is, etc. My first reaction to your question is to ask you why you would not want your mother to receive as much PT as possible so she can go home safely? I don't believe they CAN hold her "against her will" unless they feel she would be a danger to herself to allow her to go home - is this the case? Otherwise, I am thinking you misunderstood what they said. Unless this facility is sub-par and you suspect your mother is being neglected or abused, you need to allow them to do their job, even though it may be taking longer than you "think" it should. If your mother is older, it takes a lot longer to heal from surgeries and to recover from the hospital. Be grateful they are so concerned for her that they are insisting she stay - instead of fighting them, educate yourself on the process and have another sit-down with the physical therapists and social worker and ask them as many questions as you need to ease your worries. Again, if you suspect your mother is being neglected or abused, then that's a whole other story, and you should be contacting the ombudsman that is listed on the paperwork as soon as you enter the facilty (by law it has to be).

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.

All of the advice they gave you was excellent except that I do not believe any facility can hold anyone against their will as that would be kidnapping. You would have to assume all liability and sign those papers, however.

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.

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!

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.

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.

My 2010 experience with Medicare is that they will pay for 3-4 days in a hospital-rehab. If discharge is not advisable because the patient is too weak, then Medicare covered 100 days in a "Medicare-approved facility" if medically necessary for rehab purposes. One 100 days is exhausted, you are on your own whether the patient can move or not. Maybe this has changed since 2010.

I am sorry if it was not a grandparent but a parent. I reread the original question. I was getting grandparent off of 1 of the answers. I realized that Medicare would be good to call but may not be able to help you very much except in the way of some general advice. They won't make great go-betweens or advocates. There are some contacts you need to gain. Again you need a way to directly leave a voice mail with md omitting the facility from the phone tree. 2nd it would be helpful to get a phone number/email address for any local advocacy group. In Texas it is the ombudsman program. I will go into that in a min. They aren't usually as effective as the corporate office of this facility. If this property is part of a national chain (of burger joints). I don't mean to offend but after going through this maze with both mom & dad for years the handiest number I ever had was to the corp. office wherever it was. Even if in another state. Anytime there is a billing dispute, refund anticipated, complaint about customer service issues, I will try first with the home but not for long. Then I call the main office, lodge my complaint. The situation is resolved in a couple hours. That is if I can get ahold of them. The ombudsman over that home can be helpful but in my exp. they generally sound thrilled to hear from you & willing/able to look into it but once they get ahold of the facility they are on a diff. tract because the facility above all is very experienced in throwing them off. How else do they keep the beds full? In FL & TX there is a website through the ombudsman program that rates & displays any complaints & ratings for the home. You will find that handy too. Right now I would shake the rafters loose by at least finding the number to the local advocacy group & request a way to find that website with ratings & complaints & contact info for the correct person over the buildling. Then I would ask at the facility what the name of the corporation/owner is & ask if you can have the contact info for the corp. office. Even if they are not much help today at least you will have the contact info in the future.

INHO, I am not sure that legally they can refuse to DC her to go home. It would not seem that anyone can be held legally against their consent. Having said that, in a practical sense it would be hard to fight legally to take her home. Since Medicare stands nothing to gain from her staying in the facility they would be the best ones to call right now. Both the facility & a lawyer would stand to make money off of you & would be the last I would call to try & appeal what you were told. Is she still qualified for longer medicare stay? That would seem to be the case since these buildings are not usually that eager to keep a patient not on medicare. The way the food chain works is the facility wants to keep her for the money on the bed. The doctor who is unwilling to sign the dc orders for you wants to keep his contract with the building to keep his mortgage paid at home. If he were willing to sign dc orders the facility could assign more patients to a different md & he would lose business. Therefore the facility tells md not to sign dc orders & he does what the facility says not to lose his own money. The way I see it. You have a couple different avenues. 1. You can see if there is a different doctor that sees patients there & every patient has the right to choose their own md so you can ask for her to be re-assigned to another doctor. Although he will still probably want her to stay for his own money. It is still a shot. 2. Have you tried speaking/communicating directly with the md himself? It is usually easier to get these md's to call you back when they are still on medicare, you can't ever talk to them once the patient is on medicaid. Private pay & medicare you can always talk to them. First get the spelling of the first & last names. Do a google search on that name in that town or area followed by md. John Smith MD Baltimore, Maryland) for example. It will not be easy as these are not private mds & are hospitalists. Rounders in other words. But some usually have some phone number associated with them that you can leave a voice mail at. Leave a voice mail stating that you are the responsible party & where he is treating your patient. Request a call back. When you finally hear from him, tell him your grandmother wants to go home & that you would like to see what can be done to put this into place. Do not tell him that the building said she couldn't go home yet, don't bring the home's dog into it because you will have him shut down on you. He will make a call to the home & it will go from there. If you don't like the results you can request a change to a different md. I wouldn't try meeting the md when he is supposed to make rounds. You will lose whole days sitting & waiting when he doesn't show. The facility is already trying to keep you separate from the doctor which is never a good sign regarding medical care. That is a problem with both the md & the home. The md doesn't see any money he would get from talking to you. He can't bill for that. And the home can't see what they would gain from letting you speak to him. I would not try leaving a message with the home for him to call you will never hear from him as they will block the messages. I have been thru this for 3 years now in many facilities. Just google his name & gather phone numbers for his practice or group & call there.

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.

Maybe you can search, Joseph L Matthews, an elder lawyer was asked this very question, he said the facility is probably overstating the case, here is a bit of it:

The facility people might be trying to say that for your grandmother to receive Medicare coverage for any medical care , home health care , or medical equipment (like a hospital bed) and supplies, while she's living at home, a doctor must determine that the care or equipment is "medically necessary" and must give a prescription for it. Your grandmother's doctor might not agree with the decision to take your grandmother home, but the doctor can't stop providing proper, medically necessary care for your grandmother just because the doctor thinks your grandmother would be better off in the facility. If your grandmother is determined to stay at home, the doctor should prescribe all appropriate medical care and equipment to care for her there. And if the doctor properly prescribes something for your grandmother which Medicare normally covers, Medicare won't refuse coverage just because she could be in a nursing facility instead.

Work with them to make sure they know that you are able to care for mom 24/7, I hope you are able to do this very hard job.

Yes, there are facilities that want to make money on elderly and want to move them in to their homes etc, they tried to do it with my mom, but she is home.

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.

I have never heard of this happening usually when medicare stops paying they are glad to discharge people even if their families do not agree-I would consult an elder lawyer if I were you-as long as someone can care for her at home there should be no reason to keep her-does rehab also have a nursing home at it's facility with empty beds that may be why they want to keep her there and put her in the nursing home.