Has anyone else experienced the “3 midnights” rule?

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Sammons70 Asked September 2019

Has anyone else experienced the “3 midnights” rule?

To make a long story short, for multiple reasons including care needs increasing, as well as financial impacts, I need to get my mom transferred from an assisted living to a custodial (Medi-Cal funded bed in a skilled nursing facility. The dilemma: the most appropriate “locked” facilities don’t take Medi-Cal, and the non-locked facilities won’t take my mom because she has Alzheimer’s, and is mobile.

I have exhausted all resources, including communicating directly with nursing homes, using placement specialists, local senior services, and even Medi-Cal themselves, who says she makes too much with social security ($1600 a month) to qualify for the Medi-Cal waiver program.

The advice that keeps consistently being given, even from her doctor is take her to the ER, say she has no where to go, hope she is admitted for “3 midnights”, and then the hospital will find her a temporary placement under Medicare, which will eventually become long term under Medi-Cal.

I am planning to try this tomorrow. My question is if they try to discharge her, can I get in trouble for refusing to take her out of ER? Can legal action be taken against me for abandonment? I feel like a heel for having to go this route, but the system seems flawed, and I feel that mom being placed in a skilled nursing facility is the best case scenario for everyone involved, especially, mom.

Alzheimer's & Dementia Care Decisions Memory Care

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score 0 · Answer 1

Yes I have.. three mid nights before Luz,DW, was transferred to rehab. And I was actually accused of cancelling the transfer because I refused to sign a blank transport form, when in fact, the nurse cancelled the transport for medical reasons and did not record it that way. Luz's blood pressure had gone really high, again.
She was transported the next day.

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score 4 · Answer 2

Oh, and the 3 midnights thing is only for Medicare to pay a certain amount of time in rehab. The hospital will bill your Mother (make sure you don's sign off anything as being financially responsible) for any care not covered by Medicaid and they likely won't admit her but place her under observation which limits what Medicare will pay for so Mom will be billed. Are you POA? If so, you'll deal with those bills. If not, tell the Social Worker everything you know and cooperate with them, but don't take her under your care and don't sign off as being financially responsible for her care.

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The hospital is not allowed to bill her mother for anything not covered by medi-cal. Medi-cal will pickup what Medicare does not pay. The hospital has to accept medi-Cal’s payment as payment in full. It is the same for Medicaid, balance billing is generally illegal.

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score 2 · Answer 3

Yes, the system is very flawed! No you will not get in trouble and don't feel bad, there is no other recourse, but you say she is in assisted living? That makes it a whole lot easier. Why is it your responsibility to move her? Assisted living cannot release her to you if you cannot care for her safely. They need to find appropriate accommodations no? I'm assuming she is there 24/7? You tell them you cannot properly care for her at home, a discharge to you would be unsafe. And that is the truth right? But yes, unfortunately the hospital is the only way out, you have nothing to feel bad about, as the system is broken. The thing is though, the hospital likely won't admit her, only place her under observation so when they do that you adamantly tell the case manager you cannot take her home because you have to work and there is nobody to take care of her. They will find a bed for her. Just make sure you don't sign anything that says you will be financially responsible. Keep us posted and GL!

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Has anyone else experienced the “3 midnights” rule?

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