PaulBould Asked April 2021

My mother in law is close to death and we want to take her home for in home hospice but the rehab is dragging their feet. Advice?

My mother in law has great medical benefits that will pay for in home hospice. The problem is, this week she was erroneously sent to a rehab facility even though there was not a chance she would be able to rehab due to the extent of her cancer's spread throughout her body. My father in law didn't realize the discharge restrictions at the time he agreed to send her there.
She is dying and we have told the rehab facility directly that we want her home immediately because it is clear she won't live much longer, (maybe a week or two at best) and we want her family to be able to spend unrestricted time with her at home before she passes. The rehab facility is shamelessly dragging their feet so they can get paid by Medicare (she's only been there a few days so she's still under the 30 days for the most Medicare rehab payout).
We are considering an AMA given the sham and it would be good to know if we discharge her ourselves and get hospice care into the home within a few days.

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Have her physician order "Transfer to in home Hospice " and have the hospice agency interviewed now; they will arrange transfer for you. This is an MD ORDER. Has very little to do with their wishes. Will be done at once as soon as the MD order is in.

Helpful Answer (20)

Yes! This is exactly what we did for my mom a few weeks ago. The only difference is we requested her to go to the hospice house and they were wonderful. We were all allowed to visit (since they had back doors to a private patio for each bedroom). My mom passed away peacefully on April 15th with my daughter by her side holding her hand. I'm still grieving but I'm glad we made the decision to utilize hospice.

(3)

Take her home. The rehab's financial loss does not supercede the family and patient wishes EVER. Contact Medicare or her insurance carrier. Also, call the state ombudsman.

"Welcome to the Ombudsman.IN.gov website, where citizens can connect with multiple Ombudsman for state agencies. The mission of an Ombudsman is to investigate and attempt to resolve complaints when dealing with specific state agencies. Use this site as a method of contacting the Ombudsman and accessing the provided resources."

We all have the right to have our final days spent surrounded by loved ones.

Helpful Answer (10)

Rehab is an option, not a given. Dad could have turned it down. I agree, talk to Moms PCP and get an order for in home Hospice. Rehabs are not prisons. Don't ask, inform the NH you will be placing Mom on Hospice. This is a safe discharge. Tell them you need her discharged immediately. If under AMA, Medicare will still pay for the days she was in rehab and don't allow them to say they won't. Medicare will also pay for her care under Hospice. Call your State Ombudsman.

Helpful Answer (9)

I can assure you that when you inform the rehab facility that you have contacted the ombudsman, they will change their tune immediately. The last thing these places want is to get on the states radar.

(8)

Exactly the same situation happened with my mother. She wanted to die by starving ( awful choice but it was her decision) but the facility where she was wanted to force-feed her. So my brother carried her to the car to take her home which was only a few miles away. There she died two days later under the care of my brother and in-home hospice. She was happy to be in her beloved house on the coast.

Helpful Answer (9)

Exactly who have you spoken to about your situation? I don’t mean a person’s name. I mean, what position of authority are they in?

Absolutely, use hospice for her final days. They are incredibly compassionate and are excellent caregivers.

I take it that you have hospice on standby.

I am terribly sorry that you are struggling with all of this.

I wish you peace during this difficult time.

I will keep your family and your mom in my thoughts and prayers.

Helpful Answer (7)

Perhaps you can get hospice involved in getting her discharged ASAP. You can also have her transferred to a hospice facility where she will be able to spend her final days/weeks, and she will receive great care. Bringing her home under hospice care will be a lot for you all to handle, but it certainly can happen if your family is ready to step up to handle her 24/7 care. Hospice does but only so much when in the home. The nurse will come only once a week to start, and they'll send an aide to bathe your MIL, about twice a week. Other than that 99% of her care will fall on you and the family. Whereas in their facility she will receive the 24/7 care she needs. It's your choice. And just so you know, hospice care is covered 100% under your MIL's Medicare. They will pay for any and all needed equipment, supplies and medications. They will also cover her transportation by ambulance to either home or their facility.
If push comes to shove, I would just go in the rehab facility and get her out, whichever way you go, hospice in home or in their facility. I wish you the best in getting her where she needs to be.

Helpful Answer (7)

In Arkansas hospice will send a bath aide 5 days a week if you request it. I requested with with Daddy (who definitely needed it) and Mom (who needs it but not as desperately as Daddy, since they were at their home when Daddy went into hospice and Mom lives with us). It never hurts to ask for all the help you need, the worst they can say is no.

(1)

You can change the hospice agency ANYTIME. Get another one on board for home hospice and bring her home. I was a LTC Ombud in CA for 7 years. Her POA should speak to the head admin at the rehab and tell him or her you want Mom transferred to home ASAP. Keeping her a day longer is doing it against your consent and you want your "lack of consent to remain in the rehab put in her medical record." Then "threaten" to call your atty about a filing a lawsuit and the state agency overseeing the facility. Use those words, "lack of consent."
The head of the facility will not want any of this. Be strong, the POA rules.

Helpful Answer (7)

I disagree with a few other posters. Do NOT remove her AMA (against medical advice) or the insurance company might not pay for her current care at all. (It happens all of the time.)

Get the MD to write an order for home hospice. Once approved, just put her in a wheelchair and take her home.

Helpful Answer (7)

The insurance companies not paying ois a fallacy. Its what the Rehab tell you. Insurance will pay for the days you are there. They could care less if you walked out. All AMA means is against medical advice and the rehab cannot be held accountable if something happens.

(0)

You CAN just put her in a wheelchair to your car & bring her home. Have hospice ready with the bed, etc. This isn't jail. I have done this myself in CA. Good luck to you,, hugs.

Helpful Answer (6)