Discharge - can they keep someone against their will?
My sister is in an acute care center we have been trying to bring her home for months. We have round the clock nursing care they won't send. We have all the equipment in place and skilled nursing around the clock. What can we do to bring her home?
Terri Schaivo Life & Hope Network Lifeline@LifeandHope.com 1(855) 300-4673 Help for the medically vulnerable.
The Legalities The right of adults who have decision making capacity to make their own health care treatment decisions has been legally affirmed at every level of the U.S. judicial system— • By case law. • By state law. • By the federal law, known as the Patient Self-Determination Act. • By the U.S. Supreme Court in Cruzan v. Missouri Department of Health.
Angel, did you speak with the social workers caring for your Sister's complicated case? I hope you will keep us informed. I think things might go a lot better were you already here and caring for your Sister. She almost certainly won't be discharged unless you ARE here and ready to receive her, but I can understand how complicated such plans would be without reassurance that she would be discharged to your home care were you here. Through the social workers you may be able to introduce your qualifications in a way that would expedite all this. Hope you will update us as you go. We are thinking of your family.
hi after talking with the social worker today the plan is to release her on Monday. I will let you know if that happens or not. It has been a battel. Thank you
Acute Care is not a jail. Any rational person is free to leave at any time whether the facility wishes them to or not. Now if the person suffers from dementia, and if there is some concern by social services that a discharge will put them in danger of neglect or abuse, we may be talking a whole other situation. But under normal circumstances someone can leave medical facility at any time they wish to leave. I am afraid we may be missing some details in this question??? Might you give us further edification on the matter?
Are you on sister's HIPPA paperwork as someone the staff can talk to? I think what you may need to do it get to Phoenix and talk to the Rehab personnel face to face. You are getting conflicting stories. The facility says she has a fever, sister says she doesn't. They can't release if there is a sign of fever. You should have no problem in Phoenix finding someone who speaks Spanish.
You need to personally see what has been set up for sisters care at home. Maybe sister can assign u POA just to handle this for her.
I am sorry but taking care of a trach and wound care should be done by professionals. Are you an RN or trained medically at all?
In the US if its considered an "unsafe" discharge, then by law the Rehab cannot release her. Her husband being bed bound means he is of no help. Are the children for bringing Mom home? For round the clock care you need to be sure the persons caring for sister are dependable. Again, also have to trained in trachs, catheters and wound care. CNAs are not medically trained so at least an LPN probably better an RN. Very expensive in the States.
yes I am trained and nurses follow what I do. I am sorry but all her bed sores were given to her by trained professionals they have to many patents Trained care diver $30 an hour and aRN with trach experience $65 to $100 with her husband between $60,000 to $80,000 a month. Private pay. one patent to 9 caregivers. Is a better ratio we even have an RT for a couple of hours a day to take down al the information from the ventilator and check on her condition
Your sister has MS, her husband is bed-bound and they are living in the US (Arizona).
Your sister is currently in acute care for a recent issue and wants to go home, but they are not discharging her because there is no capable person currently at her home. Your sister has a trach.
You are willing to provide the 24/7 care and they have financial means but you are currently in Costa Rica. So, there is no one in place to transport her and care for her once she gets home as of right now.
Is this a correct summary of the issues?
If your sister is mentally capable but cannot drive, and her husband is "bed-bound" and can't drive to get her, and no one can go get her and the center thinks she is an unsafe discharge because there won't be a capable person in the home to help her, then they are rightfully keeping her in place.
Why is her husband 'bed-bound"? Who is helping him while she is at acute care? This is a very confusing story so more info would be very helpful.
If you really want to take care of her, you actually have to be there to receive her at home.
They can not discharge her to someone in Costa Rica that plans on coming when she gets home. What happens until you get there?
If one of her children opposes your presence I would bet they are telling the discharge planner that dad is bed bound and you are in another country, that would put a stop to discharge. As it should.
From what you've written, I wouldn't discharge her either. You have to go if you really are going to be her caregiver, there is no other way to make the hospital believe the plan except by implementing it.
Angel, if your sister is mentally fine and able to communicate, all she needs to do is tell her medical team that she is going home. She can discharge herself.
That doesn't make it a good idea, mind. Who is actually going to project manage this?
Angel, if you are the 24 hour nursing care and you aren't there, I don't see how anyone would discharge a wheelchairbound person with a trach to someone who is is bedbound.
They have already been to the home twice. and to the person who asked if she was coming to Costa Rica, no she is going to her home of 43 years in Mesa AZ. Yes I have spoken to them in person. I am a US citizen my wife is a Tica. The US Embassy has been closed for 2 years now and not giving any visas. I have been away from my wife for almost a year out of the last 2 years. It's been difficult without our Lord it would have been impossible.
her husband please read above for my answers fist time on the platform They said that she spiked a fever and needed antibiotics. I talked to her tonight and she doesn't have a fever I couldn't see any other than that. I have taken care of her for several months over the last 2 years. I facetime with her most every day I know my sister very well. I live in Costa Rica and I have made 12 trips to Phoenix the last 2 years and I am waiting to come back when she comes home. I have gotten pretty good with lip reading. I have been invited to come each time I go. My brother in law and my sister both want me and my wife to move to the states. I gave my sister my share of our parents estates so that she would have everything that she would need she isn't getting that now. I need some kind of help
Are you trying to take her to your home in Costa Rica? Is she a US citizen? Transporting a patient on death's door internationally could be extremely difficult.
we have the power and an estate for private pay. She has MS secondary progressive she is a quadriplegic with a ventilator, feeding tube and catheter. She was home for 2 months and here sons were trustees of the estate one was steeling the money 2 million or so when he found out that his uncle was going to be in charge he made a story up well it was petty good with elder abuse services. It took some time to clear that up. in the meantime she went back to the hospital. Now she would like to die at home, in God's time, at home not in the home.
Step 1 is to determine what the patient's will actually is. How has this been done?
You can have all of the equipment and all of the services in place at the patient's home; but if her medical team believe that her needs can't be met outside the acute setting, and if the medical team has no way of determining what the patient's wishes are, then they are acting in her best interests by refusing to discharge her.
Do you have: Her wishes set down in writing, for example in an advance directive? Medical proxy, or power of attorney for health and welfare, or guardianship, or any other kind of formal, legal authority to make decisions on her behalf? Her own word for it being currently expressed? Other grounds for believing that she will be better cared for at home than where she currently is?
These situations are usually negotiable. What reasons are being given for refusing to discharge her home?
i am sorry I wrote new answers can you read them. She wants to come so that her brother can take care of her. I can take car of her trac , her wound care they didn't come from home but acute care centers. I love my sister and I want to take care of her. Her mental state is fine I talked to her tonight and she said I thought that I was going home today...
Why did your sister end up in the acute care center? Why does she need 24/7 skilled nursing care? Who has POA for your sister? What reasons did the acute care center discharge person give for not releasing your sister?
I am sorry for my mistakes her tonight it's past 4am I got up 20 hours ago. It wasn't until earlier today that I found out that she wasn't coming home. Her husband has been working on it and he is bed bound and he doesn't handle stress well. My sister asked me to help and my brother in law was happy when I told him that I would help him if he wanted
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Lifeline@LifeandHope.com
1(855) 300-4673
Help for the medically vulnerable.
The Legalities
The right of adults who have decision making capacity to make their own health care treatment decisions has been legally affirmed at every level of the U.S. judicial system—
• By case law.
• By state law.
• By the federal law, known as the Patient Self-Determination Act.
• By the U.S. Supreme Court in Cruzan v. Missouri Department of Health.
Hope you will update us as you go. We are thinking of your family.
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So that you will have an overview of how complicated this could get, please read the history of the Terry Schaivo case.
I am not saying that will happen in your sister's case, but be informed if you can.
Now if the person suffers from dementia, and if there is some concern by social services that a discharge will put them in danger of neglect or abuse, we may be talking a whole other situation.
But under normal circumstances someone can leave medical facility at any time they wish to leave. I am afraid we may be missing some details in this question??? Might you give us further edification on the matter?
You need to personally see what has been set up for sisters care at home. Maybe sister can assign u POA just to handle this for her.
In the US if its considered an "unsafe" discharge, then by law the Rehab cannot release her. Her husband being bed bound means he is of no help. Are the children for bringing Mom home? For round the clock care you need to be sure the persons caring for sister are dependable. Again, also have to trained in trachs, catheters and wound care. CNAs are not medically trained so at least an LPN probably better an RN. Very expensive in the States.
How old are sister and BIL?
Your sister has MS, her husband is bed-bound and they are living in the US (Arizona).
Your sister is currently in acute care for a recent issue and wants to go home, but they are not discharging her because there is no capable person currently at her home. Your sister has a trach.
You are willing to provide the 24/7 care and they have financial means but you are currently in Costa Rica. So, there is no one in place to transport her and care for her once she gets home as of right now.
Is this a correct summary of the issues?
If your sister is mentally capable but cannot drive, and her husband is "bed-bound" and can't drive to get her, and no one can go get her and the center thinks she is an unsafe discharge because there won't be a capable person in the home to help her, then they are rightfully keeping her in place.
Why is her husband 'bed-bound"? Who is helping him while she is at acute care? This is a very confusing story so more info would be very helpful.
They can not discharge her to someone in Costa Rica that plans on coming when she gets home. What happens until you get there?
If one of her children opposes your presence I would bet they are telling the discharge planner that dad is bed bound and you are in another country, that would put a stop to discharge. As it should.
From what you've written, I wouldn't discharge her either. You have to go if you really are going to be her caregiver, there is no other way to make the hospital believe the plan except by implementing it.
And how is bed bound hubby going to care for her?
That doesn't make it a good idea, mind. Who is actually going to project manage this?
Who is in the home caring for the husband?
Wherever she is, they may need to send someone to your home to make sure that it is safe.
They said that she spiked a fever and needed antibiotics. I talked to her tonight and she doesn't have a fever I couldn't see any other than that. I have taken care of her for several months over the last 2 years. I facetime with her most every day I know my sister very well. I live in Costa Rica and I have made 12 trips to Phoenix the last 2 years and I am waiting to come back when she comes home. I have gotten pretty good with lip reading. I have been invited to come each time I go. My brother in law and my sister both want me and my wife to move to the states. I gave my sister my share of our parents estates so that she would have everything that she would need she isn't getting that now. I need some kind of help
She was home for 2 months and here sons were trustees of the estate one was steeling the money 2 million or so when he found out that his uncle was going to be in charge he made a story up well it was petty good with elder abuse services. It took some time to clear that up. in the meantime she went back to the hospital. Now she would like to die at home, in God's time, at home not in the home.
You can have all of the equipment and all of the services in place at the patient's home; but if her medical team believe that her needs can't be met outside the acute setting, and if the medical team has no way of determining what the patient's wishes are, then they are acting in her best interests by refusing to discharge her.
Do you have:
Her wishes set down in writing, for example in an advance directive?
Medical proxy, or power of attorney for health and welfare, or guardianship, or any other kind of formal, legal authority to make decisions on her behalf?
Her own word for it being currently expressed?
Other grounds for believing that she will be better cared for at home than where she currently is?
These situations are usually negotiable. What reasons are being given for refusing to discharge her home?
Why did your sister end up in the acute care center?
Why does she need 24/7 skilled nursing care?
Who has POA for your sister?
What reasons did the acute care center discharge person give for not releasing your sister?