*long read, but desperately need help*
My dad recently has had his left foot partially amputated. After the surgery, he was placed into a skilled care facility, and was very noncompliant and ended up threatening staff. He signed himself out AMA, and we (my sister & I) took him home knowing it wasn’t a good idea (he was only one week post-op, and lives alone). The next day he fell, and broke his left arm. Fast forward to today, he is back in the hospital for the 3rd time, septic, and they are wanting to discharge him once the sepsis clears up.
He DESPERATELY needs to be in a facility, but no where in the area will accept him now, due to his behavior prior. Home health will not accept him either. My sister and I unfortunately can’t provide him with the care he needs, and we don’t know what other options we have to get him in somewhere. He can barely walk, he doesn’t take his meds correctly, and just can barely do basic household things. And to top it off, he’s on the 2nd floor of his apartment complex (we’re trying to get him on 1st floor).
We have talked to the case workers from the hospital, but all they keep saying is “nowhere will take him.”
Please, please any advice or help would be so much appreciated!! This has been going on since the beginning of January and I am so burnt out, I just don’t know what else to do. If you made it this far, THANK YOU.
*also to add, I know that his behavior at the skilled care facility was completely unacceptable, and the safety of the staff comes first (my whole family works healthcare so I’m not blaming the facility for not wanting a noncompliant patient)*
Tell them that YOU will not take him either.
Be certain not to accept POA from him or Guardianship.
Tell them that "his return with sepsis to this hospital was a result of poor discharge planning" and that if he is returned to his home again you will call APS and you will report an unsafe discharge of a patient with an amputation and resulting sepsis from unsafe discharge. Tell them you will notify JCAHO (information online) the Joint Commission on Accreditation of Hospitals of their poor discharge planning and lack of cooperation."
Tell them "he needs now to be a ward of the state and placed in safe care."
Step back. NEVER agree to take him into his own home. Tell them that if they release him again unsafely you will not enable it in any way, nor participate in it, and if anything happens because of their unsafe discharge you will "see an attorney about malpractice" (idle threat; there's no money in it and no attorney will take the case.)
Be sure to use the language above. Write it out. Demand it be scanned into his chart. Keep your own copy. Begin a file. Find JCAHO number and call it.
You have power here and must learn how to wield it. They are trying to trick you into taking him into your home. NEVER NEVER consider doing such a thing.
Good luck.
so what happens if we call APS? we were told that might be a good idea for us, but we weren’t sure what all it entails?
We told them that the last time they discharged him, and they just said we had to come get him. And said we could call some private places to see if they would accept him. I just feel like there is no way they should be able to discharge him knowing he isn’t safe going home, and will have no care once he leaves.
First, it doubly confirms that you and your sister need to stay strong in not agreeing to take him home, and not agreeing to be responsible in any way.
Second, the best placement for him would be a secure psychiatric or detox facility. I'm not sure how it works about getting him into detox, whether he can be sent involuntarily or whether he has to agree. The procedures and availability of psychiatric placements varies by state.
Not placing him in a regular assisted living or memory care does make sense, because they have to protect not only the staff but also the other residents, many of whom are frail women.
A geriatric neuropsychiatrist is "a medical doctor specializing in the treatment of mental and emotional disorders in older adults, with a focus on the intersection of neurological and psychiatric conditions, such as dementia and depression." Presumably he or she could have some input about the addiction factor, as a mental health issue, along with the issues of aging.
I'm sorry you're in this very stressful situation.
I will definitely look into the neuropsychiatrist though!! Thank you again so much - I truly appreciate it
— You, sister and anyone else in the family that your father might call have to be strong and NOT pick him up from the hospital. I mean, he has an amputated foot, was septic and lives on the 2nd floor! It would be crazy to “help” by taking him back to that yet again. (And trying to move him to a unit on the 1st floor seems kind of pointless too as you say home health won’t be involved and you and your sister cannot manage his level of care at this point.)
— Could he have something cognitive or dementia-related going on that needs to be taken into account? Has his behavior changed from how it was before?
We think he may have an onset of dementia or something starting, and he is/was also an addict (pills & who knows what else), so we know that’s playing a part in this too. He had a psych evaluation done after the episode at the skilled facility, and they said everything was fine. But he definitely will freak out if he doesn’t get what he wants, when he wants it.
That neither you or any other family member will ever be coming by to pick up Dad as it would be an unsafe discharge as none of y’all will ever be there to provide for any oversight or assistance to him whatsoever wherever. Unsafe discharge. You have to - HAVE TO - be fixed and firm on this. If doing and saying something like this is not your nature, then do NOT go to the hospital as you will be guiltified to taking him out and promised help that won’t be provided. Not everyone is able to be bad bossy witch mode, if you know you’ll cave, then do not go t the hospital.
On a tangent…. He’s currently septic? Being in that condition in and of itself usually means a hard no for admission to a nursing home. They are just too too ill for what most NH will routinely provided for “level of nursing care”. If he stays septic, bet he’ll start showing signs of cascading organ failure. If so, often those type of patient are transferred from the actual hospital to an LTACH. Long Term acute care hospital. LTACH exists although more on the downlow. You & I can’t enter one directly. They are by speciality care referral only and are paid for by Medicare or their health insurance as it’s technically a hospitalization.
Next time that discharge person calls, perhaps say “his sepsis is very concerning, perhaps the hospitalist can do a LTACH referral for him to go there. Otherwise for us, it would be an unsafe discharge so we will not be able to take him from the hospital ever”. (The hospitalist is the MD who in charge of his care plan while he is in a ward). Reread what Alva wrote as that is excellent as well. If you have siblings, everyone is on the same wavelength on nope not happening.
For that discharge planner at the hospital, the easiest solution is family comes and gets them and he is no longer their problem. And they will constantly be calling whomever family they have contact info for to come and get their family member.
Try hiring an independent social worker although since you whole family works in healthcare, I would presume you know or have these connections/networks.
* Try talking to the administrator (again) - after you talk to dad's MD about being medicated ... if that doesn't work ...
* Perhaps call the licensing board (of facilities / specific place you want to get him into) and see if anything can be done. With medication, he might or hopefully would be more manageable.
* As someone below said: UNSAFE DISCHARGE ... I would contact an elder specialist attorney to get clear on what this means and if it is an avenue for you to pursue.
It is understandable, as you know, for a person to be mad, angry, fearful, depressed ... just beside himself - when these changes happen. I feel sad for your family as I know you want to do what is best for your dad. Perhaps, at the very least, 'for now' you can hire caregivers to help you - people that are experienced and know how to interact / work with a person responding as your dad is.
Gena / Touch Matters