Our family member is in a different state. Nursing home won't release her to come with family. What to do?

This could also be a case where the patient was admitted via ambulance and was incoherent from pain or had a concussion resulting from the initial fall, she could have been suffering mental lapse from the effects of dehydration, if elderly she could have been disoriented from having strangers come into her home and haul her away (which even elderly who have shown no prior dementia symptoms such an incident can bring confusion to the forefront), or for some other medical reason was unable to tell the hospital caring for her who her family was. Having worked in the ER of our local hospital for some time, I can tell you it's a frequent occurrence. At this point, the hospital is under legal responsibility to assume temporary guardianship in order to get her treated. Even underage children will be treated without parental consent if it's a life or death situation. So, the hospital was operating well within the law and serving their oath to patient care in order to treat her and subsequently admit her to the nursing facility in the patient's best interest. Now, if these medical conditions persist that keep the patient from being able to identify her family, that would also prevent the nursing home legally from being able to transfer her. It is also possible, according to the damage the fall did, it is not in the patient's best interest to be moved a long distance especially if she will have to travel by ambulance into vast areas where the nearest hospital is quite a distance away. If she is cognizant, this is another issue, and it's possible the nursing home is claiming the patient has been abused or neglected, and again if there's any doubt, no matter how small or remote the possibility, this is required by law so they are only doing their job.

Now, to the difficult part of getting access to the patient to have her transferred. And this is two-fold. First, if the patient is cognizant, the family needs to talk to her with the Nursing Home Head Nurse, her assigned doctor and their patient advocate present. At that point, all persons should be allowed to speak up, the patient first, to see what is holding up the transfer. Whether it's dangerous to transfer her at this time, if there's claims of abuse and or neglect, what evidence the abuse / neglect claims stem from, if the patient will need long-term or short-term stay and length of rehab, what the family plans are to prevent falls from occurring in the future, who will step up and help see to it the patient gets to physical therapy, takes her medications properly, keep her at whose home until she fully recovers, who will check on her once she goes home, etc. should she be released from the nursing home (whichever one she ends up in). If the family has their cohesive game plan, it's harder for the nursing home to intervene as long as the patient agrees.

Second, if the patient is no longer able or capable of making decisions pertaining to her health and finances, then the family has some hard decisions to make. First, the family needs to decide who should get HCPOA or MPOA (to make decisions for their medical needs) and DPOA (to make legal and financial decisions). This can be two people or one person can assume both responsibilities. Both of these documents require a lawyer. And the lawyer will have to ask hard questions, including why the patient wasn't being checked on regularly if they were elderly or had a known health condition. If this was a fluke accident, and the patient had been otherwise healthy, that will also be taken into account. Keep in mind, if the patient is cognizant, no one can get either without her express consent, and the nursing home will be required by law to prove either she is not suffering from any ailment or condition that impedes her judgment or that she is indeed competent.

If the patient is cognizant or only slightly altered in mental capacity, she may actually be the one resisting the transfer, especially if it's to another town a good distance from her home. She may not realize/comprehend that she can not return home at the moment, or that she is going to be permanently incapable of caring for herself alone. If that's the case, she may fear she is giving up her independence and fear she will not be able to gain it back if she were to recover. She needs to hear it from the patient advocate that should she recover, her rights will be restored to her. Of course, this is a moot point if she's having difficulty understanding, but it sometimes calms the patient and reinforces their belief they will eventually get better and return to their life as it was before the fall..

You're not done yet. As soon as the urgent situation of getting the patient transferred and her medical and financial situation in order for the short-term, it is time to discuss what will be required from each family member for the patient's continued care, especially if this is a permanent long-term care condition. Get the following in writing and have each sibling/family member involved in her care to sign it after all the agreements have been reached! You are taking on much more than you realize and it's going to cause problems within the family. Keep in mind that becoming the sole care provider totally destroys one's family life, love life, work life, social life, vacations, down time, free time, finances, hobbies, health, etc. so be sure all family members are contributing their fair share. If the other family members live far away, their major contributions will be to pay the caregiver a salary so the caregiver's family doesn't suffer physically, emotionally and financially. The other siblings also need to pay for "relief care" whether it's someone to come in and help with bathing or giving the caregiver's family a break (at least weekly and in a fantasy world, a daily break for the family to have some time together without the patient being the focus, time to focus on kid's homework, the children's social activities like going to their soccer game or taking in a movie, or just having time to sit down to supper without the patient being the center of attention. Homeowner's insurance goes up due to the healthcare workers traipsing through, so all parties split the cost of better home insurance. Week long vacations should be provided at least FOUR times a year to avoid caregiver burnout! An alternative is to provide the caregiver two week long vacations a year and a once a month weekend break and this should be left up to the caregiver to choose since they are the ones having their lives disrupted. The siblings/other family members should PAY at least half or MORE for these vacations and weekend getaways. Now, I'm not saying overseas or unreasonably expensive trips, but a week in the mountains during the color change or in the summer should they like to hike or fish, a week at the beach just before school starts, etc. The siblings/family members also need to step up and become the sole caregiver while the primary caregiver's family is away on vacation. which means the patient either needs to be transferred to the weekly caregiver's home for a couple of weeks (one week is too stressful on the patient and causes long-term problems that all family members will pay for in more ways than one can imagine), or siblings/family members need to come to the caregivers house during the vacation to provide the care. (I personally prefer this to keep from putting undue stress on the patient, but be sure the temporary caregiver's siblings/family members provide their own food, transportation and pay for any bills or damages they create while living in the caregivers home.) Be sure the temporary caregiver's understand they can not get out of the patient's normal routine, especially if she suffers from any form of dementia because the patient will "flip out" and cause all kinds of problems, and this includes them leaving her for any reason or having friends over, or not being there while the nurse or healthcare provider comes by to give her her medications, baths, or whatever services they normally provide. In other words, the temporary caregivers need to keep YOUR routine in order to not stress the patient. They also need to know if she has favorite TV routines and that they need to set their DVR's back home before they leave so the patient will not be stressed.

Now, for salary, keep in mind someone to sit with a patient in a low economic state generally charges about $10 or more an hour and the sibling / family member / caregiver is doing this 24 hours a day for 365 days a year (except for the times the siblings / family members are providing). So, to get an idea as to what the caregiver is providing $10/hr x 24 hr/day x 365 day/year comes to $87,600.00 per year and doesn't include the costs to feed her, pay for her medications, transportation to and from the doctor, clothing and toiletries, etc so you're looking at over $150,000.00 or more per year the caregiver is assuming. Nursing Home care (for low economic states) starts at around $4,000.00 per month so $4,000.00 x 12 comes to $48,000.00 but keep in mind that doesn't include her personal charges like toiletries, medications, medical tests, doctors fees, laboratory charges, clothing needs, laundry, TV and cable, phone and phone bill (neither phone service nor cable are provided by the NH), etc. which usually brings the yearly amount to around $125,000.00 or more per year. In higher economic states like New York and California, the monthly fee for Nursing Home can be $10,000 or more per month driving up the overall cost for the year to $150,000 or more and sitters charge upwards of $25/hour at 24 hours per day per 365 days a year which brings just the sitting fee to $219,000.00 and you still haven't added in the day to day costs of food, clothing, medicines, etc which brings us to over $300,000.00 a year. Now those couple hours a day for rest and quarterly vacations a year for the caregiver's family to prevent caregiver burnout are sounding like a great deal, aren't they?

Good luck to you and your family in your quest to secure the patient's care, especially if after I've scared you to death, you take on this monumental task. Having done it for 25 years, 15 years just checking on Mom two -three times a day, to the last 10 having her live with me for round the clock care, and having a deadbeat sibling who contributed ONE MEAL towards her 25 years she needed care, I know it's rewarding to know you cared for someone in their time of need. I also know what it did to me, my family and our finances. . May God Bless You!

First you state "she had no family", then you say you are family that lives in another state. I'm having trouble understanding what you mean. APS may have stepped in and made her a ward of the State, and you will need an attorney to get her where you live.

I think the OP meant that she had no family to care for her in her own home state...

Actually, Jinx4740, I've shared my heart-earned (yes, heart instead of hard) experience with several folks on this site. I wouldn't change what I did for my Mom despite the outcome and near financial ruin we faced. My brother kept promising he'd pay his share, but he never did. Mom died in 2004 because I ran out of money for her treatments and my brother still couldn't be bothered (he needed his money to buy beer, drugs and chase strippers), so my family made Mom as comfortable as we could, and I held her hand as she passed. I will never forgive my brother for letting her die because of his selfishness. I also don't want anyone else to make the mistakes I made. Which, when you look at the above, you can tell I learned the hard way. I did everything right got the DPOA, HCPOA, trusts, the will (while she was cognizant) and only used them once she became incapacitated. We gave up vacations when she was too ill to travel and took her with us (the entire 25 years) when she was able to travel. I always had her medical records with me because she would often be well, but get sick while we were on vacation. It was hard, and I got bitter towards my brother while he drove two BMW's and a Jaguar, yet always had an excuse to not help cover Mom's expenses. That's the one thing I did wrong, I trusted my brother and didn't get it in writing that he was responsible for half. He agreed, but it won't stand up in court. That's why I'm trying to let everyone know just what they're getting into and how easy the siblings and other family members have it that aren't the primary caregivers. If nothing else, it will prevent the additional strife of family members accusing each other of theft, neglect, abuse, etc. And thanks for the compliment! It's like a ray of sunshine on a cold, blustery day!

Maybe you just need to contact a social worker and let him/her guide you through this. Maybe start by contacting the local Human Resources Department in your family member's state. Anyway, it will all work out ... although it must surely seem overwhelming to you right at the moment. But, hey, there are people out there who figure all of this out for a living ... so seek their help.
All the best to you and your family!

I'm trying to get mine into one. Any advice on that?

blue ridge, talk to your mother's MD about a nursing home, a doctor's recommendation is needed.

I think you hit the wrong button. My mom's been dead 3 years.....

So talk to your FATHER's MD.....

To BlueRidge, talk to the patient's MD and see what type of care is needed. Take that information to the local nursing homes and see how they handle each issue before making the decision on which one to go with. Most times, though, it's just whichever nursing home has a bed available and how long the waiting list is. But the doctor is the best route to go getting her on a list.