Any options if a senior is “unable to make medical decisions” and has mobility and home environment concerns? Does the hospital have to present viable options?

(Blushing). Helpingson, thank you for your kind words!

I learned EVERYTHING I know about eldercare HERE. "Safe dischare,"" I can't possibly do that", and "won't there be a Medicare penalty on the hospital if she's readmitted within 30 days for the same dx?"

Stick with us! I'm sure there will be a round two.

BarbBrooklyn

You replied to my original post within minutes. I remembered your comment "Hospital is required to make a "safe discharge". Safe discharge became my theme when talking to her physicians.

Thank you very much for your prompt response when I needed timely advice.

helpingson

I know it's not much consolation but imagine I'm patting you gently on the back. You made the best of an impossible situation. Well done.

So sad, Helping. (((((((Hugs)))))))

Thank you all for your responses to my question ending with "Can hospital force a discharge or are they required to present viable options?" The saga continues, but I'll share some background; maybe it will help others in a similar situation. Your responses have helped me.

My mother spent a week in one hospital and transferred to another hospital for another week preparing for a surgical procedure. As doctors determined she was "unable to make a medical decision", I became actively involved (i.e., doctors would call me for procedure approval). Mom is a private person and didn't want me to know about her more serious ailments (i.e., surgery). The hospital rescheduled the surgery from Friday to Monday and said there was no medical reason for her to stay the weekend and would have to return to the hospital for surgery. So, I'm sitting in the hospital waiting room, it became clear the hospital prepared to discharge her and it was my understanding I would be involved in a discussion with nurses and case manager. Also, knowing the condition of her house (i.e., hoarding, won't let anyone inside EVER), her physical limitations to include moderate-high fall risk and progressing dementia/memory loss, I was uncomfortable with her going home and still believe her house is unsafe. So, I made arrangements for my mother to stay long-term with her “willing” sister, who lives an hour away in another state; however, my mother adamantly doesn’t want to stay with her (anybody) and prefers to go home.

I wasn’t included in a discharge meeting and called the hospital for an update Friday afternoon. The nurse who provided me the most detail about my mom's health said "your mom made it very clear she doesn't want to share her medical information with family and friends."

Before visiting my mom Saturday morning and not knowing the status of her surgery, my wife suggested I call the hospital to make sure she is still there. The nurse said my mom was discharged on Friday. Confused, I didn't think they could discharge her without my consent. So, I drove to her house Saturday morning, saw her walking around outside her house and noticed her odd behavior (dementia-like state, 1,000-mile stare) and inappropriate clothing (i.e., bathrobe, hospital gown). She gets in my car and I offer to buy groceries since she hasn't been home in two weeks. Honestly, it was a stalling effort until I could figure out what to do since I didn't want her to be in her house (unsafe). Then she wanted to get some breakfast, inside the restaurant and go shopping in a store, but she was inappropriately dressed. I called my sister (lives out-of-state) who reached out to several adult services organizations (most closed on Saturdays) and Adult Protective Services hotline said to “take back to ER and request a capacity assessment.”

So I drove her back to the hospital for a capacity assessment, but told her I was taking her somewhere to pick up some literature on her condition that she wanted to read. I left her in the car in the ER parking lot and discussed the situation with a kind woman who worked at the registration desk and understood why I brought my mother back to the hospital. Nevertheless my mother registered herself, a requirement for entry, and was examined by an ER doctor who confirmed her memory or dementia-like issues (i.e., she told the doctor I was her husband and said my sister was OUR child). The hospital admitted her for 24 hours for further assessment and later I learned it was by court order/magistrate.

Although I felt guilty for returning my mother to the hospital and knew my choice could cause my mother not to trust me again, observing her mental/physical conditions over the 24-hour period confirmed I made the right choice. I stayed with my mom overnight and observed multiple doctors, nurses, and case managers assess her. Her primary doctor (hospitalist) and case manager recommended two options: 1) assisted living or in-home care 24/7 or 2) live with a family member. This is when the real drama started.

My mother insisted discharge and wanted to go home, but I continued to try to convince her she should spend some time with her sister. She told me to leave the hospital and she would make arrangements to go home.

I prepared to go home when the doctor and case manager found me in the waiting room. I called my Aunt and the doctor, case manager, my Aunt and I had a conversation on the speaker phone and I agreed to have another conversation with my mother about spending some time with her sister. The doctor encouraged me to be firm with my mom and said that since she lacked the ability to make a medical decision and with the hospital, I was the “Responsible Adult”, it would be within my rights to put her in my car and drive her to my Aunt’s house. So I gathered myself, told the nurse what I was planning to do, and told her not to be surprised if it got “loud” in my mom’s room.

I firmly talked to my mom, told her I was taking her to her sister’s house, but of course she got offended and thought a son should never talk to his mother in the way I did. I believe we both started yelling. Not screaming, but I knew I was louder. She told me she would call 911 and I told her to go ahead and they would escort her to my car.

Upon discharge, she made a BIG scene. The hospital administrator, multiple nurses/staff, and two security officers escorted her from her room to the main lobby. Throughout the commotion, my mom said “a nephew was picking her up.” Eventually, my cousin pulled up behind my car in front of the hospital and said he was taking my mom to his mother’s house (another sister, not the Aunt who offered to care for my mom). He told me he would take her to his mother’s house first and then would take her to our other Aunt’s house to stay for a few days.

As of today, my mother never made it to my preferred Aunt’s house today. Collectively, my Aunts don’t want to force her to live with my Aunt but believe staying with my Aunt is the best option (younger, retired, loving, and financially secure). Her sister whom she is staying with is incapable of providing for my mom. My mom continues to ask all family members to drive her back to her house.

I saw my mom yesterday at a family gathering, three days after leaving the hospital, and physically/mentally she appeared to be doing better. However, returning to live in her house alone is against doctors’ orders, we lack financial resources for in-home care, she doesn’t let anyone in her house anyway due to hoarding, isolation isn’t good for her mental state and her health condition will deteriorate since she continues to cancel her doctors appointments/reject medial advice. I imagine a family member will eventually take home.

Although my mom and I were cordial yesterday our relationship has forever changed and I believe her quest for independence will never stop.

helpingson

debdaughter: That is actually quite shocking.

Llamalover47, unless, possibly with home health, like with my dad

The Hospitalist will not discharge the patient to the home. That is not  the protocol-safety of the patient is. It is usually the rehab unit of the NH once a Medicare bed is deemed available.

so your dad's back home again? did they get his uti taken care of?

He was for 2 Days this time, 7 Days three weeks ago. Both times discharged to a rehab. The rehab discharged him to his apartment where he lives alone.
He was in the hospital last summer and discharged to rehab then home. He was admitted to the ER 3 or 4 times in the past 6 months for falls in public, but he was not admitted to the hospital because he was not injured. The falls were from
Standing up too fast after walking for a few miles.
So now he is in rehab again, and we are recycling this drama once again. This is very very difficult-there are six of us siblings and all six are totally burned out. He will not allow anything-not home health, not a cleaning service, none of his kids are allowed to clean or throw away food.
We could not have him live with any of us, everyone works, and more than one hour with him will suck all the energy out of you.
I feel deeply sympathetic for every person posting on here. It is so difficult.

Prairie Lake, so is your dad in the hospital now?

that happened with my dad; the social worker, even though they came in the very next day after he was admitted to icu, to talk about placement, from the standpoint of him being admitted, even though with his grandson he'd had move in with him to take care of him and who'd found him collapsed, had no authority so he was considered to have been admitted by himself, in which cases they always contact social services at the hospital to check out the situation to see if they need to be placed; now, having said that, we said no at the time, that everything was fine, I was there by then; however, since I lived out of town, they could not discharge him to me and still not to grandson, so they started pressing for me to get guardianship - though not really sure how that would have worked either with me living out of state, even, but they got his assigned doctor/hospitalist, although he does have private practice and would take him on as a patient, to write a letter for guardianship saying he had dementia, which was an issue in itself because by then he was no longer in icu with the psychosis he had in there, although he wasn't all the way back to himself, but they made the "mistake", if you will, of just leaving the letter in the room while I was out consulting with some other family members, which then got found by the grandson, who thought I'd had it done and was wanting him placed; however, in the middle of all this - can't remember if like this in icu or not - he became incontinent and grandson came in and found him like that; now, mind you, he was being taken care of so not like he just found him like that, but he realized then could be something he'd have to take care of if came home, so he said he wouldn't do it, I think, thinking I'd have to or would, not sure if thinking getting somebody else in, but either way would have to have a plan, so what led to the whole guardianship/placement thing by the social worker, think the nurse who was taking care of dad and heard grandson say that told them, so...okay, then if he didn't like finding the letter, which he shouldn't have read, granted, but did, with those plans, then he'd have to make a decision - unless, true enough, I agreed to move in with him, which is a whole other issue that I don't see even being brought up with your situation either plus the added that because I lived out of state, they couldn't even directly discharge him to me, they said, would have to be discharged to nh/rehab and then to me from there, don't quite understand all that, or maybe not even to me directly from there but to a facility in my state, which grandson didn't understand at first, but also still thought I should make the move, or so he said; as proved out later, not sure really felt that way, but that's a long story, anyway he finally and the social worker had to agree, which she was uncomfortable about and only agreed if it were at first at least considered temporary and I agreed to stay; you have 30 days to see how things will go if you are allowed to take them home, although something I don't really understand is they don't seem to check on them, but maybe because what they do, or did with us, anyway, is discharge with home health and maybe let it be their decision then at that point, which, though, again, at least in our case became a whole other issue, since he was also discharged or at least recommended? to have telemetry for CHF that had dx'd him with, which only one HHA had, the one connected with another hospital or maybe that's why they were the ones recommended, saying all that because we had not used them before, so they were not familiar with our situation, had a social worker themselves who grandson - again, long story, going back to if dad was going to be there and he was the one who was going to be there as well, he - and maybe should have been, been a lot of talk about this on here - wanted to be in charge and told them he was and they didn't question it, but then they didn't with me either when I told them I was and wanted to be kept informed so maybe I should have picked up on that or should have kept better contact but I had other things going on, another long story, but even so I stayed another two weeks, took a week for the nurse to come, after we brought him home and he did seem to be better back in his familiar environment - she said strangest case of CHF she'd ever seen, apparently an atypical kind - and finally got things set up for his blood draws but also told us he was supposed to have an appointment with his specialist, somehow got dropped by the hospital in the paperwork, she didn't have it, hadn't actually been made, so she got that done, so then I felt comfortable at the time coming home; however he didn't make it to his appointment before by the time she'd come to do the blood draw, his blood had dropped so low they called for him to the ER, but of course they didn't know anything that had happened and the protocols hadn't been set up for the lab to let anybody but us know, either, and we didn't really think it would be an ongoing problem or he did still have his appointment so thought it would be taken care of then, which it somewhat was, but had a whole other issue with the hospital that had to be taken care of, not sure how all of that would have been handled had he been placed, so...we finally got standing orders in place with the hospital because it did turn out to be an ongoing issue that did turn out to be a problem with grandson but, again, more problems because the doctor didn't have privileges, other than being allowed to have these orders, at that hospital, but even though as much as it was happening he wasn't addressing the situation and it was months before we found out why; there was a major miscommunication between 2 of dad's doctors, with each thinking the other was actually managing his overall care and I not knowing that; meantime dad was being put through untold misery as well as the hospital where all this was being done at because they weren't really equipped for the situation but weren't in a position or weren't calling his doc because of that situation to have the team come in from the other hospital that was or not really sure they would or if dad would have had to have been transferred there or a surgery issue that wasn't being addressed, either, or a medication issue, which could possibly have alleviated the whole thing, which required more testing, but which hadn't even been addressed until I finally had been made aware of all this after I finally started asking more questions after the hospital finally told me what all had been going on, after they found out, again, after I started asking questions after finding out more, because found out they don't really keep an ongoing chart on a recurring patient - every incident has its own, so there's no real history - errgh - know this was a bunch, hope it just gives you some food for thought as to what all can be involved in bringing a complicated patient home, which don't think you were/are wanting to do anyway, but not sure what would have happened re dad had we not, other than it just would have but what that would have actually meant...not sure

I feel your pain and frustration.
My Dad has been in the hospital and rehab several times in the past year. He has memory problems, doesn’t take meds as prescribed, hoards food and anything else. I am the durable medical power of attorney. I cannot make medical decisions for him unless he is unable to make them for himself.
In all of his evaluations he is able to answer the questions. Last time we had them administer a competency test. It is what they use in his state to determine if a person is competent. He passed with flying colors.
That means that no matter how dysfunctional he is, how much he can’t figure out any of his phones, how much he will not get on a bath chair, how much spoiled food he keeps in the frig, how many payday loans he takes out, that he is his own person and has the right to live how he wants and where he wants. He is 90, and if he wants to die at home, we cannot do anything about it.
He was just discharged Monday from a rehab, went home and got on the couch, laid there until Thursday and was readmitted to the hospital with a urinary tract infection.
We did call adult protection more than once but they won’t even investigate.
People have the right to live the end of their life as they desire, unless they are so impaired you can prove they are a danger to themselves or others.
I understand how frustrating it is, but people have basic constitutional rights and doctors and hospitals are very aware of what they can and cannot do.

It sounds like Guardianship would/should be put in place.
If you explain that to Mom (I am guessing from "helpingson" this is your Mom) that she has 2 options at this point.
1. Reside with a family member where she will be safe and cared for.
2. Be placed in a Memory Care facility where she will be safe and cared for.

If she is not safe staying in her home the Hospital can not discharge her to go home.
If you do not think that you can care for her long term it might be be better to discharge her to rehab then have that become a permanent residence. Always saying .."when you are stronger we can discuss going home"..

You might want to discuss this with the Hospital Social Worker they may have better ways to present the options.
Also before you begin the thought process of bringing her into your home consider the work involved caring for someone with dementia. Also the mobility issues will only get worse. Is your house set up for that? And are you married? Children at home? What does your spouse think of this plan?
Is your Mom Hospice eligible? They can help greatly with supplies and equipment that will make some things a lot easier.

Hospital is required to make a "safe discharge". Have the discharge planners (Not family member) make it clear to the patient that going home alone is not an option