Medically complex and does not take care of herself. She does not take her medication, does not eat properly and just ignores all doctors orders. They moved her closer to them but they work all day and she needs to be supervised. She does not have money for Assisted Living and actually needs probably a skilled nursing type facility. She is currently in the hospital when her son found her on the floor of her apartment. I told my friend to deny the discharge that she can not be released to live on her own. Is that a thing? There has to be someway to get her to the right place directly from the hospital. Thank you
Tell your friend NOT to sign the discharge papers and refuse to pick the person up. Let the hospital send her home in a cab if they think she is competent and safe to live alone.
Then you call Adult Protective Services to report her as a vulnerable adult.
BUT be aware that competent people are allowed to make bad choices for themselves.
Family members needs to resist getting sucked in to enabling a charade of independence.
i like that.
Does your friend suspects he/she has been 'volunteeted' as a named helper?
I have called & explained my honest level of assistance, to ensure it was not overblown.
Sometimes that indeed is enough to detail a discharge & change tracks direct to rehab instead.
Many patients will claim they have family help. Others will agree to accepting home services, which will enable them to go home with more support. (ie 2 X weekly shower assist, or 2 X weekly Nurse visit). However, once at home, they may choose differently! Leave the home helpers on the doorstep. Those staff report back.. but it is the person's right to refuse.
The patient will either thrive - or fail - falls are typical. Then 'boomerrang' back to ER for another cycle.
Skilled nursing is covered by medical as long as a SKILLED RN is needed. That won't last. A Nursing Home may be the answer. Or Board and Care. If Mom isn't able to function at home alone she should talk to the Social Worker and say that sending her home right now is "an unsafe discharge" because she cannot make it on her own for the following reasons. Then list them.
If they send her home unsafe, then she will have to call for an ambulance. The mere fact that she ends in ER in a number of days will get social workers working on a safe discharge plan.
It isn't enough to say "Mom can't live on her own." It is now to find the living facilities for her that are both affordable (or on a spend-down to medicaid program) and safe. My advice to you is not to consider a move to YOUR home even temporarily.
It is a bit late to discuss this only days before discharge. If it was clear Mom couldn't return home that was the time to get Discharge Planning to work on placement options. It's a huge job. They may be able to buy a bit of time in rehab for PT and OT evaluation to see just what kind of care Mom now needs. If so contact THEIR social workers and discharge planners day one there. Wishing you luck.
honest question
If they will not discharge her unless there is a plan in place that she gets ongoing care, and there is no one to assume the role of caregiver then it would be an "unsafe discharge".
If this is the case and no family member wishes to take on the role of caregiver then other means of discharge will have to be looked at. But ALL family members have to agree that they can not be caregivers.
If she is not competent then whoever is POA or the "next of kin" and has been making decisions for her can ask that she be placed in rehab and then look for a Skilled Nursing facility that will fit her needs.
If no one is POA and no one wants to take this role and become her Guardian then the Courts will appoint a Guardian and that Guardian will make all medical and financial decisions for her
1) financial
2) medical (most states will only pay for LTC and the doctor needs to make this assessment)
Medical care need is not the same as custodial care need. Is anyone the PoA for the mom? If so, this is the person who will have the authority to make decisions for when they meet the "trigger" requirement: usually 1 or 2 diagnosis of cognitive/memory impairment (or if they have a Durable PoA then it can kick in right away).
If no one is her PoA, the mom should be encouraged to create this legal protection now before she becomes further incapacitated (and the attorney will assess for this at the time of the appointment).
If she won't assign a PoA or no longer can, then the family has 2 options: they pursue guardianship through the courts or they call and get APS involved (reporting her as a vulnerable adult) and when things for the mom get "bad enough" the county will step in to acquire guardianship and then will call all the shots.
It sounds like your mom's friend may not qualify for Medicaid at the medical need part, but hopefully the family can consult with a doctor at the ER or rehab to get her assessed. Having impaired memory or just being a fall risk is usually not "enough".
Tell your friend that if the hospital allows her to make her own discharge decision, no one is to go pick her up, even if she calls and begs. This includes telling her friends and neighbors as well. My SFIL shouldn't have been able to come home (on one of his many falls-ER-rehab cycles and when I refused to go get him he called his church and got the name of someone to call and give him a ride home. He had Parkinsons and was an uncooperative disaster.
I had no idea the MIL was only 60….she is that medically complex.
Have they looked into PACE?
https://www.state.nj.us/humanservices/doas/services/pace/index.html
Also, the financial qualifications for Long Term Care MediCAID are different from those for Community MediCAID. Be sure your friend understands the difference.
Also, the hospital cannot force your friend to take the mom into her home, nor can it force her to provide care in the patient's home.
She needs to make it clear to the hospital that mom is going to her own home and that no one from the family is available to be gma's free caregiver. Gma's resources will need to be used to pay for care.