Can a facility discharge a resident to a hospital for a psych evaluation and refuse to take them back?
On Christmas Eve my husband received a phone call from the administrator at the Memory Care Unit where his brother resided. She stated she would be discharging him to the ER of the hospital for a phyc evaluation and would not be allowing him to return due to behaviors.
BIL had only been a this facility for a month and we were never made aware of any current issues. We visited 3 or 4 times and no one said anything to use about any problems. Therefore, we thought all was well.
BIL at some behaviors in the past that had been attended to. At the time BIL was 4 hours away and we just could not be a part of the care team like we wished. Husband and I thought if we could get him closer to home, we could be more involved with him and his care plans. Thinking if there were anything else to arise, we could assist in what the problem was and how it could be resolved. So long to our hopeful thinking.
Long story short … We received the phone call from the social worker today that BIL is ready to be released but that administrator said she already told us he could not return. Social Worker asked us, What are our plans. I informed her that the administrator can not discharge him without a 30 day notice. SW stated she would contact administrator and call us back We never heard anything.
Is this situation illegal? Any advice would be appreciated.
Memory Care Units claim they can handle the behavior issues when indeed most can not.
I work in a Memory Care and we erroneously took in a woman who's schizophrenic, as it turns out. She mimics dementia behaviors from time to time, but her overall behavior does NOT fit the 'dementia/Alheimier's' profile. Her daughter is now trying to figure out where to place her next since Memory Care is not the right fit for her.
Best of luck!
Remember...........these places like to keep residency at 100%.......their goal is never to 'lose' residents but to 'keep' residents. Only when it becomes 100% necessary is when a resident is asked to leave.
Best of luck finding a good location for your BIL.
However, the staff is the one who stated he was a 'teddy bear" while at the facility, not my words.
Remember, these are specialized care units. Meaning, they must be able to care for someone who may present a mental disability or behavior issues.
I am just referring to common behavior problems. I'm not talking about slapping someone, punching in the face, choking, spitting on, biting, kicking, throat punching, pulling hair type dangers.
The administrator better proofread her own documents for admitting someone.
What you don't seem to get is that even if he is an angel 90% of the time nobody wants a loose canon in a facility, the families of the other residents shouldn't have to fear for their loved ones safety because they are too demented to be wary of your BILs hot buttons and the staff shouldn't have to fear being abused verbally or physically just for the privilege of earning a (meager) paycheck.
Dementia care facilities do handle most common behaviour problems very well but there are always exceptions to the rule - unpredictable violence and/or sexually inappropriate behaviours are examples of problems too difficult for the average facility. Yes, if we all lived in a Utopian society there would be specialized one on one care for all the people in memory care, unfortunately this is the real world and if he needs one on one care somebody has to pay for it.
Lets just say I have several years experience getting a look into services for children/teenagers who have mental disabilities along with behavior issues.
I have seen upfront these children hitting, biting, kicking, etc. etc. innocent children, staff and faculty. Was this right? NO, but it happened. At least I can say for the most part, the school would try to have a meeting and come up with a plan of action, intervention, manesfestation, so on. The child was not just throwed out the school because of a danger to others or the acts they committed.
That is all I am trying to say in the same case scenario. The only difference is, this is an "adult" in an adult facility.
It would make a lot more sense to me had the administrator called our home and made my husband aware of any behaviors not suitable. In the short time he was there, my husband and I made at least 4 visits. No one said a word to us about anything wrong. Had my husband been aware of something, he and I would have gladly had a meeting within the facility for everyone to have a clear understanding and maybe come up with an action plan.
I mean, was the administrator there trying to cover something up? Why was my husband not made aware of any issues? Was there a particular reason behind her calling at lunch time on Christmas Eve? Regardless, she did not handle things professionally or right.
During the transitions, I asked the DON to contact me every day or so (phone call or email) at _her_ convenience to let me know how Dad was doing and if there was anything I needed to do for Dad. One of the benefits of the extra transitional care was a daily report was written and the DON forwarded those to me.
I didn't try to tell the MC how to operate. When there were issues I asked what our options were. We always found something we thought would work out better, sometimes those ideas worked and sometimes we had to try again. When the plan wasn't followed as agreed, I asked about my misunderstanding of the action plan instead of starting with a confrontation. I completely understand your frustration and anger and the desire to confront the people who haven't met your expectations, but you really do need to remember "you can catch more flies with sugar than vinegar". Please try to stop being so critical of the MC, it's staff, and it's actions and try to find some way to work _with_ the MC, maybe especially when something is messed up. Often there no way to "unspill" the milk but sometimes people really appreciate someone who helps them clean up the mess without first bringing undue attention to their fault in the spill. "I don't understand how..." is often a good conversation starter.
Ask what conditions the MC would need met to reinstate BIL. Read his contract and be ready to use ask about any conflict resolution or eviction language you feel would be helpful to BIL's case, but be nice.
I am not trying to blame the staff or facility. All I am trying to say is ..... Why did the staff and administrator keep telling my husband and I everything was going well if it was not? Maybe if they had been honest with my husband he could have offer advice on handling the situation. That is not what happened though.
Once again, I appreciate you advice. By the way, I already have a geatric case manager involved, so hopefully they can steer things in the right direction.
You moved heaven and earth to get BIL into a facility where you and DH could be more closely involved in his care. Good, I agree, I have supported you all along on that.
And yet in the first month you've visited three or four times. I'm sorry, that is nothing like enough. This was a time of huge transition for BIL, there were bound to be teething troubles, you needed to be in there monitoring his progress really closely until he had settled into a good routine. Phone calls are useless - you're talking to members of staff who realistically at that moment will be thinking "which one is he..?" while they assure you he's doing fine and he's a poppet. You were just out of the loop and things happen too fast for that to work.
If you seriously want BIL to return to this facility you will have to stop blaming them and find out exactly what happened. From there you will be able to see if the problems could have been defused or avoided, but you can only do that rationally if you first accept the possibility that maybe they couldn't, and this facility has bitten off more than it can chew. In which case, you do not want your BIL in their hands and the search will be on again; but that will be the Social Worker's problem.
When your DH spoke to the administrator on Christmas Eve, what did he say? Did he ask any questions? Has either of you attempted to reach her or her managers since?
Will the psych unit not let you visit BIL?
Key question: what does DH feel now about participating in BIL's care? Are you sure he really feels equal to this?
The only option, Hailey, if you want control of BIL's health decisions would be to pursue guardianship through the courts. If you want that the psych hospital may be willing to help you obtain that relatively quickly on an emergency basis. Is there a chance APS has become involved? I would think that very likely. If so, APS may be pursuing guardianship that will allow them to make decisions for BIL and that would not require input from you or hubby to determine appropriate placement for him.
If APS has become involved this is for BIL's benefit and is not anything personal against you or hubby.
My final thoughts as I would like to try and help you but I continue to be left scratching my head with your responses every time someone tries to explain how things work
- if you are in the US, you or hubs need a HIPPA release or medical POA to discuss BIL with health care providers
- please stop expecting others - the facilities - to solve the problem
I get no one wants to get involved but it takes great effort to make anything better in this situation - I know this first hand - my mother's dementia has turned her into someone I didn't know and I fought for her in order not to have her memory care facility send her out on a psych hold - how did I fight ?
I control her care - I take her to outside doctors including a neurologist and discuss med options and research the options -
this takes time and effort which you and hubs are not likely to have but the alternative is her facility would rather use their house doctor and suggest meds that will cause her to sleep all day -
there are few options for dementia with aggressive behavior
it does not matter that BIL used to be a good decent person - he now has a disease which manifests in psychosis - his brain is broken and no amount of sweet talk from staff is going to fix it or suddenly make him cooperative
we all agree that the situation is awful, care is lacking and resources are limited but if you are able please spend a bit of time today to write down three things you can do on Monday to help move the situation forward
I would guess that a lot of BIL's problems are a lack of consistent medical providers - is he bounced from facility to facility without a doctor knowing him and constantly having his meds changed ?
I'll offer up a start
- contact psych hospital social worker and ask what is protocol for diagnosis and follow up care plan and who will be providing that care - does BIL need a referral to psychiatrist or internist and will this care provider work with him in a facility ?
sorry you and hubs are going through another difficult period with BIL especially during the holidays
I've followed your posts over time and it seems the same folks will respond to you with the same comments and questions but you don't seem to respond with more information -
mainly your question revolves around why don't memory care facilities have to take your BIL ?
the only answer is No they don't
if BIL has had several psych evaluations then his dementia (if that is his only diagnosis) must be severe - the social worker at the current psych hospital must work to find a suitable discharge
during the past 4 years, I've witnessed behavior issues from residents in mom's memory care facility -
I've seen other residents hurt and I've been hit myself on several occasions -
there is no magic memory care or way to handle or redirect these situations especially if it is a strong man -
the only solution is to heavily medicate them which means they become immobile and less volatile if not walking around
You do not need to elaborate on BIL's behaviors but I'm sure you do not want to see him hurt anyone
I understand that it is difficult to accept, but there is no cure and no memory care facility no matter how expensive or what their glossy brochure says has a magic wand to make things better - it is awful I know
the best you can do is hope he is kept comfortable, safe and fed and clean
push back on the social worker to help find a solution - this isn't a first for them
contact your local Alzheimer's association and ask for suggestions
contact your county agency on aging and ask for suggestions
BIL is not bothering the residents from my understanding it is the staff. Makes me wonder what they are doing to him My husband has told me that his brother was like a genius before all this happened to him. It says his brother is not going to tolerate no one being disrespectful or bossy with him.
I can not help but wonder if he is being provoked. My husband and I kept BIL for a few days this summer and he was a joy.
I forgot-does the state have guardianship over BIL? If so they will step up but again the possibility of him being transferred somewhere far away from his brother & your family exists again- your husband will get stuck driving to wherever he is.
Unfortunately yes his MC can discharge him if they fear he is a danger to staff or residents. I believe that is the deal breaker. Giving 30 day notice is probably not required in this situation either due to BIL’s erratic and potentially dangerous behavior. My guess is he isn’t going back there.
Again I feel bad for your husband and your family. You’ve been a great advocate for what should happen (staff trained to work 1:1 taking care of BIL) but that is not going to happen unless it’s private pay.
I will guess BIL was admitted under a behavioral contract or is currently in a probation period at the new center. As he has again exhibited inability to make proper choices & can’t control his impulses - especially since they gave him a chance when no one would - I am thinking they won’t entertain taking him back.
As another poster said, leave this to the SW and DC planners to get him placed.
I hope it it works out for you & that maybe they will give him one more chance.
Mom was in care for just over two years when she passed. Both memory care and the care home (last six months of life) required that mom have private caregiver, in addition, whenever her behaviors escalated.
Hailey, if BIL can afford that, perhaps you could get him back where he was. The 1:1 did help mom, kept her engaged with the mind more active. That was the advantage of the care home for mom. The staff/resident ratio standard was much better more like 1:4 instead of the common 1:6 or 1:8 or even more that you see in memory care.
Oh, and the care home was less expensive which did help with the increased cost due to the need for 1:1 care.
This isn’t their first rodeo, unfortunately.
I think it all boils down to approach.