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My mom has been in assisted living (AL) for 3 months, over the last month she has been very vocal about returning home, which is not possible. She walked out the door at her AL on Tuesday and required the AL staff to try redirection to get her back which didn't work. Police, fire, paramedics, and finally psych team called to help. psych team determined she lacked a suitable plan to return home and had her transported to a local hospital for a 72-hour psych hold. An evaluation occurred the next day and they determined she lacked capacity and elevated her status to dementia and a UTI....... the reason for the behavior.



Meds were prescribed and 72 psych hold was lifted though I don't believe they have the meds under control yet. Her AL home can't take her in and they had a shared room for memory care (MC) that required someone to watch her for 72 hours due to aggressive behavior costing $2,500 for her to reenter their MC population. I did not feel this was a good fit and have been working with placement to find a new MC for her needs and meet financial requirements. Every day they call to harass and want her out and say there is no reason for her to be there. It's taken 3 days to find a place that has a room and meets needs, she's still stuck in the hospital emergency department and they refuse to admit her due to dementia and UTI.



The new MC facility still requires they evaluate and approve her before accepting her which I feel will be fine, but not until 8 days after leaving her AL. She's now been stuck in the Emergency department with nowhere to go, can't go to AL nor family or old home due to care requirements and she insists she returns home. The hospital emergency discharge planner and manager have suggested we are abandoning my mother and might call APS, I said fine, do it! Then I called APS and reported the hospital situation to them. I've stated we have nowhere to take her and this is an unfortunate situation that I've never encountered before, so why hasn't the hospital prepared to admit her into a bed until a suitable MC home that we approve can take her? They certainly been in this situation before and offer no help.



If a family cannot take a parent and there are no suitable MC residences open and the Hospital requires she needs MC, what does one do when you have no control?



What to do?

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As long as you aren't her guardian, you can't get in any trouble with APS. The hospital just wants her out of there and knows it's going to be a long wait to get into her an MC due to her behaviors. This happened all the time when I worked at a hospital. It's not uncommon for people to languish in the hospital for a month before they get their behaviors under control and a facility will accept. It's not your fault it's just something that happens. Turn it back around on the hospital staff that they need to address what is occurring mentally and physically with her so that a facility will accept her and she can be discharged.
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Gnarley Jun 2022
I had a call while eating dinner I needed to take a break, it was my mom angry that she was dressed and ready t go and I'm not picking her up! I called my sister to ask her to check in and try to diffuse her which she's better at and my sister spoke to a nurse and asked if she is taking meds? The nurse says she's been refusing meds for 2 days, so what can we do if mom refuses meds in the ED? Seems she isn't a safe discharge!
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Gnarley,
In the E.R. for UTI and behavior problems on a 72 hr. psychiatric hold.

Even though the 72 hr. hold was lifted, she should have been admitted to the Behavioral Unit the minute the psych hold was placed. She should be in the behavioral unit until meds are stabilized, seen by a psychiatrist. The E.R. is not equipped to hold a patient. What is wrong with that hospital?

If they have no Behavioral Unit demand her transferred, admitted, and evaluated by a psychiatrist there. One does not get over the behaviors caused by a UTI in 72 hours. Call the hospital Ombudsman at this point.

Have you been there, boots on the ground, to see this all happen?
Patients with an advocate present will do better, be treated better.

Beware of the unsafe discharge, the hospital may try that next.
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Gnarley Jun 2022
Mom was evaluated about 20 hours after going into the emergency department by the psychiatrist and prescribed meds and lifted the 72 hold as he said it was not a psychiatric need due to the dementia. Kaiser does not have a behavioral unit and may have the worst mental health care of all HMO's in the United States. They didn't say a lot about the UTI. They wanted her out as soon as the 72 hour was lifted with nowhere for her to go and without knowing new meds would be good. Family is not allowed inside due to increase in covid cases in my region. I know they are keeping her safe but not doing as much as they could such as admitting her until we can get her into her new memory care provider. It took time to find a new one and she now needs to be cleared for occupancy in her new room so we have to wait another 3 days.

The unsafe discharge is exactly what we've been experiencing and they have threatened us numerous ways be I have stood firmly that she has nowhere else to go until accepted by her MC we selected is ready. I expect more calls today saying we are abandoning or dumping her, which cannot be true as I didn't take her there, I'm just the POA and her son trying to keep her safe.
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You're doing everything right, she may need to become a ward of the state. Just keep saying no every time anyone even IMPLIES you should do the caregiving.
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Out of Network Behavioral Unit.

Are you in contact with the hospital Ombudsman yet?
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Gnarley Jun 2022
OK, Hospital hasn't suggested this! I did report to APS and they were reporting to ombudsmen. The hospital has not provided ANY alternatives and I have asked!!! I've said certainly Kaiser has been through this thousands of times, I haven't please make some suggestions, or admit her until she's safe to discharge.
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If you did not exist placement would be found. There are no rules that say you must take your mother into your own home. They will have to find placement. Now, that you have already refused a placement we come into the realm of problematic. If Mom had no funds and no POA she would be on nursing home care via the state's guardianship. This wouldn't be "pretty care" in Mom's condition, as you know.
You have three choices here:
Give up guardianship or POA and if you have these already for a person with dementia this will require an attorney to do; give over guardianship to the state. I seem to remember that you hold guardianship over Mom.
Or
Get Mom into the placement that already existed. She uses then, her funds, with you as guardian or POA keeping careful records of every penny in and every penny out of her estate/trust until all is spent. Then Mom is on Medicaid and medicaid placement (again, won't be pretty)
Or
Take Mom home.
If someone else has another option I don't know what it is. If Mom is not admitted her supplemental insurance may not be paying for her care outside of medicare coverage; I don't know how that will work.
You are between a rock and a hard place and I don't envy you one single bit, buit do NOT be bullied into someone convincing you that you HAVE TO take Mom into your home. They simply want to be shed of her and are willing the THREATEN you to do so. Were you not ever born they would come up with something else.
Do know, however, if you are POA, or guardian, you are expected to come up with care for Mom. Good luck on that. I can't imagine where you will find even minimally decent care for her, or at what cost.
Your answer to their threats, by the way, was stellar. The answer is absolutely, "GO AHEAD AND CALL: I will call FOR YOU. But she isn't coming to my home.:' Good luck. Hope you will update us.
By the way, guess what APS and the entire state's last answer will be to all this. Taking her away from your guardianship or POA. Which would be heaven I am supposing. Let them place her, spend her money on her and then place her when she is on medicaid.
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Gnarley Jun 2022
We found a placement and they need to approve, won't see her until Tuesday! The former place had a private MC room that was more than double and not sustainable so unacceptable! They also had a shared room that we believe would not work and also required a private 72 hour monitor to ensure no violence! Kaiser is not properly medicating her as she's refusing her meds for 2 days, so what happens if the patient who's cleared to go and elevated to dementia with UTI? Seems the hospital has failed and just trying to unsafely discharge her! If that happens I'd expect her to boomerang right back in a few days, it happened to my dad when improperly discharged!
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Good for you for not falling for their threats.
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AlvaDeer Jun 2022
Amen.
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Stand your ground! You did the right thing by calling APS yourself and standing up to the hospital. Sadly the hospital's intimidation tactics often work by having the family member take the patient home which ends up being the worse outcome for all involved.
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Hospitals nowadays, only provide acute short-term treatments. Chronic or long-term cases like your mother, don't qualify for an acute admission. If nothing is found soon, she might have to be sent to a psychiatric State facility.
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AlvaDeer Jun 2022
Sounds good to me, for sure, in this case.
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The OP has said:
Her AL home can't take her in and they had a shared room for memory care (MC) that required someone to watch her for 72 hours due to aggressive behavior costing $2500 for her to re-enter their MC population.

Aggressive behavior requires 24/7 supervision.

This is provided in a Behavioral Unit.
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The deal is that your mother does not have a diagnosis that requires hospitalization. She is stuck in their "observation status" and truly needs to be discharged. The problem is the lack of a suitable place to discharge her to, Case management is the department you need to focus on working with regarding your mom's housing issues. Praying that a suitable spot opens soon.
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