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My dad is 73 years old with a diagnosis of schizophrenia. He ignored his worsening issues with his knees and back. For many years, he rejected my offer to take him to the doctor and find a new apartment (his current apartment has 8 uneven concrete steps to get into the building). Things got bad a few weeks ago where I came to his apartment and he was hugging the walls in order to walk. He was ordering canned food from Amazon because he couldn’t go to the grocery store. I ended up calling Adult Protective Services and he eventually decided to go to the hospital after a few days because things got so bad where he was crawling on the floor to get around. He ended up having nerve compression of the cervical spine and they did surgery on him. Currently, he is in inpatient rehab. I spoke to the physical therapist and they recommended he find an apartment that doesn’t require 8 steps to get in and out. My dad said that he refuses to go to another apartment or assisted living. He has enough money to afford at least 6 years in a nice assisted living, but he doesn’t want to part with his money. I’m not going to take him into my house if he’s unwilling to help himself. I am thinking about talking to the doctor to get a competency evaluation, but if he is found competent, can they just discharge him home to an unsafe living situation? If he is found incompetent, then what happens?

Your Father can WANT to go home. He can even TRY going home.

Yet let him know IT IS OK to change his mind. At any time.

When he goes home, is housebound, cannot get out to shop or live his life, then DON'T ENABLE.

This is his choice.
If Dad chooses home, then the consequences are his.

If not coping, HE can call EMS. (Or you call APS again).

Back to a hospial, back through rehab, back to wantong to home. Trying home. Home not working. Round the loop again.

See the pattern? Some people change their mind quickly, others take a few loops. Or their fall/health/illness forces a change of track: from homebound to permanent care facility.
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Redmanrulz010 Oct 18, 2024
Thank you for taking the time to write this. You are absolutely right. I need to step back and let him make his own choices.
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Use the phrase unsafe discharge and keep repeating it. Do not take him into your home.
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Reply to Southernwaver
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Redmanrulz010 Oct 18, 2024
Thank you for your response. I am definitely not taking him home after learning that he has no plans to try to better his situation.
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Generally courts do NOT find the mentally ill incompetent. They generally say that there's nothing wrong with having a mental illness and that with medication most people lead normal lives, unlike dementia patients.
Of course we all know they will not take meds once out of hospital. So there's that. But I doubt the courts will help you here.
You can continue to call APS for crisis intervention.

I suggest you read the excellent Memoir by Liz Scheier called Never Simple.
She attempted to intervene for her mother for many decades, until her mother's death in a sort of skid row housing. She had the help of the entire social services network of the City and State of New York. All to no avail.

As anyone who has dealt long with mental illness in there family there is very little help for you, I am afraid. Avail yourself of discharge planning and do the best you can do, and don't miss that book because you will learn that there isn't a lot you CAN do here. I am so very sorry.
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Redmanrulz010 Oct 18, 2024
Thank you. I am going to get this book this weekend. It’s so hard to watch a loved one make poor decisions.
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If he is incompetent and you have POA, you can have him placed in LTC or AL. But from what u have written, Dad is not incompetent and does not need 24/7 care so there is no "unsafe" discharge. The problem is...he needs a new apartment that has handicap excessiblity. At least less stairs.
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Redmanrulz010 Oct 18, 2024
Thank you for your response :)
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Rehab only needs to keep a patient who is making progress in the skills related to his or her admission. Once those goals or met (or if the patient is unable or unwilling to improve), they will be discharged from Rehab. Whether that it is to the patient's own home or to a more accessible apartment or other living facility is up to the patient or medical POA. HIs apartment or other living situation will be his own decision and expense. If he insists on staying in his currectn apartment, he may need to make arrangements that let him better naviagte the stairs.
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The inpatient rehab facility should have a doctor who would need to discharge him. Talk to the doctor and let them know that his current living situation is unsafe.

They can only keep him in rehab for so long, then he has to be sent - somewhere.
He could be transferred to a skilled nursing facility. But, if the physical therapist thinks he has improved to the point he can go home, and your dad refuses to leave his current apartment, I don't know if there's much anyone can do. If he is mentally competent, he can choose the difficult life in the home he knows.

I had an elderly neighbor years ago who had to crawl up the stairs, and was not managing her incontinence (denial?) so the hallway smelled of urine any time she opened her door. Paramedics came a couple times to take her to the hospital for extended stays, and she always came right back.
I don't know what happened. I moved away.

You ask the question, if he is found incompetent, then what happens?
You can petition to become his POA. Honestly, that would be easier done while he is mentally competent and he can agree to give you POA. It's just a form he can sign and have notarized. Otherwise, I believe you have to go to court to prove your case. If you have power of attorney, then when he is found incompetent to make his own decisions, you would take charge and make decisions in his best interest.
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Reply to CaringWifeAZ
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Redmanrulz010: Perhaps you'll have to contact APS again.
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Reply to Llamalover47
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His primary care physician or the Hospitalist can declare his living situation unsafe.
Medicare will pay typically up to 90 days with a doctors order but the facility may try and discharge him if they determine he is not making any progress. Since Adult Protective Services has already been called you could get the apartment complex involved as this becomes a liability for them as well.

It is a hard row to hoe, but it sounds like this is about his safety and well being. We had to insist on a move for my parents after my father fell and cracked his head open on the night stand.
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Reply to MTraver
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It sounds like his other problems have overtaken the mental illness problems but of course it is still there. Seek help and support from your local NAMI chapter.
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Reply to LakeErie
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I am going through a similar situation. Perhaps, you could talk him into hiring someone to help him on a daily basis? The aide could do light housekeeping and laundry. Set up groceries to be delivered (paid by his credit card). His aide, could put away groceries and do some cooking. It's a difficult situation when an adult is "competent", although makes poor choices. By hiring an aide, your dad may be agreeable, since he'll be able to stay home.
Or, he could receive meals on wheels?
Best wishes.
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