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My aunt has been in a nursing home for skilled rehab for the past month due to falling out of her electric wheelchair last month and fracturing her C-2 spine. She is not stable and cannot walk on her own, or do anything without the assistance of two people. Her doctor said last week when he did the other MRI, her fracture is no longer healing and has started to separate and there is a gap. I have not been able to see her due to having caught Covid. I received a call from the facility she is in and they told me she was leaving, I was able to talk her into staying another week (the Dr's and nurses also tried to talk to her as well), but she's supposed to be in there for ANOTHER whole month. She isn't cleared to come home, she's been having serious memory issues and they've said it isn't medically safe for her to go home yet. However she's insisting on coming home AMA, because she's homesick. Her sister is her POA and there's nothing she can do since my aunt is still legally competent. Her family doesn't take care of her, they emotionally abuse her and exploit her. Yet she's leaving so she can go back to that environment. Is there not anyway anyone can do anything? Is she able to just leave AMA even though she's going to an abusive environment and isn't ready to be on her own yet?

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I know this is going to sound weird, but perhaps after all these years she is comfortable in her normal environment where she is being abused. That observation doesn't solve anything;, it just offers another possible insight into her desire to return home.

I do have some empathy. I am considering a very serious and risky surgery for which, if I survived the surgery, I would need at least one month in rehab. I've been in rehab twice; one was a very positive experience, but I couldn't wait to get home after 6 days! A month is beyond my conception.
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Rehab should not release her if there is no one at her home to care for her. Its called an unsafe discharge. It does not matter that she is competent. You need to refuse to pick her up and take her home. You need to refuse to care for her. The POA needs to refuse to take her home and say she will not be there to care for her. And once someone walks out the door with her they are responsible for her. )

This happened to a friend of mine. She was in rehab and it was found she had stomach cancer. She suffered from heart problems and diabetes. She was wheelchair bound. We think she overdosed on pain killers by accident. There was no one to care for her. So she was told she could not leave and was transferred to the NH side and placed on Medicaid because she had no money.

She should be told if she is going AMA that she does it on her own. She will need to get a ride home. By going AMA there will be no discharge as such. The doctor is not obliged to give her prescriptions or set up homecare. I would think if a doctor does not think she is thinking clearly at this point he can keep her there. If she gets herself home, do very little for her. You need to show her she cannot do it on her own. She may have a certain amount of time that she can return to Rehab. If she winds up in the hospital again and then Rehab, her time will start from the days she has already put in. If she was already in 30 days, her time will start at 31. Not sure if there is not a penalty for leaving AMA and coming back to Rehab for the same thing.
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A call from the SW at a rehab to report abuse will almost certainly carry weight.

GMA is not going to be discharged on her own to go home while immobile. If she does that APS will certainly be alerted to her being a vulnerable adult in need of care
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Call the Social Worker at the facility and explain the predicament.

This is an "unsafe discharge" if GMA is going home with no help and both physical and financial abuse.

Use those words--unsafe discharge. Do NOT pick GMA up or facilitate her release in any way.
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jennyy2034 Aug 2023
What happens if we call and say that? Is there anything they can do? i've never dealt with this situation before
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If her fracture is no longer healing, I'm surprised they'd keep her another month anyway. I thought Medicare stops paying once you are no longer progressing.

What would they be doing for her?
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jennyy2034 Aug 2023
Her doctor asked for another month, from what i've been told, they're supposed to switch her to long-term medicaid so she can stay as long as possible. The dr wants another follow up later in September and said if it hasn't healed anymore, he's considering surgery. He told us he didn't want to because she's older and her chances of coming out of it could be slim

she's getting therapy for walking so she can be more mobile because before she was only in the electric wheelchair
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Until and unless she’s found to be incompetent she’s free to make bad decisions. Be sure her medical team knows the situation she’s coming home to and encourage the reporting of the home life to Adult Protective Services or consider doing so yourself. The best tactic is for no one to step in and provide care, as cruel as that may sound, it’s truly the only way for many people to see their need for help. If you or others rush in to help, she’ll never see why things should be different.
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anonymous1732518 Aug 2023
Can't blame her. She may think she'll never leave the NH, all the more Social Worker get busy finding her somewhere else to live.
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She may be competent, as you say.
That means there is ZERO you can do about this.
You are not POA and so you cannot even talk to anyone or threaten the facility with an "unsafe discharge".
This will be self limiting in that Aunt will soon again be on the floor, and in worse shape than ever, and unABLE to get home on her own.
I would bow out. This isn't a parent. You can't make her decisions. She is doing poor decision making and there will be a consequence.
I would form a phone tree so that she can be checked on with "wellness check" if there is no answer daily to phone call.
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anonymous1732518 Aug 2023
Aunt needs reassurance that one more month in NH would be it, then she could come home. If unsafe, Social Worker should be working on getting her a safe place, now; that could be an incentive for her to toughen it out one more month.
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Have you found out why she wants to leave besides homesickness?
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jennyy2034 Aug 2023
She says it's cause she misses her grandkids and being in her own home. So far she won't listen to anyone about staying until her dr clears her
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Report to elder abuse or call department on aging.
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