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.
If you are going to post anything about my BIL you need to get your FACTS straight. He does NOT have a GUARDIAN.
You seem to have a BIG problem with me going on with this for such a LONG time. (3-4 years) You don't understand it do you? Let me break it down for you. I am a F I G H T E R when it comes to something like this. Since you COMPLAIN so much about me going through this for so long, what do you think I should do GIVE UP? Obviously so, you called me a TROLL.
Not once, have you ever tried to offer some type of encouragement. All you ever got to say is …. What I can not do. Did I not already prove you wrong when you kept jumping on here saying I had no authority so I could not get him moved closer to home but I did.
Are you so bitter is all you can do is try to offer lost hope?
Furthermore, you have absolutely no compassion for no one. And to come on my profile and send me a private message calling me a TROLL ……. You need to troll on.
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.
At least the administrator at the other facility had enough sense to know she could not just drop him off to the hospital. She thought she could discharge him to my husband in 30 days. After I picked up the phone and made a phone call, that story changed right quick.
I am sticking to what you said. Thanks for you help.
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 ?
Oh my goodness. Your dad's situation and my BIL is almost exactly the same. He too has alz. and I saw where they try to put szh on his paperwork and my husband said he was never diagnosed with that.
You are exactly right. They do try to create a monster out of them and try to claim they have mental illness when they can not get meds to regulate the behaviors.
You are on point. I have been telling my husband all along that I feel like my BIL is only trying to defend himself not having true perception. Yet, they want to call my husband so angry and act like he is some animal. They are supposed to be loving and caring yet they dump him in a hospital and leave them there. What is wrong with these people?
If I could, I would snatch him out of their so fast and he would never go back in a facility. They do not care. Society will throw a label on you so fast that you can scrub off. Pure ridiculous. Once again, I am so sorry what you and your dad has been through.
Oh, I forgot to mention. My BIL was like your dad. Before alz took over, he was like a genious, extremely smart and reserved. Thanks dear for replying.
No, the APS is not involved at all. I already checked with them.
Hailey, we are all running around in circles trying to be helpful. I just do not know what else to say. Behaviors run the gamut, from yelling, pushing, threatening, hitting. If staff cannot control the behaviors BIL will be asked to leave. And I as child of my loved one, also a resident, would expect this to happen.
By, the way. He is not a bother to the residents. If he were, I would be terrified.
When my husband and I met the administrator of the facility, she told us if he had behaviors it was no big deal. Now she throws him out.
Unless, someone has been through what we have been through they just don't know.
DH's health is not good enough for him to put in the travel or the hours.
Doing this successfully will take not just a lot of love but also a lot of continuous hard work. So that's what worries me - wants to be involved and is able to be are two different things.
And Kansas? What's in Kansas that they want to send BIL there?
About assessments: these are snapshots, it is not reasonable to expect them to be definitive. At work, we do an initial assessment followed up by reviews every three to four days. And this is only for reablement in people's homes! - it's nothing like as complex and fluid as a person with mental illness moving into a completely new environment and having to make so many adjustments all at once.
It would certainly be no bad thing to have allies, allies with experience of your local system and resources and possibilities. But there are things you need to do first. You need to have a much more complete and accurate understanding of BIL and his current condition and his care needs; and you, more especially DH, need to have a clear goal in mind. What's going to work? What kind of arrangement are you looking for?
Yes, I know what BIL needs. Since my husband and I can not be at the facility everyday and we can not rely on anyone in the facility to alert us when something is wrong, what he probably needs is a monitor so we can monitor from home.
I am just not very familiar with their services.
Every place in this country has laws on releasing medical information. Not abiding by those laws is an invitation for law suit. And the facility could very well have legal reason to not supply information due to those laws. HIPPA is a federal law, everywhere in the country is subject to it.
https://www.hhs.gov/hipaa/for-professionals/privacy/index.html
As to the Social Worker tell her YOU have NO PLANS and hope that she does, as you were in no way prepared for nor aware of any of this. The Social Worker is in charge now. She wishes she were not. In fact she would give ANYTHING to discharge BIL to you and have YOU do the work. Do not accept discharge. Tell the social worker that this is entirely in her hands, that you have ZERO answers. That will get her working on placement right away. Do not under any circumstances let them discharge BIL to you. Who has POA for health? What happened in the memory care unit? What was the diagnosis in the hospital? What has been DONE about that diagnosis? This will be in the hands of the POA, the Social Workers and the Memory care. But no, they do not have to accept this resident back and to do so when they feel they cannot adequately care for him safely would in fact be negligent.
Loo
I will need to do exactly what you told me. Need to follow up with what he was diagnosed with and what was DONE about the diagnosis. Very good information.
The sad thing is, he has a lot of evaluations in the past and nothing is never DONE. At one point, a doctor at another hospital refused to see him any more for evaluations. He stated because once BIL gets there he acts like an angel.
Also, when the staff went to do an assessment on him, shouldn't they have know then if they were able to meet his needs or not? They accepted him there.
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.
this post is going no where to help you with BIL
from what you've indicated -
he has a mental disability
numerous psych placements
unspecified behavior issues (pushes aides)
several discharges from memory care facilities
In our state, memory care facilities may not admit anyone with a mental illness other than dementia -
I've seen men and women for that matter push aides - they get hurt
remember, these places pay min wage and hire folks - some teenagers - without any experience and show them a couple of videos, and put a name tag on them saying they're a dementia care specialist
I just reread the admitting documents of the facility and it clearly states there has to be specialized training to care for patients with mental disabilities.
I contacted the Long Term Care Ombudsman right away and she told me that was ridiculous of the facility administrator. She told me not to worry, she would be going to the facility within a day or 2 and that she would handle it.
Received call from Long Term Care Ombudsman that he was not my BIL that was the actual problem. She investigated and stated the staff had been disrespectful to BIL and was not giving him his meds.
Wonder if the same thing has happened again?
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.
Otherwise, they are saying children in daycares or schools must be kicked out due to behaviors. They push, kick, bite, etc. ectc. each other.
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.
In my opinion, it is time to get better Memory Care units that can actually do what they claim they can do.
Such as the one he was at. Before, we decided if we thought placement was a good fit for BIL, my husband and I met with the admin. She had a lot of BIG TALK.
We going to do this and we can do that. If BIL has behavior problems that no big deal we can handle that too.
This isn’t their first rodeo, unfortunately.
I think it all boils down to approach.