Stepdad has been in the hospital for over a month and still no long term care placement. Should I just let the hospital handle this?

No No No. Mom needs to keep telling the CM she is not able to safely watch and take care of him at home. That is not an option. Let the hospital keep working on this, the hospital wants to get him out as soon as possible, they will keep trying. While they ae in the process of finding a facility, SD is safe where he is.

What the elderlaw attorney told your mother and sister is exactly what we tell people on this site.

I read your other posts -- your mother is only 58 (you are 32), and your stepdad is 30 years older than your mother. !! Your mom has a LOT of years left. She canNOT risk her physical, mental, and emotional health by bringing your stepdad home.

Does she go to visit your stepdad by herself? What is her first language? I wouldn't past the hospital to find someone who speaks her first language to talk to her and try to convince her to take him home. Make sure she knows that the hospital will promise all sorts of things that will NOT happen (they will "help" her find in-home help, they can't find anywhere now but will continue working on that if she takes him home, etc.).

Your mother needs to continue working -- she canNOT give up her life to take care of this man when she needs to plan for her own financial security.

Did she ever get POA? HCPOA?

Please keep us updated.

Has there been a cognitive/behavioral assessment performed with the goal of beginning medication ?

My LO was a fierce escape risk, but once a compassionate psychiatrist saw her and she was placed on a minimal dose of carefully chosen medication, she became much more like her old self, and began to enjoy her life and visits from us again.

Try a search for “geriatric behavioral psychiatry ”. If you can have him seen, and get a behavioral plan, you’ll have a professional statement about what may be an appropriate placement.

And do NOT allow him to be sent “home”. Be sure someone is with your mother whenever she is seeing hospital personnel. HER safety and welfare are important too!

I am surprised he has been in a month and no medication has been found to make him sleep. Has he had a Neurological examination?

Your attorney told the hospital that they cannot do that. To put such a patient in the care of another elder is an "unsafe discharge" and this must be emphasized. Thank goodness you go the attorney!

Apparently there are no neuro-psyc units in your area that are rehab Staying as long as he is in hospital is almost unheard of and I wonder how even the hospital is managing without 24/7 sitters. A locked facility is of course a requirement for him. So he needs a whole lot. No facility will want him. He is not currently manageable other than one on one care.

Again, thank goodness for the attorney. If hospital needs a cease and desist on some Social Worker calling to suggest your Mom take your Dad then get that from the attorney.

I am so sorry. This, for your Dad, your Mom and yourself is just a disaster I cannot imagine the exit for. People complain all the time about some seniors being drugged into stupor. Your Dad prove the case of why it happens.

You have done everything right. Esp the attorney. My own personal opinion your Mom should visit every few days for an hour or two only. This could kill her before your dad passes.

Tat, DO NOT take your step-dad out of the hospital for anything.

Insurance says, if they are well enough to go with you to an appointment, they are well enough for discharge and there will not be a bed for him when he returns.

ALL medical appointments need to happen in the hospital, or completely arranged by the hospital, including transport to and from.

Be on your guard, these social workers, discharge planners will lie through their teeth to manipulate, guilt and any other underhanded behavior to make him your problem and not theirs.

Request they bring in a geriatric psychiatrist to medicate the behaviors. As sad as that is, it is the last recourse for him.

Best of luck, this is a terrible situation for all of you.

hi everyone. thanks for the responses.

will accompany my mom tomorrow, monday, to the hospital to request to have my stepdad tested for uti and ask for a geriatric behavioral psychiatrist to evaluate him too.

i just wonder tho, just wanna be proactive. as early as now, should we already apply him for medicaid? according to my mom the hospital said they will take care of it. how true is this? the most recent thing they made us do, the hospital and one of the nursing home admins was, to drop his primary insurance which we did do immediately. they wanted him to have medicare as his sole insurance.

i dont want to just take their words for it and not do anything and then down the line find out that we have to apply for medicaid ourselves.

not familiar with the process with medicaid so any sort of enlightenment would be amazing. thank you so much.

Tat, this is important -- if your mom and dad are married and mom will remain at home, she needs an Elder Law attorney to help with the Medicaid application.

As the "community spouse" she may be entitled to keep some of dad's income. No NH is going to help her with that.

Find mom a lawyer who knows the Medicaid process is your state. Here is a good place to start:

https://nelf.org/search/custom.asp?id=5427

1) there needs to be an accurate diagnosis so that you know what you're dealing with. Often dementia is diagnosed by discounting all other causes (UTI, stroke, dehydration, diabetes, HBP, vitamin deficiency, thyroid problem, tumor, etc).

I read that he was admitted due to extreme Sundowning. Was he extremely agitated and violent? Does he have a prior diagnosis of dementia/memory impairment?

2) Medicaid (in most states) only covers LTC. As it stands, your Dad seems to need MC because he doesn't have a profound, progressive and debilitating physical health condition. His symptoms are cognitive only. LTC is assessed as needed by a doctor.

3) Has your Mom provided the hospital with her PoA paperwork? If not, she needs to do this now. Is she also his Medical Representative (a HIPAA form signed by your Dad naming your Mom as MR)? It may be a goood idea to have your Dad assign you as his MR. Ask for the form at the hospital. You will it out and all he has to do is sign it. This allows his medical team to legally discuss his private medical info with the MR without your Dad being present and consenting.

What state do they live in?

Have you requested a Filipino interpreter for him/your Mom (because medical lingo is not easy to translate)?

I agree with opening an online portal (as him) to access his medical info. You shouldn't have to request records... if it's anything like my portal, you will easily be able to see all his appointments, doctor's notes, bills, payments, prescriptions, etc.

I'm wondering how Medicare is covering this long of a hospital stay for "only" dementia? You don't want your parents to be surprised by a huge hospital bill... is your Mom staying on top of this?

I'm sorry for this dilemma. Provide as much info and updates as possible so that we can give you the most informed guidance. May you and your Mom receive clarity, wisdom and peace in your heart on this journey.

Tat, you really need to see an insurance broker. This entire drop his advantage plan so Medicare will kick in makes your parents 100% fully responsible for his medical care, unless there was written confirmation that he is now on standard Medicare. Advantage plans are NOT supplemental policies to Medicare, they take over for Medicare and are NOT in addition to, it requires a professional to help you understand.

Please do not try and figure this out from an anonymous forum, it could cost your folks everything.

Do a Google search and get with an insurance broker like today.

Do not allow the Hospital to file for Medicaid or a nursing facility. Like said, since your parents are married, I would see an elder lawyer. Mom will need to be established as a Community Spouse so she can receive part or all their monthly income (Social Security and any Pension). She remains in the home and has one car. The lawyer can apply for Medicaid for Dad.

It must be an elder lawyer because they are well versed in Medicaid law.

Tat, speaking to a broker will help you understand this crazy insurance, I went cross-eyed trying to figure it all out. A broker was able to give me the confidence to advocate based on the insurance my dad had and was going on to. I understood what to expect would be paid for for my dad and that was priceless.

I am happy your mom saw an elder law attorney and they agree, that's who would know.

Always the best solution to see a professional in your area when you are dealing with life changing, potential catastrophic choices. Which this situation most certainly is.

Is your step-dad in the psych unit of the hospital or a dedicated psychiatric hospital?

I'm wondering if this is why he's being allowed to stay so long. In my recent personal experience I have a cousin (69 with ALZ) who is unable to be cared for at home or by her adult children (for multiple valid reasons). She had to be physically taken to the ER for an infection (she was agitated and uncooperative). Once they go her infection under control, her son (the PoA) refused to go get her because she is an "unsafe discharge". She has been in the psych ward of the hospital since (so approx 2-3 months). She also has a "minder". She doesn't qualify for Medicaid since she is not LTC assessed (and not sure she' qualify financially). I don't know either who is paying for her care or how -- I know neither she nor her kids could afford to pay for this hospitalization... so, thinking it may be covered under Mental Health services of Medicare (and any supplemental coverage policies)?

"If the person with Alzheimer's or dementia is a Medicare beneficiary, Medicare will pay for some, but not all, care costs."

Source: https://www.alz.org/help-support/caregiving/financial-legal-planning/medicare

Here's a layman's explanation of what Medicare pays for Mental Health costs:

https://www.nerdwallet.com/article/insurance/medicare/does-medicare-cover-mental-health-services

Hope this helps!

Tats, was it a Medicare Advantage plan through UHC or a UHC Medigap (Medicare Supplemental) plan that dad had?

They are two VERY different things.

How did mom go about dropping it? Are you certain that dad's Medicare parts A and B are back in force?

I would talk to the hospital social worker to confirm this.

I worked in a hospital for 45 years. I saw this situation several times. The patient stays in the hospital and the social worker works on finding a place. Usually it will be a long term facility, skipping rehab and filing for Medicaid or Title 19 if under 65. There will be no unsafe discharge done.
As for mom, her fmla is ending. If she does not go back she will lose her job. Encourage her to get on with her life. Her husband is cared for whether she is there or not. I doubt she is doing anything for his care while sitting at the bedside. Otherwise your life will be worse if she becomes impoverished. I have seen many spouses mess up their lives and doing nothing to help. BTW you mom may need professional help for the anxiety which is controling her behavior

A UTI is an infection not a disease. I bet your dad has one if he suddenly went out of his mind. That happened to my wife. She took anti-biotic medications and went back to normal. The test is really ez. Just a urine sample.

Yes sometimes placement can take weeks and rarely can take months under certain circumstances. I am not sure if he needs a geriatric psych unit or more meds since he requires a sitter. The hospital is taking appropriate care of him in the meantime and is probably close to mom. He will not be kicked out. With a difficult placement may mean a longer distance for SD. Do not mention this to her yet.
You might also want to keep on the back burner if he will require Medicaid for LTC that his income may be utilized for his care so mom will have to live on her own income. This depends upon the state where they live.

If they are currently in a hospital bed, and their family cannot take them home be because it would be an unsafe discharge, then the hospital discharge planner just flat has to work trying to figure out a placement. The discharge nurse will do whatever they can to convince you, and everyone in yiur family to take your dad home but if you know it will. Ot and cannot work for him to go into your home or back to be with your mom you need to just be firm and fixed that nope it’s not going to ever happen.

In my city, New Orleans, there are apparently a handful of these type of patients that are long term occupants of hospital beds. From what I’ve gathered there seems to be 2 main threads as to why: obese with behavioral issues and there are zero facilities who can accommodate them and the level of very intricate care needed OR citizenship issues which morphs into insurance coverage issues as hospitals have to provide for care for those that show up but custodial care facilities are pretty much set up to take folks in under “dual” insurance coverage. Dual is Medicaid and Medicare and if you’re not a citizen (birth or naturalization) you might have 1 but probably don’t have both. Yiu might be a legal permanent resident and can be eligible for Medicaid but that’s an issue for how most NH and long term care places run. Knowledge on this is not my wheelhouse.

What seem to happen is they end up shuttling from one smaller community type of hospital with an open bed to another; often for weeks if not months of a stay. To me the big take away in this sad situation is to remember the discharge planner cannot force family to take your I’ll family member out of the hospital and into your home is if it would be a unsafe situation. But you and everyone in your family has to be 100% in unison that this is what you all will tell anyone at the hospital.

update

hi everyone. just wanted to share that my stepdad has been transfered to a long term care facility today.

will post a more detailed update tomorrow on exactly how it all transpired.

but damn, i didn't expect my heart to feel this heavy... i already cried twice since we left the hospital this afternoon. how do you even deal with all the emotions?

tomorrow, me along with my sister and my mom, we will all visit him and bring over additional supplies for him. <3

Tats, thanks so much for the update.

I can so remember the extreme emotional response I had when my mom was transferred from rehab for her broken hip (post stroke, post dementia dx) to a NH for rehab.

I had read somewhere that the average stay in a Nursing Home was 6 months. For whatever reason, I felt that my mom must only have 6 months to live. I wasn’t ready for her to die and I wept like a baby, driving from Connecticut back to Brooklyn.

Even with dementia, mom worked hard at rehab and walked with a walker. She enjoyed going for wheelchair rides around the landscaped grounds. She enjoyed "people watching" and the religious services, activities, dog therapy and visits from family.

My mom lived, mostly quite happily, for 4 1/2 years.

Take heart. And let us know how it's going.

hi everyone. just another update.

the morning after my stepdad was transferred to a facility, we were getting ready to visit him and bring him additional stuff and other necessities when my mom received a call from the facility saying my stepdad was taken to the hospital again because he was being combative and trying to escape his first night there. they also said they don’t restrain residents and thats why they sent him to the hospital instead. (im still trying to get more info on this)

my mom, my sister, and myself drove to the hospital. this was yesterday, 07/15. this was a different hospital now. the facility he was taken to is 1 hour and 30 minutes away from home and in another town.

he was in the ER and we spoke to the doctor there. she asked us if we would like to have him transferred to their senior behavioral health center which is 40 minutes away. i looked it up online. its one of their specialty care locations. its a 12 bed secured facility that serve adults experiencing dementia with behavioral changes. after some more research and discussion with my mom and sister, we agreed to send him there.

we spoke with someone in the senior center and she went over several details about my dad’s stay. so he’ll be there for two weeks. they’ll conduct a medical and psychiatric evaluation on him. once he stabilizes, they’ll send him back to the long term care facility.

im mentally exhausted and emotionally drained. :( i fly home on wednesday. my mom hopefully will have some peace of mind for the next two weeks.

Tats, thanks for the update! Exhausting and draining, indeed. Hang in there. Make sure you and your Mom do some self-care. It's a marathon, not a sprint.

hi @MD1748

this wasn't the first time he was taken to the hospital. for different reasons in the past but most likely dementia related still. but to answer your question, yeah, id say so, 9 days prior to him being admitted over a month ago, we attended this event involving my brother in a different state.

that was the first time my mom has seen him behave that way. cuz had she known, had we known, we would've advised them to just stay at home and not go.

but essentially what happened was, they were at their hotel, he told my mom he wanted to take a walk outside. so they did. they were strolling around and it was all great until at one point somewhere, he just sort of shifted. he kept on insisting to walk farther and farther. he's convinced he's back home and he knows his direction around. but to cut the story short, he ended up crossing the highway, my mom fell chasing after him. they were literally in the middle of a highway, cars passing by them. police saw them and came to their rescue. they both ended up in the hospital that night. and they both were not able to attend my brother's event the next day.

i was scheduled to fly in the next day so i wasnt there when all of this happened.

after they got back home after a couple of days, this behavior continued for the next three nights. he'd come out of the house in the middle of the night and just wander in the darkness, refusing to go back inside. there were hallucinations involved as well like calling out names of family members no longer with us. on the third night, that’s when he was taken to the hospital. he was restrained for 3 days because he was being physically aggressive.

also yes, it is confirmed that he has UTI. he was tested at the ER at this new hospital. they did a ct scan on him however the doctor does not think the uti is contributing to his overall problem with dementia so she strongly advised us to have him taken to their geriatric psych facility so they can do in-depth evaluation of him. so yeah, he’s there for a 2 week treatment plan rn. i think it's a good thing that he ended up there somehow, as a lot of you guys suggested. i really hope he gets the attention and evaluation he deserves to contain or manage his condition.

hi everyone. just a quick update.

my stepdad is still at a geriatric behaviorial center. he doesn't have discharge date yet as per the case manager. she's actively looking for a facility tho. as far as we know, my stepdad needs a secured memory care unit.

the cm sent a referral to this facility that's both a nursing home and rehab however when i called the facility, they told me that they don't have a secured memory care unit.

is it procedure that when discharged, a patient stays at a regular nursing home/rehab first? or can they be assigned to a secured memory care unit right away?

i am just worried that if they place him into a regular nursing home/rehab again, he'll have another episode on his first night like what happened at the first facility, and the facility will call 911 again and he'd be taken to the hospital. im worried that this cycle will keep repeating.

the first facility that took him called 911 because on his first night there, he was being combative and was trying to escape.

Where I live there is no memory unit as such in the LTC facilities which Medicaid covers. The Memory Care is private pay and part of an Assisted Living facility. Medicaid can't even be considered unless you have paid at least two years privately.

So, it all depends on how Dads finances are. Also, where a bed is available. He may have to settle for what there is.

hi everyone. i just wanted to check back in again. i need some advice regarding another situation we're in.

my stepdad is still in the hospital. no long term placement for him still. ive been working closely with his case manager remotely via email to help my mom with the communications. i actively help her out when it comes to looking for facilities she can refer my stepdad to, as well as veteran homes. we were even open to facilities farther away from where my mom lives.

but same thing. facilities keep denying him admission due to 1.) his condition and them not having a locked unit or 2.) the very few that has a locked unit, simply don't have availability (although one of them is for female residents only) and then 3.) the veteran homes have a wait list of a minimum of 3 to 12 months.

there is one facility right now that is willing to take my stepdad. although i spoke with the administrator, she said that their residents, on a scale of 1 to 10, when it comes to severity of their mental condition, 10 being the worse, are mostly at 8 she said based on the assessment (not sure by who, either by the hospital or by her) my stepdad is at 2. i dunno for sure but it felt like this was her hinting at managing our expectations when we go visit the facility.

my mom and my sister paid a visit to this facility last saturday and according to them, it was REALLY bad. my mom said while they were still by the door waiting to be let inside, they could already smell a bad odor. the dining are were so dirty. there was a trash can catching water drippings from a leak. rooms were very dirty as well. i don't wanna go into more details anymore but basically, it doesn't look like a near decent living environment at all.

not being picky at all with the facility but this was just a huge no no. we're not looking for anything grand, i mean we don't have the means to pay for that luxury, but we hope to find a place for him that's decent enough and clean.

having said this, the case manager has hinted that we are running out of options and that if we still can't find a facility, we may need to go the discharge to home route. i will do my best to be firm on making it known that it's not safe for him nor for my mom, to send him back home.

my sister and i are expanding our research and looking into cities outside where my stepdad lives, it may be farther 3-4 hr drive away, and we may need to pay extra for transportation, we don't mind at all, as long as we can find a decent facility for his long term stay.

anyway, do you guys have any advice on how i can tell the case manager that we don't feel comfortable sending my stepdad over to that facility? i feel like she's expecting us to say yes to that facility and have him transferred over asap.

my sister and i are really doubling our efforts in looking and doing research for potential facilities to lessen her workload even a little bit.

i've also been talking to the admin in that facility, and i'd also need to break it to her that we are no longer interested in her facility. im having a hard time figuring out how to explain to her why we made such decision. she knew we were gonna visit so she probably already know why :C

The hospital wishes to foist this off on Mom and be rid of the problem.

You are correct. She needs to say no. She cannot be forced to accept your Dad home and she should not do so. Once this happens they wash their hands of it all and on they go.
She needs to say she is not physically or mentally capable of this care. Ignore their social workers who will say "We can help" and "together we can work to get this done". They can't and they won't.
Your Mom needs to say NO at once and make it clear he cannot return home. Keep using the terms "This would constitute an unsafe discharge". Stess that your Mom is in no way physically or mentally able to do care in the home.

Thank you for the updates, and it's clear from all of this that stepdad cannot be taken care of by you, mom, people you might hire, or at home. Even though your mom is being pressured to accept taking him home, you and mom have to be emphatic that it isn't an option. If you have to say it a thousand times, that's what you need to do.

He's about as unsafe a discharge as anyone I've ever heard of. It's already been a nightmare, and you can't let it escalate.

No to "it's only for a few days, weeks, etc." No to "we'll send help for you" because that's unlikely to happen once they get rid of him.

As you said, let the case manager do her job. Even though you've studied this, researched and tried to prepare, it's not your job or mom's. You can play dumb a little bit if you have to. Don't give in. Get what you want by being strong about what you WILL NOT do

I wish you luck in a really difficult situation.

I would not except that place. Where is the State in there inspections. I may call an Ombudsman to find out when the State last did an inspection. The trashcan catching water is a big no no in my opinion. Everything you saw, an inspector should also see. In the Stated my daughter works in, a NH can get a warning about a chip in the paint.