SNF Patient demanding to leave - page 2

What happens when a competent patient who is a Hoyer lift 2 person transfer demands that they go home?... Read More

  1. by   hppygr8ful
    Quote from CrunchRN
    Thank you all for your responses.

    Currently she is at a very nice rehab and getting excellent care. She is truly lucky to have gotten into this one.

    Her confusion has increased even after UTI treatment. However, she is confused, but can answer almost all questions appropriately and is being manipulative. So not like my mom who up until this started was very intelligent and had great common sense although id not like the changes of aging. She has gone from being fully functional to a 2 nurse+hoyer transfer in 4 months.

    Home care is not possible as it would require 2 aids in the home around the clock. We are going to sell the house to pay for assisted living as my dad cannot make it alone. My mom was his caregiver until just recently.

    They are calling what she has "Parkinson's Plus" not a regular version in any way, but definitely progressive.

    My brother is up there now and trying to find viable options, but the one thing we know is that she needs the rehab so that hopefully she can get functional enough for assisted living.
    I went through the same thing with my mother. She had moderate cognitive impairment and was living independently until she fell walking her dog two years ago. She insisted on going back to her home after she completed rehab. She even arranged for 24 hour care and a ride home. When the first bill came she refused to pay it "I never imagined it would cost so much!" (contract that she signed was for $22.00/hr Plus extra for overnight. She called the police saying that she was the victim of fraud. After some wrangling with her Doctor we (Treatment team and family) determined she was not competent to meet her own needs. Dr. signed the paperwork and we moved her into an assisted living against her will. She attempted to leave more times than I can count so we had to move her into a locked memory care. She was in a total of 4 facilities before we found the right fit. Medicare does not cover Alzheimer's care as it is considered custodial and our average monthly bill was $9,000.00. This all started two years ago. She passed away last Saturday. It was rough two years but she is now at peace.

  2. by   kbrn2002
    Quote from hppygr8ful
    In California refusing to re-admit an AMA would be considered taking punitive action against the patient and not allowed by law. Patient's who have "reconsidered" are allowed to change their minds and come back.

    That's interesting. Wisconsin obviously has no such law, unless my facility is breaking that law without being aware of it. The corporate owners are not based out of WI and frankly I wouldn't be surprised if they weren't aware of a law that disallows that.
  3. by   nurse lala
    Quote from Oldmahubbard
    If the pt wants to leave, you cannot stop them, nor can you help them.
    In my state we can place individuals on a legal hold if the person is unable to communicate a viable plan for self care.
    In this case family would have to agree to accept the individual back home, if not the individual can be kept for Grave Disability.
    Last edit by nurse lala on Jan 11 : Reason: Added info
  4. by   Sunshine.nurse
    If she has been declared competent to make her own decisions by her MD, then you are SOL. You do not have the power nor the authority to legally usurp her right for self determination. The only thing you could do is take to the court level and have her declared incompetent by a judge. However, that gets UGLY quick and the emotional toll it takes on both sides need to be weighed.

    If it were my family member, I would be very suspicious that the UTI has not been cleared, and I would be insisting on getting another UA & urine culture with sensitivity via straight cath. I cannot tell you who many times I have seen patients still have a raging UTI even after treatment and providers blow it off either as it is within the 1st 30 days s/p tx or the specimen was contaminated. Especially with the over 85 crowd. Duh.. people can be infected with their own natural flora.. it is called overbloom! It was a running thorn in my side dealing with this issue. If confusion is worsening, I suggest talking to provider directly about your concerns of worsening confusion and risk of urosepsis. And ask her nurse to document that you have requested the tests.
    Last edit by Sunshine.nurse on Jan 19