sorry to use the forums like this, but i'm so far from my specialties, i don't know where to start. can someone point me in the right direction?
a friend has asked for some help and advice regarding her father in law. he is very elderly but a&o, lives independently, drives, enjoys visiting friends and still actively farms. recently, at home he stepped on and fell over his rocking chair rocker, falling on his l side and bruising himself. concerned if he might have fractured a rib, he called his fam doc practice (does not have a strong relationship with the doc that took over when his retired) who sent him to the hospital. he was admitted and many tests were done. hops staff insists that he probably does not remember the accident, probably blacked out first then fell, and probably landed on right side since he's right handed (?! hello? bruises on the left?) he had not named any of his 6, involved children as poa, afraid to pick a "favorite" and not feeling he needed one. so now the county(?) has taken over. he is assumed incompetent to make decisions or name a poa. he was admitted to a local nursing home ("he can't live by himself") for "rehab" several days into admission he has yet to see the pt (online search tells me the facility has only part time pt and ot) "he needs to rest before he can start therapy" (?? open heart pts are oob next day, i think this man can handle it!) he has been confined to a wc with seat belt. yes, it's not a restraint since he can open it, but he's been scolded for doing so. waited three hours after telling staff he needed to use rest room before he couldn't hold it any longer, now they make him wear a brief!! oh and a social worker told him he would enjoy this facility since he likes to play cards and so do some other residents. he has yet to see another a&o person there! (btw i work in peds and i know better than to tell a kid, "you'll like it, they have a tv" or whatever. c'mon even a kid can prioritize, how condescending!)
so, what can his family do? they are involved (or at least trying) he also lives near a local religious community where he has many friends who visit daily and bring meals, homemade bread, etc.
why can't he at least choose his own facility- "they" said no to his two choices, including one that has onsite assisted living and apartments as well as full time pt and ot. (does he really need pt? i don't know, but he will soon! how much has he already atrophied after a week in his wc?)
i have numbers to pass on for the county ombudsman, but does that help coming from the same ageing agency that has created this mess in the first place!?)
how is competence/ incompetence decided? they said he needs a ct to prove he's competent (perfusion, i guess?) i thought a mini mental or the like would be enough? of course, ins won't pay for the ct, and now he needs transportation back to the hospital, too!
thanks for any tips you can give me before he looses another muscle fiber or actually does loose mental function from boredom or humiliation!!
Hi !! Well, I'm a Director of Nursing at a 100 bed facility and we frequently get patient's from acute that have orders stating that they "Do Not" have Mental Capacity....But, at any point, if my staff feel that this is inaccurate, they tell me, and i will meet with the patient. Even if they are occasionally a bit "forgetful", I have my social worker do the mini mental (with me present). I then fax the MD the actual test and tell him what I observed and that i feel that the patient is able to understand etc...Never have i heard that someone needs a CT....and in our area, the ombudsmen is a help...might want to request that the mini mental be done with the ombudsmen present...good luck !!
Thinking on this situation and how it was presented. I still really wonder if family isnt willing to take any responsibility and that is why he had a guardian declared. We have no idea how these kids were raised, what kind of a parent he was, or what his situation and relationship between he and his children have been. Maybe it was in his best interest to have a guardian appointed if none of the kids get along or maybe they are barely competant to handle their own affairs let alone his and maybe he wasnt a parent that they could maintain a relationship with. Maybe he doesnt trust the kids for some reason? There has to be more to this than just the county stepping in and taking over.
Thinking on this situation and how it was presented. I still really wonder if family isnt willing to take any responsibility and that is why he had a guardian declared. We have no idea how these kids were raised, what kind of a parent he was, or what his situation and relationship between he and his children have been. Maybe it was in his best interest to have a guardian appointed if none of the kids get along or maybe they are barely competant to handle their own affairs let alone his and maybe he wasnt a parent that they could maintain a relationship with. Maybe he doesnt trust the kids for some reason? There has to be more to this than just the county stepping in and taking over.
I agree...I can't imagine how someone else besides a family member got guardianship if one of the kids would do it or what you have described above. Also if he really is A/O x3 and he wants to leave, keeping him there against his will might be a violation of the law.
I'm also not too sure about Medicare/insurance not covering if a patient leaves AMA...I've heard alot of nurses say that but found out (at least in my area) from others sources that that is simply not true. But I'm certainly no expert, but I would be skeptical of that. I know I've had several insurance policies and not one said signing out AMA would be cause for non-reimbursement.
I sure hope the patient/family has a lawyer, if not they should get one ASAP. I've been through the guardianship with a family member, and a lawyer's help is a must.
Specializes in Gerontology, Med surg, Home Health.
" We all know that medicare will only pay 30 days and after that his assests become liable and at this rate he rally won't be OK in 30 days. I don't even want to imagine anyone is thinking that way...but... :"
Medicare pays 100% of the SNF bill for the first 21 days and then 80% after that. Where did you get the 30 day figure? Each spell of illness has a benefit period of UP TO 100 days depending on the skills the patient requires and if he is making progress.
DONDenise
7 Posts
Hi !! Well, I'm a Director of Nursing at a 100 bed facility and we frequently get patient's from acute that have orders stating that they "Do Not" have Mental Capacity....But, at any point, if my staff feel that this is inaccurate, they tell me, and i will meet with the patient. Even if they are occasionally a bit "forgetful", I have my social worker do the mini mental (with me present). I then fax the MD the actual test and tell him what I observed and that i feel that the patient is able to understand etc...Never have i heard that someone needs a CT....and in our area, the ombudsmen is a help...might want to request that the mini mental be done with the ombudsmen present...good luck !!