I’m sorry that it came to that. It must have been very difficult.
And I’m sure history won’t repeat itself after that experience
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Right! The estate lawyer who represented me in the conservatorship for my parent is the same estate lawyer we use. We recently updated ALL of our documents and made it very clear that we wanted POA for everything so our kids never have to deal with what we had to do.
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Yes, my mother has been having discussions with them. She requested a psych eval for him and met with the psychiatrist. I think it is obvious to all that he cannot go home at this point. He is furious, convinced he’s been imprisoned and that the hospital and his doctors are just trying to milk some more money out of the situation.
The neurosurgeon feels confident that a) the behaviors he was exhibiting prior to surgery were textbook symptoms of the tumor, and there should be notable improvement, but that it can take up to six weeks to see them, and b) this current situation (delerium) is a result of the anesthesia, and it will resolve….but it is unclear how long that might take.
I guess the only silver lining to this is that no attorney in their right mind is going to allow my father to make a change to his will now. That was weighing very heavily on my mom.
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When my father was in the hospital or in a rehab facility, they refused to release him to any place that would not be able to properly care for him. In one case, they kept him in the hospital for an extra week until a rehab spot opened up for him. In another case, they would not release him from rehab to the assisted living he had come from, as the assisted living could no longer care for him. We needed to find him a skilled nursing facility instead.
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Does anybody know how that would work, if patient in rehab (Medicare etc coverage)… getting ready to return home?
Technically there is supposed to be a safe plan for discharge but IME, rehabs are laxer on d/c plans than hospitals.
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At the time the social worker at the hospital seemed to be coordinating the effort. Although I did also speak to the doctor coordinating his care.
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They are discharging my dad tomorrow (they were ready to do it today but my mom pleaded for an extra day) 
. He is a lot calmer, thankfully, but still so very confused. He is exhausted, sleeping a lot, but when he wakes, he thinks he is at home, and keeps talking about “I just need to lie down for a good nap and then I’ve got to (names random household chore). This type of delerium (hypo, as opposed to the hyper, which he was exhibiting before…I’m learning so much…LOL), is a little easier to deal with.
The hospital said the conditions of his discharge is that he cannot be left alone. He is refusing to go to rehab. We did have the attorney fax over his living will, which stipulates my mother as his health care proxy (and me, second in line to the throne, so to speak), which the hospital said had to be on record for us to request a second psych eval, should my mother wish to override his wishes and have him discharged to rehab. I’m not sure she is going to do that. We have contacted a home health agency to arrange to have an aide at the house. They are sending a nurse to the hospital today to do an assessment, which will inform what is needed. He is probably going to freak out about having an aide, but we are going to present it as not optional, and the condition of his release.
I feel better that there is a plan in place, and my mom seems to, as well.
As I’ve learned through all of the medical excitement of the past several months with them…stay tuned! Things can be completely different in an hour or a day. But for this hour, I’m just feeling relieved and calm, and maybe a little hopeful that we will all get through this.
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I think it’s a smart plan to present the options as home with an aide or to rehab. Not other choice.
I hope this transition home goes as smoothly as possible.
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In my state, to go from rehab to AL or IL, the AL or IL facility comes and does an assessment to make sure they can safely go there. Going home is a different story - typically it goes to the social worker and the family with lining up home care help or what is needed to go home.
In a lot of situations, a hospitalization or an event will focus attention on the problems on care needs not being safely met where the patient is living.
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On the other hand, after my mil fell and broke her pelvis. The hospital just decided to release her late on Friday afternoon.
No way to get anyone out to assess the situation until Monday. My husband had been there for a week. He went home for a night and came back until things could be set up for home healthcare, PT and mobile meals.
His sibling. He left Saturday morning for vacation. Left his dog at my in laws for them to watch.
I hope that everything works out but in my experience, the hospital isn’t always the advocate that you would like.
The reason why my mil was released. She wanted to go home. She didn’t want to stay in the hospital over the weekend. Her preferred and only rehab option had a waiting list. The PT decided she could walk. Sort of.
My fil was in worse shape than my mil but he was still living in the home.
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“The hospital just decided to release her late on Friday afternoon.”
”She wanted to go home. She didn’t want to stay in the hospital over the weekend. Her preferred and only rehab option had a waiting list. The PT decided she could walk. Sort of.”
”I hope that everything works out but in my experience, the hospital isn’t always the advocate that you would like.”
No one in the family had the backbone to have her remain in the hospital until being more ready for home, since rehab wasn’t available due to waiting list. “His sibling. He left Saturday morning for vacation. Left his dog at my in laws for them to watch.” - Yes, he was just looking out for himself (not wanting to pay for dog to be cared for elsewhere) and “all will work out fine”. Yeah. Awful! “My fil was in worse shape than my mil but he was still living in the home.” Your BIL doesn’t want to see it nor does he want to deal with it because he has his vacation/plans after all….
For others on this thread, be very cognizant of having plans made properly prior to the hospital Friday tendencies to get these discharges to home or to other facilities - that is reasonable for the family and the patient.
They tried to get my mother to get discharged to home when it took 2 people to assist her out of the hospital bed (she had a severe car accident and facial surgeries and a broken wrist/surgery) - I raised concerns on the phone (as I was 750 miles away) - my two sisters there didn’t know how to manage the hospital telling them she needed to get discharged to home (one sister an easy pushover). The nurse must have noted my concerns (and that I was going to be at my mother’s home to assist her as soon as I could leave to travel, coordinating with my one sister when mom would be able to go home with one assist - one sister taking the first week and I would be taking the second week) - as my mother lived alone at that point in time. A senior level MD actually did come to her room in the evening (wearing a tux), and approved mom staying in the hospital for a longer period. It gave us the extra days mom (and we) needed.
The hospital often hires people specifically managing patients to not continue over the weekend or continue in the hospital beyond the average days of care for a specific diagnosis and reimbursements (focus movement on patient coordination for getting discharged somewhere) when the hospital is not typically going to get discharge planning and discharged typically outside of the M - F timeframe. Hospitals get reimbursed by diagnostic related group (DRG) - they make money if they can treat people for shorter periods of time than the average. I worked earlier in my career when DRGs came into ‘being’ with insurance/reimbursement in the early 1980’s (I coordinated to make sure proper payments were made from self-insured large Blue Cross group in TX, as well as some insurance fraud that was going on from a few providers - so I lead those investigations coordinating with our lawyer who largely handled worker’s comp, and our insurance claims team). I worked with difficult insurance claims and made sure the payments were properly done. Within my last 6 years of employment before retirement, I had some supervision of LPN students in the hospital setting where I would see these specific hospital people (typically RNs with this specific experience - paid well but expected to get bottom line results) coordinating hospital social services and others to get specific patients moved from the hospital setting.
Our skilled care/rehab nursing administration reviewed the patient records of those desiring admission (most transferring from hospital) - and if we would accept (there were legitimate reasons to reject an admission from a care standpoint), we needed to get the room equipped appropriately - including a special bed for an obese person, other extra equipment needed. I did nursing admission assessments (required within 24 hours of the admission). I would see the paperwork/orders - and we would get the meds and all prepared to be administered on schedule (in addition to our pharmacy delivery for our facility network - delivered every night, we also had a pharmacy next door which we would have some meds specifically for these afternoon/evening admissions). Sometimes the skilled care/rehab facility I worked at would have up to 11 admissions expected into rehab on a Friday afternoon/evening - and because ambulances weren’t often available (or the distance from the hospital), we would have patients showing up between 9 pm and 2 am. Some of these actually didn’t come until Monday or Tuesday because the hospital ‘jumped’ things, or they couldn’t get the ambulance transport, or other reasons.
Hospital staffing has gotten to where there is such limited nursing care and nursing assistants on a care unit - I managed myself as a hospital patient (several overnight surgeries) but I would not leave my husband or other family w/o someone knowledgeable to advocate for them.
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For all - the comments to this article are very enlightening. I am still working my way through them. It might help for some ‘talks’ with your relatives/friends that are not facing declining health situations well.
It seems BIL, age 70, morbid obese, diabetic, has some cardiac issues that are getting fully evaluated. He was having difficulty in his sleep the other night, his legs were swelling up, and went by ambulance to the hospital. They know his wife and him well there. Will see in the upcoming time if they work through it, and how far they follow medical provider instructions, plan, and recommendations. If he didn’t have a strong heart, he would not have made it this far - but the diabetes and his morbid obesity are challenging his heart now. He is challenging family longevity on both sides of the family with his poor choices.
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It is difficult to navigate hospitals, this seems like a useful trend and yes, blame a third party whenever available. It is pretty standard for healthcare facilities to want copies of any documents related to decision making. You are doing a good job.
We discovered, thru the course of many parental hospitalizations, that asking for a PT eval often creates extra time, but they rarely offer (you have to ask).
My parents benefit/ed from really excellent insurance coverage, so hospitals have been more cooperative but sometimes they just are gonna stick us with terrible decisions. It’s only easy after the fact to see the choices, so nobody here needs to second guess themselves.
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That is a point I hadn’t thought of.
My in-laws have a Medicare advantage plan. My mil said she picked it because they offer dental insurance
Although when my fil was admitted to the hospital, rehab and skilled nursing, his care didn’t seem to be affected. He wasn’t in any shape to go home and was incapacitated
My mil on the other hand was coherent and vocal. The hospital probably wasn’t going to be paid for the weekend. My mil wanted to be home because her husband could not have been left home alone. Her options for rehabilitation were slimmer. Other options would have had to been explored if she had gone to rehab. My husband couldn’t move in, his sibling works.
The hospital was going to get paid one lump sum for all the diagnoses and specifics of his care - it didn’t matter if it was a few days more or less. “The hospital probably wasn’t going to be paid for the weekend.” It is not like a hotel or how hospitals used to be paid prior to DRGs (I’m talking 1970’s and before)- when I was in HS, I was the 2nd shift hospital telephone operator which dealt closely with hospital admissions (my supervisor was also over admissions. Before sophisticated computerized billing systems too - I would see the itemized billing that was run daily for every patient of this 300+ bed hospital…. I saw the schedule for various room assignment rates per night.
For a real throw-back, there was an index-card index system from the 1950’s and 1960’s and I looked up how much my mom’s hospitalization costs were in the 1950’s when she had my siblings and me at that same hospital. ‘The old hospital’ was remodeled after a huge new wing was built in the late 1960’s.
”My husband couldn’t move in, his sibling works.”
All you can do is watch as their situation unfurls. Talk on the phone with the sibling(s) about the specifics of their parents’ medical needs and safety/well-being in their current situation. What options are available; what can be done to prod the parents to a better situation. IMHO keep ‘working’ on them with time, listening, understanding - and keep offering baby steps with moving towards safety/well-being. A catastrophe may happen and then it will be a drastic step or steps.
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Correct, they were going to get paid. The same amount. Whether she was there for 3 days or 6 days. It’s in their best interest to discharge after 3.
I’m not sure if an advantage plan will pay less than a supplement plan for a hospitalization
This stands out in the comments from that NY Times article.
”Then, we came to my mother who refused to leave her home and had a rural hospice care for her for two years. They came once or twice a week and washed her but the medication was up to my brother. He has no experience with basic medical knowledge and she developed bed sores, severe pain and dementia- she died a horrific death because my brothers were all over the place with doling out meds. She had turned over all her property and power of attorney to one brother because he was the one who agreed to her staying at home no matter what. I agree with others that when you want to go, the medical world should help it be a peaceful experience but I am afraid a lot of people are telling themselves that dying at home will be a good experience.”
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She “died a horrific death” not because of the brothers, but because American healthcare is horrific.
But agreed, too many people imagine dying at home as some gentle gathering of family and wise last words. I imagine that is not what happens most of the time.
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The one tool I have used when I didn’t agree with how things were rushing in the medical setting was saying I object and will be appealing when they wanted to stop mom’s OT/PT when we still wanted her to get stronger and learn how to enter & exit different vehicles/homes because she was coming and going in our many different cars and homes.
They asked me what more we wanted and were willing to extend and do more training of us and mom and aides.
Similarly, if they planned to discharge and there hadn’t been an appropriate place to discharge mom to, I would have objected and appealed. Fortunately, mom had an opening in skilled nursing where she could go and that was where she was discharged to.
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