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.
I work in a Memory Care and we erroneously took in a woman who's schizophrenic, as it turns out. She mimics dementia behaviors from time to time, but her overall behavior does NOT fit the 'dementia/Alheimier's' profile. Her daughter is now trying to figure out where to place her next since Memory Care is not the right fit for her.
Best of luck!
At least she notified you, many don't, as long as they follow proper procedures for discharge.
My mom did end up being kicked out because of behaviors. She was on hospice at the time, they recommended a smallish care home that worked much better for her.
Read the admit documents. Think about it, Hailey, what would you want if another resident was actually your loved one and your BIL were allowed to come back. Think about the liability. The facility is responsible for keeping all residents safe.
Is the situation illegal...
Is that actually the right question? Where does it get you? Where does it get BIL?
So. To go back a few days. BIL was admitted for a psych evaluation. Which found that... What? To me it's bizarre that the social worker rings to ask what your plans are; surely the first step is a case conference where the findings of the evaluation are discussed and BIL's care needs are specified.
How is BIL now? Have you and/or DH been able to see him?
The reason I asked if it was illegal for someone to get discharged and not admitted back was bc my BIL has no where to go. I was just hoping the administrator could not do this and she would have to take him back.
My husband and I thought we had him at a good place and we were willing to work through this, given a chance.
I agree with you so much about the first step should have been a case conference of findings and care needs specified. You are on point.
To me, this is the biggest problem we have been having. The facility will say they are having issues, send BIL for evaluation and then they are ready to throw him under the bus.
Husband and I have not been able to see him but I have been calling and talking with the Nurses and they say he is doing fine.
I have a gut feeling, BIL is more intelligent than all of them. Surely if he was the monster they betray him to be, his mother could of never cared for him in her 80's.
sorry you and hubs are going through another difficult period with BIL especially during the holidays
I've followed your posts over time and it seems the same folks will respond to you with the same comments and questions but you don't seem to respond with more information -
mainly your question revolves around why don't memory care facilities have to take your BIL ?
the only answer is No they don't
if BIL has had several psych evaluations then his dementia (if that is his only diagnosis) must be severe - the social worker at the current psych hospital must work to find a suitable discharge
during the past 4 years, I've witnessed behavior issues from residents in mom's memory care facility -
I've seen other residents hurt and I've been hit myself on several occasions -
there is no magic memory care or way to handle or redirect these situations especially if it is a strong man -
the only solution is to heavily medicate them which means they become immobile and less volatile if not walking around
You do not need to elaborate on BIL's behaviors but I'm sure you do not want to see him hurt anyone
I understand that it is difficult to accept, but there is no cure and no memory care facility no matter how expensive or what their glossy brochure says has a magic wand to make things better - it is awful I know
the best you can do is hope he is kept comfortable, safe and fed and clean
push back on the social worker to help find a solution - this isn't a first for them
contact your local Alzheimer's association and ask for suggestions
contact your county agency on aging and ask for suggestions
BIL is not bothering the residents from my understanding it is the staff. Makes me wonder what they are doing to him My husband has told me that his brother was like a genius before all this happened to him. It says his brother is not going to tolerate no one being disrespectful or bossy with him.
I can not help but wonder if he is being provoked. My husband and I kept BIL for a few days this summer and he was a joy.
you don't need to share with us but I'm assuming you were told what BIL did to be sent out on Xmas eve for a psych evaluation -
is that not correct ?
if the administrator did not tell you, then you or more likely your husband (if he has power of attorney) needs to be fully informed, since you asked another member what danger to others means.
Has he hit anyone? Kicked, pushed, or choked anyone, or used a fork or a knife as a weapon? Picked up a chair or table and threw it ? Does he remove his clothing, urinate or defecate or masturbate in public areas?
these are all examples of behavior that can occur and result in being sent out of a memory care facility
The 5 days he stayed with my husband and I, he never pushed me. I was left alone at home with him and in the car alone with him, never once was he aggressive with me.
The month he was in the hospital, the case manager stated he she never saw any behaviors while there. Two months and a half in rehabilitation, administrator stated he was not aggressive and he would not harm anyone. That he just loved to wander all over the place and needed and activitiy to keep him occupied.
He has had many evaluations done with obviously no behaviors there.
My husband and I have been through this before. Administrator accused him of having behaviors and wanted to discharge him to us. I contacted the ombudsman and she stated that would never happen. Therefore, when she got involved, she turned that ship around.
When she investigated the situation, she stated that staff had done a lot of things that she did not like. She stated that once they got all new staff and got him involved in daily activities, he was not having any behavior issues.
I agree with her. He is a very intelligent person, he will not tolerate no one trying to be bossy with him and he does appear to like to be busy.
I forgot-does the state have guardianship over BIL? If so they will step up but again the possibility of him being transferred somewhere far away from his brother & your family exists again- your husband will get stuck driving to wherever he is.
Unfortunately yes his MC can discharge him if they fear he is a danger to staff or residents. I believe that is the deal breaker. Giving 30 day notice is probably not required in this situation either due to BIL’s erratic and potentially dangerous behavior. My guess is he isn’t going back there.
Again I feel bad for your husband and your family. You’ve been a great advocate for what should happen (staff trained to work 1:1 taking care of BIL) but that is not going to happen unless it’s private pay.
I will guess BIL was admitted under a behavioral contract or is currently in a probation period at the new center. As he has again exhibited inability to make proper choices & can’t control his impulses - especially since they gave him a chance when no one would - I am thinking they won’t entertain taking him back.
As another poster said, leave this to the SW and DC planners to get him placed.
I hope it it works out for you & that maybe they will give him one more chance.
Mom was in care for just over two years when she passed. Both memory care and the care home (last six months of life) required that mom have private caregiver, in addition, whenever her behaviors escalated.
Hailey, if BIL can afford that, perhaps you could get him back where he was. The 1:1 did help mom, kept her engaged with the mind more active. That was the advantage of the care home for mom. The staff/resident ratio standard was much better more like 1:4 instead of the common 1:6 or 1:8 or even more that you see in memory care.
Oh, and the care home was less expensive which did help with the increased cost due to the need for 1:1 care.
This isn’t their first rodeo, unfortunately.
I think it all boils down to approach.
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.
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.
Otherwise, they are saying children in daycares or schools must be kicked out due to behaviors. They push, kick, bite, etc. ectc. each other.
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.
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?
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.
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.
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.
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
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.
Unless, someone has been through what we have been through they just don't know.
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.
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.
No, the APS is not involved at all. I already checked with them.