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Ask if it is a safe discharge to send mother home alone in a cab with no one to check on her for several days. Tell them about the steps. Indicate that you do not and cannot live with mom. Ask them to put the fact that this is a " safe discharge" in writing.

Do not sign anything for discharge. Do not show up to take her home.

They are trying to bully you. Your mother needs rehab.

Has anyone done a psych eval?
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Hanging, has anyone from discharge given you a discharge date? If not, don't panic. Understand that they are telling you that they can't send mom anywhere against her will, and that your reply needs to be,

"that's all well and good, bits YOUR job to make sure she's being discharged someplace safe and she lives alone. She has a history of noncompliance with help and meds. I'm not going to kill myself, lose my job and become homeless trying to care for her 24/7. I won't be there, so she's going to end up back here within 30 days. So what's YOUR plan to avoid that".

This is not said angrily or tearfully. It's just the facts.

Your mother also needs to know that you are not able to give her the care she needs and deserves, that she needs to accept being in rehab until she gets stronger.

And what about a psychiatric evaluation.?

You mentioned palliative care. Have they determined that your mom has cancer and that it's not treatable? What is her prognosis?
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I can't believe they want to discharge my mom today!!
The nurse called & said my mom doesn't fit the criteria from Medicare to be a "hospital inpatient" so she has to leave.
The fact that she can't even walk or stand w/out help isn't a factor.
Because my mom has been deemed as "competent " she can make her decision that she doesn't want to go to a skilled nursing home.
I told the nurse what you guys said about putting in writing if this will be a "safe discharge " & the nurse kind of skirted around that & said their hands are tied w/Medicare but they may be able to use some criteria under Medicaid to see if one of the rehab facilities will accept my mom to allow her to get physical therapy there so she can get stronger to be able to walk on her own, at least w/her walker..
The nurse said she would talk to my mom & try to advise her to do that.
But if my mom refuses, they can't force her..
Oh my God, what a nightmare this has become.
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((((((hugs)))))) just stay firm that you cannot provide proper care at her home and she cannot look after herself. She is non compliant and delusional about being able to care for herself so push for a psychiatric eval. Insist in getting something in writing about a safe discharge. Yes, it is a nightmare. I am so sorry you are going through this.
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If you can get her to rehab, I think you can still ask for a psychiatric consult there. From everything you've described, your mom is making decisions that prevent her from being safe and comfortable. You know she is going to be back in the hospital if she goes home like this, but your mom really does not need a broken hip on top of all her other issues.

If you want, you can ask them to page the doctor responsible for the discharge decision and when they call you back, ask him or her specifically what they think is going on with your mom, & why they chose not to evaluate your mom for dementia or other cognitive or psych. issues. The doctors use the nurses to get people off their backs. The doctor should have to explain their reasoning for this decision. If nothing else, ask the doctor to talk to your mom and emphasize the importance of rehab, if they haven't done so already.

We went through this loop with my grandparents. So much hinges on which individuals who happen to be working that day. So at least if she goes to rehab, you are going to come into contact with a couple new people who can talk to your mom or who might know the system. You just need to encounter one person who both cares and knows what they are doing. (Unfortunately that's a lot harder than it should be.)
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All the nurses say my mom has changed her mind & will NOT go to rehab.
She wants to go home.
I asked that they put something in writing that it's a "safe discharge" & the social worker said they would never sign anything like that
The psychs doctor did examine her & he has "no definitive diagnosis or cognitive impairment".
I CANNOT BELIEVE THIS!!
I HAVE recorded messages on my phone from my mom for the last 6 months where's she sounds like she "sundowning" but they are all denying this!!
What will happen if after I speak w/the doctor (he's supposed to call me within the hour) and tell him I don't feel like my mom is going to be safe?
What after he stands his ground saying "there's nothing else we can do" and they get her ready for discharge and I don't show up??
Can they press charges against me??
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They are saying she's competent. Presumably that means she can arrange for her own in-home care, medical appointments, transportation, etc. They can't have it both ways.

You have no legal obligation to take physical care of your mom. (There are a few states where children have some filial responsibility to their parents; I think it is usually a financial responsibility -- and in specific instances -- but hopefully someone else will speak to that.)

This is not abandoning her. You have a job you need to go to, you are trying to get help for her. Both she and the medical community are essentially saying you're wrong, she doesn't need any help.

Tell her doctor that based on her past behavior, when she is released from the hospital, she doesn't follow doctors' orders and is non-compliant with meds. Tell him she does not understand the risks of not following medical advice. Remind him of her multiple health issues, that she gets agitated when left alone, and that you cannot be there with her everyday. Just be honest and tell him you are scared and exhausted, you can't be in two places at once and that neither of you can afford out-of-pocket in-home care and she refuses what she gets via Medicare. Ask him how you are supposed to ensure she will be safe at home.

Good luck. I hope you get somewhere with these people. It sounds like they made up their mind already. At some point there is nothing you can do if this is truly what your mom wants. But that is really unfair for her to ask you to pick up all the slack.
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A question for if your mom gets sent home: have you talked to her and told her all your thoughts about this? Or is she in denial and it's understood that you don't discuss it?
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She is being brought home w/a medical van & they told me there going to help get her up the stairs & into the house so I'm waiting here for hem to come.
It's 7pm.
The doctor said "his hands are tied" because she is still able to make her decision to "go home".
Her "sundowning" episodes are not enough to declare my mom "incompetent" or have a lying else make decisions for her so that's it.
I have to leave for work @ 8:30pm so I'll have about an hour to get my mom settled in.
Then I have to leave.
If she starts crying or having anxiety I don't know what I can do.
I'm out of breath right now from cleaning & getting her bed made up.
Why does this have to be so hard??
:(
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How are you holding up? How was your mom? You must be exhausted. My heart aches for you. I can remember my mom being in tears because they'd have told us "Oh she'll be in here for at least a few more days" but then someone else would call and say, "We're discharging her in a few hours." Then it's a scramble, just like you described.

Did they at least order the visiting nurse or in-home PT for her?

I cannot believe they sent your mom home like that. I hope you will be able to go home and go to bed after your shift. You need some time to just deal with your own business.

Just as a side note: When grandpa first started calling several times a night, we used to leave notes for him saying "Don't call us before 9:00pm" or whatever.  It had to be very direct.  It did help for a while till his dementia got worse.
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Thinking of you hangingon61
You must be exhausted!
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That just isn't right. And there you are, helping her come back home against your and any other sane person's judgement... maybe try a different social worker or eldercare attorney? :-(
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They are supposed to have access to medical legal help if someone really is a danger to themselves like this!
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Well my mom has been home 4 days (came home on 5/17) & has had one visit from a nurse a few days later (Wed) who evaluated her needs & filled out some paperwork.
She took moms vitals & observed her getting around w/her walker.
Very nice lady, my mom felt very comfortable w/her & liked her very much.
This nurse called me last night & asks me "how often do you see your mom?
I told her I go to visit 2-3 times a week, usually staying a few hours as I have to work split shifts on my jobs.
So the nurse tells me "you know I observed your mom has some vision problems, dizziness & mobility issues, so my question is are you able to accept the position of her caretaker or have someone else in mind to provide care her because that's what I am there for & that's to train the caregiver".
I told her "no, I can't provide the care for my mom & neither I or my mom has the means of can afford to hire someone else to"..
So she was very concerned & she said "you know I'm going to have to speak to my supervisor about this because I cannot continue to see your mom, that's not within my work guidelines, because my job is to TRAIN the caregiver, I do not provide the care myself".
So WTF am I supposed to do now??
I told the d*mn doctor this is what I was talking about if he discharged my mom back to her house in her condition & she has no one to stay with her but he told me "his hands were tied, we can't force anyone against their wishes & if they want to go home, we have to allow that".

My nightmare has come to reality because my mom DID tell the doctor that she would not go to rehab & wanted to go home & she would allow the nurses & care givers to come inside her house, that she wouldn't be in "non compliance" w/any help she would be offered & now it turns out that the state, or Medicare, Medicaid, whoever the H*ll is responsible for these decisions is not going to provide sh*t!!!

Forgive me for cursing but I've gone from being scared for my mom to being angry at this point.

I'm angry at our health care system for elderly people who cannot afford to hire live in nurses to care for them and/or be there with them when they have mobility problems & cant be left alone for extended periods or they can seriously injure themselves.
Your pretty much on your own.
Just die.
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You can be unhappy with the health care system, and you can also be angry with your mom who has been deemed competent to make her own decisions and who is making a very dumb one, it seems to me.

Her "independence" was being bought with your slavery. Not any more.

You need to call the agency and tell them that they need to tell MOM that needs caregivers. That either she needs to hire them or she needs to get someone to apply to Medicaid on her behalf so that she can get assistance.

Assistance will be provided to those who ask for it and who qualify for it. But she has to ask.
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BarbBrooklyn my mom has Medicaid since 1991 (when my dad was killed) so she doesn't need help getting that.
The other major problem is that the psych doctor did NOT deem her incompetent to make her own decisions so that's the issue right there.
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Dang Hangingon!
My dad will be going back home soon also with his doctors saying he's competent
I have no answers for you, I hope someone here does!!! Ugggh!!

Hugs
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Hangingon, I am so sorry this situation is getting more stressful. The day my grandma passed away, much of the medical staff still had no idea she had cognitive issues. She was 86, my mom accompanied her to every appointment, she often acted child-like and "sassy" to the doctors, and was not asking any questions when they gave her some significant diagnoses. It was bizarre that they couldn't see it. And it really impacts the elder's care because on one hand the medical staff must sense the person is "not right" and tend to address the elder as if she is a child, but on the other hand they completely defer to the elder's judgement, and ignore the concerns of the person who is shouldering the responsibility. It makes everything harder.

Did the nurse ever get back in touch with you? Do you have DPOA or medical proxy or anything? Will she call you, or would she call your mom to say what's going on?

I don't understand how the staff at the hospital thought this would work when they should know Medicaid does not cover night time help (and mobility problems and dizziness don't go away at night.)

For now, you can try to get her to a better primary care doctor/geriatrician if hers doesn't seem to know what's going on, and can try to get in touch with the Medicaid case worker or Dept. of Aging social worker to see if there are more options for your mom. It sounds like she is starting to accept that she needs more help; maybe she would let caregivers come in.

With my grandpa, he was not declared incompetent. My mom had medical/DPOA for him and he had a dementia diagnosis (from that stupid clock test they do in the geriatrician's office.) It was enough to get the doctor's to take my mom more seriously. (But grandpa was fairly cooperative.)

There only so many hours in a day. You've been trying to help your mom and she and the medical system have made that a really difficult job. You did not make this mess. I worry that you will burnout if you haven't reached that point already. This is such an emotional process -- the emotional part is really hard work too.

There is a lot here you don't have control over. Can you just give yourself a few days to clear your head out a little, and then maybe next week start thinking about what you and your mom can live with, what's reasonable, etc?
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Hangingon, you need to be in touch with Medicaid about getting your mom assistance at home. Ask the agency that is providing home care for help in setting that up.
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My Mama was fainting and doing all the same things. She had a pacemaker last month. Them she fell and broke her pelvis. They measure her blood pressure laying siren abd standing. Everytime she stands up her b.p. drops. This is a common problem. I don't want her in a rest home either. But now she has been in 1 for 9 day's abd now at a phych. Hospital. She is going to another rest home next for more skilled nursing. It seems awful at first but now I have found the answer to all the crazy behavior and phone calls in the evening. They said she is having awful sundowners. She is now on anti depressants and Alzheimer's medicine. It is like a whole new Mama. Do not be afraid to place her for awhile! I am finally sleeping and so is she. I had no idea all of this was actually dementia. This sight and all of you here have been a Hugh source of love, inspiration and information! Hang in there!
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Before I got all off topic was that since she is back home you may just have to wait for "the fall". This is actually what happened to my Mom. She broke her pelvis. However, that gets you back to the hospital. This time she was sent to a large hospital in our nearest big city. Those people were the one's that finally started my help for her. I'm sorry it is such a long road for those of us who have these " tricky" patents that seem so sane around the hospital people and those " in charge" of their medical needs.
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My mom just got discharged back home from her most recent hospital stay this past Sun-Tues (yesterday) and they did some testing this time & the doctor believes my moms cough is from the nodules they saw on her lungs from the most recent cat scan of her chest.
The doctor said that could be metastasis from her breast (cancer).
The constant dizziness (moms been dizzy for the past 2 yrs) could also be a tumor that metasisized to her brain but she refused the MRI for that so it's just a guess right now..:(
At home last night mom did bring up some things that I wasn't expecting her to talk about when she came home.
She asked me to put the 2 wedding rings, hers & her mothers, (my grandma's) in a safe deposit box, but she first wants me to have them appraised so that I don't get ripped off when the time comes when I have to sell them (the money will be needed for her cremation & interment w/my sister @ the mausoleum).
I'm going to try to visit my mom every day, if only for a few hours because I don't know how long she'll be w/me at this point.
She's praying God takes her in her sleep @ home if she has to go, rather then in a hospital.
I didn't know this most recent medical information until yesterday.
I'm feeling like someone just kicked in my stomach really hard, a sick feeling..but I know why because I'm fearful of losing my mom & wish I could do more for her, especially to ease her discomfort & anxiety at having to live alone..
I have to ask if any of you know what is expected for a person with cancer who hasn't had any treatment..
I mean what could happen to my mom physically??
Will she experience a lot of pain?
Will she need strong pain meds??
I don't think I can get her out of the house now that she's home from the hospital to see her doctor, but they are setting up a visiting nurse to come x2 a week for now but that's the only medical attention she'll be receiving.
I love you mom.💖
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Hanging, has anyone discussed Hospice with you or with mom?
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No BarbBrooklyn because the doctor that discharged her didn't say anything about that.
From what I understand, hospice is only if the patient has a 6 month or less time to live as the prognosis?
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The 6 month prognosis is the one I've heard most often.

Did you ask the doctor what he thought the time line for your mother is? I would feel free to call him back and ask if a referral to hospice is appropriate.

Or, you could call some local hospice organizations and discuss what they would need from the doctor to do an evaluation.
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Today I got a call from a nurse who works for palliative care & she said she received the order for my mom for that (palliative) not hospice.
How are they different from eachother?
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My mom is also on Palliative Care. She is Hospice-eligible, but we, as a family, are not there yet (it's my brother whose not there yet, but whose arguing).

So, we don't have a specific Hospice organization that is running the show, the folks at the NH are. Mom is getting comfort, not curative care for her CHF. She still gets some PT and is on a walking protocol. She is on antidepressant meds and scheduled pain meds, with antianxiety and MORE pain meds as needed.

We have a "no transport" order--if something happens that they would ordinarily take her to the ER for, they don't. They will call us and we will decide if we want to treat it. (we would treat, say, a fracture, but we're not going to treat pneumonia any more aggressively than can be done in the facility).

With Hospice, there would be extra aides, chaplain, volunteer visitors, I'm told.
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Hi Hangingon61, I'm so very sorry about your mom's sad news.

From all the posts on this website, it sounds like a lot of these things vary state to state. But I think, in addition to the hospice 6 month prognosis, one of the main differences is in billing. If your mom were to choose hospice care, her health care bills (which would be limited just to comfort care) would be paid solely by Medicare. (However if she was getting in-home help via Medicaid, I think that continues to be billed to Medicaid, like the room and board part of the NH bill continues to be billed to Medicaid. But I would definitely ask to make sure.)

It probably also depends on your hospital system/palliative care team, but as Barb described, our hospice provided some support for the family: there was a chaplain who talked to us and also prayed with us and grandpa, and a 24/7 phone number we could call if we had questions. Hospice also will help once the person passes; the NH or family calls them and they come out to the residence to fill out necessary papers and handle the logistical part of things.

My thought is that your mom's doctor just might not think she is within the 6 month time frame yet, unless he suggested it and your mom nixed it. If you are thinking you might want healthcare proxy (or whatever it's called in your state) maybe the palliative care nurse would be able to address that in a practical but delicate manner with your mom?
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The palliative/hospice nurse came yesterday to examine & evaluate my mom.
She then started talking to mom & myself about what she's recommending..
My mom has refused the nurses suggestion that she receive hospice care (so she can remain at home instead of having to go back & forth to a hospital when she's feeling very ill..)and I don't understand why..
When she's feeling short of breath, chest pains, she will need to call 911, paramedics come & take her to the ER where she will most likely. E admitted to the hospital (which she hates.. understandable), then after a time they will discharge her to go back home & they can't treat her for anything else..
So it would be back & forth to the hospital..
The nurse did tell mom she does have breast (metastatic) cancer & her symptoms indiciate that it has traveled to her lungs (nodules seen on recent cat scan) & lymph nodes, possibly her brain because of her constant dizziness that they can find no other explanation for (mom declined an MRI to be definite but that's her choice & I understand & respect that).
When the nurse suggested hospice & what that entails (pain management, skilled nursing visits weekly, respite care, visiting doctor who will come to mom, she won't have to go to see him, etc)
Mom did mention to the nurse the reason she doesn't want hospice is because she remembers my grandma's (mom's mom) having hospice before she died when she got cancer and how sick she was from all the chemo, radiation & surgeries and "she still died anyway"..
The nurse told mom a lot has been improved since (1991) so it would be much better for mom to have a team of care givers along the journey then to be all alone.
And that's just it, my mom is alone most of the time and I can't be her 24/7 so I'm worried that this journey is going to be nightmarish.
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I think my mom feels like if she "signs up" for hospice, that they are going to make it happen quicker for her, much like when your being superstitious if you put your name on your tombstone before you die..that's "bad luck"..
Does that make sense?
I can't convince her of anything, she's a very strong willed & opinionated woman & I'm absorbing a LOT of guilt.
She told the nurse the only time she doesn't feel scared or afraid is when "my daughter is here"..
It's killing me that I can't spend more time w/her.
Feeling like I'm going to have a heart attack but I'm powerless to do anything to change what's going on.
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