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Old 06-30-2014, 06:40 PM
 
Location: it depends
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I'm up on this self-determination thing. BUT my mother, when living "independently" in her own home, used to expect me to leave my shop and drive an hour round trip to replace a light bulb for her in the middle of the workday. She stayed in her own home too long.
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Old 06-30-2014, 07:18 PM
 
Location: Sierra Nevada Land, CA
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Quote:
Originally Posted by marcopolo View Post
I'm up on this self-determination thing. BUT my mother, when living "independently" in her own home, used to expect me to leave my shop and drive an hour round trip to replace a light bulb for her in the middle of the workday. She stayed in her own home too long.
Good for you, but that was a personal choice on your part.
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Old 06-30-2014, 07:25 PM
 
Location: Sierra Nevada Land, CA
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Quote:
Originally Posted by anifani821 View Post
When an agency is involved, there is often little choice but to remove a person with diminished capacity from the home and find placement into a higher level of care facility -- b/c of liability issues that might put the agency itself at risk.

Adult children often feel the same way and they also should be concerned about liability issues, at least in some states/jurisdictions.

Frail elderly who are of sound mind might be of sound mind one day and two weeks later, they may not be, which is also a consideration. And one's physical condition can change in moments, such a with a stroke.

No easy solutions but in general, I would say that it is best to consider the short term consequences of NOT putting someone into a higher level care facility - and if the risks are low, then continue assessment until such point that the short term consequences outweight the benefits of in-home care (safety, overall health assessment, mental health status, ability to successfully complete ADL with or w/o assistance, etc).
Not so in CA. Here it is about self determination. If mom wants to die in her own home that is fine. Perhaps it is different where you live.
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Old 06-30-2014, 08:26 PM
 
Location: State of Being
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Originally Posted by Mr5150 View Post
Not so in CA. Here it is about self determination. If mom wants to die in her own home that is fine. Perhaps it is different where you live.
The process for securing a guardianship (conversatorship in California) is not that rigorous if someone is determined to pursue it.

So if Mom is showing signs of dementia or Alzheimers, there are definitely mechanisms in place to declare a person incompetent and then the decisions are out of the Elder's hands.

The weak link with "self determination" is when an elderly person becomes ill or has an accident and ends up in the hospital but wishes to return home at discharge. They may not be "allowed" to return home - and that is true in all 50 states.
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Old 06-30-2014, 08:31 PM
 
Location: State of Being
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Determining if a patient can be safely discharged to home is approached many different ways. I thought this article was interesting - gives some insight on what physicians may be thinking when assessing a patient.

Today's Hospitalist :: Discharging a frail, elderly patient? Try reviewing function, not just systems
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Old 06-30-2014, 09:04 PM
 
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One people miss is you don't have to be frail. I have a lower exremity neuropathy that pretty much guarantees a fall periodically. However I am in good enough shape I just get back up and dust off. It is very unlikely though not impossible that I will break anything as I obviously fall well. If it should get to the point where I don't easily get up and if my wife is no longer able to assist I will go to a tilt switch and use that. May have to do my own though as I won't call 911. Ain't going to get hauled to the hospital unless I actually broke something.

My mother went through this. Got somewhat fall prone and used her fall button a couple of times. And each time they hauled her to the hospital. After that she would just grab a pillow and sleep on the floor until the morning help came on duty. She would rather sleep on a tile floor than get hauled to the hospital.

Mother made it to 90 living in her summer home in Montauk Long Island. There were multiple discussion with her about some better arrangements but she would have none of it. We went to a live in which lasted a month before mother threw her out. The problem was always mother. Know one but a strong man could hope to live with that broad. We finally hit upon two ladies taking 8 hour shifts so she had coverage from morning to afternoon. They would leave her with dinner and she was perfectly happy. And she had a pretty good support system in Montauk. She knew how to make anything she wanted appear at her front door in a couple of hours.

Mother was always cogent. Difficult but all there. She was a retired lawyer...actually a ranking US expert on the income tax in her prime. Too some degree she refused to keep herself moving and probably cost herself some small number of years. She turned sedentary and that made her more sedentary that is pretty much what got her in the end.

No one ever considered anything for mother she did not agree to. Once she got the LLB she never stopped being a lawyer. Even hint at something she might not fully agree to and you could hear the legal machine kick in.
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Old 06-30-2014, 09:17 PM
 
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My understanding is that it is almost always less expensive to have caregivers at home than to be in a facility. So where does this pressure come from, to put people in facilities?

Is there funding for the facilities but not for the in-home care? And, if so, are we doing something about that?
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Old 06-30-2014, 09:36 PM
 
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Quote:
Originally Posted by NilaJones View Post
My understanding is that it is almost always less expensive to have caregivers at home than to be in a facility. So where does this pressure come from, to put people in facilities?

Is there funding for the facilities but not for the in-home care? And, if so, are we doing something about that?
Classical hooker. It is substantial cheaper to treat at home. But there are substantially more people who will qualify if at home treatment is paid for. So you use the more expensive facility to keep bigger sets of people from attempting to qualify.
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Old 06-30-2014, 09:48 PM
 
Location: Baltimore, MD
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Quote:
Originally Posted by anifani821 View Post
The process for securing a guardianship (conversatorship in California) is not that rigorous if someone is determined to pursue it.

So if Mom is showing signs of dementia or Alzheimers, there are definitely mechanisms in place to declare a person incompetent and then the decisions are out of the Elder's hands.

The weak link with "self determination" is when an elderly person becomes ill or has an accident and ends up in the hospital but wishes to return home at discharge. They may not be "allowed" to return home - and that is true in all 50 states.
?? No hospital can prevent a patient from returning to his or her home unless the hospital is ready and willing to begin guardianship proceedings. This is probably why my father was discharged to his home when I made it clear he would be signing out AMA rather than accept the facility's plan to transfer him to an ALF.

In terms of guardianship proceedings in Maryland, every respondent (the alleged disabled) is appointed an attorney to represent him or her in court. The attorneys are well aware their duty is to represent the respondent, NOT the petitioner(s), children or other interested parties. The respondent not only has the right to appear and testify on his own behalf, he has the right to a jury trial, as well.

How many hospitals do you think are willing to spend the time and money to prevent an elderly patient from going home? Hahah.
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Old 06-30-2014, 10:05 PM
 
6,756 posts, read 8,317,089 times
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Originally Posted by lvoc View Post
Classical hooker. It is substantial cheaper to treat at home. But there are substantially more people who will qualify if at home treatment is paid for. So you use the more expensive facility to keep bigger sets of people from attempting to qualify.
Heaven forbid that frail elderly people should have the assistance they qualify for!
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