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Old 07-01-2014, 06:11 AM
 
Location: State of Being
35,885 posts, read 67,205,825 times
Reputation: 22375

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Quote:
Originally Posted by lenora View Post
?? 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.
It is not laughable.

Hospitals do not want patients staying past reimbursement periods. That is true. However, the onus is on docs and hospital staff to make sure patients don't have re-admits within 30 days.

Social workers are under pressure to find placement for folks who qualify for placement, rather than sending mom or dad back home when there is likelihood of another admission within 30 days. So it depends on diagnosis, prognosis, care plan, etc as to what recommendations staff will make.

You can sign out AMA, yes, but what happens with subsequent care if you sidestepped following Medicare reimbursement regs? It will not be covered. Not everyone has the thousands of dollars they will need to cough up if they end up with bills that are disqualified under Medicare.

As far as a hospital spending money to keep a patient in the system . . . it isn't even a matter of spending the money. It is a matter of patient care under Medicare regs and to do otherwise can put a hospital's medicare license at risk.
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Old 07-01-2014, 07:32 AM
 
Location: middle tennessee
1,926 posts, read 993,510 times
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good reasons to avoid going to the hospital. I don't think elders realize that when they allow themselves to be taken to the hospital to get "checked out" after every minor incident that they are setting themselves up to be institutionalized.
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Old 07-01-2014, 07:51 AM
 
Location: Verde Valley AZ
8,624 posts, read 9,696,398 times
Reputation: 11007
Quote:
Originally Posted by Robyn55 View Post
There's a big difference between someone deciding his or her own fate - and spending his/her own dollars to reach that goal - and imposing on family members to accomplish what they might prefer to do. No way I'm going to spend my 60's or 70's being a caregiver/nurse/maid/etc. for others. YMMV. Robyn
That is your option. I don't mind taking care of my mom and I have to say she is doing SO much better now than she was a month ago. She would never want to impose on her kids to take care of her but I CHOOSE to which is okay with all of us.
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Old 07-01-2014, 07:57 AM
 
Location: Verde Valley AZ
8,624 posts, read 9,696,398 times
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[quote=Teddy52;35453309]
Quote:
Originally Posted by LivingDeadGirl View Post

I do live the life of a hermit ( a hermit with modern conveniences, however )
All my family lives 870 miles away.

Every morning, between 8:30 and 9, I call my daughter and leave a short message on voicemail.

If by then there is no message, she is to dial my number.
If no answer, she is to dial again in an hour and then call the local police to check if I don't answer.

She is to tell the police where the house key is hidden.

About once a week we talk live on the phone, also.
I leave for work fairly early on some days, before my mom is awake, so I don't stop in and check on her. The other night I told her if she woke up by 8 AM to give me a call to let me know she's awake and okay. So, what does she do? She called me at midnight! She said she remembered I told her to call but couldn't remember what time or why. lol
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Old 07-01-2014, 08:31 AM
 
Location: State of Being
35,885 posts, read 67,205,825 times
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Quote:
Originally Posted by boogie'smom View Post
good reasons to avoid going to the hospital. I don't think elders realize that when they allow themselves to be taken to the hospital to get "checked out" after every minor incident that they are setting themselves up to be institutionalized.
Very perceptive observation . . . it is a real and possible scenario, depending on reason for hospitalization and subsequent care plan.
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Old 07-01-2014, 08:33 AM
 
Location: State of Being
35,885 posts, read 67,205,825 times
Reputation: 22375
Quote:
Originally Posted by AZDesertBrat View Post
That is your option. I don't mind taking care of my mom and I have to say she is doing SO much better now than she was a month ago. She would never want to impose on her kids to take care of her but I CHOOSE to which is okay with all of us.
Yes, this is a choice that is very individual!!!
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Old 07-01-2014, 08:52 AM
 
Location: State of Being
35,885 posts, read 67,205,825 times
Reputation: 22375
I should add . . . if an elder is admitted to the hospital for 48 hour observation, and subsequently sent back home, they will be billed as an outpatient. Medicare will not reimburse as a hospital stay. The 30 day readmission regs are part of ACA. Hospitals have to absorb the tab if Medicare patients are readmitted within 30 days.

Also, observation stays can affect whether or not a patient will be able to go into a nursing home setting with reimbursement from Medicare. Medicare requires 3 days in hospital stay.

Now you tell me: if you were a hospital administrator, what would YOU be advising staff? The shortfall for hospitals is in the billions with re-admissions. You would have that patient evaluated and you would be assessing the possibility of future admissions within 30 days (something very likely with many diagnoses, and in particular, heart failure).

Perhaps it is best for that patient to be in a higher level of care unit within the hospital or transfer the patient to a nursing home facility.

Perhaps it is best to get other agencies involved and do a home assessment and include home health visits and so forth.

Things have changed with Obamacare. Elders and their families may not be aware of the changes. When it comes to Medicare reimbursement, folks need to be educated about what to expect with hospital admissions and observation stays. It is no longer a matter of "self determination" in many situations when the patient's bills are being paid by Medicare.
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Old 07-01-2014, 08:55 AM
 
38,300 posts, read 14,965,857 times
Reputation: 24713
People are allowed to make foolish decisions all the time. As long as you are your own guardian, you can ride a motorcycle, take up base jumping, or climb Mt. Everest in your bare feet.

Some times the social worker types in home health care agencies notice things because they are with individuals more than family members or APS. They often make recommendations based on their best judgement of what would be safer for the individual and/or reduce the liability of their agency.

But unless the courts have determined that the person is in need of guardianship or the person has signed guardianship over, they can continue to make decisions about what is best for them regardless of whether others believe it is foolish or not.
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Old 07-01-2014, 08:56 AM
 
38,300 posts, read 14,965,857 times
Reputation: 24713
Hospitals are supposed to follow a discharge plan that does not involve just dumping people but that doesn't always happen.

My aunt was discharged to her home in such poor medical condition that the home health nurse who came by the next day refused to assume responsibility for her care and called an ambulance. She died in the hospital two days later.

I've seen people who are barely able to ambulate discharged to homeless shelters.

Last edited by GotHereQuickAsICould; 07-01-2014 at 09:42 AM..
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Old 07-01-2014, 08:57 AM
 
38,300 posts, read 14,965,857 times
Reputation: 24713
I've known many people who wanted to stay in their own home but required a great deal of assistance to do so. At some point it is more cost effective to get this assistance in an ALF.

Some expect their kids and relatives to provide this assistance. If they're up for it, I don't see why not.

One woman I know lived in her own home and her four children rotated through taking care of her. One was my hairdresser and she and her kids moved in with her mom for 3 days a week for several years. The other others divided up the remaining days. They worked out holidays, family vacations, etc.

I didn't know the others, but my hair stylist said it was no big deal. She loved her mother and it was a blessing to have her around her kids so much.
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