When No Nursing Home Will Accept Your Loved One, Then What? (adult, parent)
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I work in a LTC/Rehab facility, and I've oftentimes wondered what became of those that were deemed troublemakers, or family members who created too many problems for the staff, they're sent to the Hospital and the facility they were in will no longer accept them. "Sorry, we're full!" Which is a useful line for saying: No way will we ever allow you back into this facility!
I've heard nurses say, after their admittance to a hospital: "Good luck to the family for finding a place for this person!"
I know one woman, a big trouble maker, after leaving our facility, could find no other facility in the city that would accept her. Luckily, a facility 130 miles away in St. George, UT accepted her, making it a long drive for the family to visit.
If I were an Administrator of one of these facilities, I would certainly want to get as much info on this potential resident as possible. Fall risk? She, or the family, filed a lawsuit in the last facility the resident was in, which is why that facility refuses to re-admit the person? Family members being too vigilant, forever pestering the staff? A resident that continually puts the call light on, taxing the staff?
More curiously, what happens in these smaller towns with just one nursing home and that nursing home, for whatever reason, rejects that potential resident?
I oftentimes read posts of the dumping of a family member in a nursing home as it's as easy as dumping an old TV at a recycling center, and I don't think the naïve realize its not that simple to do.
Has anyone run into this, of heard of it, someone unable to find a facility for their loved one, and what other options were there?
Curious as well. Maybe there are facilities that pay their staff accordingly to the BS they will put up with and maintain professional decorum that cater toward these individuals? Kindof like high-risk insurance companies.
I work in a LTC/Rehab facility, and I've oftentimes wondered what became of those that were deemed troublemakers, or family members who created too many problems for the staff, they're sent to the Hospital and the facility they were in will no longer accept them. "Sorry, we're full!" Which is a useful line for saying: No way will we ever allow you back into this facility!
I've heard nurses say, after their admittance to a hospital: "Good luck to the family for finding a place for this person!"
I know one woman, a big trouble maker, after leaving our facility, could find no other facility in the city that would accept her. Luckily, a facility 130 miles away in St. George, UT accepted her, making it a long drive for the family to visit.
If I were an Administrator of one of these facilities, I would certainly want to get as much info on this potential resident as possible. Fall risk? She, or the family, filed a lawsuit in the last facility the resident was in, which is why that facility refuses to re-admit the person? Family members being too vigilant, forever pestering the staff? A resident that continually puts the call light on, taxing the staff?
More curiously, what happens in these smaller towns with just one nursing home and that nursing home, for whatever reason, rejects that potential resident?
I oftentimes read posts of the dumping of a family member in a nursing home as it's as easy as dumping an old TV at a recycling center, and I don't think the naïve realize its not that simple to do.
Has anyone run into this, of heard of it, someone unable to find a facility for their loved one, and what other options were there?
This happened to my late mother. It was horrible.
She had a history of UTI's that literally drove her insane when they happened. The trick was to catch one coming on because that's when her symptoms would start. She had other physical problems, of course but the UTI's were the worst.
We'd moved my mom from Michigan to live with us. She'd been in the hospital up there with chest pains, and whenever she was hospitalized she insisted on a urinary cath--and they can cause UTI's. Well, on the drive down here she started to act insane and we didn't no what to do--we had no experience at all. Drove her right to the hospital when we got home and she was in kidney failure from an extreme UTI. Of course, after she was released it was to a local nursing home for rehab. But...when they moved her, she was still hallucinating from the UTI and other drugs. She'd have her good days and bad but the nursing home couldn't handle it. I begged them to retest for a UTI but instead they diagnosed her as paranoid-schizophrenic and wanted me to move her across the state to a psychiatric facility. I refused. They then gave me three days to move her. I hired an attorney and the nursing home backed off. In the meantime I was searching for another nursing home/rehab but...every single one refused her. Every single one. Apparently they call the nursing home the patient is in and are given the records and the social worker "black balls" the patient.
Well, I thought the nursing home had backed off! They hadn't. One day Mom was sitting outside smoking, not hallucinating at all, very cognizant, when suddenly she was put in an ambulance and taken back to the hospital. They called and told me and said she'd been saying her deceased husband had visited her during the night. And they told me she could not come back. The social worker at the facility was horrible, just horrible. And that's called "patient dumping". I went to the hospital and Mom was in the ER. She was fine. The hospital found absolutely nothing wrong with her. Nothing. The nurse in the ER told me this nursing home/rehab does this all the time. We took Mom home, where she was fine for a while. A little memory loss, normal for her age and health.
Then, she started acting nutso again. Took her back to the hospital, she had started a UTI. They treated her but she was not being cooperative due to the hallucinations. At that time, she had not been declared legally incompetent, so she could refuse treatment and meds and did. She just wanted to go home. Instead, the hospital social worker insisted, based on the nursing home's assessment of paranoid/schizophrenia, that she be moved to the same psychiatric facility across the state. I refused. I just wanted to take her home.
The head of Social Services at the hospital told me he'd called all the facilities in the area and none would take her. In the meantime, he'd told Mom that she was going to a psychiatric facility and she, of course, got mad at everyone, including me. She refused to go home with me. The head of SS wanted to bring in a psychiatrist to have her declared mentally incompetent and move her to the facility anyway. I refused, so he then told me....get this...that since Mom refused to go home with me and I refused the facility, they were going to release her and drop her off at a homeless shelter! My God!
In the end, they wore me down and Mom was declared legally incompetent, sedated heavily and taken to the psychiatric facility that was a 3-4 hour drive from us. When she arrived, she was--that very day!--examined and found to have both a UTI and pneumonia.
That facility was a nightmare. The patients roamed the halls, some naked and some urinating in the halls, zoned out, talking to themselves, screaming and screaming by other patients, and on and on.
The nurses at this facility, once mom was treated, all agreed. Mom did NOT belong there! I finally was able to bring her home, but it took months only because every single time she'd be ready to come home her UTI would return. It was common for the nurses to phone me and say, "Your mom is acting nutso again so we're testing for a UTI." And each time, that's what it would be.
Oh...mom was also diabetic and would hallucinate when blood glucose would go too low. That was diagnosed there too.
We were finally able to bring mom home. Whew! I even got help to come in when she got too frail and sick so that I couldn't lift her. When she went to the hospital for that final time, it was to a completely different hospital and a much better experience. But she did pass on.
I later learned that patient dumping is illegal. (I pulled mom's records and other than 'mild occasional hallucinations, there was nothing...). And I learned that hospitals cannot...repeat cannot...dump a patient in a homeless shelter because she is mad and refuses to go home! And guess what, I pulled those records too and there was no mention anywhere of a homeless shelter! Just hallucinations and refusing treatment for the UTI. No, I didn't sue. My word (and my husband's and son's) against theirs. Big money against me.
Sorry this is such a long post. But my point is, patient dumping by both hospitals and nursing home/rehab facilities can and does happen. Black balling of patients does happen! Heck, my attorney even phoned a good friend of his who runs a nearby nursing home/rehab and he couldn't talk them into taking her---it was the hallucinations. No one (except the psychiatric facility!) even cared that the cause was a continual UTI and occasional low blood sugar. She'd been diagnosed by that first nursing home/rehab doctor as being paranoid-schizophrenic with mild dementia and that was it.
I'm glad to say after mom came home, I found an understanding doctor (Mom loved him!) and was able to find help at home through our Medicaid program (mom didn't have much money but what she did have went to the nursing homes until it ran out) and our State Ombudsman. I'm so glad she was able to finally live happily with us, as I'd promised her.
But beware...things like what happened to my mom happen to others every single day.
I can't advise others on what to do if your loved one is blackballed from facilities or patient-dumped. Yes, you might have to place them in facilities outside your area. It's worse then, because you can't keep a frequent eye on your loved one's treatment. Try to keep them home but if it gets too bad it might be your only recourse. Mom and I had a horrible experience. I hope nothing similar ever happens to others.
My dad became combative and regular nursing homes wouldn't take him. The phonebook listed one for difficult patients, so I talked to the director. They only had Medicaid patients, but she agreed to take my dad. He was there 2 weeks before passing away at age 97. He'd been only slightly senile at home when he had to go to the hospital a few weeks earlier. He kept trying to leave, so had to be tied to the bed. The doctor told me if he was going to recover, he needed to be at home, so I brought him home. In a couple of days I hired a woman to stay in the room with he and my mother during the night, but my mother created problems whether she wanted to or not. It was difficult all the way around. My parents in their mid-nineties, a stranger and me. My dad had never been violent, but tried to hit the woman when it was time for his medicine. That's when I knew he couldn't stay at home. He had enough of his wits to tell me he thought he'd gone crazy. I agreed with him and assured him it would be all right.
During the few days he was home, he had to stay in bed, sedated with Ativan. My mom had changed his wet diapers. For some reason I was going to do that and when the diaper was pulled down, my dad opened his eyes and saw me looking down at him and slapped his hand over himself. I didn't blame him as I didn't want to see. I insisted mother come finish and she did.
The nursing home for difficult patients was more like an institution for mentally challenged indigents. He was kept sedated and 4 days before dying he had no idea who I was. I've heard of situations where a loved one didn't know who anyone was for many years. I'm so thankful it was a very brief time with my dad.
What a horrible experience, Trivettes! I'm so sorry you all went through that.
I live and work in rural areas. The nursing facilities I've worked in occasionally get clients who have problem behaviors and some places definitely respond better than others.
I've seen situations where a patient/resident did need to go to a psychiatric facility for inpatient treatment, but with the goal of returning to their "home" building. And never for untreated UTIs. I have also worked at our state's psychiatric hospital and met some people who could not live well outside of that setting. But, we did not have people running around naked, etc. The nursing staff there helped develop and really followed behavior modification plans well, and the geriatric psych unit was peaceful and the residents living there were engaged in living.
There are also regulations that can interfere with the mental health of persons. One example is, that nursing homes are supposed to try to reduce psychotropic medications. Antidepressants, anxiolitics, etc. So if a patient begins to "do well" on a medication regime, facilities are charged (and have to show) that they have tried to reduce the medication. Doesn't make sense, unless you review the misuse/abuse of medication that was more common in years past. Such as, using meds to sedate patients for staff convenience. Finding physicians who manage medications in elderly patients can be tough in any market. I used to think it was just our rural areas, but I hear similar stories from urban colleagues.
Some facilities, very rare, have geri-psych units. Those are a godsend for many. I really think there is a need and market for more. The good ones are unbelievably good. The bad ones are cesspools of stressed residents and staff. It doesn't need to be that way.
YOUR STORY needs to be sticky posted on this forum because it is CLASSIC CLASSIC CLASSIC.
And super common example of how physical problems can be totally ignored or people so easily written off as "difficult".
Thank you.
Many times an elderly person will have slight dementia but go absolutely nuts if a UTI is even starting, not to mention when that UTI is in full force. Add other physical problems...diabetes, pneumonia, etc. and it can become a nightmare. And *some* facilities, nurses, doctors, social workers, etc. just put it all down to dementia or psychiatric problems. The facility that dumped Mom refused to even test for another UTI and since Mom was competent at the time, I couldn't force them. And, being on the verge of the UTI, all Mom would say was that she didn't feel well and then became angry and uncooperative.
When symptom free, my mom was as normal as anyone else, just with forgetfulness or sometimes she'd think a dream really happened. Then later she'd say, "I dreamed that, didn't I?"
I knew nothing about any of this--nothing of facilities, social workers, patient rights when we brought mom to live with us. I learned the hard way.
If anyone has any problems similar to mine, go straight to your State Ombudsman in charge of your area. Go to the State agency that regulates facilities. If necessary, as I had to do once at the psychiatric facility (tho for the most part and depending on her nurse being there, they were okay most of the time), call DCF (adult protective services). I didn't know to do any of this so I just called my attorney and honestly, that just made everything worse. No kidding. An attorney can be very good and yes, I recommend hiring one, but honestly in my case it just made the facility more uncooperative and then they dumped her for no reason other than she stated her deceased husband had visited her during the night.
I learned the hard way so I'm hoping by telling my story, even tho it hurt so bad inside bringing up those memories!, that I can make it a little easier for someone else.
I know. EVERY SINGLE POST I make here emphasizes that. Dehydration and UTIs.
And yes, my client and others I see have REASONS why their dementia seems so random. Your mom is EXACTLY like my client. No different that MOST!! IT's outrageous. So sad for her. (ok my client may be in a later stage it sounds like, but still....)
It took me FOUR MONTHS to have my client properly diagnosed and treated this past time. I'm not even a nurse or CNA I'm her DOG WALKER LOL.
Her CONCIERGE PCP doctor didn't want to do the culture and kept doing stupid meaningless things like prescribe a LOW DOSE antibiotic.
BIG SHOCK it wasn't even the correct class antibiotic for her particular bacteria.
THIS after falling several times and going to the ER even being admitted (where I WAS able to get a culture done and 24 hour drip of a/b and fluids).
FINALLY the family insisted and got him to write the order for monthly testing. Since we cleared her she's like her OLD self, mid-late stage dementia but manageable UNLESS something bad happens like the staff sends a MALE to do her hygiene when they KNOW they should NEVER DO THAT.
She even started doing things she hasn't done since last year like call her daughter on the phone, CHARGE THE PHONE, go out to LUNCH in a group and out with her granddaughter all week long! (yes you have to watch for overstimulation).
SO, BIG SHOCK her dementia REVERSED in a few ways.
They all hover on the brink of dehydration anyway.
And dehydration/UTI or not, their dementia is often just the catch all category for very common things like hallucinations or false ideas that WILL PASS or can be medicated. It doesn't mean they're clinically untreatably PSYCHOTIC for chrissakes.
I really can't believe your mom's awful bad luck. It is the NUMBER ONE delusion/belief that their family members visit in dreams or while awake. NOT UNCOMMON and NOT SEEN AS A PROBLEM. There are TECHNIQUES for this. First of all, you AGREE with them and redirect.
In fact, I insisted they take my client off melatonin because of her seriously harsh dreams that she couldn't kick in the daytime.
IT HAPPENED TO A 30 YEAR OLD HOST ON FOX AND FRIENDS WEEKEND!
It's a KNOWN adverse reaction!
Don't get me started...!!!.
ETA: And who's to say they are NOT having visits in their sleep from their deceased husbands and mothers. IT's almost a form of passage, some might say.
Last edited by runswithscissors; 08-20-2014 at 08:37 AM..
There are also regulations that can interfere with the mental health of persons. One example is, that nursing homes are supposed to try to reduce psychotropic medications. Antidepressants, anxiolitics, etc. So if a patient begins to "do well" on a medication regime, facilities are charged (and have to show) that they have tried to reduce the medication. Doesn't make sense, unless you review the misuse/abuse of medication that was more common in years past. .
Are you sure about this?
I've never heard it.
"Nursing homes" use psychiatrists who MUST write the order for the RN/LPN. Medications are a delicate balance between adverse reactions, side effects, overdosing or underdosing - keeping symptoms under a certain threshold....and you just don't arbitrarily mess around with them for WHAT reason if they are stable. That's not to say the PCPs don't write orders that they have NO BUSINESS writing and should be done by a psychiatrist.
ALFS' patients use PRIVATE DOCTORS.
They just can't arbitrarily administer or change things unless it's a PRN.
What state has this statute?
Or are you referring to facility POLICIES not "regulations". Or some obscure MEDICAID cost cutting nonsense on the order of Obamacare rules and regs.
Are you a nurse?
Are you referring to CURRENT politics not old policies? I ask because you used the term "nursing home" which, is not really the current terminology for these patients' facilities. At least in the USA.
Last edited by runswithscissors; 08-20-2014 at 08:50 AM..
Yeah, they put my mom on Melatonin. Among other things. Rispirdal for one. Even one psych drug that knocks a patient out immediately (can't remember the name of it), tho I found out about that one and stopped it immediately and filed a complaint with the State, who investigated within 24 hours. I mean, WTH? The facility was cited, tho honestly that doesn't mean much except that if they don't correct the problem within so many days they can lose their license. Usually the facility will correct...until the next incident, of course.
In that "bad" hospital, which is local to me, a major problem was that Mom refused treatment and that was a major reason she was admitted to the psych facility with both pneumonia and a UTI. The hospital said they couldn't treat her because she'd NOt been declared incompetent. Yet, they brought in a psychiatrist and had her declared incompetent....and rather than treat her after that, they transferred her to the facility (over my objections and with threat of dumping her at a homeless shelter because she, by then, refused to go home with me). As soon as she was treated for the illnesses, she wanted to come home! But by then I had to fight to get her home.
At that same hospital, before all that happened, Mom phoned me once at night and was completely incoherent. I phoned the nurse on duty and was told she'd just checked Mom and Mom had been fine. I insisted on checking again because Mom was on Insulin and her blood sugar was maybe low. I was told that they were only allowed to check blood sugar twice per day. What? So I drove over, checked her sugar myself with my own meter and it was 55. Oh, I raised Cain (to put that in a polite way). A couple glucose tabs and some juice (given by the Charge nurse) and Mom became coherent again. Angry, but coherent. lol
LOL, I don't know if these memories are good or bad for me--I'm hurting bad right now--, but I do know that they might help others. So it's worth it. Always, always keep on top of things! Complain, call the State, whatever you have to do.
And if you find no facility will take your loved one, for whatever reason, call the State Ombudsman or Adult Protective Services...or an attorney if you have to. Facilities just shouldn't be doing this---refusing patients, dumping patients, poor medical care. I took Mom home, finally...won the battle! Thank God! And then I found a doctor for her who understood!!! What a blessing.
It was hard with Mom home. I won't say it wasn't. But I'm glad I did it. If you can't, tho, then fight to find a good facility...nearby if you can. Nearby is important, IF you can do so. But fight for your loved one in any way you can. They're worth it.
I wish I'd known back then even a tiny bit of what I know now.
Been two years. I miss Mom every single day.
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