My mom has fallen twice this summer. In late June she broke her knee and required a knee replacement. We were livid when she insisted to the hospital staff that she be sent home (she and my father live with us) instead of to inpatient recovery as we are already dealing with my father with Parkinson's and still have kids at home and both work full time. Fast forward to late July and she cracked her pelvis and they discharged her home again this time from the ER. They essentially had her waiting at the curb when I got to there. Since she has been home she hasn't been able to leave the bed for pretty much any reason and seems to be getting worse instead of better. I am trying to determine if she insisted on being sent home again but should have been in a facility.
A specific medical note needs to be entered into the EHR that states that patient lacks capacity to make medical care decisions, or some similar language. MDs are reluctant to do this, due to legal implications and risks of lawsuits. Plus, it takes longer to do tests and treat sick folks if you have to contact someone not at the bedside, explain the plan, obtain consent, document the call, and then order the test or medication change.
And even with mild dementia, patients are considered capable of expressing choices.
case management is focused on maximizing billable resources (meaning that any patient who stays in acute bed that is not needed loses money).
Family members need to agree that patent is unsafe at home, and one person needs to be the 'point person' to communicate with hospitalist, care manager, discharge planner, etc. about what family CAN realistically do, to provide data about the home situation, and be willing to participate with the patient in a discharge planning meeting that can get rough.
And start with an elder care attorney or financial planner to figure out how to pay for care....as elders are certain to decline over time..
it's not an easy process, it's not anyone's fault that it is so difficult, and you. just have to do the best you can.
Its too late to just take her back to the ER unless you are prepared to abandon her there. They will only admit her for observation unless there is a new injury. This will affect her eligibility for Medicare funded rehab.
In the future, refuse to transport her if she tries to be discharged to your home when she needs more care. Tell your mother what you are going to do the next time if she insists upon returning home before she is ready. The hospital is required to evaluate the safety of the discharge and they know it. They are literally dumping your mother on the sidewalk under the guise of patient preference. Go elsewhere and make them pay for what they have done to you and undoubtedly others.
Going from ER to rehab is much easier than home to rehab. Call her doctor and tell him the situation to see if he can get her admitted to a rehab. If that's going to be a lengthy process, tell him you need home health set up for her immediately with maximum physical and occupational therapy days for her.
Her PCP, the social worker and hospitalist NEEDED to work together for the better care of your mom and dad.
If she insisted on being released home and the social worker after a 10-minute conversation deemed her cognitive and able to self care -- then in-home nursing needed to be demanded! This means a nursing assessment for nursing care for the fracture including CNA assistance for personal grooming as well as Physical and Occupational therapy assessment for her balance issues. A nurse probably once a week, CNA up to 5 times, PT and OT 2-3 times a week for up to 12 weeks.
Her PCP needs to have her evaluated by a neurosurgeon/neurologist to determine what is causing the falls more likely balance issues from mini TIA. Major blood work from basic CBC to diabetes to cancer needs to be done asap as well as C-scan or ultrasound for the head and body.
In reading some of the answers regarding hospital discharge, even if you have Medical POA, and she has been determined competent and decides to go home you are not in a position to overrule her decision UNLESS you want to go to court. Hospital discharge without in-home assessment for care MUST be requested.
I know I recently went through this with my sister who was deemed competent even though her overall health chronic non-compliant diabetes, bacterial pneumonia, Irvine Gass eye syndrome, refusal to wear body brace for L-1 fracture, colostomy, perianal wound rebound -- she requested home discharge with in-home nursing care. Her request overruled her PCP demand that she be admitted to nursing rehab.
She did come home and set-up for in-home nursing care. She did have an in-home evaluation done by a social worker from Aging Services who did find her home borders on hoarding but was fully cognitive and a great story teller.
Until the day your mom like my sister is ruled incompetent by social worker trained as psychologists there is very little we can do to overrule their wishes.
Three fractured ribs are a qualifier to prevent pneumonia.
Rehab and skilled admissions are decided at the hospital.
True, even at a facility she might refused to participate and at that point her insurance will stop paying but at that point she might be a candidate for long term care if you can't provide for her many needs at home.... and providing for those many needs can cause you serious mental and health problems.
Good Luck and please keep us updated.
If she were living alone, they probably could not have discharged her to home care but would have her in a rehab facility for at least 30 days. It's not automatically a matter of whether the patient is elderly but depends upon the home situation he/she is being discharged to. Your mother's situation looked like she had care available, so she was allowed to go home.
You need to establish that you cannot do the level of care she needs and that she needs care and PT and OT and CT therapy in a facility. That may be hard to negotiate.
mom to a rehab facility asap. With the anesthesia, two surgeries, and pain PLUS her getting worse, she’s in trouble. She may get pneumonia. Unfortunately, from what I know, it is far more difficult to get her into rehab once she’s been discharged. Call the hospital care management team. They can help.
My mom was discharged to a “rehab” nursing home after a hip replacement and she needed emotional and physical rehab from the rehab when she came home. I am sure this is not everyone’s experience, but it added more setbacks.
Make sure someone is coming out to help with physical and occupational therapy. If you or another family member can be present for these sessions, you can reinforce and support her recovery by following instructions after the sessions. If there is no in-home PT/OT in your area, take her to an outpatient clinic for these services. This is covered under Medicare (possibly up to 3 months treatment at a maximum, depending on her needs and diagnosis).
Taking mother to PT appointments several times a week is physically more taxing than already being where the therapy already is.
you but a year or so ago my Mom fell broke her wrist and cracked her pelvis. She went to rehab for about two weeks after hospital. They had her up using a walker. I went into rehab before her discharge and was shown what she could do/couldn’t do etc. by the PT. The PT told me that if my Mom stayed in bed she’d never walk again. She needed to be up and moving every day. I bought Mom home, she did at home therapy and in 12 weeks she was healed. A year later she broke her hip and same story there. Hospital, rehab, home with at home therapy. I cannot imagine her coming straight home after either of these injuries. I would definitely contact her primary doctor and/or her orthopedic doctor. In my opinion she needs therapy. Best of luck to you!
Start with your primary care doctor or maybe even the orthopedist, especially if they have a social worker to see if they can help get her admitted. If not, contact Medicare ASAP and appeal that she was discharged too soon. I would hope someone there would look at a knee replacement followed that soon with another fall resulting in a cracked pelvis would warrant an appeal that she had not totally recovered. Rehab is less expensive than hospitalizations for repeated falls. The least I would hope for is some kind of home health since she obviously can't leave your home. I'm thinking time would probably be of essence so work as fast as you can to call everyone you can to try and get her case evaluated. I think some issues need to be addressed within 30 days.
If perhaps your father is a veteran, at least check into benefits such as respite care for your father (I get 14 hours a week) and aid and attendance for your father and spousal aid and attendance for your mother.
My heart goes out to you as your plate is flooding over.
Emergency or Acute care is just that. It is not recovery care for the time it takes broken bones to heal.
Treatment for # pelvis is usually conservative management - meaning CAN move & walk as tolerated. Bones will heal in time. (But due to pain/fear/fralility many will stay in bed).
Once healed, physio may be useful. Often done as outpatient in community (or in-home if insured for).
If unable to self-care at home, then stay with informal carers (ie family/friends). If none available, then inpatient formal care instead (may be called respite care or skilled nursing where you live). Then, once bones healed, either inpatient rehab or direct home.
For your situation right now: You weren't to know this would be too much. But if it is, speak to Mom's Doctor & arrange a new plan asap.
Where is her primary care physician in all of this? What does he suggest you do?
Is she well enough to tell you her side of the story as to why she didn't want to go to inpatient recovery? Could she have misinterpreted a question someone was asking her?
One option is to take her to the Emergency Room of a hospital. Tell them what happened and that she no longer can leave the bed and that you want to know why. If she gets admitted, make sure that she is not admitted with "observation status". Medicare will NOT pay for "observation". Otherwise, Medicare will pay for some number of days with 0 co-pay.
Come up with a care plan for your mother with the social worker at the hospital. It might include some time in a SNF. I believe Medicare will pay some amount for care at home if she opts not to go to a SNF and still needs medical care.
At this point, it doesn't matter if she insisted on going home or not. You need to deal with how she is now and what future action needs to be taken. The ER has all the records from the previous visit. At the ER reception area, make sure that they have all the approvals they need to share her medical information with you.
As a caution: There are a lot of confusing, contradicting names of medical facilities. Emergency Care at an Urgent Care Center is NOT the same as an Emergency Room in a hospital. In addition, ensure that wherever you go, they accept your Mom's insurance. Not all places do, even though they have an area called "Emergency".
For me, we can only get PT at home if we have not gone to an office for PT for the same "illness". Once PT comes to the home, the first thing they will do will evaluate her. Don't expect much from the first session for her. However, from that first session, they should be able to tell you what they they can do and what she is capable of.
P.S. Walking in this case, means walking with a device like a walker or a rollator.
P.P.S. In my case, my Mom refused to do the exercises on her own. Hence, I worked with the PT to figure out what kind of interactive exercises we could do together. Doing exercises together helps you get stronger too.
Is there some way for her to private pay for NH care until the fracture heals?
Have you ever consulted an eldercare attorney about Medicaid?
Your parents' needs clearly outstrip the resources available at your home.
You may need to have a tough conversation with them about the fact that you can no longer do this.
Alternatively, some folks take a "therapeutic fib" route-- we're going on vacation, the house needs to be fumigation, it's temporary for a month, for the winter-- and get their parents into care that way.
The next time she is hospitalized, you start working with the discharge planner on Day 1. You tell them " no, she cannot return to our home; it would be an unsafe discharge."
For the present moment, call mom's PCP for immediate advice about her condition worsening, and see what's suggested for rehab?
For the long term, you really need to consider placing both of your parents in long term care now, together...........they both require a level of care that you're unable to provide for them as at least your mom needs 24/7 caregiving. I don't know what condition your dad is in, but Parkinsons Disease often reaches the point where 24/7 care is also required. In home care is often not feasible for two parents with this level of need, with you working, and also having children who require your attention. It's too much. I had to oversee my parents care in Assisted Living (and then Memory Care) and it was almost a full time job, in and of itself! It went on for 10.5 years, too, and took all of my strength to manage. If I tried to do it in home, it would have literally killed me.
Wishing you the best of luck with all you have on your plate.