Over the last year, my mother (with dementia) has started to use the tactic of hospitalization to articulate her dissatisfaction with things, such as not being able to obtain certain kinds of medications at certain times. In other words, when she is not happy with something, she will say that she wants to go to the hospital. To provide context, she currently lives in an ALF, one that she has lived in for a very long time. Unfortunately, over the last two months, she has been hospitalized twice for falling because of low sodium and a UTI. These hospitalizations have been legitimate (emergency) hospitalizations. However, she's now in rehab (second round) and is now using the hospitalization tactic at the facility where she is currently getting rehabilitation. Based upon my conversation with the nurse, if a resident continues to request to go to the hospital, the facility will take them to the hospital. I explained to the nurse that this tactic of wanting to go the hospital has been a thing for a year, that she even uses this tactic at her ALF. While this provided context to the nurse, the nurse did repeatedly say that if she continues to request to go to the hospital that they will take her to the hospital. I explained to the nurse that unless her oxygen saturation drops, BP goes super high or low, fall, etc., she shouldn't be taken to the hospital. However, the nurse, again, told me that if she continues to request it, she will be taken to the hospital. Of course, this is happening two days before she will be reevaluated by her ALF. Is this normal protocol for rehabilitation and nursing homes - to take a resident to the hospital when they request it even though she's physically stable?
My mom was always calling EMTs or insisting that she go to the ER. She was always perky and putting the full force of her witty and charming personality out there.
One of the times that I was with her in the ER most of the day because she insisted that the tiny spot of red on her eyeball might be serious, she said on the way home, “Well, that young doctor was very handsome and very nice, but he never even touched me.”
Being the center of attention was what it was all about.
Just sayin’.
As they want her out, find the contract and see exactly what the terms are for exit are…. Do they require a full 30 Day Notice? Or 60 Days? Because they are going to expect mom to pay every cent of it. Unless she transfers to the MC that is a sister facility with the same ownership, I bet. And look over whatever costs upon exiting there will be, like carpet cleaning. If your mom has loads of stuff in her room, you & your partner each take a box & a small trash bag this weekend and fill both. & every visit thereafter. Be ruthless in this. If you flat cannot do this, get someone in your circle of friends who is a big no nonsense personality to go with you to give you the stink eye till you fill that box and fill that bag… completely. Remember LTC Medicaid means shared room.
& on the “leave a good impression / architectural look” of a place, well, ya know, the place your mom is in currently knows that this kind of stuff matters to you and they have sized you up accordingly. They are oh so not going to cut your mom or you a break on costs if they can help it. So try to dial it back when looking at new places and make it abundantly clear on places you & your partner tour that mom when she runs out of her financial resources will be filing for LTC Medicaid program. Facilities may want to see her “awards letters” from SSA and other retirements as those will give them an idea of what her copay or SOC will be to them once she is on LTC Medicaid. They will find out eventually. Imho might was well know from the get go if running out of $ is a matter of months not years. Good luck in your quest.
Furthermore, when the nurse from her ALF comes by to do the assessment for reentry back to the ALF, she may determine mom no longer meets their criteria and now requires a higher level of care in Memory Care Assisted Living or a SNF. That's exactly what happened to my mother after a week in the hospital w pneumonia, then 21 days in rehab where she went into a wheelchair fulltime. The nurse from her ALF where she lived for 4 years decided between her dementia progressing and her mobility issues increasing, she would only be a candidate for their Memory Care bldg. So that's where she went, much to her disappointment and at a much higher monthly cost. It turned out to be the right move, just about 6 months too soon.
Best of luck to you. I know how hard the whole situation is, in reality.
I have POA activated for my mom. She lives in AL and has mild/moderate dementia. I have said yes to going to the hospital after an unwitnessed fall. I couldn't go there to be with her that day and she had covid so it was kind of a disaster and totally unnecessary. I decided my new answer will be no. Can we transport your mom to the hospital? No. Unless they can convince me that she has some real reason to go. Not "just" because she fell.
Best of luck.
That mom does not herself have the $ is beside the point. They may not know that, but to admissions it’s not relevant, they view you & your hubs as able to afford it, after all you are a college professor. They think you will pay…. they have $ized you up.
You can refuse to pick your mom up from the hospital. Mom then becomes a problem for the discharge planner at the hospital. Although the discharge nurse will heavily lean both the AL and on you & other family to come & her. What happens next really interdependent on what her health is like and what custodial care programs your State Medicaid pays for. LTC Medicaid in a NH is the main one but there are waiver programs that pay for others depending on your State.
What sorts of medication is she seeking that she's not getting?
I would ask for an evaluation by a geriatric psychiatrist. It seems possible to me that her anxiety is ramping up because she's not getting enough care/structure/attention.
Dementia is progressive. It may be time she went to memory care.
You can understand, I am sure, the liability involved were a rehab to refuse to transport a patient to the hospital when they request it. It is not up to the rehab to diagnose and decide your mother's level of need.
I would allow the rehab and the hospital itself to handle this. You have made your wishes known, and apparently, for some reason neither you nor I can fathom, it is the policy to transport the patient to the hospital. We cannot know what symptoms your mother is giving the nurse; you don't mention the severity of your mother's dementia, but it does come to a sticky situation when workers are asked to take on diagnosing NEED in a patient with complaints.