Can a Hospital Force You to Go to a Nursing Home
Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical weather. Many of them volition exit the hospital with profound weakness from their astute and chronic medical weather (and unfortunately without a palliative intendance consult). In many situations, these patients volition be besides weak to take intendance of themselves. They will need extra help with their activities of daily living either from family or from trained dwelling health care representatives. Patients who cannot safely return to the community often demand to transition through a nursing domicile (with skilled nurses) before returning home. These are chosenskilled nursing facilities, or SNF for brusk (prounounced sniff).
If you're going to a SNF, that means you're going to a nursing home to receive a combination of physical therapy, occupational therapy, speech therapy or other therapies intended to get y'all back to the community. This SNF status is paid for by the Medicare National Bank and your supplemental insurance for up to 100 days per benefit period. There are many rules that must be met in order for Medicare to pay for these benefits, but that's the subject of another discussion.
Let united states of america say y'all or your family member has met the criteria to accept their SNF benefits paid for by Medicare. Permit us say the concrete and occupational therapists at the hospital you lot take been admitted to are recommending that you lot or your loved one transition to a skilled nursing facility upon discharge from the infirmary because they exercise not feel you or your loved one can safely be discharged to home to provide cocky directed activities of daily living. Let usa say you or your family member does not want you to go to a nursing home or a SNF or an assisted living facility or anywhere other than habitation.
Tin can a hospital strength a patient to get to a long term nursing facility or short term skilled nursing facility (SNF)? The answer is no. No doctor, no nurse, no physical, occupational or speech therapist anywhere in America can force y'all or your loved ane to go anywhere y'all or they don't want to go. If a patient wants to get domicile against the recommendations of their medical team, they take every right to become dwelling house, with one caveat. They have to have the chapters to make their own medical decisions or have a surrogate conclusion maker assuasive discharge to home against the recommendations of the medical team.
For many elderly folks, giving up their independence and being forced into a nursing habitation is their biggest fear. If in that location are any elderly folks reading the Happy Hospitalist, remember, nobody can ever force y'all to get anywhere you don't desire to become, equally long as yous take the capacity to make your ain medical decision. Your doctor tin't forcefulness y'all. Your nurse can't strength you. Even your powers of attorney tin't force yous. If your family is telling y'all you take to go to a nursing dwelling house or skilled nursing facility and you don't desire to and yous have the chapters to make that decision, no matter how poor that conclusion is, you accept the right to get abode against everyone's wishes. End of story. Tell them to get lost.
However, if you have been accounted unable to make your ain medical decisions because you lack the capacity to practice so, and y'all have a powers of attorney (POA), your POA can strength y'all to become anywhere they want you lot to go, whether you concord to information technology or not. Who makes the conclusion on whether you accept the capacity or not to make your own decisions?
Scarily enough, any licensed physician tin can brand that conclusion even though most physicians take never been formally trained in the process. Your hospitalist could brand that determination. Your family doc could brand that determination. Your surgeon could document your lack of capacity to be involved in your own medical decision making. Fifty-fifty your dermatologist could deem you incapable of making your ain medical decisions. If there is whatever question, I usually get a specialist (psychiatrist or psychologist trained in this process) to document a patient'due south chapters status.
If you do non accept a POA and you have been determined to lack the capacity to make your own medical decisions, so a court must found a guardian through the direction of family guidance. If y'all do not have whatever family for guidance, the courtroom will assign a guardian for you lot, unremarkably a lawyer who knows zilch virtually you. Establishing a guardian is a court process that comes with expenses. Information technology is not free. If y'all have no family unit, no POA and the hospital has to establish a guardian for you, and that guardian recommends a nursing dwelling (which they volition if the hospital recommends it), then that is the only circumstance where a hospital can forcefulness you to go to a nursing home or skilled nursing facility.
I implore everyone to get a POA. If yous're in the infirmary, you can become these forms from the infirmary. Y'all can also observe free POA forms off the internet. Discuss your wishes with your POA and so they will always make decisions for you that are consistent with your wishes should the fourth dimension come up anytime that you can not. Otherwise some family fellow member may force your doctors to resuscitate your decomposing body over and over again just to document your fourth dimension of death by the midnight hour and so they could collect one last VA inability cheque from your cold dead body. Yes, that really happened to me.
Oh and one other matter. If y'all are in a nursing home or skilled nursing facility and you desire to leave them against the medical communication of your doctor, Medicare will pay for all intendance you received upwardly to that point. Don't allow anyone tell you that if you left, Medicare won't pay for the care you already received and you may get a bill. At that place is no truth to that argument. You lot have nothing to worry virtually. Nursing homes are non prisons. I don't know who widespread this misinformation is in skilled nursing facilities, but a reader contacted me with their dilemma. What a tragedy. Here is their comment:
I wanted to requite you a quick synopsis of my situation to make certain I have my facts straight. I am POA for my mom and was told by the director of a SNF she went to subsequently a three week hospital stay that she would get a "$15,000 beak from Medicare if she were to become domicile". That didn't sound correct to me and don't know if information technology was more of a scare tactic directed toward her and so she would experience obligated to stay. She is presently in a SNF that I don't feel is conducive to her recovery at this indicate. A visiting physician I talked with also agreed with me. I recognize her need for a caregiver at dwelling house and experience she would exist improve off finishing her recovery there. My only worry was the annotate made by the manager that she would get slapped with a huge bill from Medicare if she were to leave. I simply wanted to brand sure I wouldn't exist breaking some kind of Medicare protocol and exist on the hook for prior services received. Any advice you could give me would exist helpful.
This was my response:
Medicare pays for claims based on medical necessity. If your loved one's stay has been medically necessary up to the point they leave, Medicare should pay the nursing home and doctors for the care they take provided up to that point. If you choose to have your loved 1 out of a facility against the advice of the doc, that is your correct to exercise and so. We do not put our loved ones into locked upwardly prisons. While I cannot comment on the specific details of your case, I cannot recollect of a circumstance where the care they have already been provided with will non go covered. If a director of a SNF told me my mother would get stuck with a $15K bill for taking her home against the advice of her physician I would ask the manager of this facility to provide me with a resources to investigate that claim myself that they are using to make the aforementioned claim. I would likewise contact my Medicare claims provider and ask them the same thing and tell them the proper noun of the facility and the person telling you lot that Medicare will non pay if you take your loved one out against their communication. I think Medicare would desire to know what kind of distress this domicile is putting you and your mother under. I would also contact my local newspaper and possibly my county attorney and tell them my story. Information technology sounds similar something that may exist either illegal or immoral. Either way, if they are saying this to you, they are probably maxim information technology to others either out of ignorance or the demand to keep their beds filled. Perchance a local news person could provide the correct respond for many other loved ones in your community.
Remember, America is non a law state, even so. Y'all have every right to go out a nursing dwelling at any time, and so long as you take the capacity to make that conclusion and you aren't going to be on the hook from Medicare for medically necessary services already received. And if you don't have the ability to brand your own decisions, your POA or guardian has every correct to release you as well without whatsoever risk of getting a bill for care already received.
Source: https://thehappyhospitalist.blogspot.com/2012/07/Can-Hospitals-Force-Patients-To-Go-To-SNF-Nursing-Homes.html
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