Why the Elderly are Discharged from Nursing Homes, Assisted Living, and Memory Care Communities
Caregivers can be distressed when they feel elderly parents are kicked out or discharged from nursing homes and assisted living communities. Unless one asks, healthcare systems and care communities rarely share the conditions under which
elderly persons are discharged or asked to leave.Nursing homes and assisted living discharges from facility happen for various reasons.
These reasons include a lack of participation in therapy, medical goals that cannot be met, declines by health insurance, care needs exceeding what a community can provide, and unlikable residents including those with behaviors that threaten or harm staff or other residents.
Once an adult enters the health and community care system, they give up a degree of control over their life. Health facilities include hospitals, acute care hospitals, nursing homes, and rehabilitation centers. Community care includes assisted living, memory care, and personal care homes. All of these have requirements to receive treatment or to receive ongoing care.
Discharge from Facility: Hospital
Specific to hospitals, admissions occur for acute care needs. An acute care need is an urgent and time-sensitive healthcare need.
Hospital stays are usually short, a matter of days, and are approved by Medicare or Medicare Advantage insurance plans. While a hospital discharge can be appealed, there must be very specific reasons to remain hospitalized.
Let’s talk about hospital discharges and readmissions.
Hospital readmissions within 30 days of an original stay are a major financial concern for the healthcare system.
The Patient Protection and Affordable Care Act of 2010, section 3025, established the
Hospital Readmissions Reduction Program which established financial penalties when patients are readmitted for various health conditions.
Conditions that result in financial penalties to hospitals include COPD, elective hip and knee replacement surgeries, heart failure, pneumonia, and coronary artery bypass surgery. The Hospital Readmissions Reduction Program’s goal is to encourage hospitals to improve care coordination efforts specific to hospital discharge procedures by improving communication with patients and caregivers.
Part of the challenge for hospitals is a lack of staff who can work with patients and caregivers to help them understand discharge procedures and after-hospital care.
Older adults and caregivers must be their own advocates in all types of care situations.
So, if you are an older adult admitted to the hospital or an adult caregiver, get involved when a loved one is admitted to the hospital and begin asking about the timing of hospital discharge and steps to manage health concerns after discharge to home or to assisted living or memory care.
If you don’t ask, you might be surprised when your parents experience discharge from the hospital.
Health Conditions of Older Adults Requiring Nursing Home Care
Many older adults who are admitted to nursing homes have
a lot of health conditions that are difficult for them to manage. They may be admitted to hospitals several times a year to treat chronic diseases like heart conditions, diabetes, COPD, asthma, kidney disease, cancer, or symptoms related to dementia.
Some older adults have no family support. Even if family support is available, the health of a loved one can continue to decline.
When older adults are in poor health before being hospitalized or experiencing a nursing home stay, there can be a lot of work to do to return home and live independently.
The hospital can treat the condition resulting in the condition, but after hospital discharge or transition, physical recovery efforts are up to the individual.
Most adults don’t realize that being physically fit is a primary factor that prevents hospitalizations or nursing home stays when older. When general health concerns are managed by patients who work with their primary care physician, hospitalizations become less likely.
An inability to perform daily activities is the main reason that older adults begin to need assistance, whether from family caregivers, paid caregivers coming into the home or moving to a care community. In addition, having several chronic health conditions can make it more challenging to remain in top physical condition.
So, if you haven’t been admitted to the hospital or a nursing home, get motivated to improve your physical health. Start exercising, strengthen weak muscles, and build physical endurance.
An ongoing commitment to physical improvement can help minimize the need for frequent medical care.
Nursing Home Regulations to Prevent Hospital Readmissions
Like hospitals, skilled nursing facilities are measured based on unplanned hospital readmissions for SNF residents within 30 days of discharge from a prior hospital stay. The formal name for this is
SNF 30-Day All Cause Readmission Measure (SNFRM).This means skilled nursing homes are penalized during the 30-day discharge from facility timeline. According to CMS, SNFs are measured on the following:
- Healthcare-associated infections requiring hospitalization
- Total nurse staffing hours per resident day
- Total nursing staff turnover
- Discharge to community outcome scores related to PT/OT/ST rehabilitation, self-care, and mobility
- Percent of residents experiencing one or more falls with a major injury
- Discharge function score
- Number of hospitalizations per 1,000 long-stay residents
- Within stay potentially preventable readmissions
So, with this information, one might wonder if older adults in nursing homes who need hospital care might be refused this care. To what degree might staff more concerned about fines for hospital readmissions within 30 days refuse to send patients back to the hospital for needed care?
As a care manager, when my clients were in nursing homes for care there were times I made the call to 911 because the staff did not want to make the call. As a care manager, I knew the health conditions of my clients better than the care staff.
This is a factor that patients in nursing homes and their caregivers should consider. If you are a patient in a nursing home and you believe you need hospital care and the staff disagrees, make the call to 911.
SNF Discharge from Facility to Home Transition Planning
Older adults are usually admitted to nursing homes after a hospital stay where they are confirmed to be too physically weak to return home and live independently. Some older adults may go to the hospital and then a skilled nursing facility to return to an assisted living or memory care community where they live.
If you are a caregiver or an older adult living in assisted living or a memory care community, know that these communities can decide whether you can return when you are hospitalized and sent to a nursing home.
Assisted living and memory care community staff must confirm that you can care for yourself in a way that is comparable to the level of care you received before you left. If you cannot, they can refuse to accept you until you have completed physical rehabilitation.
As you can see, being admitted to the hospital is the first step of risk related to having a lot of health problems and being able to return home to live independently.
Being admitted to hospitals and nursing homes can make older adults and their caregivers feel like they are losing control. While discharge from facility is the goal,
many other factors impact the ability of older adults to return and live in a home setting.
The list below applies to a private home setting. Older adults living in assisted living or memory care may have access to many of these services as a part of their community care plan.
- Attending follow-up primary care, specialty, or other medical appointments.
- Confirming availability of family or paid caregivers to assist with activities of daily living (ADLs) and instrumental activities of daily living (IADLS)
- Committing to participate in physical therapy and strengthening exercises
- Managing medications
- Implementing home safety measures, i.e., shower chairs, stair railings, etc.
- Utilizing community resources as needed
- Implementing the use of an emergency call system
- Ensuring the availability of a power of attorney agent to assist with financial or healthcare decisions if necessary
Can a Nursing Home Kick You Out?
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Pamela’s YouTube ChannelThe Transition from Hospital to Nursing Home
So let’s say that you are in the hospital and learn you can’t go home. You need to go to a nursing home.
The list of nursing homes you can be discharged to depends on your insurance, Medicare Original or Medicare Advantage. Most nursing homes accept original Medicare.
Medicare Advantage plans have a list of nursing homes associated with their plan. So, if you want to choose a nursing home, ask the hospital discharge planner for the list.
Otherwise, you’ll be sent to the first nursing home on the list with an available bed.
The next step for you and your caregiver is to start planning for a discharge date to home or your assisted living or memory care community. If you live in a care community, it’s important to understand what the community requires residents to do in order to return.
Otherwise, you may be moving out of your community to find another community that will accept you based on your updated care needs.
Transfers from One Care Setting or One Community to the Next to the Next
Hospitalizations are the perfect time for nursing homes, assisted living, and memory care communities to decide whether to allow a resident to return.
For family caregivers, hospitalizations and nursing home stays are also the time to be realistic and re-evaluate the level of assistance an elderly parent will require to return home.
Caregivers should be realistic in confirming whether they can or cannot provide this new level of time and attention. Think of it this way: if caring for your parent is challenging, is investigating a care community a practical next step?
Ask these questions:
- Does Mom or Dad have a difficult personality?
- Does an elderly parent complain all the time?
- Are parents rude or demanding to you as their caregiver or to the care staff in the hospital, nursing home, or care community?
- If Mom or Dad lives in a nursing home or memory care, do they have difficult behaviors like refusing to bathe, yelling, screaming, or harming community staff or residents?
Difficult parents can become difficult residents that communities don’t want because their behaviors are disruptive to residents and staff. Additionally, the staff may not be appropriately trained to manage the behaviors related to memory loss or mental health concerns or provide the high level of care that a resident needs.
When
searching for an assisted living community for elderly loved ones, great care must be taken to choose the community with the greatest flexibility of care options so that your loved one does not need to move again.
High Care Needs Can Result in Discharge from Facility
A caregiver recently reported that a nursing home discharged their parent, even when the caregiver expressed concerns about not being able to deal with a parent’s dementia behaviors.
These transfers or discharges, called unsafe discharges, are called “dumping.” Dumping is the opportunity to deny problem patients the opportunity to return to a community for care.
Hospitals, skilled nursing communities, assisted living communities, and memory care communities dump problem residents.
Persons with dementia are often dumped from hospital emergency rooms who are not equipped to manage behaviors along with other conditions like urinary tract infections and delirium.
Nursing home and assisted living discharges happen more often when the patient or a family member is unwilling to work with the community and medical staff to identify solutions for the behaviors.
In some cases, the only solution may be medications if an elderly patient has extreme behaviors and is a threat to staff and residents. Sometimes, family members may be unaware that medications can be a solution for some behaviors.
Family Members Hide Information from Assisted Living and Memory Care Communities
On the other hand, adult children can also be accused of dumping.
Let’s say a family caregiver fails to share information about their parents’ behaviors with care community staff. The parent is admitted to an assisted living or memory care community and begins acting out.
When care staff expresses concerns about a parent’s behaviors, the children act shocked.
If you are a caregiver and your loved one has challenging behaviors, it’s up to you to attempt to address or manage the behaviors before trying to move your parent into a care community. If this is not possible, then I recommend being as honest as possible with the care community staff and letting them know you are willing to do whatever it takes so that your parent does not become a problem for them.
If your parent has behaviors, and you contact several care communities who assess but decline to admit, your parent will be added to the list of “declined” residents. This will make it more difficult for a parent to be accepted by a care community.
When I was a care manager, medical power of attorney, and guardian, I had clients who had extremely difficult behaviors. My staff and I worked very hard to work with the hospitals, nursing homes, and care communities to manage the behaviors so that my clients would not be subject to discharge from the facility.
Routine Nursing Home Discharge
Separate from behavior issues, being routinely discharged can mean that you or your elderly parent completed seven or more days in a nursing home.
Earlier discharges happen due to failure by a patient to participate and make progress in therapy or skilled services. A lack of measurable progress can end payments by the insurance company to the nursing home and result in discharge.
Patients and their family caregivers rarely understand the insurance qualifications for staying in a nursing home. A nursing home isn’t a place for a parent to hang out, so you, the caregiver, get a break from caregiving.
All patients in a nursing home for rehabilitation must work hard to get better, or they will be discharged.
Typically, patients are discharged when the initial 20 days of Medicare or Medicare Advantage coverage are completed.
If you are unsure if you or an aging parent can go home and live independently, Medicare offers another 100 days of care with similar qualifications that include participation in and improved results from therapy and skilled medical services.
So yes—nursing homes or rather the insurance companies that pays for care in a nursing homes— can kick you out.
Assisted living and memory care communities can do the same based on the information in their admission paperwork.
Read the Find Print in Admission Agreements Before You Sign
What do you do with the paperwork you or an elderly parent signed when admitted to the hospital, nursing home, or care community?
Don’t just sign it. Read it. Ask questions, and then edit or sign the agreement.
Older adults and caregivers are shocked when they learn about discharge from facility.
The details are all there, but few people read the agreements because they are so lengthy. A typical nursing home, assisted living, or memory care community agreement can be 40 pages long, requiring multiple signatures and initials.
Don’t sign for your parents if you are not the agent under a medical or financial power of attorney. Otherwise, you can become financially responsible for payment.
Nursing homes offer a 3-day notice before discharge. Assisted living and memory care communities can do the same.
Your parent might sign the form but forget to tell you. If you are the power of attorney agent, you should receive the 30-day notice of discharge to sign.
Learn About Health and Care Community Discharge from Facility Guidelines
If you or your parent is involved in the care system, it’s important to learn about the discharge policies so that you or an elderly parent are not shocked by a discharge from facility notice.
Specific to nursing homes, assisted living, or memory care communities, being attentive to staff concerns is important. If your parent’s behaviors are a problem for you, they’ll be a problem for other people.
Don’t ignore problems or issues because they have become routine for you. Caregivers are often more willing to accept circumstances from which anyone else would immediately run away.
It’s important to be realistic and plan for future health and care needs.
A large percentage of people over age 65 are hospitalized each year. Persons with dementia are hospitalized at high rates.
How will you deal with a hospital stay or a nursing home stay? Make sure you or your elderly parents have a plan to plan for being discharged from the hospital or a nursing home. Also, have a plan to avoid discharge if your parent lives in assisted living or memory care. One can never be too prepared for unexpected health issues.
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