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Old 02-25-2013, 10:34 PM   #1
hereyago
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Why do some medical professionals think patient rights are more of a guideline:vent

My mom is 79 and near the end of her life and still ;here" mentally. she has stated she doesn't want hospice more then once at different times. I am her durable poa and medical directive. She doesn't believe she is near the end because she has come close many times etc and her narcisstic personality disorder are still very much here as well. She is in hospital now and i have had a very rude dr and a case manager call me and say that she needs hospice or skilled nursing and she refuses both. Last time she was in skilled nursing, she cane honr in december weighing seventy two lbs. And had a wound where you could see a bone becausr their idea of wound care was to rinse it out with wound wash and put gauze over it. The ones around here at 4 i know of are crappy. so they think another one will make her eat ,nope. And the wound was healing,but she got cdiff and hospitalized and cane.out with dead tissue and bigger wound. She is on a special hospital bed. I get that they have to give opinion, but she has the right to refuse.
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Old 02-25-2013, 10:44 PM   #2
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Originally Posted by hereyago View Post
My mom is 79 and near the end of her life and still ;here" mentally. she has stated she doesn't want hospice more then once at different times. I am her durable poa and medical directive. She doesn't believe she is near the end because she has come close many times etc and her narcisstic personality disorder are still very much here as well. She is in hospital now and i have had a very rude dr and a case manager call me and say that she needs hospice or skilled nursing and she refuses both. Last time she was in skilled nursing, she cane honr in december weighing seventy two lbs. And had a wound where you could see a bone becausr their idea of wound care was to rinse it out with wound wash and put gauze over it. The ones around here at 4 i know of are crappy. so they think another one will make her eat ,nope. And the wound was healing,but she got cdiff and hospitalized and cane.out with dead tissue and bigger wound. She is on a special hospital bed. I get that they have to give opinion, but she has the right to refuse.
Sorry to hear about your mom, it must be difficult. She has the right to refuse care but the hospital isn't obligated to keep her there if they feel it isn't medically necessary, insurance or medicare will not pay for it. If they discharge her, you'll need to find somewhere for her to go.
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Old 02-25-2013, 10:45 PM   #3
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What does she want to do and what do you expect to be done? Basically her options are a nursing home or going to her home and having 24 hour care. DH is a PCP and that is what he said he would do. At least from the info/ situation you are describing.
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Old 02-25-2013, 10:50 PM   #4
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Sorry to hear about your mom, it must be difficult. She has the right to refuse care but the hospital isn't obligated to keep her there if they feel it isn't medically necessary, insurance or medicare will not pay for it. If they discharge her, you'll need to find somewhere for her to go.
I agree. I am sorry you'er having a hard time OP. But I don't understand your exact complaint. Are they saying she can't go home, but must go to a different facility? Are you willing to take her home with you? Or to another family member's home? You really can't just expect her to stay in the hospital if she doesn't need acute care.
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Old 02-25-2013, 10:58 PM   #5
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Sorry to hear about your mom, it must be difficult. She has the right to refuse care but the hospital isn't obligated to keep her there if they feel it isn't medically necessary, insurance or medicare will not pay for it. If they discharge her, you'll need to find somewhere for her to go.
yes i am aware lol. She will be coming home, she will eat for me unfortunately all the protein that goes in her to heal the wound. She has refused feeding tube. She does have home health cone.out for the wound.
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Old 02-25-2013, 11:05 PM   #6
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I agree. I am sorry you'er having a hard time OP. But I don't understand your exact complaint. Are they saying she can't go home, but must go to a different facility? Are you willing to take her home with you? Or to another family member's home? You really can't just expect her to stay in the hospital if she doesn't need acute care.
Where did.i say.i expect her.to.stay there forever lol . My complaint is she has told the dr no, that should have been the end. Then he calls me, i tell hin the same thing, then today care director calls with same discussion. So that is 3 times of the patient and me her representative saying no. what part of patients having the right to refuse is hard too understand.
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Old 02-25-2013, 11:10 PM   #7
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As for medicare, they would not pay because there has to be 60 days of facility free time including hospital s and she has not been 60 free. Which i didnt know until after the director told me. Not sure about tricare, but she doesn't want to go and considering the last i cant blame her.
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Old 02-25-2013, 11:17 PM   #8
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What she says is one thing.

What is in writing...and does the hospital have a copy? Does she have advanced directives? What about a living will?

Sorry that you have to deal with this!
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Old 02-25-2013, 11:18 PM   #9
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Where did.i say.i expect her.to.stay there forever lol . My complaint is she has told the dr no, that should have been the end. Then he calls me, i tell hin the same thing, then today care director calls with same discussion. So that is 3 times of the patient and me her representative saying no. what part of patients having the right to refuse is hard too understand.
Oh, I'm sorry to have upset you further. I misunderstood what you meant. Of course, if your mom & you have told them she would be going home, that should certainly end any discussion of other facilities. They should start planning for home care & that's it. I hope they finally got the message & you get the help you need to care for her at home.
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Old 02-25-2013, 11:18 PM   #10
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Originally Posted by hereyago View Post
Where did.i say.i expect her.to.stay there forever lol . My complaint is she has told the dr no, that should have been the end. Then he calls me, i tell hin the same thing, then today care director calls with same discussion. So that is 3 times of the patient and me her representative saying no. what part of patients having the right to refuse is hard too understand.
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As for medicare, they would not pay because there has to be 60 days of facility free time including hospital s and she has not been 60 free. Which i didnt know until after the director told me. Not sure about tricare, but she doesn't want to go and considering the last i cant blame her.
I'm with the PPs. I don't see where your mother's rights as a patient have been trod upon. The hospital staff, in their own round about way, is telling you that your mother needs to be moved out of the hospital. They're giving the options that they have available to them. But you and your mother are within your rights to take her into your home instead. The hospital just wants that to be sooner rather than later. I imagine that you will continue to hear from them about moving your mother until she leaves the hospital.
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Old 02-25-2013, 11:35 PM   #11
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I'm with the PPs. I don't see where your mother's rights as a patient have been trod upon. The hospital staff, in their own round about way, is telling you that your mother needs to be moved out of the hospital. They're giving the options that they have available to them. But you and your mother are within your rights to take her into your home instead. The hospital just wants that to be sooner rather than later. I imagine that you will continue to hear from them about moving your mother until she leaves the hospital.
once again it should not take 3 times of us knowing the options and opinions and saying no. No means no. having to refuse 3 times was 2times uncalled for. It doesn't say in patients rights:must take 3 times. Lol
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Old 02-25-2013, 11:48 PM   #12
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What she says is one thing.

What is in writing...and does the hospital have a copy? Does she have advanced directives? What about a living will?

Sorry that you have to deal with this!
Yes she has living will, but she didnt write hospice that was something we had talked about a few times and honestly didnt thiink about adding it. As for skilled nursing thing, that wasnt added either because she just got out of one in December. However they have copies if all the paperwork.
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Old 02-25-2013, 11:54 PM   #13
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once again it should not take 3 times of us knowing the options and opinions and saying no. No means no. having to refuse 3 times was 2times uncalled for. It doesn't say in patients rights:must take 3 times. Lol
No, 3 is the magic number in sales.. Push until you hear 3... Lol..

On a serious note, I am sorry you and your mom are going through this. Assistance living, nursing homes can have many affects. Good and bad. I know with my grandma it actually helped her for a few years. But from what you have said you don't have any good choices. Which is hard. I am shocked that they took care of a wound that way. If you can have her home with you or a relative maybe she would be more comfortable.

My suggestion for the Dr and staff. Address them in a way "my mom and I talked we want her to go home so how do we go about to set up in home nursing care?" Be direct with them in what you and your mom want and have them give you the resources to make it happen.

Best of luck to you and your mom.. Hoping for a speedy recovery.
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Old 02-25-2013, 11:54 PM   #14
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once again it should not take 3 times of us knowing the options and opinions and saying no. No means no. having to refuse 3 times was 2times uncalled for. It doesn't say in patients rights:must take 3 times. Lol
It doesn't say that they should stop trying, either. The patient (or their representative) can continue to refuse the hospital's options. The hard facts are that they are not being paid for the time that your mother is occupying a bed. And in their opinion, she does not need the acute care that hospitals provide. They are trying to get her moved to a place where she can be given the level of care that she needs. So while your and your mother have said no three times, they are going to continue to contact you about plans to get her moved. It can be frustrating to deal with. My SIL had to cope with it over and over again with her father. At one point, the hospital discharged him and had him sitting in a wheelchair in the lobby until she could make arrangements for him to move to a long-term care facility. The private nursing home that he had been living in prior to his hospitalization refused to take him back (something about Medicare and payments).
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Old 02-26-2013, 12:39 AM   #15
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Where did.i say.i expect her.to.stay there forever lol . My complaint is she has told the dr no, that should have been the end. Then he calls me, i tell hin the same thing, then today care director calls with same discussion. So that is 3 times of the patient and me her representative saying no. what part of patients having the right to refuse is hard too understand.
The patient has a right to refuse treatment, but that's not what they're asking. They are no longer getting paid for her care, so they're telling her she needs to leave the hospital. That, she has no right to refuse. The skilled nursing facility and hospice are just suggestions for places she might go. They're being low-key about it now, but eventually, they're going to insist that you take her out of the hospital.

If you and she are agreed that she should be cared for at home, then talk to the care director and start making arrangements for her discharge. They will set up a discharge plan, and help your find resources to help with her home care.

One thing you might look into is hospice at home. My friend's dad did that, and it worked out very well. It was provided at no charge by their county. The hospice nurses came by the house every day to provide whatever medications were needed to keep him comfortable, and were always available by phone for questions.
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