During my 25 years of practicing elder law, I have regularly encountered families whose loved one with dementia has taken a fall and been admitted to a hospital. As the patient recuperates from his or her injuries, the family comes to me at a time when the discussion is about whether their loved one will return home or enter a care facility.
In some cases, the loved one does return home. Unfortunately, when an older adult has dementia, the risk of subsequent falls increases significantly. Another hospitalization could be on the horizon and then the question becomes…. “Can the older adult with dementia return home safely, or is a long-term care facility the wiser choice?”
The answer to this question will often come down to discharge planning at the hospital, along with input from the family of the older adult. Good hospital discharge planning is intended to ensure that the older adult does not have a readmission. Developing a plan to discharge the patient to the right environment will help ensure that a readmission does not happen.
By the time I meet with a family, they have often already faced multiple issues with the care of the older adult. They have attempted to address the physical and mental challenges with home care, primarily with family members and often supplemented with hired caregivers.
During the discussion of the hospital discharge plan, the family members need to ask themselves honestly if they are able to continue to care for the older adult at home. Has the dementia of their loved one increased to such a degree that the adult is likely to suffer injury again due to poor decision making? Have the care needs of the older adult increased so that the spouse can no longer provide the care that is needed, such as transferring them out of bed or a chair? Keep in mind that the role of a caregiver is taxing, particularly on a spouse who may have health issues of their own.
The hospital cannot force a family to take the older adult home if they insist that appropriate care cannot be provided due to the limitations of the caregivers at home. The family can insist that the older adult be admitted to a facility. Placement options could include assisted living, where adults with dementia can get assistance with memory care services along with supervision and medication monitoring. For those that need a higher level of care (such as a nursing home), the older adult will need to be evaluated to determine how much help they require with the activities of daily living, such as getting out of bed, dressing, toileting, bathing and eating.
Assisted living, also known as personal care, is typically private pay. Unless the resident is a Veteran or has long term care insurance, the resident pays privately. Most facilities will want to ensure the residents can pay for their care for at least a three-year period. While nursing homes are more expensive, Medical Assistance is available to help pay for the resident’s care. The source of payment for a person’s care does not determine the quality of care at a nursing home.
If the decision is made to admit the older adult to a nursing home, the family will be allowed to choose which one. If the family can locate a facility close to them, they need to call ahead and make sure a bed is available, and then work with the nursing home admissions office to coordinate the discharge to that facility.
The admissions office will have questions about payment for care. If the prospect of paying privately for nursing home care seems overwhelming, the family needs to reach out to an elder law attorney. The elder law attorney can counsel the family about qualifying for Medical Assistance and preserving as much of the individual’s savings and assets as possible for the spouse and children.
