Do patients ever transfer to a nursing home from the ER instead of getting admitted as inpatients?
As my parents are getting older I want to make sure that I have more knowledge on how to take care of them. So is it possible they would get transferred to a nursing home if they end up in the ER somehow?
Answers ( 2 )
Sometimes, but only under certain circumstances.
First most Skilled Nursing Facility (SNF or "nursing home") Patients or Residents are seniors, and on Medicare. When your insurance is Medicare, in order for you to access your SNF care yearly benefit of 100 days of skilled care (which includes your hospital stay), you must have a 3-midnight qualifying stay in a hospital; so, absent something rather odd going on, an ER patient would not be able to access their Medicare to pay for a SNF. The ER knows this, of course, and if it was at all possible, if they could swing it- the medical issue such the person needed skilled-but-not-hospitalized care- the person would be admitted for those three midnights, then discharged to a SNF.
But that isn't the norm. The norm is at least that three-midnight stay because that type of care- in hospital- is needed.
Now, sometimes, a person who is already in a SNF as a long-term Resident gets ill or falls and injures themselves, and is shipped to the ER. In this case, a bed-hold is placed on that Resident's room, for 24 hours, after which they are discharged from the facility into the hospital's care. The Resident is likely already Medicaid (SNF care is very expensive, running an average $7000 a month in the US) and so some other rules come into play- the Resident has already been approved for long-term care, and does not need a three midnight qualifying stay to come back "home", although with a three-midnight stay, Medicare can kick in and provide additional therapy, which is always nice. **
Also, if the person has the means and/or insurance and does not need further hospitalization, but may need therapies and skilled nursing, it is possible a SNF might take the person. This is less common, as private insurers are loathe to pay and try their darnedest to wriggle out of every penny, so SNFs are somewhat wary of accepting such a Patient. But, if the SNF has low census (butts in beds), they likely would, just to get their numbers up.
And of course, private pay- the creme de la creme- is taken 24 hours a day, and charged all they can bear, so would be taken straight from the bar, if it came to it.
Reading your question, it appears you may be laboring under the misconception adults in the United States of America who have not been adjudicated as needing a Guardian, can somehow, against their will, be placed in a SNF. Nope. Every person over the age of 18 years in the US keeps all of their rights- including that of free movement and to refuse medical treatment- even in a SNF- until they die, or are adjudicated as incapable of making their own decisions. If your folks go into an ER for something, they- or their spouse/Health Care POA- get to say what happens.
If you have any more questions, please don't hesitate to ask- that's what comments are for.
** If the Resident has not been... a good Resident- lots of falls, complaints, nastiness- the Facility does not have to re-admit if they can plausibly say there are no beds. But that doesn't happen much. Even a 'bad' butt in a bed is better than not enough butts in beds.
Regarding knowledge on how to care for your parents as they age, see below. I will first address the question of patients being admitted from ER to a nursing home. Then I will talk about a more realistic approach to caring for your parents.
Jurisdiction may be important with regards to hospitals and how ERs handle patients. J Starr's answer obviously applies to the United States where patients of certain income levels must pay for hospital stays. But in many countries, hospital stays are paid for by the government. I'm in Ontario, Canada. I was told about a man who could no longer care for his wife. The eighty-year-old husband was discovered weeping in the lobby of his building by another tenant. Herself a senior by now, this other tenant had a lot of experience working with seniors through Red Cross earlier in her life.
When the weeping man shared his problem, she told him, "Take her to ER. Leave her there and they will have to take care of her."
I don't know the details of how that story ended. However, much more recently, I was involved in finding a nursing home bed for a friend of mine who was struggling with advancing Alzheimer's. What I learned in that process is that nursing homes do not have empty beds. In other words, I am not sure how the hospitals can possibly send people there from ER.
However, in my county there is a hospice of some kind where people sometimes go to convalesce when they are well enough to be out of the hospital but not good enough to be at home. These are not terminally ill people but people who need more care than they have available in their own homes. I am quite sure the government pays for stays at this place. I can see a person like the above man's wife being sent there until a bed becomes available in a nursing home.
Re Old Age: Be Proactive
Find a Nursing Home Before it's Needed
Another thing I learned via the process of seeking a nursing home for my friend was that one should look for and place one's name on the list for a nursing home long before it's needed. Waiting lists for the best nursing homes are five to ten years long in my county, I was told. She eventually got in on short notice through her caseworker's recommendation that the case was critical.
Know What Seniors' Programs Exist Locally
So how should you prepare yourself? The best advice I know is to be aware of the programs for seniors in your area. Your parents' doctor should know what programs exist. Or the nearby nursing home, if their doctor doesn't. I had been advised of a local program when I talked to others about my concerns for this friend. But I wasn't responsible for her at the moment. Then the person with whom she was living got serious health issues and could no longer be responsible. I told him to put her on this program (I had told him before but he hadn't done it) and he said he just called them. I contacted the program and got satisfaction that she was on it, though they could not give me actual information due to confidentiality. Later, with my friend's permission, I was given access to confidential information.
Sign Power of Attorney While Healthy
I can't emphasize enough how important it is to do these things, and get power of attorney signed, before a person is disabled by Alzheimer's or other serious disabilities. A stroke can also leave a person unable to talk or communicate wishes and sign papers. One concern people may have with signing power of attorney (POA) forms while they are still healthy is the fear that their POA will take over while they are still healthy. Not so. Insert, or make use of, the clause that a doctor's written statement is required for the POA to take effect.
Set up POA to Require Doctor's Statement to Access Your Assets
This applies more for the person making out their own POA. However, you can also protect yourself against claims/accusations (e.g. from other family members) of fraudulent access if you help your father and/or mother insert the clause. They should each have a POA.
This may seem overly formal, like you don't trust your family members, but it can also save a lot of heartache when things go wrong. It can prevent things from going wrong; we never know the power of temptation until we are exposed. Being in possession of a POA can present a powerful temptation. In the end, all of us are just human. Put the clause in and go on in life. If anyone resents it, you can probably be sure that this person is not exactly trustworthy. You may want to entrust the care of your assets to another person. (That is just my opinion.)