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Help for the medically vulnerable.
The Legalities
The right of adults who have decision making capacity to make their own health care treatment decisions has been legally affirmed at every level of the U.S. judicial system—
• By case law.
• By state law.
• By the federal law, known as the Patient Self-Determination Act.
• By the U.S. Supreme Court in Cruzan v. Missouri Department of Health.
Hope you will update us as you go. We are thinking of your family.
So that you will have an overview of how complicated this could get, please read the history of the Terry Schaivo case.
I am not saying that will happen in your sister's case, but be informed if you can.
Now if the person suffers from dementia, and if there is some concern by social services that a discharge will put them in danger of neglect or abuse, we may be talking a whole other situation.
But under normal circumstances someone can leave medical facility at any time they wish to leave. I am afraid we may be missing some details in this question??? Might you give us further edification on the matter?
You need to personally see what has been set up for sisters care at home. Maybe sister can assign u POA just to handle this for her.
In the US if its considered an "unsafe" discharge, then by law the Rehab cannot release her. Her husband being bed bound means he is of no help. Are the children for bringing Mom home? For round the clock care you need to be sure the persons caring for sister are dependable. Again, also have to trained in trachs, catheters and wound care. CNAs are not medically trained so at least an LPN probably better an RN. Very expensive in the States.
How old are sister and BIL?
Your sister has MS, her husband is bed-bound and they are living in the US (Arizona).
Your sister is currently in acute care for a recent issue and wants to go home, but they are not discharging her because there is no capable person currently at her home. Your sister has a trach.
You are willing to provide the 24/7 care and they have financial means but you are currently in Costa Rica. So, there is no one in place to transport her and care for her once she gets home as of right now.
Is this a correct summary of the issues?
If your sister is mentally capable but cannot drive, and her husband is "bed-bound" and can't drive to get her, and no one can go get her and the center thinks she is an unsafe discharge because there won't be a capable person in the home to help her, then they are rightfully keeping her in place.
Why is her husband 'bed-bound"? Who is helping him while she is at acute care? This is a very confusing story so more info would be very helpful.
They can not discharge her to someone in Costa Rica that plans on coming when she gets home. What happens until you get there?
If one of her children opposes your presence I would bet they are telling the discharge planner that dad is bed bound and you are in another country, that would put a stop to discharge. As it should.
From what you've written, I wouldn't discharge her either. You have to go if you really are going to be her caregiver, there is no other way to make the hospital believe the plan except by implementing it.
And how is bed bound hubby going to care for her?
That doesn't make it a good idea, mind. Who is actually going to project manage this?
Who is in the home caring for the husband?
Wherever she is, they may need to send someone to your home to make sure that it is safe.
They said that she spiked a fever and needed antibiotics. I talked to her tonight and she doesn't have a fever I couldn't see any other than that. I have taken care of her for several months over the last 2 years. I facetime with her most every day I know my sister very well. I live in Costa Rica and I have made 12 trips to Phoenix the last 2 years and I am waiting to come back when she comes home. I have gotten pretty good with lip reading. I have been invited to come each time I go. My brother in law and my sister both want me and my wife to move to the states. I gave my sister my share of our parents estates so that she would have everything that she would need she isn't getting that now. I need some kind of help
She was home for 2 months and here sons were trustees of the estate one was steeling the money 2 million or so when he found out that his uncle was going to be in charge he made a story up well it was petty good with elder abuse services. It took some time to clear that up. in the meantime she went back to the hospital. Now she would like to die at home, in God's time, at home not in the home.
You can have all of the equipment and all of the services in place at the patient's home; but if her medical team believe that her needs can't be met outside the acute setting, and if the medical team has no way of determining what the patient's wishes are, then they are acting in her best interests by refusing to discharge her.
Do you have:
Her wishes set down in writing, for example in an advance directive?
Medical proxy, or power of attorney for health and welfare, or guardianship, or any other kind of formal, legal authority to make decisions on her behalf?
Her own word for it being currently expressed?
Other grounds for believing that she will be better cared for at home than where she currently is?
These situations are usually negotiable. What reasons are being given for refusing to discharge her home?
Why did your sister end up in the acute care center?
Why does she need 24/7 skilled nursing care?
Who has POA for your sister?
What reasons did the acute care center discharge person give for not releasing your sister?