Yes, you can check yourself out of a nursing home if you are mentally competent. If you fear that your nursing home will deplete the insurance approved for maximum stay, then leaving against medical advice (AMA) is the only option. However, the nursing home may intimidate and discourage you from leaving AMA and insist that you be liable for your total bill.
Knowing Your Rights As A Nursing Home Patient/Resident
There exist some state and federal laws that help to safeguard your rights as a nursing home patient. You will protect your loved ones and yourself if you know what to do when a nursing home violates your rights. Here are some of them;
Federal laws prohibit nursing homes from discriminating against protected classes. They will not treat patients according to their color, religion, race, sex, age, or any other protected characteristic. If you suspect that your nursing facility has violated any of the above rights, report to your state’s agency regulating nursing homes. You can also write to the long-term ombudsman in your local government.
A qualified nursing facility should state in writing its services and the chargeable fees before a patient moves in. The nursing home cannot impose a buy-in fee for patients to change into another facility if the need arises.
Upon Admission Into A Nursing Facility
Once a patient gets into a nursing home, he/she undergoes a health assessment that continues daily for the full length of stay. The doctor and other staff evaluate the patient’s mental and physical health. They also look at the patient’s ability to manage daily chores such as eating, dressing, bathing, medications, and the ability to make decisions and speak.
Medical practitioners use these assessments to plan for treatments and evaluate your progress. These examinations also help to determine your eligibility for medical coverage. Nursing facility residents are permitted to take part and weigh in on their care plan. If you cannot do it, a trustable person such as a sibling or an adult child may participate on your behalf.
Humane Treatment In A Nursing Home
According to federal laws, a nursing facility patient has a right to be treated with respect and dignity. You can decide when to wake up and go to bed, when to eat, and carry on with the day’s activities. These decisions must, however, not conflict with the care plan.
Staff should not physically or verbally abuse patients. They are also not allowed to administer medicines outside the treatment plan or restrain the patients physically if their activities do not endanger others.
Patients should not be involuntarily isolated from others, and their properties must not be taken or used. Other residents or visitors should not be allowed to use or take one’s items. A patient has the right to personal property and privacy, such as the opening of mail and a right to phone conversations.
One can receive visitors at reasonable times and also prohibit visitors. A patient’s relatives will have access at any time unless one doesn’t desire it. The nursing facility should also be responsible for the patient’s behavior towards each other to avert trouble.
Although a nursing facility can offer to manage a patient’s funds, it is not a requirement. The nursing home cannot act as a financial custodian without the written consent of the resident. In case the facility is authorized by the resident to manage the funds, it must give quarterly financial statements.
The resident will still have a right to access his/her bank accounts, financial documents, as well as cash. If a patient deposits over $50 into a managed account, then the resident must be paid some interest from such deposit.
Patients have the right to know what they are ailing from, even if they are in poor health, be it mental or physical. They should also know their prescribed medications and see their medical records.
Patients may continue to see their doctors or decline the services of a resident practitioner. They may also refuse the medications and treatments that outpatients get. If a patient needs legal, financial, or mental counseling related to the drugs, the facility must offer these services.
A nursing home is not supposed to keep track of the Medicare benefits used for a resident’s care. Medicare coverage covers a stay entirely for a particular period and pays a set amount for extra days. This kind of payment is under certain conditions, and then the resident is responsible for the total bill if they don’t have long-term care insurance. The facility should not inform a resident when the benefits period is ending and can continue to charge them for their services.
However, there is an exception if the initial benefits stop earlier than expected due to the care being termed as medically unreasonable or unnecessary. A nursing facility is expected to notify the patient’s resident about the stoppage of the coverage, why it is ending, and when. The patients also need to be informed that they will cater for further costs and how much. A facility will also not require a patient’s care to be paid for by another family member.
When Leaving The Facility
Nursing facilities need to help a patient with the discharge plan. They are not supposed to transfer patients to other nursing homes or to discharge them without their consent. If they do, then they must first meet any of the following criteria;
1. A patient’s health has declined so much that the facility can no longer cope with their needs
2. one has fully recovered and does not require the facility’s services any more
3. If a resident poses a threat to his/her welfare or that of other patients
4. If a resident is not paying the facility’s bills, they can be discharged. An exception is if the delinquency results from a delay in Medicaid payments
How Long Can A Person Stay In A Nursing Home?
According to the National Care Planning Council, a resident can stay in a nursing home for 835 days. For those who have been discharged, including those on short-term rehab care, the average stay is 270 days. The following table shows the cost covered by Medicare for the number of days stayed.
Cost covered in nursing home VS numbers of days stayed
|Number of days||Cost covered by Medicare|
|1 – 20||The full cost of treatment|
|21 – 100||Everything except a daily co-payment|
|Above 100||No cost covered|
What Are The Consequences Of Leaving AMA?
Physicians may frequently inform patients who leave the hospital AMA that they will be liable for finance charges. However, it is not clear whether or not insurers such as Medicaid and Medicare will decline to pay the hospitals under such circumstances.
Patients who leave a nursing home against medical advice are at a higher risk of readmission. They are also more likely to incur extra expenses on medical care. Studies also show that those who discharge themselves AMA are highly likely to die early or experience morbidity.
Can A Suicidal Patient Leave AMA?
Studies show that between 6% and 35% of voluntary psychiatric residents leave the nursing home AMA. The patients usually have severe symptoms or are acutely ill at discharge. Residents also have high rates of readmission and bad outcomes than those who don’t leave AMA.
If a mentally challenged resident demands to leave the facility AMA, there will be a conflict between the psychiatrist’s duties and the patient’s rights. A mental patient discharged against medical advice (AMA) may be dangerous and can pose liability risks to healthcare providers. Such factors make decisions about AMA releases difficult, and they need to be handled carefully.
A patient who is not in an altered mental condition and who is of sound mind has a right to decline medical treatment. If the individual is found not to pose any danger to others and themselves after a psychiatric assessment, they may have a right to refuse treatment. But, if the resident is seen to pose threats to themselves or others, they will not be allowed to check themselves out.
Can A Nursing Home Hold You Against Your Will?
There is no doctor, physical, occupational, speech therapist, or a nurse who can force you to stay anywhere against your will. While many elderly patients leave hospitals with profound weakness and will need extra help, no one can hold them back.
A patient who wants to go home against medical advice has the right to if they have the capacity to make their own decisions. They can also be allowed to go home if they have a surrogate decision-maker to authorize a discharge against what the medical team recommends.
If, however, a patient cannot make medical decisions, the powers of attorney (POA) can force you. You will go where your POA wants regardless of whether you like it or not. Any licensed physician, hospitalist, or a family doctor could decide for you. Your surgeon or even dermatologist can document your lack of capacity to make a medical decision.
In case you have no POA and are incapable of decision making, a court assigns a guardian. The guardian could be through the guidance of a family or a lawyer who knows nothing about you.