Robin Schiltz, C.D.S.You knew your elderly parent wasn’t thrilled about moving into a skilled nursing facility, but you had no other recourse. It’s not like you could fulfill their care needs in your home.
Each time you visit the nursing home, though, your parent talks about collecting their things and going home. Now you are worried – can older adults actually check themselves out of a nursing home?
A senior can check themselves out of a nursing home, unless they are under the care of a court-appointed guardian/POA or have been declared mentally incompetent. If either of these conditions apply, the family member or caretaker would decide whether to keep a senior in a long term nursing facility or care for them elsewhere.
This is a dicey topic with a lot of rules and regulations, but we’ll make everything clear for you in this post. Make sure you keep reading!
What Percentage Of The US Population Ends Up In A Nursing Home?
A 2017 study from the RAND Corporation has found that over half (56%) of Americans age 57 to 61 will use a nursing home at some point during their lifetime. This is more than previous research suggested.
The rise in nursing home use may partly be a result of shorter stays. The RAND study found that nowadays people are staying in nursing homes for briefer periods. About 28 percent utilized these facilities back in 1998; by 2010, this number had risen to almost 34 percent.
One possible explanation for these shorter stays could be due an increase in certain types of skilled nursing care.
For example, those who receive rehabilitation services (like physical therapy) need less time to achieve effective results. They would leave an intermediate care facility more frequently compared with other medical conditions requiring round-the-clock monitoring (for example, in Alzheimer’s disease).
Can A Nursing Home Keep You Against Your Will? (USA)
When you first broached the idea of living in a nursing home to your senior mother or father, they probably gave you massive push back. I’ll bet they weren’t sure if they’d like it at the home, and the last thing they wanted to do was to be kept there against their will.
If that was the case, I’m sure you assured your parent that that wouldn’t happen, but now you might have started to wonder. Once you’ve signed a person into a nursing home in the United States, can elderly patients freely leave should they want to?
Well, yes and no.
New residents in a nursing home will be physically and mentally assessed upon their arrival, as well as every single day thereafter for the duration of their time as a patient.
Besides these physical and mental checks, the healthcare providers and occupational therapists at the nursing home review a senior’s basic abilities and activities of daily living.
For instance, are they speaking clearly and coherently, or have they become uncommunicative? Are they taking their medication throughout the day every single day? Are they able to perform personal care, such as bathing and toileting or do they need assistance? Can they dress and feed themselves?
Everything above will factor into whether a senior is deemed physically and mentally capable enough to check themselves out of skilled nursing facilities.
In the US, the nursing home staff members can refuse a senior’s discharge if they believe the senior is a risk to themselves or others.
Unfortunately, it doesn’t take much to designate a senior with a lack of capacity to make their own medical decisions. Your family doctor could make that call, as could any licensed medical doctor.
A senior who is deemed mentally unfit to make their own decisions will require someone else to be their surrogate decision maker.
This person would obtain power of attorney through legal counsel so they could make decisions about medical care for the senior. The person who does so is usually a family member of the senior, like an adult child, but they can also be a caretaker
Once you have been granted powers of attorney, if you wanted the senior out of the nursing home at that point, you could get them discharged. You could also decide to keep them there.
Usually government programs, such as Medicaid or Medicare, pay for nursing home care, so an unscrupulous nursing home could refuse to discharge a senior for nefarious reasons.
For example, if the nursing home isn’t financially solvent, the staff might bully elderly folks into staying so they can continue to collect monthly payments.
If the senior has proven that they’re physically and mentally competent, though, the nursing home staff should not be able to stop them from leaving. Should the nursing home try to coerce the senior into staying, they could have grounds for a lawsuit.
Can A Person Sign Themselves Out Of A Nursing Home? (UK)
What if you and your senior parent are based in the United Kingdom instead of the US? From our research, it appears that many of the same nursing home rules apply.
If a senior pays for their own care (or has insurance cover the cost of their care) and they’re deemed healthy per the UK’s Mental Health Act, which was passed in 1954, then they’re free to leave care homes as they please.
According to the Mental Health Act rules, “the Act was designed to make treatment for mental disorders voluntary and informal, to clearly define cases in which compulsion to treatment may be necessary, to give a proper legal framework for that compulsion, and–as much as possible–to shift care from institutions to the community.”
The UK National Health Service or NHS updated the Mental Care Act in 1983 and then again during the coronavirus outbreak of the early 2020s.
Under the Mental Health Act, senior patients can be detained in a nursing home if the staff there believes they “are at risk of harm to themselves or others,” per the NHS.
Leaving A Nursing Home Against Medical Advice
In nursing homes and other assisted care facilities, you’re likely to sometimes hear the term “against medical advice” or AMA. This is also sometimes referred to as “discharge against medical advice” or DAMA. We’ll call it AMA for the duration of this article.
As the name implies, AMA refers to a situation in which an adult leaves a medical facility despite the recommendations of a licensed physician or other health care providers. AMA does not only apply to nursing homes but can include hospitals as well.
The reasons a senior might decide to leave a nursing home AMA can be many.
They might not like the nursing home and feel like another facility would be better suited for them. They could decide that the care provided at the nursing home is not up to their standards. They might be enduring abuse or neglect.
Some nursing homes will threaten the elderly and tell them that if they leave AMA that they could face financial repercussions and that their Medicare will no longer cover them.
That’s more than likely not true though. It’s just another scare tactic the nursing home staff will use to keep a senior at the facility.
According to a 2012 report in the Journal of General Internal Medicine, Medicare denying coverage to AMA patients happens rarely. Their study occurred from 2001 to 2010 and involved 46,319 participants, the ages of which were not disclosed.
Of that group, 526 of the patients left the hospital AMA, which was only 1.1 percent of them. Up to 4.1 percent of those patients were not approved for Medicare payment after their AMA exit from the hospital.
However, this might be more coincidental than anything.
The study reports that administrative errors were the top reason the 4.1 percent of patients were denied Medicare coverage and that no Medicare provider outright stated that the patient’s leaving the hospital AMA was the reason.
Does that make leaving a nursing home or hospital AMA a good idea? No. You’re in a care facility for a reason, to receive treatment. Assuming you can treat yourself better at home or elsewhere historically does not end well.
Many patients who leave a medical facility AMA are likely to be readmitted due to ongoing health issues. Their rate of death might also increase according to another report from the Journal of General Internal Medicine, this one from 2010.
How Do You Get Someone Out Of A Nursing Home?
Perhaps your senior mother or father aren’t the only ones who are displeased with the care services that are being provided. Maybe conditions at the nursing home aren’t up to state standards.
Whatever the reasons, if after several visits, in which you’ve spent hours at the facility and kept a close watch on things, you might have decided that your parent doesn’t belong there.
Whether you want to move your senior parent to a more highly-rated nursing home, you want them in an assisted living facility, or they’re going to move in with a sibling or family member, how do you get them out of the nursing home they’re currently in?
Here are our tips.
Have a Plan
Although it can be especially unsettling when your senior parent is being abused, neglected, or mistreated at a nursing home, you’ll still want to give the nursing home advance notice that you’re removing your loved one from the facility. That gives you time to arrange for the continuation of medical services.
After all, you really shouldn’t rush your parent out without some type of care plan.
If they need occupational therapy, a physical therapist, or some type of skilled nursing care, how will you provide for these health services? What is the plan to take care of any chronic medical conditions or possible palliative care?
Another important factor to consider is if you don’t have alternate living arrangements for your senior parent, then the chances are good they’ll end up living with you.
As we talked about earlier in this article, it’s not always feasible for senior parents to live with their adult children. Among other things, there can be concerns about issues such as whether you can provide appropriate care, having a lack of space or even a lack of finances.
For example, when my mom was in her last few weeks of life, my father wasn’t in the greatest physical health. She couldn’t transfer herself from her wheelchair and he wasn’t strong enough to keep her from falling.
If he had been her sole care provider, it would have been dangerous for both of them. In this case, we hired extra help in the form of a home health aide so Mom could safely receive palliative services in her own home.
It’s fine if you can’t move your senior mother or father in with you, but you must have arranged for them to go elsewhere before they leave the nursing home.
Work with the Nursing Home
The nursing home staff should help your senior prepare for their departure. The senior (or you as their guardian) might have to sign paperwork discharging the senior from the nursing home.
The staff might assist with packing the senior’s belongings, as well, but don’t plan on it.
Even if you didn’t have the greatest experience with the nursing home, unless in cases of abuse and neglect, then be amiable. You won’t have to deal with the nursing home staff for very much longer anyway.
In the case of nursing home abuse or neglect, you should document everything and seek legal recourse as soon as possible before records or other evidence can be destroyed.
Prepare the Senior’s New Living Quarters
The whole reason you considered a nursing home for your senior in the first place was due to their declining health. You now must ensure their new living quarters are designed for them. Handrails and guardrails will help your senior parent get around more easily.
You also might have to add ramps, shower seating, and smart technology that responds to voices so your senior can control the thermostat, lighting, etc. without having to get up.
Conclusion
Living in a nursing home is a fate many elderly people face, but it’s not the best choice for all seniors. If your senior parent is trying to leave their nursing home on their own, don’t allow them to do anything rash. Sit them down and find out why they want to leave.
If it’s a matter of receiving poor care or if they’re being abused, then you shouldn’t want your senior parent in that situation either. You can act as the senior’s guardian and make decisions on their behalf if necessary.
We hope this guide helps you navigate the tricky situation that can result if a senior wants to leave a nursing home!
