What Happens When You Leave a Nursing Home Against Medical Advice?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

When you hear the dreaded words, “I want to leave,” you know in that instant that going home may not be feasible. Your loved one’s home is long gone, and the care they need isn’t available anywhere else. The thought of taking care of a family member in your home does not inspire confidence or may be impossible to achieve.

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The conditions that brought your family member to a nursing home are most likely ongoing and long-standing. Even with long-term care planning in place, you may want to take a closer look at their medical condition and think about the possibility of improvement at a different location outside of what you have considered.

Perhaps your family member can no longer dress themselves, transfer, shower, or eat without assistance, which are all signs an aging adult should not live alone. Perhaps they are in need of advanced medical care like catheters, IVs, wound care, and more. What do you do?

Start by taking a deep breath and staying calm. Have a positive attitude and think about how you can manage this request.

Why Would a Resident Want to Leave Against Medical Advice?

There are several reasons a resident would want to leave a nursing home against medical advice, and many of these reasons are legitimate. The family’s challenge is how to decide if a loved one is unhappy where they are or if they would be unhappy anywhere but back home. 

It is important to remember to take all complaints and feelings seriously. Acknowledging your loved one’s distress with compassion will help keep them calm and open to ideas. Here are some of the common reasons people want to leave a nursing home.

Inadequate care and attention

Nursing homes are struggling to provide adequate care and comply with safety protocols during COVID. Unfortunately, this was a problem pre-pandemic due to staff numbers and has only come into greater focus now. Some of the stories coming out of nursing homes have been horrifying and tragic. 

If your loved one is complaining about not getting enough care, they could be right. Common complaints from nursing home residents are being left in soiled clothing, not responding to call buttons, infrequent bathing, and not getting assistance with eating and drinking. Dehydration is also a common problem in nursing homes.

Loneliness

Although many nursing homes offer various activities for residents, it can be difficult to access these activities if someone is bed-bound or can’t transfer without help. During quarantine, most nursing homes across the country have had a moratorium on visits. In many cases, families have not personally interacted with a loved one in months.

It is hard to imagine how devastating this must be for people who already might feel neglected or abandoned. Make sure you are using everything you can to stay in touch with your family member. Ask the staff to coordinate calls and virtual meetings.

Wanting to go home

Sometimes a loved one wants to leave a nursing home and go back to their home. People who have dementia may not remember why they went to a nursing home and why they have to stay. Even after repeated efforts to explain, due to memory problems, they forget and ask to go home. Despite your continued efforts to explain how and why this happened, it may never get through. 

Afraid of dying

People often think of nursing homes as the last place they will live, and that they will die there. In a 2018 study in nursing homes over three years, about a third of all residents died there over that three years period.

So, this fear has a basis in reality. If someone is in a nursing home, their medical problems are significant enough to warrant a very high level of care. Many conditions that bring people to nursing homes are terminal in nature. 

Can Nursing Home Residents Leave Against Medical Advice?

Unless a nursing home resident is under guardianship, they can request to leave against medical advice. If you are the guardian of the person making the request, you can legally prevent them from going. If the person has recovered sufficiently to be cared for safely in another environment, they can leave.

But in many cases, a nursing home will state that leaving is against medical advice so that they are not liable for any illness or injury after leaving. A nursing home will make every effort to prevent someone from leaving against medical advice.

What Happens If a Resident Leaves a Nursing Home Against Medical Advice?

A person leaving a nursing home against medical advice has to have a place to go. Although it has happened, it is against the law to discharge someone to live on the streets. Even if they go to a homeless shelter, that is considered a legal discharge.

If possible, find out exactly what medical conditions are of most concern in saying that it is against medical advice to leave. Ask for copies of all medical records and care reports. If you do end up moving a loved one, you want a clear picture of the kind of care they will need.

As a family member, if you refuse to find appropriate and safe accommodations for a loved one who leaves against medical advice, you could be accused of elder abandonment or abuse which is a federal crime. Work with social services staff at the nursing home to find a temporary place until you can find a more permanent placement.

If your loved one’s capacity is in question and leaving would threaten their safety, consider petitioning the court for emergency guardianship to prevent them from leaving if you have no other recourse. Consult with an attorney to see if you have a viable case for emergency guardianship.

Tips for Convincing a Nursing Home Resident to Stay

Convincing someone to stay in a nursing home without trying to solve the problems is unethical and dangerous. Don’t assume that the complaints are an attempt at gaining attention or that they are exaggerated. Try going through these steps to convince your loved one to stay.

1. Take all complaints seriously

Listen carefully to what your family member has to say about their care. An empathetic and caring approach will help your loved one feel that they can trust you to make things better.  Sometimes all someone wants is to be heard and taken seriously. 

2. Be proactive in solving problems

Start by making a list of all of their complaints and problems. Then, work to identify who is responsible for solving those problems at the nursing home. Cleanliness issues are housekeeping, and medical problems should go to the director of nursing. If there is a problem with aides responding to the call button, talk to the aide supervisor.

The frustration of dealing with overworked staff in a nursing home can be a challenge. Try to be kind but firm in your resolve to solving problems. If necessary, make a complaint to the long-term care ombudsman about any serious safety issues.

3. Be honest about the challenges of moving your loved one

Be completely honest about the level of care required to move your loved one somewhere else. It is easy for someone to start growing accustomed to the level of care they need without realizing how much it takes.

Let your family member know the details of taking care of them, from durable medical equipment to hiring a nurse and the expenses associated with care outside the nursing home.

4. Investigate Medicaid Waiver options

If your loved one is on Medicaid, investigate Medicaid Waiver Options or other programs that would allow them to move to an assisted living facility paid for by Medicaid. This option could take some time to find out if it is available. However, if your family member could be safely supported in a less restrictive environment, it might be worth the effort.

5. Be an advocate

Being an advocate now is a big challenge, but with enough creativity and focus, very possible. One solution is to hire a private caregiver for your loved one to augment care in the nursing home.

A professional caregiver can provide companionship and report back to you on any problems. They can also help coordinate virtual visits with you and the rest of the family to help alleviate loneliness.

6. Offer to find a different nursing home

If you are unable to solve problems at the current nursing home, consider another nursing home. The risk is that the next one might have the same issues, or the one you like doesn’t have any beds. At least offer this as an option to buy you some time to figure things out. 

Call the Ombudsman office to find out about complaints on any nursing home under consideration. Speak with your local area agency on aging about any nursing home recommendations they might have. You may find out that your loved one is in one of the best nursing homes available.

Leaving a Nursing Home Against Medical Advice

Placing someone in a nursing home can be distressing but when that person wants to leave, you can also have feelings of shame and guilt. Though it is hard, you will weather the storm if you approach the situation with compassion and resolve. In the end, there may not be a solution that will please everyone but have confidence that you have tried your best.


Source:

  1. “Mortality in Nursing Home Residents: A Longitudinal Study Over Three Years.” National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143238/ 
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