It has been 27 days. The facility has not developed a care plan with any measurable goals. We have not had any follow up from the doctor, the nursing staff doesn't follow her medication schedule, the meals are always cold and under cooked, and have refused her snacks and water. Mom is 80 years old, recovering from double pneumonia and has made a huge improvement in her physical strength and outlook on life. I have requested the purpose and goals for Mom as well as progress updates, but all my requests have been ignored. They do not know my Mom's physical abilities prior to getting sick, don't believe what we tell them bout everything is does daily, prior to illness. In the afternoons, after her therapy, we sit together while she pays her bills and balances her checkbook. The PT and OT have said they think our goal of discharging Mom in a week is realistic and that she has made such progress, they are impressed by her positive attitude, willingness to try everything they ask of her, and her physical strength is amazing. But, they also said, unfortunately, it is not their call to make.
I want to know if we can request the facility to begin the discharging paperwork, even if they do not agree and if we do discharge her against their recommendation will it affect Medicare's payment for her care?
It is entirely possible that this place has excellent therapists and sub-standard administrators!
You do have options:
1. You could find another facility and request a trasnfer for continuation of her therapy in a facility, or
2. You could ask her doctor or the facility doctor to script for home care.
Given the description of the cold food and other issues, my inclination would be to talk to the doctor who scripted for her rehab, presumably one of the doctors who treated her at the hospital.
Assuming she has some assistance from you or siblings at home, ask that doctor (or her regular treating physician) for home care, but find a home care agency first. Some hospitals have their own home care divisions. Make a list of your goals, your mother's conditions, and ask how they would plan to help her continue on the road back to health.
Most likely they'll tell you that they can't determine that until after an evaluation, which is generally true. But their attitude and tone of voice when they respond can be indicative of what kind of cooperation you can expect from them.
Ones that get huffy about being questioned should be crossed off the list. Ones that patiently explain how things work are candidates.
The reason I suggest this is to establish up front that you have goals you want incorporated into any care plan. Some agencies, especially when there isn't a strong family presence, set the goals themselves. You need to make sure that they know you'll be involved and that they'll be working with YOU and your mother on your mother's care. I've met a few from agencies who are so convinced of their superiority that they dismiss any family contribution.
After you find an acceptable agency, tell the rehab doctor your mother is ready to move on to home care and ask for a discharge.
Don't just leave AMA and jeopardize Medicare coverage.
Medicare does not require improvement. Not losing abilities is reason enough to continue HHcare.
It sounds as if "it's worked" though, since you say your mom has gotten stronger. Yay!!!!
The nursing home where mom stayed had a Discharge Nurse. See if your facility has the same and talk to her. I can't emphasize enough that you would be wise to ask the DN to set up some home healthcare for your mom. It's a wonderful thing. And free. The PT and OT will transition her into her home; make recommendations for things that will make your mom safer and enhance her life.
The long and short of it is that your mom can discharge herself any time she'd like. That assumes you agree with her. If you didn't, they'd probably ignore her requests.
Question can I get the first hospital to be responsible for ambulance rides since they misdiagnosed her?