Can nursing homes reject a patient with behavioral issues?
A friend's grandfather is in a nursing home in which he became somewhat agitated and violent, and he is currently in the hospital. His caregiver, my friend, is looking for a nursing home to put him into, but they are all rejecting him based on his RAGE (Rating Scale for Aggressive Behavior in the Elderly) scores. Do nursing homes have the right to reject patients on this basis?
You ask about nursing home rejections due to behavior, specifically rage. The question could also apply to other difficult behaviors. The short answer is, yes nursing homes do have the right to reject a person whom they believe will not be a fit for their facility. They have not only a legal right to do so, but may have a legal obligation to do so, as patient safety is their primary responsibility. If a nursing home does not have the staff to design a specific program to help manage a person with these issues of rage and acting out, it can put both staff and other residents at risk of harm. If, for example a person with this kind of conduct cannot be properly managed, and he strikes out and hurts another, the facility would be liable for the injuries to others because they knew he had this behavior problem, and it was foreseeable that he might cause that kind of harm. It may be that the only recourse is a properly designed medication regime, together with a behavior management plan. With persons who have dementia, for example, and are unable to adequately express themselves, rage can be a manifestation of fear, frustration, or even panic. Behavioral approaches to distract and calm the person have been successful, in combination with the right medications. It would be useful to seek an expert geriatric psychiatrist to evaluate your dad for changes in medication to help him, as well as for advice with behavior management. It is possible, if he is better able to adjust to those two additions in his life, that he will be more likely to gain admission to a nursing home. Even if he is admitted, he will require frequent family monitoring to be sure the behavior management plan is followed, and medications are adjusted as needed.
Same thing happened with my 87 year old mother-in-law! She had previously had a UTI which led to a psychotic episode. She was prescribed Rispiradal but we eventually switched her over to Gabbipentin. Two nursing homes so far have rejected her despite the switch in med and her current history of cooperative behavior. What do we do now? If she is beyond the level of care of these facilities then she's certainly beyond the care we could provide her at home! What do we do?
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