I am part of the professional community that is able to place patients on a psychiatric hold against their will for up to 72 hours. To qualify for the free stay in a hard bed with shitty-ass food, they need to be a danger to themselves or others. A few years back I worked for a nursing home and the administrator wanted me to send a woman with dementia out to the psych hospital so that they could hold her for three days. After that, she would qualify for Medicare to pay $800 per day for her to receive physical therapy, occupational therapy and speech therapy. It didn't matter that she lacked the cognitive ability to retain anything that she might have learned and that the therapies wouldn't make a bit of difference because they weren't at all necessary... so I refused to sign the forms. She yelled at me, then threatened me with my job. She also threatened to file a report against my professional license. She insisted that the patient might wander out the front door into traffic - which doesn't constitute a "danger to herself or others," (although it did say a lot about a nursing home that admitted a patient who wandered without the ability to monitor her whereabouts). But I digress - her threats didn't work.
For those of you who are movie buffs,,. think of the bank scene from "Leaving Las Vegas." I simply couldn't sign the forms.
The Administrator got a nurse to sign the forms, sentencing the patient to 3 days in a psych ward, and in appreciation she suspended me a couple of weeks later. She was fired soon after that, after I reported her both to the company and to the State for her behaviors. But she still works in the industry, ruining people's lives and controlling the elderly by ignoring their rights and treating them subhumanely. It just ain't right.
A nursing home I know of has a staff member who wields way too much power. How much? All he has to do is say that a patient is "unsafe" to live alone and the nursing home will do everything possible to block the patient from returning home. The nurses will tell the doctor that the patient can't leave, and the doctor will refuse to discharge him. If the patient wants to leave, he will have to leave "AMA" (Against Medical Advice). That means no after care, prescriptions or equipment will be provided. It's common in these situations for the staff to threaten to call Elder Protective Services (EPS). This often scares the hell out of the patient/family, and so the patient remains in a nursing home until his death, lonely and miserable.
Sometimes the nursing home's assessment is correct - that the patient probably shouldn't return home. But other times it appears that the decision is based on the fact that the nursing home has a low census and needs patients. This is especially true when a patient requires expensive treatments and he has the ability to pay for them - such as g-tube feedings or specialty beds which can cost hundreds of dollars extra per day. I've seen patients pay close to $15,000 per month for a shared room, which would pay for 24-hour care (and then some) in the patient's home.
Patients don't realize that they have the right to self-determination, which means that they have the right to return home if they wish. EPS can't remove a patient from his home as long as he is able to make decisions and appears well-cared for. We all have the right to make decisions unless a court says otherwise.
If the nursing home refuses to discharge your family member, it's always possible to call your primary physician for a Home Health referral, prescriptions and equipment. For additional information, buy a copy of The Nursing Home Survival Guide.