Sorry about how long it's taken to get back to ya'll.  Had a lot going on.  So, today I'll tell you the story about the nursing home administrator who is trying to force his staff to put a patient onto a bus and send him to live with his family in another state, about a 12 hour bus ride.  The patient is incontinent of both bowel and bladder and wears a brief - he has stage 4 decubitus ulcers (bedsores) on his buttocks and is a paraplegic.  So - to recap, the patient can't walk, shouldn't be in a seated position, shouldn't remain in a dirty brief, and has no ability to get off the bus during stops.  
     The reason that the administrator wants the patient discharged so badly is because he doesn't have the money to pay for his room & board in a nursing home and probably won't qualify for Medicaid.  The administrator doesn't want to wait and see about the Medicaid, so he tried to force his staff to send the patient away on a bus.  This is illegal on so many levels, as well as a human rights violation.
       Of course, the staff members who he's bullying have nothing in writing and it's a given that, if anyone reports his actions to the State, no one will back them up.  One worker took a stand this week and told him "NO."  The administrator responded by rescinding his permission for a scheduled vacation until she complied with his demands.  She walked off the job (and reported him to the state).  There will be an investigation, but the only way this administrator can be stopped is for someone to tape the administrator and submit it as evidence to the state.  I'm not sure of the legalities of taping someone without their knowledge...
     This happens more often than one can imagine.  Do your homework, people.  If the nursing home is poorly rated, don't go there.  If your Medicare HMO/PPO only contracts with these facilities (this is often the case), revert to Medicare A&B with a supplement.  
     I'll tell you about another nightmare discharge next week.