Upon hearing the words nursing home, may individuals imagine dark rooms filled with very sick people and the smell of body odor and urine. Nursing homes have evolved over the years and many are remodeling to become more home like. However the financial bottom line still exists. While Medicaid, or government assistance, pays for ongoing or long term care for many individuals, many other individuals pay privately. Statistics indicate that many long term residents of nursing homes are women, often widowed, who have no one to advocate or represent their needs.

Assuming there is physical progress, Medicare pays for 20 days of care. On day 21, in 2008, a co-pay of $128 per days is due. It is usually after day 21 that many nursing homes attempt to convert individuals to remain permanently in the facility. I recently worked with an older female who had been at a nursing home for about two months and wanted to return home. Admittedly she had a complicated case. She had a catheter and had frequent urinary tract infections that required, or at least required, according to the nursing home, IV antibiotics.

It should be noted that nursing homes, while many have physicians on call, do not provide the level of care of a hospital. This was a detriment to my female client, who was continually given antibiotics for an infection that may not have existed. The urine samples were drawn from the catheter instead of directly from the source and continually showed infections.

My client finally decided that she wanted to go home, regardless of cautionary warnings from the case manager at the facility and the physicians assistant. This was her right. She wanted to go home, one more time, to see if she could physically manager. If not then another decision would be made. After two weeks of negotiating we arranged to take her home. A last minute call came from the case manager at the facility on the day of discharge saying that residents had the norvo virus and they suggested my client remain. We all agreed this was not going to occur and was a feeble attempt on their part to retain my client. It was a last effort by the facility to keep my client and a source of ongoing revenue. My client went home and remains home, infection free.

It is in these situations that many families are intimidated. When told by a facility that a family member must remain, many families acquiesce because they dont know they have any options or what options exist. And especially if they have little experience with the healthcare system, going home against medical advice is intimidating. But it is possible and frequently the individual improves and does better at home than in the nursing home.

If you find yourself in this situation, contact a professional who can provide advice about your options. Dont allow nursing home staff to intimidate you into leaving your family member or yourself in a situation that is not in your long term best interest. You better than anyone know what is possible as far as ability and willingness to recover from a health incident.