Ask Miriam – February 2025
Dear Miriam,
My cousin is 75 years old and has frontotemporal dementia. She never had children, and does not have a significant other, so I am her closest relative. She was living in a nursing home in Los Angeles, about half an hour away from where I live, but most recently she’s been extremely combative, yelling, cursing, and even trying to hit the nurses there. The nursing home threatened to evict her, and when her behavior got to be too much for them, they sent her to the hospital for a psychiatric evaluation. The hospital says she is now “stable” and wants to discharge her; however, the nursing home is refusing to take her back. The hospital’s social worker said that no other nursing home would take her. She can’t live with me – I care about her, but I’m 65 and work full-time, and my apartment is not big enough. She can’t live on her own. I know she has Medicare and Medi-Cal. Is it even legal for the nursing home to refuse to take her back? What am I supposed to do?
—Concerned Cousin in LA
Dear Concerned,
I’m so sorry you’re dealing with this. Caring for someone with dementia – especially frontotemporal dementia, which can cause severe behavioral changes – is a tremendous challenge. The short answer to your legal question, though, is that it is complicated.
In California, a nursing home cannot discharge a resident without following strict protocols. They have to give notice to the family and the resident, as well as find a safe place for the person to live. However, it’s true that if she is seen as a danger to herself or others, they could refuse to allow her back. But there are still some things that you can do.
The first thing is to contact California’s Long-Term Ombudsman program. These are people who advocate for nursing home residents. If your perception is that your cousin is not a danger to herself or others, then they may be able to intervene and discuss with the nursing home the possibility that she be allowed to return.
You can also speak further with the hospital Discharge Planning Department. The hospital, and the social worker there, is obligated to find a safe place for your cousin to reside after being in the hospital. If the original nursing home does not work out, then it is their responsibility to find another one. If you feel able, you may want to assist with this process by locating potential available nursing homes yourself and let the discharge planner know.
Speaking with your cousin’s doctor, especially about how her behaviors are being addressed, may help. Ask the doctor to provide evidence, either through her medical records or a phone call, that your cousin is receiving appropriate treatment and is not a risk to the nursing home.
Finally, you may want to consult with an elder law attorney or the organization California Advocates for Nursing Home Reform (CANHR). It is important for you to know your and your cousin’s rights and to seek help with an appeal of the nursing home’s decision.
I know this can seem overwhelming, but you are not alone. Consider attending a caregiver support group where you will find emotional support and practical advice from others who are experiencing similar situations. For additional resources and support when caring for someone in a nursing home, contact the Alzheimer’s Los Angeles Helpline at 844-435-7259.
Best,
Miriam
Questions for Miriam can be sent to askmiriam@alzla.org.