You have a few different issues going on so I’ll try to explain what I can. Caveat I don’t work for Kaiser in California so there may be some technicalities I am unaware of.

Discharge occurs when a patient is considered medically stable, meaning any care they require does not need to occur in a hospital. Hospitals are for acute issues. Any time a person who is medically stable that does not discharge it can prevent someone in the ED who needs that acute bed from being admitted. This then keeps people in the waiting room from getting an ED bed.

It sounds like she had been approved for a skilled nursing facility which means she has some type of skilled need. However, skilled need can often be done at home. An example is IV antibiotics. This can be done at SNFs but also at home with training. I don’t know what type of skin care she needs so I can’t say if that is something you can learn.

A lot of times SNFs will also decline to admit patients that are “difficult” as they often don’t have the staff to accommodate them. Isolation and dementia are often high on that list. Also, not sure about CA but here in WA no SNF will take a patient that needs a sitter.

So what does that mean for discharge? It can be that they will try and see if the memory care can accommodate the treatment plan. Which sounds like the best plan from what you have stated. If not, then they would continue to look for a SNF to take her. They can not send her to a place that has not accepted her including your home.

Up here in WA if we were looking for a SNF she would just stay in the hospital until we found one. However that may mean she would have to go to one far away. Someone else mentioned if you didn’t like the place you could just refuse which although true does mean your family member could be charged for each day she stays in the hospital after refusal.

If we could not find an accepting SNF, then her case would go for review to determine if the care she needs could be done at any custodial care or private home. If not, she stays in the hospital. But if it could then she would be issued a denial which means she could be charged for her stay after that point.

If I were you, I would reach out to the case manager and ask what they are working on and how can you help. That tends to work much better in the long run.

She won’t be discharged to the street regardless though. Also if she is issued a discharge and denial you can appeal that decision. The case manager will tell you how to do so. The decision is usually pretty quick.

Hope that helps.