A Personal Story from Pam and Her Mom’s Exit from the Nursing Home. Will it be AMA?
Have you ever heard the term “Against Medical Advice” or AMA? If you’re caring for an aging loved one, it’s a phrase you might encounter—and one that can bring a lot of worry and confusion.
Today, I want to share a personal story from my own family’s journey, and why understanding AMA is so important for anyone supporting an older adult through a hospital or nursing home stay.
Our Story: When My Mom Left the Nursing Home AMA
A few months ago, my mom was in a nursing home recovering from a serious illness. She was fiercely independent—always wanting to make her own decisions, even when her health was fragile. She was newly on continuous oxygen and needed more oxygen with any activity. She spent 9 days in the hospital and was going to rehab for strengthening.
Prior to being in the hospital she was living on her own in her home. She was doing alright up until going into the hospital with breathing difficulty.
I did all the things I was supposed to do. I checked Medicare Compare for nursing home rating scores. A 5-Star nursing home was covered by her insurance but they were full and not accepting any new residents. I called every day. No luck. We ended up with a 1-Star facility and I knew I had my work cut out for me to stay on top of everything.
Concern and incidents over and over again. We were extremely frustrated but I was eager to have mom get the intense physical therapy she needed. She never did get that.
It was a Saturday morning, again the 9th day she was there and she called me up on the phone and shared a story of a not so nice aide and being left unattended in a wheelchair in the therapy room where she was going to be weighed. In about 20 minutes she decided to try to get herself wheeled back to her room. Thank goodness she had her oxygen on. She passed a gentleman in a wheelchair down the hall and they locked wheels. They were both calling for help and finally someone came, unlocked the wheels and left them both in the hall.
That day she also waited an hour and 45 minutes to get a pain pill. When she called me up on the phone I said that’s it. You’re coming home. To make this happen we had a lot of work to do.
My goal was to get her properly discharged from the nursing home and not get her charged with AMA or Leaving Against Medical Advice. We will discuss some of the repercussions of leaving AMA.
As a nurse and an advocate, I knew what that meant on paper. But as a daughter, it was overwhelming and emotional. Was she making the right choice? What would happen to her care plan? Would insurance still cover her needs? I suddenly found myself on the other side of the equation—navigating the same tough questions my clients face every day.
What Does “Against Medical Advice” (AMA) Mean?
When someone leaves a healthcare facility AMA, it means they’re choosing to go home or transfer care before the medical team believes it’s safe or appropriate. This can happen in hospitals, rehab centers, or nursing homes.
Why Do People Leave AMA?
- Desire for independence: Many older adults want to return to familiar surroundings.
- Discomfort or dissatisfaction: Sometimes the facility doesn’t feel like “home,” or there are concerns about care.
- Cognitive changes: Dementia or delirium can make it hard to understand risks.
- Family pressure or misunderstanding: Well-meaning loved ones may encourage a discharge before it’s safe.
The Risks and Consequences
Leaving AMA isn’t just a paperwork issue—it can have real impacts:
- Health setbacks: Without adequate support, loved ones may end up back in the hospital or experience complications.
- Care gaps: Home may not be ready for their needs, leading to falls, medication errors, or missed treatments.
- Insurance challenges: Some insurance plans may limit coverage or not pay at all if a patient leaves AMA (though this isn’t always the case—check your policy!).
- Emotional stress: Families can feel guilt, fear, or even conflict about the decision.
What Can Families Do?
If your loved one is considering leaving a facility AMA, here are some steps to take:
- Pause and Listen: Try to understand their concerns. Are they uncomfortable? Missing home? Afraid?
- Talk with the Care Team: Ask the doctor, nurse, or social worker to explain the risks and what supports are needed at home.
- Plan for Safety: If leaving is unavoidable, work quickly to set up home health, equipment, or extra help.
- Document Everything: Keep records of conversations and care plans.
- Seek Advocacy: Don’t be afraid to ask for a patient advocate (like us!) to help bridge communication and ensure safety.
- Consider getting our free checklist on “Transitions in Care” Going from one level of care to another.
My Takeaway as a Nurse Advocate
When my mom left the nursing home AMA, it was a turning point. We had to scramble to get her home set up, arrange for therapy visits, and watch her closely for any setbacks. It was stressful—but it also gave us a new perspective on how important it is to plan ahead and have honest conversations with the care team.
If you’re facing a similar situation, know that you’re not alone. These decisions are never easy, and there’s no “one size fits all” answer. What matters most is making choices with your loved one’s safety, dignity, and wishes in mind.
At the end of the day after discussing our concerns with the administrator on call we started the ball rolling to bring her home. It was a Saturday morning and how in the heck were we going to pull this off?
We spoke at length with the administrator. We asked that we be not discharged AMA and that we have my sister who is able to bring her to her home. She works from home and can be available. We had the equipment we needed to bring to my sister’s. We asked that the provider be called for a discharge order.
The nurse practitioner that was available on Saturday happened to be the one we met a couple of times. After assuring her we had everything in place she agreed to discharge us home from the nursing home and NOT AMA.
She was kind enough to write the prescriptions for her new medications, set up the paperwork for home health, and gave us everything we needed for a safe discharge home.
Today, mom is still at my sister’s and adjusting well. She has agreed to permanently move in with our sister and we are starting to make all of those arrangements. We have put together a plan to take her with us on vacation and hopefully she will have a great time seeing all the grandkids and the greats!
Need Support Navigating Complex Care Decisions?
At Your Nurse Advocate Consulting, we’ve helped dozens of families through AMA situations and other tough transitions. Whether you need help understanding your options, advocating for your loved one, or planning a safe discharge, we’re here for you.
Don’t be caught off guard.
Reach out to us for guidance, support, and peace of mind as you navigate the healthcare maze.
Resources for More Information:
- Alzheimer’s Association: Hospitalization and Dementia
- Family Caregiver Alliance: Hospital Discharge Planning
- National Institute on Aging: Hospital Care
- Your Nurse Advocate Consulting – Free Resources
- Transitions in Care Checklist-Your Nurse Advocate
- Emergency To Go Folder” checklist
Have you experienced an AMA discharge or worried about a loved one leaving care too soon? Share your story or questions in the comments below—or reach out for a private consultation. We’re here to help.
Let me know if you want to add more personal details, a call to action for your membership/community, or any other resource links!
Thank you for spending time with us this week. We’re so glad to be part of your journey in caring for your aging loved ones. It’s an honor to share resources, insights, and a little encouragement to support you along the way. We look forward to bringing you more helpful tools and compassionate guidance in the weeks ahead. See you back here soon!
With care,
Pam and Linda
Your Nurse Advocates
About the Authors
At Your Nurse Advocate Consulting, Pam and Linda’s mission is to empower aging adults and their families to take control of their health, prepare for life’s uncertainties, and secure their peace of mind. We are dedicated to providing compassionate guidance, personalized support, and expert resources to help our clients navigate complex medical needs and organize their personal affairs.
As independent patient advocates we have a steadfast commitment to clarity, family well-being, and empowerment, we strive to make a meaningful impact by ensuring our clients feel confident, prepared, and cared for every step of the way on their healthcare journey.
Expert Guidance You Can Trust
With over 80 combined years of R.N. experience navigating the complex healthcare system, we stand as trusted guides for seniors and their families. Our expertise ensures they can access the care and resources they need without feeling overwhelmed by red tape or confusion.
