It was then that realization dawned about exactly what our family was facing: Dad was a ward of the county and no longer in our care. He had been committed for a 72-hour involuntary hold, called a "302 commitment" after the part of a Pennsylvania law the process is named for. The law says that a severely mentally disabled person may be subject to involuntary examination and treatment when physicians or certain county mental health personnel or police officers observe that he or she poses a "clear and present danger" and "has made a threat of harm to self or others." In order to get him back in our care, we would have to have an attorney or public defender come in, and there would be a hearing at the hospital. It would be up to an administrative judge to determine Dad's competency and decide whether to release him to go back to Sunrise, return home, or remain institutionalized. We were frantic—and powerless.
"We do everything in our power not to 302," says Koch, who wasn't part of the decision that day. "The only reason we do 302 is if there has been physical harm done to someone. It does not happen very frequently, but, unfortunately, there are times when we don't have a choice." Koch says that Sunrise wouldn't use a 302 commitment simply because a resident was being difficult, but rather because he was physically harming someone else. "We deal with difficult behaviors every single day, because it is an Alzheimer's community," she says. "We try to calm and soothe them."
But in researching how common our situation that day was, I have learned that this is not an unusual fate for Alzheimer's residents at long-term care facilities. My reporting shows that seems to happen less often at assisted living facilities than in nursing homes, perhaps because the eviction laws are looser for assisted living units. Generally, nursing homes are required by the federal Nursing Home Reform Law to give 30 days' written notice before they evict someone, giving the reason for the eviction along with the facts of the case. The notice must provide the telephone number for the state agency that inspects and licenses nursing homes and instructions on how to appeal the home's decision. An administrative law judge will hear both sides and rule. (Assisted living facilities are subject to state law, which varies widely state by state. Most states do require some period of notification, but there may not need to be a reason given for the eviction or a right of appeal.) Some nursing homes try to evade the 30-day notice requirement and possible appeal process by transferring the resident to a hospital or psychiatric unit, then refusing to take him back, says Eric Carlson, an attorney with the National Senior Citizens Law Center in Los Angeles. "Hard-to-manage nursing home residents with Alzheimer's and other dementia are often committed involuntarily from nursing home facilities to psychiatric units," Carlson says.
When a person is sent out for a psych evaluation, the process falls under the jurisdiction of state law. Generally, there's a short evaluation or hold period of, say, 72 hours, which varies state to state. That is followed by some kind of adjudication, which allows for the person to be held against his or her will for a longer period or returned to the care of his family. In Pennsylvania, the law provides that within three days of a 302 commitment, a hearing must be held to determine if a 20-day extension is warranted.
Dad's case was to have been reviewed in 72 hours, but it was Easter weekend. So for five days, he remained in the psychiatric hospital, mostly in the highchair and strapped to a bed at night. There was no change in medication that we know of. Finally, Monday morning, the public defender arrived and Jack explained the situation. The hearing was held. And, thankfully, as quickly as he had been taken away from us, Dad was back in our care.