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In March I had to move my father to assisted living. He has moderate dementia. Trying to get some respite, I've planned a trip out of the country with my husband. The hospital closest to his AL is just awful. We've been there a couple of times for a nosebleed and a fall. If my dad says he needs to go the hospital this is where he would go. And since the AL is not a SNF there is full-time nurses on staff. My idea is that if I had an RN on call (whether it be day or night most likely night) if he happened to end up in the hospital, she/he could act on my behalf, be his advocate and get him to the VA hospital if needed or deliver care orders back to the AL. Unfortunately, we have no family or friends to rely on for this.

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I take offence that you should say EMS take kickbacks. That is unethical and illegal. Many EMTs are volunteers. If an injury is specific such as a stroke, the patient goes to the specialty. I never heard of a VA hospital with specialties nor as a level 1 center. You can let administration know your preference, but once in the ambulance, EMS will be in communication to the hospital that is appropriate
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Reply to MACinCT
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Vanessa8686, you had mentioned "kickbacks'??? If 911 is called, a county/city EMT crew comes out and if the person needs to go to the hospital, the ambulance goes to the nearest available hospital. Now in my area, we have two separately run hospitals which are the same distance away, thus we can request either hospital, but only if that ER is not overwhelmed.


The above is the reason EMT's do not take a patient to a hospital outside of their assigned area. I doubt even an RN would be able to get the EMT's to take your Dad to the VA hospital. You would need to hire a private ambulance.
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Reply to freqflyer
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The RN may not be on duty 24/7 but she must be available by phone. There may be a an LPN on at night.

Tell the AL it must be in his records that he is to be taken to the VA hospital and EMTs must be made aware of this. I am assuming that Dad is signed up with a VA hospital.
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Reply to JoAnn29
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First, I am of the belief that AL is not the place for a person with dementia.
Now...If he is in AL why are you helping to the point that you need to hire someone for Respite? Is that not what the staff at the AL is paid to do?
So..you expect the nurse at the AL to call the nurse on call and have the nurse on call meet him at the hospital? This seems rather confusing and time consuming.
I would, if he needs to go to the hospital ask that he be taken to the VA hospital. If he is in their system ALL ER visits need to be cleared with the VA or they may not cover the service. (I should say they need to be notified within I think 24 hours. But if any procedure needs to be done it would be done at the VA hospital so he would be transferred there anyway.)

But to answer your question there are "on Call" medical providers just do a search for what you want in the area you are in.
You could also do a search for Care Managers and that my cover what you need.
Make sure that you have all the documentation that is needed and that the provider has the authority to approve procedures.
That said if you read any of the comments here that people have getting hospitals, medical staff and other people to recognize a POA good luck with getting this done as well.
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Reply to Grandma1954
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Vanessa8686 Jul 27, 2024
Thank you @grandma1954 for your insight - Understood, and I will likely have to move him to a Memory Facility at 8K+/month. This is something I just can't do right now because I haven't sold my parents house. I have a full time job, and it is all still very new to me. Unfortunately, the AL leaves it to the EMTs being called and the EMTs (probably because of "kickbacks") take him to that hospital regardless of our wishes and even if it isn't life threatening.
I have found out about the VA needing to be notified about ER visits and transfers. Given that to the AL and the hospital he has been taken to.
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Ensuring documents are in order eg Resus Directive or Advance Care Directive (or whatever term is used where you live). These may help somewhat but are specific & limited.

What you want is a subsitute for yourself, right? A daughter/son-sub in. An RN with medical knowledge would be perfect. But how to get this..?

It seems you want a Health Care Proxy - to make health care decisions with/for Dad (if you are unreachable). This person would need the legal authority to act in this capacity.

Have you asked the AL Doctor? Does he/she have a Practice Nurse? Or have any useful ideas? Getiatric Case Manager is a term I have heard but not fully explored yet.
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Reply to Beatty
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Vanessa8686, since the Assisted Living facility has a full-time nurse around the clock, it would be up to the nurse to help your Dad. My Dad had a couple of falls while in senior living that required 911. If the Assisted Living knows that you would not be available, then someone from the facility will ride along with your Dad to the hospital, plus the Staff would bring along Dad's file. The hospital would call the facility to let them know what is needed regarding care, medicine, etc. when Dad returned.


Hiring a RN around the clock would be very expensive. And the Assisted Living facility would need to vet him/her before being allowed into the facility. They don't like having strangers showing up. My Dad had a morning caregiver who would come in to help my Dad in the morning, but before she could step foot into the facility she had to be vetted, even though she worked for an Agency. The facility wanted to make sure of her background, and if she had the required shots (such as Covid shot, etc.)
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