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Dad back at Assisted Living Facility after 911 trip to Hospital ER in middle of night. Have not received any bills yet, but with transport could be quite high. He was not admitted, total time there about 6+ hours. He is 93 has history of very frequent chronic UTI's most antibiotics are no longer effective after many years of fighting UTI's, so it's just a matter of time now, and why he's on Hospice. He was transported to the Hospital because of chest pains but after tests Hospital found no issues. Assisted Living Facility acknowledged mistake but stated "accidents do happen" so not getting warm fuzzy that they will pick up the tab for their mistake. Do I have any recourse? Thanks..!

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I'm 85 and saving these good answers for my children in case I'm ever on hospice and they face a similar situation. When my late husband -- who was on hospice care -- fell in a nursing home and fractured his femur I received a phone call from the NH in the middle of the night asking whether I wanted him sent to the hospital to have it set or have him remain in the nursing home "so it could heal itself." I reminded the NH staff that he was on hospice care and told them not to send him to the hospital. Months later, the medical examiner found on autopsy that my husband had suffered a brain bleed from the fall, and that was the cause of death. There is no moral to this story; just one person's experience.
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A DNR can mean different things to different people. I found this out last time my mom was in the hospital. For example, if my mom falls and get a bad cut, they will clean the wound and patch her up or stitch it, and administer antibodies. If the infection becomes systemic, and her organs shut down, they will not put her on a feeding tube or oxygen. My mom's doctor had the original form, and emailed it to the hospital so they could see her specific intentions. Basically, we provide normal meds, nutrition and comfort, but no extraordinary means. I have explained this to the aides who care for my mom in her home, and they all get it. Like if she doesn't wake up in the morning, don't call 911. But from what I understand, each DNR is different, or can be detailed.
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Highlander has explained how hospice and Medicare work together. The problem here is that the ALF did not first call the hospice prior to calling 911.
There is always a RN on call 24/7 and she can make the visit to determine if the patient needs to go to the ER or she can give permission over the phone and call the ambulance company that that particular hospice has a contract with. In the case of something like a serious injury, or other medical emergency the RN can give permission over the phone to go but he/she should go to the hospital and be responsible for determining what level of care the patient should receive.
The POA must also be informed and be given the option to decide how much treatment is given. If the hospice does not agree the patient will be discharged while the patient is treated but can be readmitted when that phase has passed.
Hospice usually has a contract with an ambulance service to transport patients for certain fee. If the patient is discharged from hospice then Medicare/Medicaid or private insurance will pick up the fee. If patient has none of these it becomes the patient's responsibility unless the POA signs as guarantor.
My experience has been that hospice can be very flexible in these cases but they don't usually approve a stay in hospital of more than five days. The best course is to contact the hospice office and they will be able to say what their usual policy is.
It is always best to be proactive rather than wait for the bills to come in and possibly acrue late fees etc.
Clearly in this case the facility is at fault for not calling hospice before transporting the patient but people panic and this is frequent occurrence.
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Do you have reason to believe Medicare won't cover the cost?

The only time Medicare rejected a 911 bill was when mom fell and wasn't transported- $250 to pick her up off the floor 
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There are a couple of issues here. If dad is still competent, if they ask him if he wants to go to the hospital and he says yes, i think they have to transport/call 911. Does dad wear a DNR bracelet? I know my mom does, and when she goes on Hospice, Im assuming that THAT information is going to be added to her alert bracelet that she wears in the NH.

I don't think that it's going to be difficult to arrange with hospice that retroactively, they remove him from that service for the time of transport.

Call the hospice admins and ask what they advise in a situation like this.
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I've seen this happen before, the ALF did the same, It went to collection. It may depend on his ability to pay, Do not accept personal responsibility for the bill. The ALF was aware of the Hospice situation... is it a Corporate facility?
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Highlander--
How frustrating. I take it YOU weren't called??
First off, be super kind to whomever you speak with. Keep records of the people you talk to, what they say, what you say. Nothing to be gained by coming off angry from the get-go (I don't know you, so I have no reason to think you would, but long experience has taught me that kindness towards the "billing dept" goes a long way)
But I can't see how YOU would be responsible for the transport.
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It is my understand when both of my parents were in Hospice, that comfort was the main importance.   Thus, if the patient was having some type of pain and it was possibly chest pains, then I would want the senior care facility to call 911, so that the patient can get relief.

Even Urinary Tract Infections are treated, otherwise the elder would be having nightmares, pain, hallucinations, etc.
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Yes, Hospice needs to be called but if the person answering the 24 hour hotline cannot make that decision, a message as to be sent to whomever can. Time is of the essence.
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Veronica91, Thank you...you hit the nail on the head.
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