Dad is on hospice at an assisted living facility was mistakenly sent to hospital. Who pays?

Veronica91, Thank you...you hit the nail on the head.

freqflyer, I can only address this case...in this case the Nurse Assistant at the ALF did the right thing (@ 2:30 AM) and called the ALF's 24 hour on call RN. All the RN had to do and should have done was to immediately call the Hospice 24 hour Nurse. She never made that call...in fact, Hospice was never told anything until 10AM, the next day. I'm the DPOA and I didn't even know anything until 9AM the next morning. There is a strict protocol and Hospice was not happy...and the ALF admitted the screw up to me. Changes have been made since then...my original question was who pays in this case? Do you stick the family with a charge of thousands of $$ when Medicare states rightfully so, they will not pay. The ALF should pay and the bills haven't rolled in yet...but as it stands now I don't get a good vibe that they are going to pay. Only time will tell...stay tuned.

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.

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.

freqflyer, Remember once the patient has entered Hospice it's not the call of the Senior Care Facility to send the patient to the Hospital That decision first must go through Hospice. If the family over rules Hospice that's fine..but know the patient will then be removed from Hospice..and he/she will have to go through the process again, to reapply..which could take some time. Also remember..."...if you go to the hospital and your hospice provider didn’t make the arrangements, you might be responsible for the entire cost of your hospital care." - Medicare.

Hope this helps to explain the rules better. This is at the core of the problem, when someone on Hospice is sent to the Hospital without the knowledge and consent of Hospice.
From Medicare....

"If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. The cost of your inpatient hospital care is covered by your hospice benefit, but paid to your hospice provider. They have a contract with the hospital and they work out the payment between them. However, if you go to the hospital and your hospice provider didn’t make the arrangements, you might be responsible for the entire cost of your hospital care."
https://www.medicare.gov/what-medicare-covers/part-a/how-hospice-works.html

Since this occurred in the middle of the night and chest pains are deemed a medical emergency, the facility did the right thing to call 911.

The facility should have called you to tell u they wanted to transport ur Dad if u have POA medical.

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.

Your elder owes the hospital pays since chest pains are deemed a medical emergency.

Highlander

What insurance does not pay, Ambulance company may and probably will come after you for any part not paid.

Midkid58, No neither I (DPOA) nor even the Hospice nurse on call 24/7 was called. The ALF sent him off to the Hospital....as it turned out he was OK....and now waiting for if/when the bills to roll in. 6+ hours in the Hospital (with ER, Tests, plus Transport to and from the ALF..).

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.

well first off I am an RCFE licensee and owner and I have it clearly marked that my residents are on hospice and staff are clearly aware to call the hospice agency always! If I made a mistake like that I personally would pay for the costs. Your secondary secondary insurance should cover some of the costs and I would cover the remainder. Communication and training is lacking here!! Best Wishes, a fellow RCFE Owner & Operator

Decatur30033, Yes, in my case the ALF he's in..is owned by a company with 25 such facilities around the country. Still waiting for the dust to settle, haven't received any bills yet...but I'm sure that will change soon.

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.

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?

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.

MsMadge, If your Mom was on Hospice and someone sent your Mom to the Hospital WITHOUT the approval or even knowledge of Hospice for something RELATED to the reason she was on Hospice.. Then yes, there is a good chance you yourself will have to pay many..if not all the accrued bills out of pocket...without the help of Medicare.

BarbBrooklyn, As I'm now finding out it's a new world once you put someone on Hospice. I'm the DPOA because most of the time my Dad is not competent at this point. That night the Nurse's Assistant called the RN on call and instead of the Night RN then calling the Hospice Nurse on call, she called 911 and had him sent to the Hospital. Hospice was never notified till the next day. Remember a DNR bracelet (he has one) does not automatically stop someone from being sent to the Hospital. Once you put someone on Hospice and they reside in a NH or ALF, Hospice must approve trips to the Hospital. If there is a trip to the Hospital that they didn't approve....you run the very real risk of having to pay out of pocket for the total bill. This is a very clear case of the ALF screwing up. Once the bills come in I'll know the full scope of the issue. Just grateful he didn't stay over night at the Hospital...transport and 6 hours of testing is quite enough. Spoke to Hospice today but they were cut out of the loop during this event, they had nothing to do with the problem. All they can say is talk to the ALF and hope management will pay for their mistake.

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.

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