How do I get a nursing home to transfer someone to a hospital for reevaluation?

Take matters into your own hands!

His, or the Nursing Home doctor must write an order for an evaluation at a specific location (hospital, psychiatric unit,....).
You need to tell the Charge Nurse (RN) caring for you dad, or talk to the doctor yourself. If you have already talked to the nurse... & nothing is happening, then call the doctor yourself.

You could take him out for the day to "get some air" or "go for a drive" and take him to the ER yourself. Call the nursing home after he gets to the hospital and inform them that he had some troubling symptoms while you were out (fill in the blank) and you felt the safest thing to do was take him to the nearest ER. They can then either like it or lump it.

That's if you're desperate and have talked to the NP, and the medical director and they won't cooperate and won't give you an acceptable reason why they don't feel a hospital visit is necessary. I fully understand your desire for hospital evaluation, because I know what nursing home evaluation consists of, and that it can be found wanting. The hospital *will get to the bottom of why your parent is sleeping all the time and not eating. Nursing home medical staff will offer you anecdotes and be content to "wait it out." So, as your parent's advocate, you do what you see fit!

My mother is in a nursing home as well and it amazes me how resistant they seem to giving care when that's why they exist. Good luck to you.

I totally agree with the hospice suggestion. I don't know if getting him transported to an emergency room with no real certainty as to what is wrong, and it not being an emergency, is going to get him properly evaluated.  He's going to be stuck amongst/exposed to people who are sick, waiting to be seen, and from experience, Emergency Room Docs aren't going to know what to do with someone who's presenting symptoms are sleeping and not eating.  Beyond that, have you thought thru what if's? You're presuming that he may need a medication adjustment...Is the hospital going to admit him for this?  Has he been on a path of steady decline up until now? Does he have all his "emergency treatment" wishes in place?  Even if you go the hospital route, they are set up to take heroic measures - would dad want that if something is discovered more serious than medication adjustment? The hospice option may help give you some insight/perspective on what may or may not work, other alternatives to consider. My mom has Alzheimer's. I will avoid any hospital admission/intervention if at all humanly possible. I've reconciled that her condition is terminal and as the disease progresses taking extraordinary measures to intervene is NOT doing her any favors. That's just my two cents/perspective...But, I would contemplate some of the "what if's" and understand calling in hospice for an eval is not calling in the angel of death.

Declining in our loved ones is so hard to accept! Is this near the end of his life, or does he need some additional/different treatment? We don't know, and naturally we want to check out all possibilities.

How old is your father? How long ago was he diagnosed with possible Parkinson's? Has he shown any signs of dementia? Has he lost a lot of weight since he stopped eating? Those are all things that could factor into your decision.

I like the idea of having an hospice evaluation. The NH doctor will probably order this if you request it. If not, you can probably call a hospice service yourself and ask for an evaluation. If they conclude that he is at the very end of his life, then you will have an answer to the basic question, and they can provide comfort care, right where he is.

If they say his not ready for hospice, then you can decide what further steps you can take.

Getting him to a hospital will be somewhat traumatic for him. Having the NH doctor evaluate him (if hospice rejects him) would save all that disturbance. Perhaps the doctor could order some tests done right where he is. Have you had a face-to-face meeting with this doctor? Is he/she a geriatrician?

You are in a very distressing situation. I hope you get some resolution.

Suggestions to get a Hospice Evaluation seems the right way to go. I don't know what area you're in so your requirements may/may not match ours, but, typically the patient's primary care doctor has to submit a request for Hospice which states that the patient has 6 months or less to live. This is a requirement in my area in order to ensure Medicare/Medicaid will then pay for these services.

If you need to arrange transportation support and the Skilled Nursing Facility does not provide this, you might search for 'inhome medical care' services or call your local Area Agency on Aging. They have access to every support service available to elders and can advise. Typically Geriatric Care Managers are a valuable source of support and can take over all the legwork for you. There are generally quite a number of these managers in any given area. They do charge for their services but typically taking this burden off your shoulders is well worth it.
I wish you the best at this difficult time!

Since you have Medicare and Medicaid I would have Hospice step in and evaluate him. They will do what is needed. I'm sure sleeping because of depression but there could be something more medically wrong with him so I would call Hospice.

I just went through this, and dealing with medical services can be frustrating; even maddening. Hospice was a great help. You may find, with their help, that given the described condition, palliative care would be best. Have hospice do an evaluation and then adjust what you choose to do for your dad.

When did the doc or nurse practitioner last examine him and run labs?

He has possible parkinsons and been on meds for a year. He said his brain was changing recently. I know you can become immune to meds and he is not eating.

saffron007, what is difficult is that this is usually our first rodeo when it comes to nursing home care. When we see things that are changing it is a real concern. Medication can be a concern. Lot of sleeping could be a side effect.

The nursing home has seen patients like your Dad 100's of time, thus they know the symptoms. It could be what your Dad is going through is normal [though it might not seem normal to us]. May I ask why your Dad is in a nursing home, what are his medical issue?

He would need a medical transport van from what I can tell. He is sleeping around the clock. He doesn't have an outside doctor. The nursing home is content to just let him be and not step in. He has Medicare/Medicaid.

Ask the head nurse to have the doctor that is assigned to the nursing home to check on your Dad.

Otherwise, does Dad still have a primary doctor outside of the nursing home? Would Dad be mobile enough to ride in a car to visit this doctor, or would you need to hire a medical transport van?

I think nursing homes only send patients to the hospital for emergencies, thus 911.