If a hospital ER is maxed out and family cannot take a parent, what can be done for them while they wait for a suitable MC bed?

I am baffled that a family member is not allowed in the ER with a parent with a diagnoses of Dementia. They cannot do an accurate diagnosis without an accurate history of the patient. My Alzheimer's mother was sent to the ER two days in a row for a hip problem and both ERs asked me to accompany her. They wanted me there to give an accurate history and to manage her while in the ER. They ended up admitting her to the hospital and she tested positive for covid. I even had authorization to enter her hospital room after she tested positive for covid. I had to wear the protective gear.

My mom is in a similar situation with a medical condition that requires a higher level of care than where she was living, so I have been searching for a new place. I've been polite, but firm with the discharge planner and we've come to an understanding that I am doing my best to get Mom situated. The discharge planner actually called me several times to get the discharge going before I ever heard from the doctor. I told her I would make no plans for my mother until I had the opportunity to discuss my mother's situation with the doctor and had a chance to see my mother.

I think it would be to your advantage to insist on being with your mother in the ER. The quality of care she receives is based on the perception of the person who is treating her. Some of the nurses see my mom as a whiney old lady, while others see her as a charming woman who is in excruciating pain. The latter is accurate. I've had to intercede on her behalf numerous times and it is amazing how cooperative my mother is when the caregivers are properly apprised of the situation.

Your mother is trying to advocate for herself, but no longer has the skills. Someone needs to be in there with her and advocate for her. They are telling you what is happening, but what do you (your family) see? With her dementia she is unable to give them the information they need to properly diagnose. You know your mother--how she acts when ill, how she responds to medical personnel, what upsets and her calms her down, etc. Her agitation could be from the UTI and it could be from strangers poking and prodding her, unfamiliar surroundings, another medical condition, and many other reasons. Your mother is scared and she is in fight or flight mode with no one to protect her. This is cruel to her. These doctors don't know her baseline behaviors and they should be working in tandem with you. I would absolutely insist on being in the ER with her. If they say no, then tell them you will be reporting them to the state licensing board and send a written and certified letter to the hospital documenting the insufficient care she is receiving. Also insist on working with the hospital ombudsman. Best wishes for you.

Gnarley: Something seems amiss. Why isn't the hospital addressing your mother's U.T.I.? Do NOT allow the hospital to discharge her. This would be an unsafe discharge.

Kaiser can refer her to a palliative care program (they have one!) to see her in the memory care facility, with nurse practitioner who visits and can be reached via phone. Provides access to medical oversight, adjustment of meds, etc. Helps the facility 'tolerate' the risk of admitting a patient with behavioral issues.
It stinks that Kaiser is NOT addressing the need for her to receive medication for her UTI, even in the ER. Kaiser is a great plan for everyone - expect frail elders with dementia or complicated conditions.
The state department of public health regulates all care facilities, and Medicare also regulated skilled care settings.
Kaiser is managing her Medicare benefit, call the Medicare quality assurance number and see if they can help.
What a mess...feeling badly for your mom, and for you.

The deal is that your mother does not have a diagnosis that requires hospitalization. She is stuck in their "observation status" and truly needs to be discharged. The problem is the lack of a suitable place to discharge her to, Case management is the department you need to focus on working with regarding your mom's housing issues. Praying that a suitable spot opens soon.

Does your mother have any funds? If she does, you should be able to find one that will take her and you can self-pay. My experience is that if waiting for a hospital to place, it may not be a place that you want. Otherwise someone could stay in hospital forever as you could say every place isn't suitable. Many homes have significant waiting lists so you need to accept ANY open bed.

I think you should continue to say she isn't safe for discharge but you also need to either accept any open bed or self-pay.

The hospital won't admit her unless she has a medical reason that "justifies" admission. Justifications are becoming narrower and narrower as hospitals try to reduce expenses. This certainly creates some difficult situations, but hospitals will not serve as holding areas while people wait for placement.

Why is the UTI not being addressed. Sounds serious if it is effecting her cognitively. And wonder how they can access her until its cleared up. My Mom needed IVs in the hospital. Was there the 3 days needed for Rehab...to get her strength back. If you could accomplish this, that would give you time for a suitable placement in MC.

As long as you aren't her guardian, you can't get in any trouble with APS. The hospital just wants her out of there and knows it's going to be a long wait to get into her an MC due to her behaviors. This happened all the time when I worked at a hospital. It's not uncommon for people to languish in the hospital for a month before they get their behaviors under control and a facility will accept. It's not your fault it's just something that happens. Turn it back around on the hospital staff that they need to address what is occurring mentally and physically with her so that a facility will accept her and she can be discharged.

Out of Network Behavioral Unit.

Are you in contact with the hospital Ombudsman yet?

Stand your ground! You did the right thing by calling APS yourself and standing up to the hospital. Sadly the hospital's intimidation tactics often work by having the family member take the patient home which ends up being the worse outcome for all involved.

Knarly , you say you need 3 days , is it possible to get a hotel room with a suite, and somebody be with her the 3 days to clear occupancy ?

Good for you for not falling for their threats.

If you did not exist placement would be found. There are no rules that say you must take your mother into your own home. They will have to find placement. Now, that you have already refused a placement we come into the realm of problematic. If Mom had no funds and no POA she would be on nursing home care via the state's guardianship. This wouldn't be "pretty care" in Mom's condition, as you know.
You have three choices here:
Give up guardianship or POA and if you have these already for a person with dementia this will require an attorney to do; give over guardianship to the state. I seem to remember that you hold guardianship over Mom.
Or
Get Mom into the placement that already existed. She uses then, her funds, with you as guardian or POA keeping careful records of every penny in and every penny out of her estate/trust until all is spent. Then Mom is on Medicaid and medicaid placement (again, won't be pretty)
Or
Take Mom home.
If someone else has another option I don't know what it is. If Mom is not admitted her supplemental insurance may not be paying for her care outside of medicare coverage; I don't know how that will work.
You are between a rock and a hard place and I don't envy you one single bit, buit do NOT be bullied into someone convincing you that you HAVE TO take Mom into your home. They simply want to be shed of her and are willing the THREATEN you to do so. Were you not ever born they would come up with something else.
Do know, however, if you are POA, or guardian, you are expected to come up with care for Mom. Good luck on that. I can't imagine where you will find even minimally decent care for her, or at what cost.
Your answer to their threats, by the way, was stellar. The answer is absolutely, "GO AHEAD AND CALL: I will call FOR YOU. But she isn't coming to my home.:' Good luck. Hope you will update us.
By the way, guess what APS and the entire state's last answer will be to all this. Taking her away from your guardianship or POA. Which would be heaven I am supposing. Let them place her, spend her money on her and then place her when she is on medicaid.

The OP has said:
Her AL home can't take her in and they had a shared room for memory care (MC) that required someone to watch her for 72 hours due to aggressive behavior costing $2500 for her to re-enter their MC population.

Aggressive behavior requires 24/7 supervision.

This is provided in a Behavioral Unit.

So, do I gather that the hospital wants you to take your mother home?

Okay. What care requirements can be met in hospital that can't be met at home?

I'm not arguing that the family can take her. I'm just asking what it is that you can't do that she needs.

Hospitals nowadays, only provide acute short-term treatments. Chronic or long-term cases like your mother, don't qualify for an acute admission. If nothing is found soon, she might have to be sent to a psychiatric State facility.

Gnarley,
In the E.R. for UTI and behavior problems on a 72 hr. psychiatric hold.

Even though the 72 hr. hold was lifted, she should have been admitted to the Behavioral Unit the minute the psych hold was placed. She should be in the behavioral unit until meds are stabilized, seen by a psychiatrist. The E.R. is not equipped to hold a patient. What is wrong with that hospital?

If they have no Behavioral Unit demand her transferred, admitted, and evaluated by a psychiatrist there. One does not get over the behaviors caused by a UTI in 72 hours. Call the hospital Ombudsman at this point.

Have you been there, boots on the ground, to see this all happen?
Patients with an advocate present will do better, be treated better.

Beware of the unsafe discharge, the hospital may try that next.

You're doing everything right, she may need to become a ward of the state. Just keep saying no every time anyone even IMPLIES you should do the caregiving.