My mom is on a memory care floor in an assisted living facility. They send her to the ER by ambulance when she does not need to go. Are all facilities like this?

When my Dad lived in senior living, anytime he fell and depending where he fell [like falling in the bathroom, there is always that chance for head trauma] he would be taken to the ER via 911 after being checked by the facility RN. Better safe then sorry.

I agree with Sunnygirl regarding the hospital ERs. I listen to an EMT scanner and it is not unusual for one hospital ER to be booked, thus the patient is driven  to the next hospital on the list.

Today's ambulances, the EMT's can do an EKG which is automatically transmitted to the hospital and get advice from the emergency physician on what to do next.

In both the regular AL and the Memory Care facility that I dealt with, the hospital which transport will be used is in the contract for services. I'd check the paperwork.

I wonder if the near-by hospital was full and that's why she had to go elsewhere. I recently heard that on some weekends, a hospital near me gets so full that they start diverting ambulances to another one that is about 15 minutes away in another county.

From my conversation with someone who works at an AL making calls to transport to ER depends on which staff member is working, whether the behaviour/problem is causing enough disruption to seriously hamper their routine and effect the other residents, and whether the symptoms are of a kind where the facility needs to cover their a**es (chest pains could fall into that category). Management has let it be known that nobody dies on site unless it is totally unavoidable.

My understanding is that paramedics make the call as to which ER to transport not the facility

In my case I'd prefer the hospital 5 miles away where mom's doctor has access not the local poorly rated one

Does your mom need skilled nursing care ?

I chose memory care over a nursing home following discharge from the hospital in order to give my mom a better quality of life and frankly nursing homes aren't locked down and can't always deal with dementia - the best ones are dismal and wouldn't take her anyway with her behavior

Nursing home, more appropriate? That would be her doctor's call as he would need to prescribe it.

Rules vary for each state. In my state, assisted living (AL) is not allowed to have a 'do not transport' option. Since ALs in my state don't require a nurse at night, there are only aides during that shift. If there is an emergency, they call the nurse on call. The nurse then makes the decision as to what to do. Without hands on ability to assess the situation, they cover themselves and the facility and send the resident to the ER.
While this might not happen in the nursing home, nursing homes (in my area) are twice the cost of memory care and not as nice.
Can you speak with the Executive Director and ask how to address this situation? He/she may have some ideas.

They said she had "chest pains". It was during her sundown period and the floor care knew this was "typical" of my mom. The ambulance took her to a hospital 30 min away- if she had "chest pains" there is a hospital 5 min from the facility for emergencies. This is typical of the care-they use the ER like a doctor's office. Would she be better in a nursing home?

They said she had "chest pains". It was during her sundown period and the floor care knew this was "typical" of my mom. The ambulance took her to a hospital 30 min away- if she had "chest pains" there is a hospital 5 min from the facility for emergencies. This is typical of the care-they use the ER like a doctor's office.

Yes, assisted living facilities are not hospitals nor is memory care. They are not equipped or staffed to handle medical emergencies. Though if she were on hospice they would not call an ambulance. They would call hospice instead to administer comfort care, not to fix her.

It is their call to determine whether emergency treatment is necessary

Check the contract it is probably signed with instructions on when hospital transport will be utilized. What sorts of things are they transporting her for?