My father has been in a VA home for almost a year. My brother and I who now have guardianship, POA, etc... We are trying to move him into a private facility but he has to have his PEG tube removed before they will acccept him. He doesn't need the PEG tube anymore, actually his POA says he shouldn't have one....not sure why that wasn't honored. They have been giving him medication through it. They have been stalling us on getting it removed - one excuse after another. Does anyone have advice.
Was the facility aware of the Medical POA and Dads wishes? Get a doctor involved.
A few things are often happening in these situations:
- the physician has not formally written the removal order,
- speech/swallow evaluations are incomplete,
- the staff fears aspiration/liability,
- or the VA system is moving slowly administratively.
The quickest path is usually:
- Request a formal care conference immediately.
- Ask for the attending physician, nursing supervisor, social worker, and patient advocate to attend.
Ask directly:
“What exact medical criteria remain before PEG removal?”
“Who specifically is refusing to authorize removal?”
“What written policy or medical concern is preventing discharge?”
Then request all responses in writing.
If his advance directive or POA expressly refused artificial feeding, bring copies to the meeting and ask why that directive was not followed.
You should also contact the VA facility’s:
1) Patient Advocate,
2) Ethics Committee,
3) and possibly the facility director if needed.
If they continue stalling without a legitimate medical basis, an elder law attorney or healthcare attorney can sometimes resolve this quickly with a formal demand letter. Guardianship authority is generally very strong unless physicians believe removal would create an immediate serious medical danger.
One important nuance:
If they are still using the PEG mainly for medications, there may be alternatives (crushed oral meds, liquids, etc.) that need physician approval first before removal can safely occur."
(Information aggregated through ChatGPT)