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Sunday morning call (today) from the SNF where my brother's been for a week. I quote: "He's been up all night, verbally/physically abusive to aides, now sitting in his urine refusing to allow aides to take him to shower. Threatening to shoot everyone with a gun. Unless you come in/talk him down, we'll have to call 911." I can tell they want to be rid of him. I told them I'll come talk to him but cannot provide a safe environment, so cannot take him. What am I facing when I get there? A psych eval might be a good thing. Would it count as a new hospitalization for Medicare/Medicaid purposes? Thanks.

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“Psych emergency” 6 hrs later: brother sedated but still angry; “being held prisoner.” Evaluated by clinical psychologist who recommended (1) different seizure/antidepressant meds; (2) full psych work-up, and (2) transfer to quieter facility w/ lock-down memory-care floor. Every day a new world. Thanks for thoughtful replies.
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When my neighbor's husband talks this way (shoot people, shoot the president)
his wife tells him to stop it and go into the house.

Transport by paramedic. He does not have a gun, no crime has been committed.
Yes, get a psych evaluation.
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Sister; Did you ever get POA for your brother?

It may not be that the facility is wanting to be rid of him; did they call you as POA or the person on the HIPAA release? They may have been bound to notify next of kin before calling 911.
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Yes, definitely have him transported to the hospital.

He might have a UTI, but of course the facility can't figure that out without his cooperation.

I'm troubled that they think that YOU can do anything about this!
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I'd have him taken to the ER immediately and ask for a psych evaluation. And yes, if he's admitted to the hospital or a psychiatric facility, it would be considered a new event for insurance purposes, I would think. Of course you should NOT be taking him to your home, either.......let everyone know that is NOT an option!!

The main thing is to get your brother evaluated and treated; if the SNF has to call 911, then so be it! They can easily transport him to the ER as well. Mass murder threats are nothing to take lightly, that's for sure!

Best of luck.
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