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He takes off his oxygen and gets confused and can’t breathe so calls 911. He’s been in the hospital with pneumonia twice in the last month. Hospital Dr let me make the medical decision and said I could send him to a nursing home but it changed when my dad refused. The Dr said he could go home and could make his own decisions. Now that he’s home he’s confused, weak and is found without his oxygen at times and calling for help. Idk what I can do next bc I’ve been told he’s allowed to say he wants to be home if he’s able to say it. Plus I feel bad for the many calls the EMS gets. I live an hour away, work and have a family so I can’t be there 24/7. Any suggestions?

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How is he getting home? Are they being told there is someone at home with him who will look after him? Tell them it is an unsafe discharge.
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I used to manage an apt complex where I had a resident who was an alcoholic smoker who barely ever left his recliner. At least once every 2 weeks he would call 911 b/c he would get up and fall in the middle of the knight.

Well, one morning I came in to work and found the fire dept there yet again and when I went over and asked them what he did this time, they said this was the last straw. He was occupying too much of their time and they were going to start charging him for the responses as well. This time, he had gotten up, pooped all over himself and the floor, fell in it, and smeared it all over himself and the floor. They told me they were going to report him to social services as not being able to care for himself anymore.

This worked out b/c his son told me they had tried to get him to go to a facility for years but, b/c he could speak for himself and wasn't technically 'crazy' (alz or dementia) they/judge couldn't force him. But now, the family finally had the ammo they needed to force him to go somewhere where he could get help and live.

My advise, get the first responders to file something with social services stating he is over using the service and can't care for himself anymore. It carries weight.

Good luck,
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Isthisrealyreal Aug 2021
That is great to know that 1st responders saying inability to care for self holds more weight then family.
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I think it might be a good idea to hire (dad pays) a caregiver that will be there most of the day.
The caregiver can monitor and make sure he is using his oxygen as well as do other household chores.
I would also put cameras in so that you can monitor him when he is alone and if you see that he is without oxygen you can call him and remind him.

Has he been diagnosed with dementia? if so that may be an "out" if he refuses to go to a Nursing Home.
Or next time have him sent to rehab first they will evaluate, help him gain strength and it may be that they will not recommend that he return home if he is going to be living alone.
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First - contact Adult Protective Services with your concerns.

Next - the next time he goes to the hospital advise them that he is an unsafe discharge and you will hold them responsible for anything that happens if he is discharged home.
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DrLokvig Sep 2021
My sons had to through this with their dad. It's tough because you have stand firm, really firm, with the hospital. Refuse to take responsibility for him and make it very clear that he's not safe at home alone. My sons finally told the hospital they could discharge him if they insisted, but the family would hold them liable for any mishaps after his discharge. (And they recorded the conversation)
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I would call Adult Protective Services in your county, and tell them your dad's situation. If they come out to your dad's house to evaluate him it might help get him the services he needs and advise you.
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Sadly, I guess the loop gets repeated : panic, ER, hospital, rehab, home, panic, ER.. until the person gives in, their health forces it, some sneakery... or the end happens.

I've personally seen when acceptance financially comes (after countless loops) to move to permanent care. Tears, sadness, grief 😞

Seen elders accepting permanent care as after-rehab option that was *sold* as 'respite until you are stronger/better'. (Just a teeny weeny little white lie).

Heard of stubborn elders locking out home visiting help so often it results in their demise.

Maybe time to have an honest chat with Dad. What does he really want as he ages? What does he value?
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If Dad is calling 911 because he forgets to wear his oxygen, he needs 24/7 memory care. I agree with cetude - You do need a new doctor who recognizes the need for a nursing home, and doesn’t cave when Dad refuses. If it’s possible, try to get a call report from the EMS - it might be on his Medicare claims - that comes to Dad’s house and give a copy to his doctor.
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What will end up happening is that the paramedics will inform APS and your father will be placed in a care facility whether he refuses or not.
Waterspirit (in the comments) is right and EMS will start charging for his calls if they are responding to so many non-emergencies.
My advice to you would be to not interfere. Let him keep calling 911, then let the state take over and place him in care facility.
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Beware, after a couple of calls, EMS quite possibly will start to charge him for these trips. Constant repeated visits are proof enough. Get the reports from EMS if possible, what was his oxygen saturation level off of his oxygen, what was his mental state when they arrived or any other medical information. As advised by another, contact Elder Services to report an Elder at Risk. He clearly is and is not safe at home.

He needs supervision and his doctor needs to realize it. Another idea is to take him to the doctor with his oxygen, have the oxygen removed and let the doctor see for himself the change in mental status and possible drop in his blood oxygen levels. Then push for him to receive care full time wherever is financially and medically best for him.

I once has an inpatient who was a former professional boxer. He had neck, throat surgery, a trach tube in his throat and was on oxygen. We always knew when his levels were low as he would stand up, put up his fists as though he were in the ring. We ended up putting around the clock nurses on him. One night at midnight I heard a sound no night nurse wants to hear. I RAN to his room, found the bed half way across it, his nurse on her knees gasping for breath. Yet she was still holding on to both of his hands. He had tried to pull out the breathing tube. When she grabbed his hands, he kicked her in the chest, sending the bed and her. (I grabbed him to allow her to curl up to breathe, and another nurse and I cleared his airway). After, with oxygen restored, he apologized as he knew he had 'done something to hurt someone'.

Low oxygen levels need immediate attention. Involve Elder Services.

If you don't have Medical and financial POA, get it ASAP.

Best of all in this very difficult situation.
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Make sure Dad knows that EMS can start charging him for the visits to his home and his insurance may or may not pay if they decide this isn't medically necessary. Can he afford this? If not, tell him he needs to make another choice. Bring in a social worker to discuss his options. If he makes the decision instead of being told what he has to do he might be able to move forward.
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