My father has been in the emergency room twice in the last 2 weeks for the same issue. I knew the first time that they didn't run all the bloodwork they should have. I was pretty alarmed they didn't run as many tests as they should have, hence the second visit, where they finally located the source of the issue.
At that point I said to the ER Dr. "So, it would be a good idea to keep him, given his age, and the issue, etc." He replied, "No, the best place for him is at home." Then more reasons why he thought that would be best option. He's peeing blood basically because of a mass on his bladder, but yeah, being home is the best thing.
So he's been home and I have to look at this everyday until his next appointment (4 days away) and I really don't think anyone one gives a @$%#$* because of his AGE.
I'm thinking, that it's quite possible that the standard approach, is "hey the guy's 94, he's lived a full life, this is his time to go." That's what I think is behind this whole, "No he doesn't need to be admitted." I hate being derailed like this. It's not fair, and not right that someone gets to decide the level of care he should get just because he's 94. It's not up to them how long he lives but that's exactly what I think this means. The medical community either because they're understaffed, stressed, etc. triage according to age. I know they had to do that at the peak of the COVID pandemic when there were only so many beds and hard decisions had to be made. Give the bed to a 30 year old or a 55 year old who smokes and is in bad health?
My Dad, worked his whole life, was self-employed and never took anything from anyone. He deserves every chance to live as long as he wants to. He's still alert, cognitive, pleasant, no other heath issues, not in pain, has a moderately good quality of life and is entirely capable of enjoying every day (or at least most days). So who gets to decide that "his time is up" just because they don't want to use their resources on someone who is 94? I'm repeating myself I know.
My brother and I are trying to decide what to do. Why go back to the same emergency room only to have them tell us the same thing all over again. I'm thinking we should bring him to a different hospital.
Today I walked into the bathroom and there was blood and pee all over the floor. Thankfully he was okay. He was not dizzy, his blood pressure was good and he didn't have a temperature but who knows what his hemoglobin levels are. My brother said, "he could bleed out in the middle of the night". Why are we the only ones concerned about this? I'm frustrated and afraid for him. I don't trust the very people we need to rely on to care for him and make good decisions that will support his ailing health. Do ALL that they can. He may die, yes, I know. Why should I concede to having him die of NEGLECT. I hope that's not the plan? I just can't not do anything and assume the problem will go away? I hope that's not standard protocol now at hospitals in regards the the elderly.
It's a rant I know.
I suspect there are some serious decisions to be made. We could move him to a rehab facility but that still has to be ordered by the Dr. (at least in my experience). A Nursing home isn't going to deal with someone peeing blood, they'll send him right back to the hospital. One way or the other he needs Nursing care of some kind. He needs to be in a hospital that can monitor his symptoms. I don't understand, what qualifies to be admitted into the hospital. My Mother has been admitted for less, for some reason.
I would definitely make an appointment with his regular doctor and not go to the ER.
We have heard lots of comments from doctors when we ask questions regarding her health (like diet or medicine she takes) that it doesn't matter much "at this age" what she eats or that she pops Tylenol PM like candy. It strikes us as a little odd too.
Your brother's opinion that he might bleed out one night is based on what medical foundation or is it just because it's an appalling situation for you two to handle?
What treatments have they recommended? IS there anything to be done for his condition? Monitoring symptoms without a planned course of treatment isn't really a thing for a hospital to do, so I'd say he belongs in a skilled nursing facility, not necessarily rehab.
I agree that some decisions need to be made, and one of them may well be deciding when taking him to the hospital over and over with no improvement is no longer viable. I made that decision with my mother, because she had dementia and other issues that could be treated at her facility, and trips to the hospital were not really more beneficial than being treated as best as they could in her memory care. It was the best decision I made, because she was no longer subjected to long waits, being alone in there (with dementia to boot), and no real improvement in the quality of her life.
We all wind down our lives in different ways, and this may be how your dad is winding down. I don't think it's necessarily fair to blame the ER doctors when there may not really be anything concrete that can be done in the hospital. If the mass is the cause of the bleeding and nothing can be done about the mass, then...decisions need to be made.
There should have been a talk about what the immediate next steps were.
I don't understand if you don't think your getting proper care at an ER why you would keep returning. Why aren't you seeing your PCP who can run tests and determine what the problem is and have you admitted to the hospital.
How long has Dad had the mass?
What is the diagnosis of the mass?
What is the prognosis of the mass?
What options have been explained to Dad or Dad and POA?
What is the likelihood of Dad surviving (because age IS a real factor in life) any surgery that might help?
Was Hospice or palliative care proposed, suggested, spoken of with Dad?
What are Dad's thoughts and wishes and is he able to make choices for himself? My OWN Dad was so exhausted with life in his 90s. A good and happy and comfortable life, but he was just wanting to stay in bed, wanting peace and the final rest. We were able to talk in such a deep and profound way at the end of his life. He was so ready to go. I am 80 now and that becomes easier and easier for me to understand. And hard for families to sometimes accept.
Is the OP the POA.
We can guess and suppose and opine all we want, but we need more information from the OP; what we have is a diatribe against medical neglect of the elderly. As I said below my own response days earlier, my own experience with my Mom many years ago and my recent one with my brother there was nothing but OVER-TREATMENT by the hospital leaving myself and my family, my Mom and my brother in torture too many days, and begging for Hospice. Had I not been an RN I fear I would have been powerless in saving them from further torture.
I like my Dad's telling me in his 90's --"Kid, if doctors get hold of me, you stand between me and them with a shotgun". Of course the man never had a gun in his life, and never taught me to shoot straight!
My father in law woke yesterday with profound anal bleeding that leaked past his depends and onto the pads and into the bed. He was admitted to make sure he didn’t bleed out while doctors figure what’s going on.
If they just sent him home, I like you would be upset.
When I talked to the surgeon in pre-op - because that was the only chance we got - as FIL refused to allow us to meet with him because he was the only surgeon that would offer any surgical option whatsoever (read: he was the only one foolish enough to offer an 82 year old, 300 pound, diabetic, multi co-morbidity patient who DID NOT WALK INTO THE OFFICE OR THE HOSPITAL a surgical option and PROMISED HIM he would WALK OUT!!!) I asked him how many of the surgeries he had performed. Thousands. How many had he inserted more than one of the devices into a patient. Hundreds. And finally how many had he done - successfully on patients like my FIL. He got up and walked out of the room and did not answer my question and refused to speak to me again before or after the surgery. All communications regarding FIL's surgery after that were handled by a nurse.
My FIL was promised by this surgeon that he would WALK OUT of the hospital THAT DAY. He didn't even walk IN that day. He rode in a mobility scooter and couldn't walk more than 15 steps with a walker. We knew it was all going to go belly up but FIL was hellbent on getting the surgery even though we begged him not to.
That was 7 years ago. To this day he has LOST even more mobility and that surgery actually made him worse than he was when he walked into the hospital. I think it actually contributed to him going downhill and when BIL/SIL moved in with him 5 years ago (temporarily due to their own need) he just literally stopped doing anything for himself. That being said, in the 2 years between them moving in and that particular surgery, his ability to move degraded significantly and we 100% blame that surgery, he moved so much better BEFORE the surgery and had LESS pain.
For example, if my FIL walked (well...let's be honest rolled in on his mobility scooter) into the ER with hip pain - they would stabilize him and send him to his PCP. His PCP would probably give him some kind of topical pain medication and - maybe...MAYBE something stronger to assist with the pain depending on how that stronger pain medication would interact with his other co-morbidities & medications. If my husband walked in with hip pain they would examine him for as many possibilities as they could, stabilize him and either send him to his PCP or send him to an orthopedic specialist for a referral for the hip pain. The PCP or Ortho might then consider hip replacement if needed. Why the difference? Aside from the fact that FIL has already had three hip replacements....his body 100% can't tolerate anesthesia anymore, unless it is emergent and even that is dicey. He has been under the knife way too many times, most of them electively now and his exposure to anesthesia has been way beyond a comfort level to begin with, but now with all of his co-morbidities and his age - the chances are he wouldn't wake up from the surgery. If he were an emergent surgery the chances would probably have to be about the same that he wouldn't survive either way.
Why do I say all of that? While it's a more extreme case, as we age, exposure to hospitals, exposure to surgical procedures and more medication exposure on top of other medications they have to be very careful what they put them on and how they interact. I don't know that they don't want to treat them equally or ignore them because they are over a certain age, I haven't seen that at least with the doctors we have seen with my 95 year old grandmother and my 89 year old FIL.
What I HAVE seen is doctors that give up on patients due to their list of illnesses and they think their time is better spent helping 'mostly healthy' patients where the outcome is going to be better. That happened with my dad, and when he was in his 60s, and we were trying to get his true diagnosis and his PCP was just unwilling to see him through because he saw him as "older" and not super healthy. (very younger doctor, looking to make a name for himself) So he basically said that he was "older and he should just stop worrying about it" Mom was furious and switched doctors and we finally got his terminal diagnosis thanks to the new doctor and dad was able to get the compassionate care he needed for the remainder of his life. So I have seen doctors on both sides and the patient doesn't even have to be what I consider older, just someone they think they are wasting their time with. I think honestly it really depends on the doctor and the medical system they are working in.
If you want to, take him to a different hospital but, don't be surprised when they refer you to a follow up with a specialist instead of admitting him.
I would not want to be in a hospital right now if there was any way to avoid it. I actually think sending him home was the best solution.
I seriously asked to go home after being hospitalized for 3 days because I was dying from no sleep, so being home is best.
Does dad know what happened when there was blood and urine on the floor? If not, definitely take him to another ER. If he just didn't make it, get him some adult incontinence briefs to wear until this is sorted out.
Keep notes of frequency, blood every time, color, incontinence, etc. I would ask him to not flush so someone can have a look and keep notes.
Is he on blood thinners?
I would have thought that the ER doctor would refer you to Dads PCP for further testing. Since Dad is peeing blood he should be seeing a Urologist? That is the doctor who should be running a series of tests to see what the problem is. That's who gives you the diagnosis and sets up treatment and/or surgery. In my local Hospital, these people are not on staff. They are doctors who have privileges and are called into consult.
"No, the best place for him is at home." This kind of response gives me the impression that the ER doctor was under the impression Dad was already being seen by a Specialist and there was nothing more the ER could do. To have a "mass on his bladder" Dad must have been showing signs, like blood, before it got to be a mass. Both my parents had bladder cancer and both were cured because they saw blood in their urine and went immediately to the doctor. If your Dad is already under care, I really don't see what you thought ER could do?
I too think we are missing some back ground info here to be able to give you informed answers. Please be aware that this mass maybe serious. Once bladder cancer is outside the walls of the bladder, it may have spread. Its a curable cancer if contained to the inside of the bladder, once it breaks through the lining, a different story. You and Dad maybe making some hard decisions soon.
Rehab is for people who have been hospitalized over 3 days. Its basically for physical therapy to get up and walking again. Therapy after a stroke. They don't do skilled nursing. They are not set up for that. If Dad has surgery, then he may be sent to Rehab to get his strength back but they do not do hands on caring as such without the physical therapy. They may change a bandage and be given their meds. Once the physical therapy is done, he may be sent home with "in home" care if needed. Some times family is expected to do the care once the patient is sent home.
Please come back with an update and vent all u want.
1. Immediately, yesterday, take your father to a urologist. If his insurance allows him to bypass his PCP, do it. Hospital EDs are not set up for what you are asking them to do. Triage is the name of the game.
2. If the urologist is booking months out (typical for almost all doctors these days) explain the problem to the scheduler and asked to be worked in urgently. They usually don't like to do this with a new patient, but see what you can do. Be patient and kind with them. It goes far. If he has a PCP, talk to them about getting him worked in with a urologist right away. Again, calm, nice, and polite.
3. The ED should have admitted him, stabilized him, done imaging on the mass, and then referred him to a urologist or oncology urologist. If you're unfortunate enough to have him end up in an ED again (and I agree about going to another hospital) ask them to explain their plan. If it sounds hinky to you and it's during office hours, go to the office of the administrator above the ED head administrator. If they aren't available (they never are), talk to his/her assistant. Explain your problem nicely and calmly. Ask for their advice.
4. My father is almost 94. He's seen in an outpatient gerontology clinic at the state's teaching hospital. They respect him, but I've encountered a few other physicians in the system who've had the attitude that, oh, he's 93. He'll die before whatever ails him really gets ahold. I don't put up with that. He lives until he dies. Period.
5. I do think there are physicians and practitioners who discount very old people. If your father needs surgery and the oncologist or surgeon balks, ask why. My father has a low-grade cancerous mass in his lower leg. I've been told by two oncologists that he should not have surgery because people his age don't do well with general anesthesia. But I'm a google-nut and found that there are various safer ways to anesthetize older people. I will be talking to the doctor this week and will ask about it.
6. Once this current problem is sorted out, try to find a well-recommended gerontologist or gerontology clinic. And don't put up with ageist practitioners. If you're in a big enough city, there's always another one around the corner.
Best wishes to you and your dad.
One local hospital sponsors newscasts, gets its people on them and if I didn't know better, wouldn't think there are other hospitals in the area. And that particular hospital also has a history of med mal suits, including one instituted by its medical staff.
We've had a few experiences with them, enough to run rapidly to others in the medical profession.
OTOH, there are hospitals that don't seem to want or require such large amount of publicity, and in my experience they're much better than the publicity hound hospital.
There certainly are some medical pros who aren't as sympathetic to elders, or as I at one time thought, to women. They got dumped very quickly. One of those self absorbed doctors "treated" me after my stroke. He was such a that I was through with him before he even stopped yapping.
Unfortunately, I think that choosing doctors requires good checklists and summaries of issues, good questions and equally good responses. If that kind of communication isn't established, it's often difficult to get good assistance.
Yes. I find that hospitals and doctors give less attentive care to the elderly, the older they are. Plus they're not Covid related where they can rake in $100K, so off they go. I've had the same problem with my mother who was 95 at the time and seen at the ER for chest pain. She was given a blood test and the bums rush. I placed her on hospice afterward knowing she'd get no good treatment at the hospital moving forward.
I'm sorry you're going thru this. No elder should be suffering, in pain or sent home from the hospital with unresolved issues. Ever.
Best of luck.
FIL tested positive at a mandatory pre op. The hospital makes patients able to schedule wait until their covid is done.
The only ones getting admitted with covid are immediate need. Once they find out you have covid, on the spot isolation costs mount even if one doesn’t have to be treated for covid directly, representing a potential loss.
he already had a complete urologic work up previously, with a diagnosis of advanced bladder cancer in a patient too old for treatment. I'm sure he wasn't sent home without any instructions for follow up. It's done routinely in every ER in the U.S. Furthermore, I would't be surprised if the patient is already under Hospice care at home. It seems to me that we're not getting the full story.
It's true that during an epidemic hospitals follow a public health policy of giving admission preference to younger patients in detriment of the very old ones.
My mil was diagnosed with a rare lymphoma in 2020. Soon after, fil had a stroke. They are both still alive because of their treatments and surgeries. They both can’t walk because of the treatments. What do they want? More treatment.
Just as choosing to NOT be the primary caregiver is yours.
But I don't believe the issue the OP is having is a disagreement between the patient and the caregiver(s) about the continuance of treatment. I think OP's issue is the feeling that the ER is not, in OP's opinion, meeting the patient's needs due solely to the advanced age of the patient. Which, if that is what is happening, is ageism.
Happened to my mom, the final time she was checked into the hospital before she passed, they had to locate a PCP, since the one she had been seeing removed herself from her care (with no notice, ). They wound up using the one who was the NH doctor and was also on staff at the hospital.
That said, what does your dad's PCP/urologist have to say about his condition? That's who should be treating him primarily. Have you called any of his PCP's before you have taken him to the ER to see what they might suggest? Or to see if they're willing to call ahead to make it a little easier?
When my son was an infant, I had to rush him to the ER on a Sunday because I thought he might have appendicitis. Thank goodness he didn't; but when I went to his pediatrician the next day, he scolded me for not calling the office first. I asked him what would have been the point, since he would have told me to take him to the ER, and he answered (and I have never forgotten this) "Damn right, I would have told you to take him to the ER; but depending on who was the doctor on call at the time, I would likely have met you there myself to run the tests." So anytime I had to take mom to the ER, I would call her cardiologist (or the service) and tell them what was going on and where I was planning on taking her.
I have been into enough ER's in my life, between work and personal/family health issues to know that the primary goal of the ER is to either get you stabilized enough so you can seek medical treatment outside of the hospital, or to admit you because there is no way you can be stabilized enough to leave. And that doesn't have as much to do with ageism as it does with the number of people who lack insurance (or enough insurance) that they use the ER as their primary care physicians, because they know they can't be turned away for a failure to have the funds to pay for care.
When they have discharged dad from the ER, have they given him/you paperwork with the names of doctors to follow up with? I have never once left a hospital ER - either for treatment for myself or a loved one - that I didn't get a packet of paperwork, part of which is a list of doctors to call for a follow up.
If you've already gone this route with this ER, then the only advice I can give other than what I've already said is to try a different ER and see if you get a different response.
Because unless and until it is treated your father will continue to have the blood in the Urine.
What have you discussed with a urologist about your father's mass, its prognosis, it's diagnosis, and the risks of treatment and surgery (which at his age he may not survive?)
What is your father's mentation? Acute hospitalization is often dreadfully difficult for our elders, and it will not cure or change the blood in the urine. The only thing that "may" cure it is treatment, and this is why I am asking you about treatment. Is your father able to discuss his options with you for treatment, surgery, palliative care, hospice?
You asked if the hospital is considering your father to be dying, and the honest truth is that I am surprised no one has discussed with the MPOA the options now for treatment versus palliative or hospice, and the choices that realistically you are facing.
Yes, age makes a difference. It makes a difference in whether someone can survive treatment, it makes a difference in the quality of life expected if treatment is not survivable, it makes a difference in what options are available and in almost everything else. Aging is a fact of life. We have four score and ten, and sometimes some more and sometimes less, but none of us survive age. Age and illness is particularly dire.
Triage is not instituted without orders from on high in dire emergency situations. But you are also correct that in a REAL triage situation age is one of the factors measured. As an RN trained for triage I am aware of that.
Your father is unlikely to be accepted for rehab without treatment of his condition, nor is he likely to be able to participate in the difficult work of rehab PT and OT at this particular time.
If your father is unable at this time to weigh in on his options because of any mental dementia or deficits then his POA is now responsible to make decisions for his quality and quantity of life, with the help of expert advice. I am so sorry for this. It is never easy to face the coming loss of those we love.
I wish you much luck and I hope for peace and comfort for your father, and healing if this is a possibility.
My brother and I had, decades earlier, had to battle another hospital and doctor in the state of Missouri to allow my mother with her severe CHF and valvular disease along with pulmonary hypertension to pass peacefully with hospice age 96. So yes, for me it has been overtreatment, not undertreatment. One many years ago, the other much more recent.
I understand your frustration.
As for dad peeing blood and it going everywhere maybe depends would help with containing the urine if he can't make it to the bathroom in time. This way he retains his dignity from having accidents. And less chance of dizzy spells abd him falling when he gets up to pee.