My mom lives in a memory care facility. She had an unwitnessed fall last week and the facility sent her to the ER unaccompanied. They did call me but I was out of town. Is it typical practice for a facility to send someone with pretty significant Alzheimer’s to the ER alone?
I can see with shortages where this would happen.
One way around this might be to have mom evaluated for Hospice. If she is on Hospice there are no trips to the hospital and the facility would have called hospice for instructions. (or they may not have called and just recorded the fall and informed Hospice and family later. If there were no visible injuries there would have been less of a reason to call.)
What we tried to do was contact the family or the listed representative to advise them of the need to send the resident to ER after a fall or any other serious medical condition (of course, if it was life threatening the resident was going to ER immediately). We also tried to make and send with the ambulance crew a copy of the latest medical information from their chart (some of these charts were several inches thick so you could not make copies of the entire thing) and a copy of their current med list. The poor ER staff is caught in the middle if a family member didn't show up (and that happened sometimes). Is it enough? Not by a long shot but until you can convince the private entities, who own the profit facilities, to let some of the funds they are being paid drift down to the lower levels (CNAs, kitchen staff, laundry, housekeeping) it is going to be pretty hard to convince people to join the industry at that level. CNAs in most states still start at $15/hr (that comes to about $13.80 with min tax) and some states are lower than that. $15/hr will barely get you enough gas to get to work in NJ. We won't talk about outrageous rents, utilities, car insurance or childcare.
I arrived there for an unrelated reason (ER visit after my first week caring for my mom in home hospice). My friend’s sister was there, I greeted her mom, (who now thought she lived there after being there night all waiting for the ambulance). And the staff member started giving ME the information. Total s**t show. I’m surprised everyone is so surprised.
The ER will do a million tests, leave the elder alone for extended periods of time, etc etc. It's horrible. My mom has a DNR but that doesn't keep her AL from wanting to send her out. I wonder if a patient is on hospice or even palliative care, if the push for ER trips is reduced or eliminated?
My mom has dementia and my MIL too. They can't give the staff any info that they ask for about what happened and their history etc. It's just horrible.
Best of luck.
I mention this because of the advantage of a facility where POA can be more available when emergencies occur, and I realize that we were very lucky that this turned out as it did.
Was there a “second in command” in your mother’s situation, SGL0419?
A couple of times she did have to go to the ER by ambulance for pneumonia and illness, but I always met them at the hospital. If I couldn't make it, I would've called my son or daughter, or my husband would have met her at the ER. A few times dh and I were out of the country on vacation, or out of town for a wedding or whatever, but I had a backup plan in case of emergency. I didn't expect a caregiver to accompany her for the 4 hour minimum stay that always takes place in the ER. I don't think it's the facility's practice to do that...I know it wasn't at the Memory Care facility I worked at.
The ambulance attendants always see to it the resident gets back to the MC and to their room safely, and the hospital staff looks after the resident as a patient. It can be quite disorienting for the elder, however, especially with dementia going on.
If I had not gotten called by the terrified aid at 4:30am whispering that she wasn’t supposed to tell me, I’d not have known. As it was the DON when I called at 9 when she got in and when I still hadn’t heard anything didn’t know which hospital Mom was in or how she was. I called the ER, who by that time wanted their nurse’s hand back because Mom was clutching her hand in a death grip, and they invited me to come on down.
The ER did the best they could in that case, but Mom did not do well. She would have been better to have stayed in the ER than go back.
She was sent unaccompanied. My husband followed the ambulance. It was at the beginning of COVID, and I couldn’t be exposed.
My husband was told that he couldn’t come into the treatment room with my mother.
Luckily, my SIL (who is a police officer, and sometimes works there) stopped by in his uniform, made his way back and talked the nurses into letting my husband come back and advocate for my mother.
If we all were out of town, I don’t know what on earth they would do without a family advocate there. My mother has a 1 minute memory, and would definitely be a flight risk.
When we had first admitted Mom into MC, the salesperson told us that if Mom went to the hospital, someone from the facility would go with her. Nope. Didn’t happen.
When the day was over, what we didn’t know was that if a patient returns after 7pm, they wouldn’t be readmitted. It took begging and pleading not to have Mom sent back to the ER till the morning.
The whole thing was a mess, I’m sorry to say.
Head falls are awful! My mother typically fell backwards due to her Parkinson’s disease. She needed staples in her head.
Mom had beautiful white hair and it was awful to see bright red blood flowing through her hair. Thank God, No brain bleeding occurred.
Only once did she fall forward and cut her forehead. The bleeding with head falls is awful.
That fall didn’t require any staples. She scraped her forehead just enough to start bleeding.
My daughters loved the bandages with cartoon characters on them. I didn’t have any plain ones.
Mom wasn’t thrilled with wearing a cartoon character on her forehead! LOL 😆
Sorry that this happened to you.
I am sorry that this happened, especially since you were out of town and not available to be there with your mother.
Best wishes to you and your family.
Did you contact the licensing organization for facilities in your state to find out if this is allowed? Or an ombudsman? Sorry for the distress it caused you!
By "overtreatment" I mean treatment that does more harm than good, including extra tests that run down or hurt the patient, and that would produce no actionable information anyway.
Also: electronic medical records seem to provide no guarantees that treatment preferences will be honored. My mother many years ago signed a POLST, which has been re-affirmed and uploaded multiple times to the same medical group's system, yet in that group's ER and hospital she was somehow listed as "full code" during the entirety of her last stay (this even though the POLST was discussed and confirmed early on during this last stay). I didn't make this discovery until we were back home and I was going through pages and pages of hospital notes on my PC. (At the hospital I had only my phone.)
Being tubed and tied down is one of her greatest fears. At this point I see no way to prevent that possible outcome except 1) keeping her out of the hospital, or 2) staying with her every minute during hospitalization.
EDIT: I just now recalled a recent exchange on this forum about DNR bracelets linked to official documents. Since hospital staff have to scan the hospital bracelet before giving meds, maybe a DNR bracelet on the same arm would provide a modicum of protection...
They do send with contact information (for you and for them).
Was there a head injury? Often residents, especially if a DNR is involved, are not sent if there is no apparent injury and the head had taken no injury.