We're accumulating a lot of clear x-rays and CAT scans at the local hospital. I'm thinking of asking the MC to call me to come see him BEFORE they ship him off by ambulance. Last night we spent 6 hours in the busy ER in the hallway between a young heroin addict with serious medical issues and an older cocaine addict who kept wandering around touching all the other patients. During all that time, I was trying to keep my husband lying on a hospital bed because he wasn't in any pain and couldn't remember from one minute to the next where he was or what was happening. Any advice?
He didn't understand where he was or why and my husband and I realized he didn't have to be there; we could just take him home (back to his regular facility) without their permission. Once he was home again, he was much better mentally and we were able to get PT for him at his home living facility.
Medicare wasn't much help either. They took down notes about what I was saying but didn't seem to have any advice to offer. They said they'd get back to me in a few days. In a few days????!!? I couldn't wait "a few days" to get him out of there!
It is expensive to have your loved one shipped by ambulance but the liability issues are great if that's not done. Meanwhile, in your case, your husband was subjected to that cocaine addict touching people. EMTs are trained to move injured patients and are probably the safest way to transport them.
Not knowing exactly what the test results were for your husband, I'm not sure what to advise except that you are not forced to keep him in an unacceptable facility, although it may cost an ambulance ride to move him.
On the up side, he did receive the tests he needed and the recommendation for PT, if warranted is good.
In our case, I've learned the lesson not to just accept what we're told and not to agree to anything until. I fully understand the procedures. Also, I now insist on the names of the attending nurse and doctor and that I have numbers where I can reach them. I also know that I can remove him at my discretion, not theirs.
The AL needs to have alarms on his bed and wheelchair to alert them if he is getting up.
More assessment and more monitoring seems in order to prevent falls, rather than limit care when he does fall.
I imagine the AL is required to call EMS, who then assess and decide to transport or not. But, with dementia, the assessment would be extremely limited and they would almost certainly decide to transport because he can't accurately answer questions to rule out a brain injury.
It strikes me that you were with him at the ER for 6 hours and did not choose to check him out and take him back to AL. You could have signed to check him out against medical advice. Medical professionals are obligated by their license to rule out injury and once the EMS is called. The AL has policies, that you signed, when you placed your husband. Please let these policies and procedures work smoothly, and let the professionals do their job - until you sign to take him out against doctors advice. The professionals need the liability coverage that the P&P and medical protocols provide to ensure good care for everyone.
That said, all of your medical documents should be filed with both the AL facility and the hospital where he would go for care. You can have a DNR and a Medical Directive filed. However, check with the hospital about if the ER has to observe them. In my state, once EMT is called, full measures will be taken to save his life. I believe that is true for the ER as well. The implication is that if a patient lands in the ER they are to work to save them. Period.
This is where hospice can be helpful. Hospice will not call EMS and directs families to not call EMS - for the above reasons. If he is eligible for Hospice, it is time for a new placement.
Falls can be fatal and damage can only be fully assessed by hospital personnel.
You can skip the ER if you care for him at home.
The nursing home suggested that they thoroughly exam him and then call us with their findings and ask us if we wanted him transported.
We would have lived at ER! Ask your nursing home to set up the same system.
In pursuing this line of questioning you and the MC can find ways to avoid/decrease these falls in the first place.
Unattended falls, instead of auto transport would be assessed by EMT. They let me talk to EMTs and I make the call to transport or not.
Now she is on hospice, and they are called to assess if necessary; haven't seen how that goes yet, she hasn't had a fall since we started hospice recently. She does have a DNR.
Its not that I don't want her treated for an acute injury, but the whole ambulance ER thing is so traumatizing for her, that it's often not in her best interest. And one time she was transported for an unattended fall, because she was complaining about her leg, and I was concerned about her hip. Hip was fine, but she had broken ribs!
An unseen fracture, a concussion, brain bleed...
And what was the cause of the fall? Was it a BREAK then FALL?
I am sure for liability reasons they would not want to "waste time" contacting you then possibly waiting for you to get there before calling 911.
When my Husband would fall at home I would call for a "Lift Assist" and they would ask if I wanted him transported and I always said no. They never insisted.
You could find out if your husband is eligible for Hospice. Once on Hospice THEY become the 911 and a call would go to Hospice and they would probably decline the transport to the hospital. That is not to say that Hospice would always refuse transport to the hospital if they think it is serious enough to order it they would. (Chances are if he were admitted he would go off Hospice and then Medicare or Medicaid would be the coverage then once discharged he would go back on Hospice. Can not have 2 agencies billing at the same time)
Also if he has a POLST or DNR they may not transport him either. Check with the facility to determine their policy on that.
You can die from bleeding to death from a broken hip and of course you could just be bruised or have a hair line fracture.
Going to the ER is an awful experience especially with dementia.
Nor only is it very hard on the person bur you could actually catch something there and get sick.
I think I would rather go check my husband out myself and not go unless he is feeling pain or showing any signs of distress.
I think I would just spend the night with him so 8 can keep an eye on him and see how he is the next morning.
A few times, my mother complained the next day of pain in her arm or leg or whatever, so her PA ordered the traveling xray team to come to the MC to take an image; nothing was ever broken (believe it or not) in any of her falls. Early on in the AL, she broke a couple of ribs and a sternum bone or two, but she never pressed the call button for help, so the staff didn't know she'd fallen (she was able to get herself back up alone). During an admission for pneumonia, she had a CT scan and that's when the broken bones were discovered, in various stages of healing! Even if they were discovered during the actual fall, however, nothing could have been done for her in the ER b/c those bones aren't set in any way and just left to heal by themselves.
Good luck; I know how awful the whole situation is when a loved one falls.
I think it is absurd to send someone to the ER JUST because they fell. My MILs sister used to get mad when she didn't call 911 when she fell. Then I'd go sit with her for hours and hours cuz it takes bloody hell forever at the ER even when they are NOT busy and she would whine and complain about being there so long. We finally got her trained that 911 was for actual emergencies. If you hit your head, are bleeding profusely or in major pain (after a few minutes not from the initial fall), then call 911. Instead, call us and we'll help you evaluate if medical intervention is needed.
It would be nice if MC could do something like that too! There is way too much cover-your-butt type of decisions made for patients. They are often expensive, time consuming and unnecessary.
Definitely let your wishes be known ASAP. Hopefully something can change. Also agree with other posters to brainstorm with facility to see if they have any ideas on WHY he is falling and if there is anything that can be done to help in that department.
I think that is the very definition of 'fall' but I could be wrong.
She lives with YB and he refuses to take her to the ER. I'm done arguing with him about this. She is 91, frail as a little bird and has a lot of pains and aches after these 'slumps'. YB thinks he can dx mom's injuries. Currently, from her last 'fall' she cannot move her left arm without serious pain. I think that's worthy of a checkup but neither she nor YB do.
If mom were in a NH I would WANT her to be checked out. yes, it's a time consuming thing, but she often has UTI's and they make her dizzy. She also doesn't WANT to go to the ER and I don't blame her, but I know one of these falls is going to be the last one she takes at home.
In our state, I believe it's required that a person who falls be taken to an ER unless a dr/pa is on site and can evaluate.
My Aunt in her 90s was in the Skilled Nursing part of a retirement community in Florida when she fell on a Friday night while they were helping her shower. No one notified our family (her remaining family and emergency contacts). However, a local friend who would visit her often was contacted and told her legs just buckled; it was a minor thing. He was on his way out of town for the weekend and did not check on her nor contact me. On Monday he did visit her and called me to let me know "she wasn't right". I contacted the SN director who said the only way to have her seen by a doctor (who only came on Wednesdays) was to send her to the hospital in an ambulance and only family could initiate that. She had a DNR. I sent her to the hospital. She passed away there that night.
My father fell in MC also on a Friday and they tested him for mild UTI before opting to send him to the hospital "to get stronger" as there would would only be a nurse on call over the weekend in MC. He was given fluids/antibiotics and told he could return home that same day but the MC asked them to keep him over the weekend. The hospital gave him too much fluid and he took a turn for the worse so the hospital stay ended up being a week before they released him to Rehab. This was his 3rd go around with fall/hospital/rehab. He asked me "How much longer do we have to go through this?" That was the last time.
I didn't want Dad to die in the hospital like his sister. Guessing my Aunt is still mad at me.
While you are talking about falls with the administration, ask about their protocols for protecting people at high risk for falls. Every facility with population at risk of falling will have one. See if it includes: increased observation, low beds, mats by side of bed, call bell within reach, frequent toileting...
Eventually the Staff used a pillow under her legs and that worked for awhile, as my Mom would spend time trying to remove the pillow.
An ALF is housing with supportive services. They might have a licensed nurse in the building for some parts of most days. The staff are unskilled, and cannot judge if patient is injured or not. So, 911 to the ER is the default plan. You may be able to make specific arrangements for your resident if you live nearby, etc.
ALFs prefer to have any resident with falls placed on hospice, so that if resident dies at facility, there is no implied liability for failure to care by ALF.
Knew one place where 2 residents in the first 6 months they were open died of head injuries as not sent to hospital..or checked hourly. After that, even a suspected fall went to ER for about 3 years.
An example: my father, in his late 90s at that point, fell down the cement porch steps one day in December; the church friend who was with him took him to Sunday services, and another congregant put bandaids on his skinned leg. No one told me. (This was a major issue as he aged; they didn't feel I needed to know as they felt they were qualified to care for him.)
A few weeks later an issue arose which required ER treatment. I saw the skinned knee, covered with a bandage, which was being overgrown by skin, trapping the bandage against his leg. The ER doctor declined to debride the wound. Since I didn't know until then that he had fallen, I hadn't made the necessary efforts to have it debrided.
We had a podiatric appointment in a few days, during which I was trying to find someone (medical, not a church acquaintance) to take care of the wound. I asked the podiatrist, who was one of the top doctors we were seeing if she could offer some recommendations. She knew how to debride, and she did, taking care of something that never should have gone as far as it did.
So, I would opt for a ER visit just to make sure everything is all right and there's nothing hidden than might show up later, in a more complicated state.
I was told when Mom went to skilled nursing that they do not send residents out every time they fall. If they hit their head, yes, out they go. Otherwise, they observe the person.
I know, its a catch 22, damned if you do and damned if you don't. What if this fall "is" serious. I took on that responsibility. They do not go with the resident and I was the one that sat there, in an uncomfortable chair, for 3 to 4 hours.
So at the Care Plan meeting we agreed that if they could treat mom on site, UTI’s, etc, she would not go to the ER.