Oops- cross posted with you and CF, momsquad.
Some of this depends on what a condition is or how bad it is. One advantage to an ambulance over the facility driver or a taxi is their training. And the facility nurse would inform them of what they assessed, the paramedics would then convey this to the receiving staff at ER. Of course for something minor, one might wait for family or go in a cab.
I love CC because my outraged feelings are so often validated whereas others (including some family members) leave me wondering if I’m over reacting. After a morning calling various Ombudspeople and the regional chapter of a long term care advocacy group I was put in touch with a service that provides house calls to seniors as an alternative to urgent care. We’ll pay a monthly fee of $30, but they are available 7 days a week and she won’t have to travel to urgent care. The kicker? Her assisted care facility contracts with the company so we get a 50% discount, yet no one thought to tell us about it!
If you assert that when the care facility staff assess someone as needing a trip to urgent care, they are instead sent in an ambulance, then you are asserting that there is never a case where a person needs urgent but not emergency care. This sounds like exactly the opposite of the kind of sensible cost controls that we need to move toward. People who don’t need to go to the emergency department should not clog up ambulances and the emergency department at great expense and trouble. The care facility is delinquent in its responsibilities, to not have people under its care who need to be seen by a doctor be seen by a doctor.
@momsquad, am glad your digging found this service but feel it odd that the assisted care facility didn’t point out this option to you. Hope you bring it up with the administration there so that others don’t have this issue.
CF - my comment was it was a lot of money TO HER. Not that they aren’t worth their weight in gold. $100/day for an aide adds up. And when you pay $100/day and they’re on your nerves and not doing a lot - it’s a lot to someone at their heydey made a couple hundred dollars a week.
momsquad - that seems unacceptable to me. We all have experienced small issues ballooning into major problems with our parents.
Sorry, eyemamom, I misunderstood. For sure, $23/hour is a lot of money to the aide. I apologize for misconstruing.
Actually I was saying the 23/hr was a lot to my mom. She doesn’t have a lot of money, never paid the bills, and when she worked it was part time in a clothes store and as a secretary. She even worked as an aide and never made nearly that much. So to her, paying that much is a lot of money.
At the in-laws assisted living. Urgent visits were typically handled by ambulance to the emergency rooms. I don’t think lack of drivers on the week-end is unusual.
I am very surprised a resident could not be driven to ‘urgent care’ or a ‘doc in the box’ on the weekend. ER is sometimes ‘overkill’ when it is a start of a URI, UTI, etc. I would think if they don’t have a regular driver, that this assignment gets added to a Sat/Sun staff person who has the driver skills.
^^ @SOSConcern #5489 , if only. But from the facility’s point of view, there are two problems with this approach.
The first is staffing. These places have very carefully calibrated staffing levels, based on state regulations and their own budgets. If the law says that there must be 4 aides on hand at all times, the facility would have to hire 5 aides in order to be legal, if someone has to drive a resident to urgent care. Senior housing is a cut-throat, cost-conscious industry, and they’re not going to pay an extra body to be there for the occasional “just in case” event. Sad but true.
The other problem is liability. Corporate headquarters does not want low-paid aides deciding how serious an illness or injury is, and thus where the patient should receive care and how they should get there. Imagine the lawsuits if (when) they miss a symptom, or misinterpret a symptom, and send the resident to urgent care when they needed emergency care.
My mom’s AL does not provide any kind of transportation for medical care (except a van which takes them to scheduled doctor appointments). When there’s a problem, the AL will call me and either say “We’re sending her out to ER” or sometimes "This is going on and we’re not sure. What do you think?’ They have me make the decision – no care, urgent care, or ER (and I’m sure they document that I made the decision). I’m lucky in that I live close, so if the call is urgent care, I can take her myself.
I don’t know if everyone is aware of another tier of transportation which can fill the hole between ambulance and personal auto. It’s called medical transport. This is a specially outfitted van, which will pick up your senior where they live and take them to the doctor or urgent care or probably even ER – though we haven’t tested that – and then bring them home again. IMO this is a better option than a cab, because they can accommodate wheelchairs and even gurneys, and the driver has experience handling frail elderly. In my area, a round trip to the doctor runs $50-75, a bit more than a cab – but far less expensive than an ambulance ride which Medicare decides wasn’t necessary (which has happened to us). There have been several situations where this “in-between” option has been just the right solution for us.
@LasMa I agree with your comments. It would seem that if the facility is in a medium to large sized city, perhaps there is a service like you are talking about. If family lives nearby, certainly if the facility medical staff (be it LPN, RN, or even if an aide alerts their management) lets the family know.
I do understand all the limitations you mention. That can certainly be true with stand alone AL. However when there are higher levels of care, they may have more facility options before seeking out an outside service.
However I do not like the idea about just waiting from Friday after 4 pm until Monday 8 am.
Something readers need to think about on the details with facilities.
Good point about continuing care communities. In that case, certainly an RN from the skilled nursing wing should be able to make an assessment about what level of care the resident needs.
The medical transport option which I mentioned can also cover weekends. AFAIK, they are round-the-clock, though this will probably vary from one agency to the next. There are quite a few of them in my area.
So true about checking it out with facilities, preferably before a decision is made to move in. I confess it was something I never thought about when we were looking for a place for my parents. There is SO much to this parenting-your-parents that would never occur to the average middle-aged adult like us. Quite a bewildering landscape.
The only problem with medical transport that I’ve experienced is that they pick up well before the appointment, and they don’t stay during the appointment so you have to call them to pick up the senior and then wait for them to return. I’ve had times when they’ve shown up within 15 minutes of calling, but there have also been times when they’ve shown up over an hour after I’ve called. Try waiting with an impatient parent who may need to use the bathroom or voices her complaints loudly while you’re in a waiting room with other people. Having said all that, it’s still my preferred transportation for my wheelchair-bound mother.
Shellfell, it’s not always ideal for sure. Like so many things with our parents, it often seems to boil down to the question of what’s the least unacceptable choice, as you say.
Right now we’re in the process of moving my 91-year-old Mom. The choices were go broke or move her. It sucks.
eyeamom-
That 74 yr old aide has GOT to go! She has no boundaries. Is your mom moving to a CCRC where she will not need any private aides (hopefully). This one sounds very self focused, nosey and inappropriate.
Not sure there is a perfect solution yet, not if we include affordable.
I think the term may be “Non-Emergency Medical Transport/NEMT.” Depending on the area, there can be a variety of service levels to that. I also think a lot of this depends on what may be going on, medically. I’m not sure the facility driver would be the right person, even if available, if it’s something like a trained RN concerned about a swollen leg. In many cases, depending on the person’s medical history, that could be serious. I also don’t think I’d be inclined toward urgent care, for that.
You’re right, LF, that’s the correct term.
We were so relieved to get my mom a spot in a quality memory care unit that we left too many questions unasked.
We naively thought all our problems were solved once she moved in to her apartment. Ha! The “continuing care” is not nearly as continuous as we’d expected. Skilled nursing is in a separate building, with separate administration and staffing. Her unit does have a nurse on staff full time, but as pointed out by LasMa they are very reluctant to make decisions on their own about her medical needs. The routine seems to be that a caregiver will notice a problem and notify the nurse. The nurse will then fax the doctor for advice, then call a family member to inform us of the doctor’s recommendation and request approval to send her to urgent care if needed. If the doctor says “ER” she’s immediately booked on the $2500 one mile ride to the hospital. During the work week they provide a driver and hire hourly caregivers from a local agency to accompany her to urgent care. The poor doctors have almost no information to go on when she arrives because the caregivers don’t know her history and she can’t explain the problem herself.
An advocacy group in California has been an enormous help the past few days. It’s called California Advocates for Nursing Home Reform. Their web site has useful information that is not necessarily specific to CA; http://www.canhr.org. I spoke to a representative who said urgent care transportation falls into a gray area with continuing care communities. Although he was very surprised my mom’s place did not have a driver on the weekend he said it is not legally required. I did speak to the director of my mom’s facility and it turns out she has only been on the job for one month. She seemed to know less about their operations than I do at this point. In fairness they do have an incredible program for the dementia residents and my mom seems to feel she is part of a family there. It would be next to impossible to move her, so the battle for quality care will continue.
@jym626 - I agree about the aides. Mom moves in a week, and needs time to settle in. She’s so nervous and anxious and upset about it - she told my two sisters yesterday if she didn’t like it she wasn’t staying, but my sis who lives in another state says where would you go? But told me privately, we were all together for Thanksgiving and the decline since then is really astounding.
In any case, we need to get her there and settled in, then we’re “re-evaluating” these aides. I’d normally boot them to the door and just replace them asap.