Mo squad, I think you hit a key point about knowing more than the new hire RN. I have a care conference with moms people today. We have to do it at breakfast because that person who did her last assessment is new and busy learning the ropes. I am betting that her assessment shows mom needs much less care than she gets now, which is not enough. And another thing I am not happy about was when mom moved in, there was an RN present somewhere in the building 12 hr a day. That has changed…without any notification to me, I might add… To an RN present three days a week. They do not have staff to take to hospital during nights and weekends either. And they just send mom off on the bus to the dr. Where she says she is fine. Basically all he has to go on is her blood work. She had lost a lost of weight in Nov and looks thinner now… But they only weight the people once a month? So they hadn’t noticed. I think she has lost weight again since I saw her last, too. My brother saw her at Christmas, but he doesn’t see her dress like I do. They give her too much Tylenol, sometimes on an empty stomach, then she won’t eat the next meal.
But still, I am sure, given my family and brothers family, that this a a good place for her overall. Just like the perfect school for young kids, you have to stay involved to avoid falling through the cracks. My mom is about seven years old I think … Able to dress, eat, talk and thinks she can do everything, but gullible and not able to control much of anything.
Good news though, the housekeeper, such a nice person and one that actually talks to mom often, found her missing underwear. I had asked at the front desk, and they had no clue as to lost and found… I KNOW the people who try to do their own laundry leave it forgotten often. They had to have a process… But the business manager didn’t know it. The head aide is waaaayyy to busy to find to ask, so it was the housekeeper, the one person who hasn’t changed in the last three months that knew. The aids change constantly it feels like, so when there is some stability, I think it is a huge help. Mom can snow people for a while, but if they are around more than two minutes a day, they do come to realize that she is here for a reason.
If a medical problem is urgent enough that it can’t wait until Monday, I believe the ER might be the best place to have the elder evaluated and diagnosed. Urgent care doesn’t have the ability to do things such as ultrasounds and CT scans. Plus, you have the additional problem of having a caregiver, aid, or driver who can’t help with giving the history of the illness. I certainly know my parent wouldn’t be able to give a history of present illness. At the ER, at least the elder can be held there, or hospitalized for an unclear picture of the illness.
I agree eyemamom, get your mom moved before any changes are made. I think I would need more information before I judged what the aide actually said or did.
Eyemamom, I agree with GTalum. One thing in this situation: do you think the cart may be before the horse, that the aide might have reacted to what your mother told her, which was a very convoluted version of the truth? I went through this at times with my stepmother’s aides.
I also agree that the ER may be the best place for an elderly person who can’t be properly evaluated in the facility, for whatever reason. The issue of no access to the medical record is awful, something that was a big problem for my dad and stepmother. That’s a big vote for accessible electronic healthcare records but our biggest problem was that there were two different networks involved and there was no way for the history to be shared.
Yes oldmom, the electronic medical records don’t communicate with each other very well, even if they are the same system/company/health care network. Even if they had your records, they don’t record the “history of present illness” in which a clear history of the problem and associated signs and symptoms needs to be given by the patient for the medical team to attempt to arrive at a diagnosis.
Great point about reporting issues. My dad was completely incapable of giving medical history, current or past. Either I had to be there, or the EMTs, who would have gotten at least the presenting symptoms from the AL aides. And then, of course, it’s not just a reporting problem; there’s also the receiving problem. They may be utterly incapable of taking on board, much less remembering later, what the doctors tell them about diagnosis or treatment.
I kept an updated Excel spreadsheet for Dad for awhile, listing not only medications and supplements, but also drug allergies, ongoing conditions, past medical events, and vaccinations. I’d put a copy in Dad’s wallet, and I kept one in my purse as well (since for some reason, most of his dashes to ER were at night, and he’d be in his pajamas and not think about bringing his wallet). I had a lot of doctors and intake nurses thank me for it.
esobay I hope your care conference went well and congratulations on finding the missing underwear! I put my mom’s name in all of her better clothes because the laundry sometimes gets mixed, even though they are supposed to keep everyone’s things separate. We have never had a care conference or assessment for my mom, even though she has been there over a year now. I visit at least once per month and speak to the nurses weekly, so I suspect not much would be gained by a formal meeting.
I can access my mom’s medical file online but I constantly need to ask them to update her current medication information. She was given Aricept when she was hospitalized instead of Exelon because the information in her file had not been updated. The hospital staff were so nonchalant about the errors, like it happens all the time. The one silver lining of the dementia is that my mom doesn’t know about her physical medical problems. She doesn’t remember she has a bad leg infection or an itchy rash. She doesn’t say much anymore but looks alert and sharp, so the ER personnel don’t know about the dementia right away. As soon as I arrive they ask me about her baseline mental status because they assume she has had a stroke when she doesn’t remember which city she is in.
Re: communicating relevant info about patient to outside care providers-
The AL and SNF facilities where my father has lived for 10 years routinely send a face sheet out with the driver or relative. It includes current medications, allergies, reason for visit-what is to be assssed and any current diagnoses. It is quite graphic and easy to scan. Contact info for facility is provided. Additionally, there is a visit summary for provider to list diagnosis, required follow ups and recommendations. In my experience, it works fairly well, but is not as good as having staff or family there. LM- I used to carry such info sheets for my parents. Keeping them up to date was worthwhile and time consuming.
I think that when urgent care is recommended, it should not be omitted purely due to transportation issues. There has to be a way to access care 24/7 and it makes me wonder if once a staff member states what is indicated (thereby taking on some level of assessment responsibility), there could be institutional vulnerability for not connecting the dots to make it possible. Would this cause a place to refrain from recommending urgent care on weekends if there as noteansportation plan in place. Anyone could need outside medical care when a friend or family member is not available. Obviously, the elder’s health is the priority; I would not want a facility to opt out of recommendations that they prefer not to pursue logistically. Agree the answer at times must be some form of medical transport. In many areas, it would mean an ER visit.
Travelnut, my point is, if there is a urgent medical problem for a frail elder which can’t wait 1-2 days, it is a problem that probably needs to be assessed in the ER.
My mom is working herself up into a world class tizzy about the upcoming move. She wants to go to the dr every day, even after the nurse comes to see her. She did agree to go see a psychiatrist at the facility next week when she moves in - she even agreed to talk therapy and medication. So that is something. My sister also found out back in 1980 my parents signed papers giving her power of attorney, so now if my mom is too flipped out to go to closing Monday she can go sign the papers.
My sister who was supposed to help me with this move now has the flu. Hopefully she’s better in a few days, but we’ll see.
I’m trying to tell my sister it isn’t necessary to make mom do or be anything when she gets there. Let them evaluate her, if she needs help they’ll give it, if they see she has terrible anxiety, they’ll help her. We can’t make her be something she isn’t, that’s why she’s going there, so she can pull that cord in the middle of the night if she has any issues. Closing is Monday, and she’s moving in Wednesday.
We’ve had nothing close to the problems you all have been facing but that may be changing. My 88 year old mom (the one who recently had her driver’s license suspended) fell at home this afternoon and is now in the hospital with a periprosthetic hip fracture. My brother (who lives 5 minutes away from her and just got back from a family vacation in Puerto Rico) is with her. All we know so far is that she will need surgery; no idea when. I’ve been reading up on such fractures and it sounds like it’s going to be a long long haul til she’s home again.
This is her third ER visit in two years after falls; the first two resulted in broken wrists. Maybe finally she’ll be willing to admit that she cannot live independently. She fell getting out of bed (at 1:30 in the afternoon) and it took half an hour for her to crawl to her cell phone charging on the dresser. (She refuses to wear an emergency button.) Fortunately finances will not be a problem because my brother and I are pretty sure she’ll need 24/7 since her objective is to stay in her condo until she’s carried out. Which, come to think of it, happened today.
My dad broke his hip when he was 87. A week in the hospital, 2 weeks in rehab, and he was home; another couple of weeks and just about completely back to “normal,” including driving which I delayed as long as possible.
He fell when the banister broke on the basement steps; he was going downstairs to do the laundry at around 5 p.m. He crawled up the steps, had my stepmother make him dinner, went to the bathroom (“oh, and getting on the toilet, that pain was a 10!”), and went to bed. Finally at 11 he had my stepmother call me. He knew it was a broken hip, this was his second. He told me to wait and come in the morning to take him to the hospital. Of course I got in the car to their house and I called 911. My daughter was in 9th grade and that’s the first time I left her alone all night.
Never a dull moment! Hope you get the outcome that is best for your mother, your brother and you.
This makes no sense for me. And I think it’s a way to clog up ERs with problems that are not emergencies and whose patients do not need to be in the emergency room.
ER’s aren’t necessarily for life and death, it’s for situations that need to be seen immediately. An elderly patient often shouldn’t wait 2 days to be seen.
Marilyn, I’m guessing the surgery will be in the next few days. I’m sorry to hear this, especially when someone is active and independent.
CF- Agree ERs are over-used at times, just am ignorant of alternatives. In some situations, there is a need to have a medical issue which may or may not be serious evaluated during non-business hours. Urgent care is not always an option, so it is a choice to either postpone the assessment/treatment or go to the ER. Can be a gap in the health care system as a 48 hour delay with some conditions could increase the magnitude of problems, causing patient distress/risk and ultimately using more medical resources than a timely intervention would.
Eyeamom- hang in there. So glad you mother can receive the care she needs and will soon be situated.
Marilyn- sorry about you mother’s hip and best with her recovery. So hard to see this vulnerability.
Urgent care, at least around here is really just a doctor practice. My kid went, when she thought she had bronchitis, wasn’t near home, and wanted a medical opinion and some oversight. My mother went, for something routine. I’d send an elderly relative there if, say, a wound wasn’t healing properly and it needed more attention than from a nurse. But something that could be more serious, the sort of thing urgent care might just send her to the hospital for, for further testing or assessment…go to ER. Happens all the time. With the elderly, dizzy, un-accounted for leg swelling, dehydration, a host of other things, go to ER.
I like lookingforward’s way of evaluating it. Urgent care here doesn’t have the ability to do most lab tests, can’t do much more than x-rays and ultrasound in the imaging area, and doesn’t have many of the drugs an ER keeps readily available. For a sprained ankle, broken finger, earache, or pink eye it is fine. With what the OP described, no, I wouldn’t think Urgent Care would be the right place at all. Horses for courses and all that.
I agree CF, emergency rooms are over-used, but due to healthy people walking in and using it at a doctor’s office. But, I am talking about a frail elders urgent medical need that can’t wait 24-48 hours. In that case, a more comprehensive assessment of the problem that is beyond the scope of a Urgent Care facility is often necessary. The dizzy, leg swelling, and dehydration that lookingforward mentions are good examples of what is beyond the scope of urgent care.
Marilyn - so sorry about your mom’s hip. I can imagine that a periprosthetic hip fracture is more complicated. I always thought that after a replacement, you didn’t have to worry about a hip fracture. It is sure to be true that your mom won’t be able to live alone anymore.
eyemamom - I have the flu so I understand what you and your sister are going through. I can’t imagine doing a big move and calming down my mother in this condition, even though I am getting better. Make sure you are sleeping and eating well to avoid getting sick!
So sorry about hips and hospitalizations and transition challenges. When did we sign up for all this stuff? We were supposed to go out with friends last night but they had to cancel at the last minute b/c friend’s MIL was getting released from rehab back to the AL (5pm on a Friday?) and they were being delayed in part b/c MIL wanted to put her makeup on first and it took an hour!
As we near Superbowl Sunday I start to have sad memories, as it was Superbowl Sunday 2004 that my mom first went into the hospital (we lost her 5 weeks later) and then just prior to Superbowl Sunday is when dad went in in 2011 (lost him 2 weeks later). So this is a melancholy time for me…