An elderly client sits in the emergency room of a local hospital. The family is tired, worn out, frustrated. This patient is the mother, grandmother or friend and she is needing more help then she realizes. Who doesn't live in some denial about the help they need. Can't get your settings right on the computer? It takes some time to actually ask IT to walk you through it, doesn't it? Can't get rid of that noise when you put on the brakes? How long did it take before you went in to the shop? Did you know what to tell the technician to get the right results?
I have logged hundreds of hours now in the emergency room with patients and their families. They are tearful, overwhelmed, confused and uncertain. In my 8th year of doing this job now I realized something. I have a unique opportunity to share what I see. How do I share this with you in such a way to make a difference? Why don't you go along for a ride with me for a moment. I will take you through a case that have occurred in the last 90 days. (Note: These stories were changed or combined to protect the patient(s).)
Case Study #1:
The son of a patient contacts me when I am the week end, on call nurse navigator for CayCare, Inc. He tells me that his mom was just sent home from the emergency room after sustaining a non injury fall. She is more confused and doesn't seem able to make a meal before he leaves. He isn't sure if he should make her something and leave or take her back to the emergency room. He calls me because for advice.
After reviewing how mom has been in the last month and what the emergency room checked for it was determined that this was not a brand new problem, just one the son had been unable or afraid to face. Mom needed placement or a caregiver right then. We talked about follow up care and symptoms to watch for. We went over an entire intake process. The son realized he had no idea what his mother had in the way of finances but had no idea had to access them. Mom had most of her information set up through bill pay at some point back and stopped managing anything.
A family care plan was discussed and reviewed and the son felt confident that for the week end they could manage until he could go in with his mom on Monday and find out what her assets were. He called on Sunday to check in and continued to keep mom safe. He reported new information about how she had not been sleeping for what appeared some time in her own bed as the sheets hadn't been changed. She also had no dirty clothes and she was throwing her underwear away.
Monday an MD appt was set. The bank was accessed and the family determined that they would feel better with someone monitoring her more closely. She saw a geriatric specialist to confirm a dementia diagnosis, was later treated for a urinary tract infection and had a family meeting to establish goals. This lovely lady has improved enough to live in a local facility and is very happy there. 6 days after placement this individual became confused and nauseated. She was seen by the physician and treated for another urinary tract infection.
Case Study #2:
This client was brought in to a local emergency room after becoming confused and refusing his medications at home repeatedly. His wife had stopped getting any sleep at home and had fallen. She was suspected to be in this state for 48 hours. They were brought in together. She had sustained an injury that required surgery and would need subsequent skilled rehabilitation at a local nursing home. He was agitated and had no injuries or medical condition that warranted a hospital stay. Now he was in the emergency room scared and confused putting himself and the staff at risk.
Once the family was contacted it was determined that he would require immediate placement. An intake was performed to review options and screen needs. The placement navigator was able to come on site and evaluate his needs and the family's wants. 3 hours later orders were being written for discharge to his new location, a local memory care center.
I share these stories for many reasons. One of them being, plan ahead. The options and the time to review them decrease considerably while sitting in an emergency room. Not to mention the entire family's mental state. CayCare, Inc is the best in the business in my opinion in handling these cases and making them really stick well. However, I can also tell you that if the family could have one do over it would be to have planned ahead.
Talk to your families about discharge plans after the discharge from the skilled nursing home upon admission. There is such a sense of relief when they have the medical support that they just don't realize that time if of the essence. If you or someone you care about lives in an independent living or assisted living find out what they can do for you there and when you may have to consider the next step. No facility every wants to lose their resident and they will bend over backwards to assist you whenever possible. That being said there are regulations they must follow. Assisted livings also have varying levels of what they will do for care. Do not assume you can stay where you are. If you are not sure about the level and feel you aren't getting answers you can call the local ombudsman for answers. www.caycare.com
