1st Fall: Hospital, Hospice, Help!
My mother took her first fall at Memory Care this week. She tore open her face and badly needed stitches. Mom has dementia. I would guess that it at the Advanced Stage.
Memory Care called the ambulance, and also called me.
As I many of you know, I have spent the last couple of months in and out of the hospital, with surgery complications and infections, and consequently, couldn’t meet Mom at the ER. So, my husband was by her side for the entire visit.
As I wasn’t there, I could not run interference between what the hospital wanted to do, and what SHOULD have happened. My husband did his best, but is not a pushy advocate, like I can be.
My mother is a Hospice Patient. She is ambulatory, but is qualified under their Palliative Care program. So, No Extraordinary Measures.
She was given 2 CT scans, along with X-rays, and the stitches, of course. It took HOURS. She missed her meds, and became almost combative. It was torture for her.
I’m looking for suggestions as to alert EVERY SINGLE CAREGIVER that she both had dementia, and should only be given comfort care, stitches, or other means to stop bleeding, etc., since she is a Hospice patient.
No one took a look at her chart. Having instructions in there wouldn’t have helped. Having dementia, Mom could not advocate for herself.
If I can’t again be there if another emergency happens, does anyone with more experience in this situation have any suggestions to help Mom avoid after-transport extra-ordinary interventions?
Thanks in advance.
Keep in mind that the CT's a diagnostic tool just like the X-rays--It doesn't provide a level of treatment.
Either they did a head CT, with and without contrast, looking for a bleed, or they did a head CT and also looked at something else like her spine or hips. The X-ray was probably to look for broken ribs.
Unless you lucked out and have her at one of those facilities that provides a wide level of care, the MC's isn't going to take her back if she's got broken ribs, or if she fell because she was having a stroke--you'd be looking at skilled nursing or rehab first. Very likely this was why hospice was talking with the ED quite a bit--trust me, the ED was aware of your mom's status if hospice was on the phone.
If the tests in the ED showed she was having something acute like a brain bleed then the POA would be asked what their preferences are and would be able to initiate comfort care/ DNR.
I don't see that the ED did anything unusual, and whatever documentation is in her chart re: hospice wouldn't have been a reason for her to not get a 'Fall' workup so you could make informed choices about her care.
I appreciate you sharing this!
As I said, this was her first fall. I’ve got a lot to learn!
I feel supported, cheered on, and have learned a bit more then I knew before asking this question.
I appreciate you all for helping me still another time through this sometimes baffling season of life!
This info lives on her refrigerator and a copy is in her wallet.
She only had to go once during covid and i could not go in the ER. The ER physician and staff called me in a timely manner to go over her needs.
The fire/rescue staff really appreciated the one page typed med list along with 2 family numbers and a list of her diagnoses to date.
Her "to go" tote is always in the front room against a wall and clearly visible.
It’s like there is a Little Old Lady protocol, and a patient is immediately plugged into it. Then, it’s off to the races, with a zillion tests and interventions. I know that the ER is a tough place to work and staff and negotiate right now. Avoiding extra interventions would have saved THEM time, as well. 🏥
Unfortunately, Little Old Ladies on Hospice don’t seem to have a protocol of their own. 👵🏻
I thought that was astounding.
Come to find the next day that she had been given NONE of them and that those electronic "notes" had disappeared altogether.
I don't know the answer, but assuredly, you are not the one lacking here.
This is a fine line for hospitals. They see an elderly person with huge wounds, they are required to deal with those, along with THOSE comes blood tests (normal and standard) and then CT scans (also normal in the setting)...at what point would you have said "STOP". After the stitches? Just stitch up the obvious and send her home?
I wonder if you had done that and she'd had a subdural hematoma that could have been caught and remedied--but she died instead--would that have made you feel like the right things were done?
I'm not on your back--I'm just seeing how this can work its way into my life with 2 elderly moms--both have DNR's but both fall and are taken to the ER and treated. Minimally x rays and sometimes CT scans. Always, always blood work. I'm not the one who ever takes them to the ER, but they've both been, multiple times. To THEIR understanding, the DNR is only in effect when they are not able to make decisions anymore. A konk on the head wouldn't really do that--
Not trying to stir the pot, just really want to know how/who makes these decisions.
From the hospital's standpoint; fix it fix it fix it. From the demented elder and their family's standpoint; bring this suffering, angst and chronic agitation to an end, please. At least for those of us who believe that death is a new beginning to eternal life.
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