New Policy sends MC residents to ER when they fall, whether hurt or not. Any suggestions?

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The Memory Care ALF where my father is living recently changed their policy to send any resident who falls unwitnessed to the ER, whether it appears they are hurt or not. Prior to this, when a resident fell, the nursing staff would notify the family and the PCP, evaluate them, and monitor them over the day for signs of head injury. If all seemed well, the resident would continue their daily routine. Now, they go to the ER regardless of any evidence of injury. My father is 89 yo, with moderate mixed dementia, and bad balance. He falls a lot. In the 6 weeks since this change in policy, he has been sent to the ER 3 times, where he can't answer the doctor's questions, and confusion is increased. So I have had to take off from work to sit with him while he is treated for nothing more serious than a skin tear. And of course there is the co-pay for the ER and the copay for the ambulance rides. Does anyone have suggestions for how to get the ALF to change this policy back to the old policy? Dad was living there under the old policy for 7 months, and all was well (although he did fall often). (The nursing staff also thinks it's an unworkable policy.)

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Two thoughts come to mind:
1) The idea of transportation other than an ambulance makes sense. A trip for $10 is certainly a lot less expensive than an ambulance ride (and the latter might be needed for use elsewhere if there has been a serious accident justifying it).
2) Would it be possible or practical for people prone to falling to wear some kind of protective helmet? I seem to have a vague memory of seeing someone with one a few years ago--perhaps something like those that kids and others wear while riding a bicycle.
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Yay! That’s great! Way to go...
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Good for you, Weary418! Your actions probably saved a lot of expense and hassle for a lot of people.
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Update. So I sent my letter of concern to the Executive Director the ALF and my father's doctor also sent a letter saying that he would prefer that Dad not be sent to the ER unless it appeared that there was an injury or other underlying condition that would benefit from ER services, and that he (the doctor) would be available for medical consult. Dad has fallen twice since then. Once he was sent to the ER, in part because he had a nasty cough, which was treated as pneumonia and with diuretics. The second time, he appeared unharmed, the nurse did a thorough exam and consulted with Dad's physician and opted to not send him the ER, but checked in on him every 15 minutes for the next day. The ED later came up to me and said that she was very happy with the arrangement and that my father's doctor was very responsive. So far so good.
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I took my husband out of an A/L because of their “must go” to the hospital policy, but keeping him home is untenable now. His dementia is escalating.

I luckily found a small home with only 16 rooms and they only take care of people with dementia. He isn’t in it yet, but because it’s small, what I’ve been told, they know the patients, know they can’t do much for themselves, and they are escorted to the restrooms and watched closely. If this is not just talk, I’m hoping smaller is better.

I asked about their fall policy, and they do a body check and patch up if needed. The problem with the many trips to the hospital are the unnecessary tests. What nuclear waste are they injecting into our loved ones to do these tests? How many times in a couple weeks would we want a brain scan done? How many chest X-rays would you want to keep getting when nothing is wrong? Pelvic MRI’s? What the heck was that for anyway?

Once an A/L gets a policy, usually dictated to them by insurance companies, the patient suffers. They could hire more help to keep a better watch but they don’t, and the patient goes off on a gurney.

Good luck with the protest letters.
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Hi-
Couple of ideas on being proactive since it looks like the ER might be coming up. Even aside from that MC policy, people call 911 all the time, and things cascade from there. You didn't call 911, you didn't want medics, but you are now stuck with the ambulance bill for $700 and the ER bill too.

1. Find out what ER they would be taken to, whether there other ER choices available, which one do you prefer for insurance/whatever reasons, can you put the preference in their records. Where does her doctor have hospital privileges?
2. Find out about the ER/hospital policy on being held "for observation" instead of being admitted. Medicare will not cover non-admitted "observation". You get an enormous bill. There may be a law/requirement that the ER has to notify the patient and get a signature before holding them for observation. All this is good to know in advance.
3. See if there is a way to get their medical records at or online with the hospital/ER, so that the ER people can access them. Something like "Forgets to use walker, falls occasionally" is what I wanted for my mother as a starting point, because they get a million tests when the ER staff are trying to rule out every possibility. (Didn't get it because their ER computers could not access the facility's records).
4. Find out the MC policy on dentures/glasses/hearing aids going with the person or not. Where is this going to be written down? The hospital lost my mother's dentures and claimed both (1) They didn't know she even HAD dentures in, and (2) Since they were missing, then they had never been there to start with because it was not written down.
5. What is the policy for an unaccompanied patient to ER? Your question is a good one. Some places have a patient advocate. Then, how do they get discharged and returned to their MC residence?
6. I learned to check what the ER/hospital staff wrote or prescribed. They are busy, the shifts come and go, the elder is confused, and opinions can get written down. Then everyone treats the opinions as true. Not sure how to put this tactfully, but those very young doctors seem to be inexperienced with the elderly.
7. A confused elderly person easily gets hospital delirium. (If you're not familiar with hospital delirium, google it).

Also I started taking notes on everything said in phone calls or conversations with ER personnel, with names and phone numbers. Because it is busy, stressful, and you can't remember it later.
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Thank you all for your comments and suggestions. I've written a letter protesting the new policy directed at the local Executive Director, and my father's PCP has written a letter expressing his preference that Dad not be sent to the ER if there is no indication of injury, and offering his services if they want a reviewing physician (rather than the ER). So far, no response from the ALF. If these are ineffective, I will reach out to the other families (I know my father is not the only resident who falls) to try to organize a group protest of the policy.
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Our mother has a very good BCBS policy in addition to medicare, and so far they have covered the trips to the ER via ambulance (of course insurance companies are always looking to cut costs, so that may eventually go away!) The first few falls they sent her to the ER (I was called first, but I was away from home and was not close enough to transport her myself.) In our area they also have "transport" vans - much less expensive than an ambulance, especially where there is no visible injury that needs immediate attention from EMT. The hospital is very close, so the one time they used it, it was only $10 (not covered by insurance.)

Of more concern to me is that they are sent alone. Who is going to watch them while they are at the hospital? What is to stop them from wandering off or leaving? Who is going to answer the right questions? Our mother is VERY hard of hearing, so even if she could explain what happened or what issues she might have (more often than not she cannot do that), she might not even hear the questions! She'll often say she is fine, but later may complain of something.

For more recent falls (she usually has more of a tumble than a fall) they have reported it to me and monitor vitals for a day or so. I do understand their concerns, but if someone had an uncomplicated simple witnessed fall, this should be a decision for the person who has medical POA. The best you can do is inquire WHY this change and what you can do, if anything, to limit the ER trips. As someone else said, damned if you do, damned if you don't - and unfortunately it applies on both sides! Think of how litigious people here have become - the slightest issue, hire a lawyer!!! We are not all like that, but how can a facility know? They do need some CYA....
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Weary, you said in one post that your dad forgets that he needs wheelchair and/or walker and gets up and then falls. My LO did that too. She would get up out of her wheelchair and hit the floor AND she would get out of bed, forget she couldn't walk and hit the floor. What helped her A LOT was a belt alarm on her wheelchair. It doesn't keep her in the chair. All she has to do it is unsnap it and an alarm goes off. She is able to unsnap it, but, when she hears the alarm, she giggles and snaps it back. So, it works to keep her from getting up unattended. If she did try to get up, a staff member would be coming to assist her after hearing the alarm go off.

The same works for her bed. They put an alarm on her bed, so it goes of when she gets up. They can get to her and assist her or she'll hear the alarm and lay back down and wait for help.

They really aren't allowed to strap anyone in, since that is a restraint, but, if they can undo the belt, it's not considered a restraint. At least not in my state.
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A lot of elders will resist the walker. I found my mother "ditching" her walker anytime someone wasn't looking. Perhaps this facility HAS had lawsuits and changed policy for protection. To avoid paying each visit, you may want to consider changing Medicare Supplemental policy.
JoAnn29 raises a good point--if the fall was not witnessed, there is no guarantee if he hit his head or not. A head bump IS ALWAYS CONSIDERED A MEDICAL EMERGENCY.
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