My mother is late stage alzheimers, cannot communicate or understand anything that is done to her. She fell backwards and hit her head last night and they called wanting to send her to the hospital because there was a cut (thought might need a stitch)
Uh, NO! I told the RN to see if they could get a better look at it and try to fix it and she agreed with me about the fact that it would be very traumatic for mom. They cleaned it up and she is fine today- What I couldnt believe though is that they were going to call an ambulance and send her off with no one! omg she would have gone NUTs fighting and crazy- When she wasnt as sick as she is now the hospital ended up strapping her down and putting a net over her bed to keep her in and drugging her up...
What in the world happens when there is no family around at all?
At least I had the nads to say NO. she fought them , but at least they got a better look at it and cleaned it up and she was fine.
If it wasnt fine it would have been a hellish night...

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Please can I have your ER, Rainmom!

But failing one as good as that, would you not expect the ALF to send an escort if the resident has dementia?

Last September my mom fell and hit her head, had a good sized bump. The AL facility called me AFTER the ambulance had picked her up to take her to the ER. I was home alone with Rainman - who is the last person you want to take to the ER - all those buttons and switched, blinking lights making beeping noises - weeeeee! I couldn't reach my brother to ask him to go and since hubby was due home in roughly an hour I decided to call the ER but wait to go in to when I could go without Rainman. By phone I was told of the tests then had begun - cat scan, xrays etc. By the time I got there all the tests had been run and we were waiting for the dr to come and tell us of results. Mom has happily lying in the bed and the world was still turning.

Good for Dad!

And 'well caught' to you, of course.

If one drives a person to the ER then it is up to triage to determine in what order that person will be seen... thus sit in the waiting room. If one arrives by ambulance, that person goes into the ER immediately. Yes, there is triage in the ER but at least one is seen by a doctor as soon as they arrive, and test/x-rays are on order.

Mincemeat, my Dad did something similar to what happened to your Dad. My Dad fell in his garage and broke his nose. Dad was also on coumadin. My Mom [in her mid 90's] was trying to help Dad stop the bleeding. By the time they called me, hours later, Dad still couldn't stop the bleeding. I called 911. Dad didn't want 911 as all it was was a bloody nose. He didn't understand how serious this could be. Well the paramedics took it seriously as Dad could have bled out plus had other injuries from that fall. Dad still had his sense of humor as he would tell anyone new "you should have seen the other guy, his memorial service will be next week".... [sigh]

The cardiologist at the hospital decided no more coumadin, as Dad was more of risk of falling and bleeding out, then he was to have another heart attack.

Mica, I'm so glad to read that you're mother's all right.

But my heart sank when I saw your headline, because I am just this week picking a fight with my local newspaper for its front page news story:


(A&E is ER, by the way - stands for Accident & Emergency)

Long (and extremely sad) story short: an elderly lady living with dementia in residential care fell in her bathroom. An unspecified time later she was taken to hospital by unspecified persons. Whether or not she was accompanied? Not specified. What medical history was taken? Doesn't say.

Four hours after she was booked in, during which time her relatives had arrived, she lost consciousness and was at long last seen by a physician. Too late. She died the next day, of an acute brain injury causing a bleed into her brain. The coroner at the inquest concluded, though, that even if she had been examined earlier it would have made no difference to the outcome - because there was no sign of head injury and nobody mentioned it, perhaps, or because there had already been a substantial delay in taking her to hospital - thanks to shocking reporting standards we will never know.

What we are told is that the family is very angry and upset, as well they might be. They are sure that if "Nan" had not waited four hours to be seen by the doctor she would still be with us today. And somebody, not very helpfully, has given them to understand that their grandmother "bled to death." Before their very eyes, yet.

The reason why I've picked a fight with the reporter is that her article does not ask

how Nan came to fall
what time she fell
what time she was taken to hospital
who went with her
who spoke to the Triage nurse.

So the article says nothing about how dangerous falls are, how vital it is to prevent them as far as possible, how even apparently minor head injuries need keeping a careful eye on, and how crucial it is that elderly people with dementia are NEVER sent unaccompanied to hospital.

Instead of that, the reporter created a lurid (and factually nonsensical) headline about the one thing the coroner found was NOT the cause of this poor lady's death - namely, the delay before she was examined and a CT scan ordered.

I've told the reporter she's missed a good opportunity to warn people about what really killed poor Mrs S., namely the fall, and she's done neither the family nor the public any service. She's gone very quiet for some reason!

I just last week experienced this. My father had a hard fall in the dining room, fell on his face and had a deep laceration on his forehead. He is on coumadin, so was bleeding profusely. The SNF does NOT do sutures, so I had to personally take him to an ER for sutures and a CT scan since it was after hours. So yes, they would have called an ambulance and sent him alone with the EMT's if I had not been able to be reached. What I did learn is that he was extremely reluctant to go and I discovered that in his weakened state, it was very hard to get him transferred from the chair to the car, car to chair 4 times that night. I think that if he really fought me, I would not have a chance of lifting him out of the car or chair by myself. I told my siblings that I would go along with the ambulance the next time...and yes there will most likely be a next time.

whew. ok thanks for the input. oh , reading my post sounds like she hit the floor or something, it was a standing machine on a rolling post- not something solid like a counter or floor..
She was a screaming crazed woman who almost got seriously injured trying to get out of the emergency room last time because it wasnt a 'closed' area. I really had to think about whether I would go there and expose myself to a situation that would have been worse for me than her in the long run of her forgetting it and me not.
When I spoke to them last night it turned out there was no blood and it cleaned up fine.
I spoke to them today and her injury was a non-issue...
thank you for telling me the two scenarios of going and not going. It was an eye-opener for me and now i know what to expect next time.

micadoormat, people are sent to the ER all the time without family members/friends coming in with them. I do volunteer work at a hospital and we see family members coming to the main desk looking for a family member or friend who is in the ER who had come in hours earlier. This isn't the doctors/nurses first rodeo.

Head bumps in elderly can be quite serious, it is better to have the whole nine yards none then just putting a band-aid on the injury.

My Mom had no visual injury after a fall where she had bumped her head on the kitchen counter top, but x-rays showed she had a brain bleed and also found was a blood clot. Better safe than sorry.

I always meet my cousin (severe dementia) at the ER when she is taken there by ambulance, except one time I didn't due to miscommunication on the Memory Care's part. As soon as I got the message, I called the ER and found out they had take the X-ray of her foot and were sending her back to Memory Care by medical transport and they were already there to pick her up. They told me that she was fine, no crying, not upset, etc. She's quite used to going to ER and getting x-rays. She's also very compliant and easy going.

The EMS workers and medical transport staff handle dementia patients all the time, so they are pretty good at it. Though, I've never seen anyone freak out. I'm not sure how that would work.

I know that there are many residents in the Memory Care where my cousin lives whose family's are from NY, NJ, etc. and are never available to meet them at the ER. I suppose they manage, since there is really no other option. Have you discussed options with the facility? Could you have someone from the facility accompany her to the ER, perhaps for a fee?

Lets try to look at a different scenario. Let's say mom's fall was more serious, say for example, down a flight of stairs, and she had not only a bump on the head but a possibly back or pelvis fracture. They would have sent her to the hospital, alone, in an ambulance. They would have provided her (limited) history of her status to the paramedics.

From there on, you have to trust that the doctors at the hosptial could handle her. She wouldn't be the first person who was in advanced alzheimers who fell and had a serious injury. They would calm her with meds and take the necessary scans etc....and of course as long as you are on the contact list they would have contacted you...but they definitely wouldn't not have been able to wait to call an ambulance because they couldn't get a hold of anyone. What if her head injury caused a blood clot? What if she had internal bleeding?? There are cases where she would go to the hospital alone, and you need to have faith that they would calm her down with meds.

Would she be upset? Yes. Would she fight them? Possibly. would she have a hard time with the move to the hospital and the stay there? Sure...but it's not something that can be avoided. You are very lucky that her head injury was minor...but playing devil's advocate I'd have wanted to have her seen...some injuries like brain hemorrhages cannot be seen with the naked eye.

Doctors are trained to deal with difficult patients. Please have faith and allow them to do what's best for her until you are able to arrive.


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