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amitebird Asked July 2020

Mom may need emergency services; I don't want to take her in. Any ideas?

Mom is now 94, in assisted living 3-4 years ago she developed COPD, made 4 trips to hospital with pneumonia, a slight leakage of heart valve which we were told couldn't do anything about, was determined to be a candidate for Hospice. We thought she was dying. Then we discovered she had dysphagia causing the pneumonia, treated and was released as no longer having dysphagia, reduced her oxygen to nighttime only, no pneumonia, and removed from Hospice. It's been 2 years of her being pretty healthy. Now she has O2 dropping to below 90, so 24 hour O2, Albuterol treatment 3 times a day and her doctors want her to go to Emergency Room in Baton Rouge. I said no. Too risky for CoVID19. I have been watching her with home treatments, teas, pushing her to Treat, but she seems to be growinig tired, esp with the breathing treatment. No antibiotics. Should I just go ahead and take her in to hospital (including me being at risk 68 yr old and overweight) or does anyone else have any ideas?

BarbBrooklyn Jul 2020
Amitebird, how are things today?

JoAnn29 Jul 2020
Just have to say, and maybe a Nurse member can back me up, that you can increase oxygen but it doesn't mean her body is absorbing it. Its not so much her Pause Ox number but if her hemoglobin is carrying the oxgen thru her body effectively. If hemoglobin levels are low than carbon dioxide is not removed from the body.

Get her to ER.

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dogparkmomma Jul 2020
She needs to be taken to the hospital. They won't let you go in so you needn't worry about your own health. If you don't take her to hospital, she will probably die. I would have her re-evaluated for hospice while she is there so when she goes back to AL, they will know what to do.

cwillie Jul 2020
I wouldn't make any decision based on fear of catching covid19, if your hospitals are anything like mine the restrictions put in place are very stringent and as someone else pointed out you are probably much safer there than in many other places. My reaction was based on the understanding that you may not be able to be with her, especially if she is admitted. I'm sorry you are in this hard place.

earlybird Jul 2020
Last week my mother had a possible UTI with a TIA and symptoms that resolved in an hour, called a new local hospital and asked if any COVID19 patients and told us no cases. Asked if I could stay with mom if she is admitted overnight. ER called administration at home and got the ok for me to stay with my mom. I did tell them no other options, but to stay with my mom. She was given IV fluids and antibiotic. She was discharged next day and doing well. All staff wore a mask and limited contact with my mom, except meds. It has been 4 months since my mom was in the ER/ hospital for a serious UTI, so caught it early. I would bring your mom to the ER, call to see if any cases of COVID and go from there. I wore a double mask as well as my mom. I have no regrets on my decision. Mother was tested for COVID and came back negative. Good luck!

AlvaDeer Jul 2020
Are you willing, at 94 to ask again for hospice, or are you not? If not, call the ambulance and have her transported. You should not go there. Risking her life will happen EITHER way; it makes no sense whatsoever to risk your own as well.

GardenArtist Jul 2020
Following on Pam's advice, given your concern about the ER, and if you have a pulmonary doctor, that's an alternative if you can get a quick appointment.   More than likely, tests would be done to determine if her need for the Albuterol and liter flow rate have changed.   

How many liters of oxygen is she on now?   That may make the difference.

When my father was on oxygen, 90 was generally considered the low point for acceptable SAT rate.  

Another possibility is to change the cannula tubes; they do get dirty and should be changed regularly (but I don't remember now how often).   And beyond that, I've had ones that simply don't carry the oxygen; they must have been defective in some way.     That's why I always carried back up cannulas with me whenever we left the house.

Same with batteries for the portable concentrators.   I always had charged back-up batteries, just in case.
amitebird Jul 2020
My mom has a pulmonary doctor, he says there is nothing he can do in his office, she should go to the ER -- and he says the ER is 100% safe. There's just something wrong with that. I raised her O2 to 3 liters tonight (long tube) so she could sleep comfortably. She keeps dropping below 90 then back up again, but it seems to be slowly dropping. I just changed the cannula tubes a week ago - but will do it again just in case they are damaged.
amitebird Jul 2020
This is her Hospice Co that she was on 2-3 years ago and she was kicked out because she got well. I am waiting to hear from them as they have all her info and may be able to re-admit her quickly. I have put the word "palliative" in my mind too now. Thanks.
againx100 Jul 2020
Sounds like you're moving along in the right direction!
Sunnygirl1 Jul 2020
Why not obtain another hospice evaluation. As people's condition changes, it might make a difference. That way, you call hospice with questions. With my LO, there is a sign in MC to call hospice before 911. Or, see if they have a palliative care program, if she doesn't qualify for hospice right now.

againx100 Jul 2020
Is she on hospice? If so, then I agree with you not taking her to the ER or allowing her to be taken there. Why bother at this point I guess?

I would say she needs to be kept comfortable and beyond that, extra things may or may not be necessary at this point. Unless she is not on hospice and wants all measures to make her life as long as possible.

Good luck!

cwillie Jul 2020
I've read post from lots of people here on the forum who actually had a loved one improve on Hospice as well as many who have been on it for years, it doesn't have to mean a choice between death at home or death in the hospital. With Hospice she should be able to keep all her COPD meds as a quality of life issue and they should also be able to prescribe oxygen if needed. I'm not sure of the process but you should be able to get at least a consult without having to take her anywhere. Just having access to their doctor and a visiting nurse could be priceless at this point in her life.
amitebird Jul 2020
I just contacted her old Hospice Chaplain, he is helping me get her an eval to re-admittance to Hospice. Thank you, breath of air.
amitebird Jul 2020
What I am wondering is why she even has a doctor if he has to depend on the ER to treat her? He says he doesn't have the equipment to do the tests. Why can't he ssend her someplace private who will do the necessary tests?
pamzimmrrt Jul 2020
As a respiratory therapist, I can only think that if she is now on her O2 24 hr a day, and 3 nebs a day are not helping.. and her sats are still low and she is getting lethargic,, her Dr would only suggest she go to the ER even if the Dr saw her, as would any good outpatient center. I also agree the ER is probably safer than the grocery store at this point,, ours are getting major cleanings and safety precautions are awesome! She may need higher O2 than a home device can deliver ( we can give up to 100%,, you can't do that at home) or she may need some time on continuous nebulizers. Or a steroid of some sort. ( with COPD I am thinking she may already be on a steroid?) Good luck
MJ1929 Jul 2020
Well, I suppose you get to decide if she MAY die from going to the hospital, or she WILL die because she can't breathe.

What I do know is that teas will do nothing to help her.

If it was me, I'd take her to the ER, let them put her on hospice care, bring her home with the support of hospice nurses who can ensure she can pass as comfortably as possible without suffocating to death.

cwillie Jul 2020
I think you have to decide whether you are comfortable with considering her to be palliative and this possibly being the downward slope toward the of end of life, if you are then it may be time for hospice rather than the ER.
amitebird Jul 2020
Thank you. If this is downward slope are the key words.
lealonnie1 Jul 2020
Well, you can't really fool around with breathing issues, esp if her O2 levels are getting low even after nebulizer or inhaler treatments and oxygen. You can't self diagnose and treat her with homeopathic remedies in such a situation, imo. What does SHE want to do? Does she want treatment? If so, I'd take her to the ER or call 911, better yet, and let the paramedics determine what they feel is going on here. Does she need to be taken to the hospital? If so, they can transport her and you can show up later on. I doubt your risk of contracting the virus is too high........the ERs are kept clean and I think I'd feel pretty safe myself going to one in the event of a real emergency. My daughter is an RN in a big downtown hospital and says it's safe ........if it wasn't, all the staff would be getting sick and they aren't. Think of it like that, I guess.

GOOD LUCK!! What a stressful situation to be in for both of you. My mother is 93.5 and has had pneumonia 3x already in the past 5 years.
amitebird Jul 2020
This is my dilemna; I actually called EMS, they showed up and said "I'm confused". Mom's walking around, slowly, they tested her and of course, while she was there her O2 was 90, 91, 92, even 93. I talked to them a long time and they told me without telling me that they would keep her out unless she gets worse. They said noone is getting admitted unless deathly ill and the ER is simply crowded with people. That's when I decided to keep her out. Later I told her she had some say in all this, and she said, you are going to have to make the decision for me. I have been making all her decisions for 4 years. I know what I would do, but she can't verbalize to me how she feels.

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