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Hello, I'm new here and would appreciate your thoughts. My father has mid-stage Alzheimer's and he took a pair of scissors and cut his ear lobe. The nurses at his Assisted Living facility called me (while I was already on my way to visit) to say ambulance is on their way as he may need stitches. I said to the nurse, over the phone, that I am 5 minutes away and that I want to speak to paramedics first. She said they should still be here and to come. When I almost arrived at the residence, I saw the ambulance leaving. I was told there was no way to contact paramedics, and that he is now in their care. I was livid.


The reason I wanted to speak to the paramedics is because I wanted to avoid having my father go to hospital during the pandemic, and to discuss alternative solutions like taking him to a medical clinic to get stitches. To be clear, I wanted to ensure he would have proper medical care, without going to the hospital - which I believe is reasonable given covid-19 concerns. Do I have grounds for complaint because this was done without my consent and against my wishes? Is this legal? I am his daughter and POA, and my father and I are very close.


The consequences of my father having been in hospital mean that he will be isolated, not allowed visits from me or the private caregiver I hired for him, and quite frankly neglected by staff because even before this incident, nothing in his "care plan" was being done - with zero accountability or proper documentation. He has also reverted back to his native language so communication is an issue.


Sorry for the length, appreciate any advice you may have.

Mindpearl,
As others have stated, yes, they can send your LO to the hospital without your consent even with POA in place.
2 months ago I received a call from my Aunts ALF. They told me she had a rash on her face. I asked them to keep me posted if anything changed.
The next call I received was the ALF telling me they sent her by ambulance to the ER (yes for a rash)!
After my ire settled down, I realized that the facility had to cover their backside. Not that I completely approve, but better a resident go needlessly than not send the resident and risk a potential lawsuit. It stinks, but I get it now.
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Reply to xrayjodib
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They have protocols in places like this. If X happens, they must call 911. This may have been the case here. Often it seems like they are much too quick to call and over little things, but it is their policy, etc.
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Reply to againx100
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One last thing, to ease your mind: the paramedics would not have waited for you to arrive. Their job is to assess the patient and take them to the ER - and they do that as quickly as possible because they have other calls waiting for them (former medic here). So, even if the nurse had asked, her request most likely would have been denied. Sorry.
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Reply to BeckyT
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Hi please don’t get the wrong impression but the resident cut his ear lobe. Do you know how much an ear lobe could bleed? Quite a bit. There was probably blood everywhere.

At that juncture the staff are risking everyone else in that center to possible blood Bourne pathogens *as well as* Covid 19.

To me it’s totally reasonable to have called 911 & if I were the nurse in charge (I am a RN) I too would have called EMS.
Staff and residents are on lockdown. We are in a pandemic. Those residents don’t need an additional exposure to blood + Covid 19 which is transmitted via droplet.

I’m happy it worked out for you but please don’t fault a licensed staff, whether RN or LPN, for calling 911 in this situation.

Please make sure he doesn’t have access to scissors anymore to prevent this from occurring again. He could stab himself in an artery/vein as they are pretty close to his earlobe.

”Normal has left the building” these days
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Reply to Shane1124
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Mindpearl Apr 9, 2020
Thanks for weighing in, Shane.

What made me upset was not that 911 was called; it is that I wished to speak with paramedics beforehand (because no visitors are allowed in hospitals now) to understand the situation better for myself, and that I was in my car 5 minutes away, and the nurse said the paramedics would still be there when I arrived. Bleeding had stopped and my father was calm at that point. But when I arrived, I saw the ambulance leaving -- the nurse did not bother telling paramedics to wait a few minutes, and I was not given an opportunity to speak to paramedics or my father. My fear was that he would be exposed to the virus at the hospital.
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I’m so sorry this happened to your dad . The AL may have rules they must follow to avoid law suits . So glad your dad’s better , everything is so stressful right now .
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Mindpearl Apr 9, 2020
Thank you. Yes, this virus has everyone on edge :(
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Hi everyone,
Thank you all for your responses. Update: my father was immediately isolated in his own hospital room upon arriving at the ER, they stitched up his ear lobe and I was notified to pick him up and bring him back to his residence. He was given a form from the hospital saying that isolation precautions at his residence will not be necessary for him.

His residence does have certain policies in light of covid (especially for clients returning from hospital) but it was confirmed today that I and his private caregiver are still allowed to visit. At this time, there is no outbreak or known case of covid in his facility, and I understand (and deeply appreciate) their need to be careful.

Certainly, if it were cardiac arrest, a stroke, or some fatal incident I would not question emergency intervention. And if it wasn't for this pandemic I would not have been upset that he was brought to hospital. However, given the grave concerns for the elderly during this pandemic, I felt the nurses should have been more sensitive to the covid situation and used better discernment. Or at least asked me first.

I disinfected him completely, threw his clothes in the wash, and did the same when I came home. I will heed your good advice and make an arrangement with the facility to be called before he is brought to hospital if it is not life-threatening.

Wishing safety and good health to you and all your loved ones. Thanks again.
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geddyupgo Apr 7, 2020
So so glad this turned out well for you and your dad. I would be somewhat concerned however as to how a person who has some memory issues manage to get a hold of scissors to cut their ear. Maybe we should go over with the facility just what Dad is allowed to access.
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In my opinion, cutting his ear was not an emergency. After my Mom fell 4x in 4 consecutive months I requested I be called before she was sent to the hospital again. Not one time had she broke anything and we spent hrs in ER. I told them I will determine if she goes. They never gave her time to get up and see if anything was really wrong. "But she said she was in pain". I said "aren't u in pain when u fall. Doesn't last does it". I was 5 min up the street. The only time they would have sent her was for a head injury.

Request that he not be sent to the hospital until ur called.

Reverting back to his native language is common.
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Tothill Apr 7, 2020
Although the injury appears not to have been severe, the action of taking a pair of scissors and cutting his ear is indicative of a change that needs to be properly addressed. It is not 'normal' behaviour to cut ones self. Perhaps he has a UTI or has a significant change in his dementia status.

At a minimum he needs to have all sharps removed from his room.

The AL may also be covering their backside as far as his ability to continue at this level of care.
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If theres an emergency I'd hope they'd send them to the hospital without getting consent. Time is often of the essence! I'm picturing someone in cardiac arrest while the AL staff is frantically trying to reach the poa before calling 911.
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Reply to HelloImMinsu
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It is a shame this decision was made, and in all truth I am surprised they would risk sending someone to the hospital if it was not clearly needed, but they do have their rules, and failure to seek medical help after a fall (an injury to the head always means xrays or scans and stitching if needed) would be negligence and loss of license. A real catch-22 in these times, and very little they can do about it. I had a similar thing happen tho not in plague times, when my bro got a nosebleed; they couldn't stop it didn't seem to understand the simple remedies and sent him by ambulance while I in another town. Yes, they absolutely can, in fact must, seek the help their rules deem. So sorry he has to go through the isolation, and the exposure so much more dangerous than an ugly wound healing, but they cannot make a failure to seek care and risk licensure. Sorry. Bad times, no easy answers.
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Reply to AlvaDeer
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I agree with Ahmijoy, and I absolutely understand your distress. We are all in a horrific situation right now, as far as decision making is concerned.

I made a comfortable agreement when my LO entered her AL facility, that they would do a careful assessment of her on site when she fell, and notify me before she actually left for the hospital.

That has worked so far in our situation.
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Reply to AnnReid
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When my mother was in a facility, she tended to fall quite a bit. And, at times she had to go to the emergency room if they thought she hit her head or was bleeding. When there is an injury or even a suspected injury, the facilities first responsibility is to their resident. If someone is actively bleeding as your father was, they aren’t comfortable spending valuable time trying to reach the POA to get permission to treat, or to be directed to a different place for treatment. This or at least part of this, is probably detailed in the papers you signed when he was admitted to the facility.

Any medical facility, including the one you wanted your father taken to, carries the risk of COVID-19. Also, I don’t understand about Dad being hospitalized for this and isolated. I think a few stitches and he would ha e been on his way.
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geddyupgo Apr 7, 2020
Maybe she meant he was isolated on his return to his assisted living facility. I think that is the protocol in many states in facilities now -everybody returning must go into isolation or at least into a ward of returnees if they have been to a hospital even if they have not been admitted. It's rather complex since each state has different regulations and different mandates. All very difficult for residents and families because it disrupts a routine.
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