Can the Assisted Living facility force us to take mom to the emergency room?

In what sense?

Do you mean, can they insist that your mother is taken to the ER but you don't agree that it is necessary.

Or, do you mean, can they force you - you rather than a member of a staff, or an ambulance - to take your mother to the ER even though you are not comfortable escorting her; but you do agree she needs to go.

No. Mom has a right to refuse as her POA you do too.

My Mom was taken to ER 4x in 4 months for falls. She had Dementia and would complain about pain. After the 4th time and no broken bone. I spoke with the RN and asked that the staff wait before calling the ambulance. 3 out of 4x I wasn't called until after she was sent. Yes, she probably does hurt, doesn't everyone after a fall but do you go to the hospital? Give her time to get up and walk around. If she continues to complain, call me. Besides hating to sit in ERs, each visit was confusing for Mom and she didn't like being poked and prodded. I would think they would just ask you to sign a release absolving them of any responsibility. If they do call an ambulance, your Mom can say she doesn't want to go and they can't make her. Besides, depending on the problem, you should not take her to the ER anyway. You could do more harm than good.

What am I missing, JoAnn? Where did you see that the OP's mother had had a fall, or that DaisyB is her POA/HCP?

Sorry about that Countrymouse - I wasn't very clear. Yesterday the Assisted Living called me at work to say mother-in-law might have a UTI. The cultures they took came back contaminated so they wanted her to get catheterized for a good sample. I agreed. I immediately called Urologist who couldn't see her until July 10. The Assisted Living nurse told me that was not soon enough and I would have to take her to the Emergency Room immediately! Mother-in-law was not in ANY discomfort at all. She does not get physical symptoms when she has a UTI. Her behavior changes a bit in that she becomes more confused than normal. I called the Urologist back and basically begged for an appointment because I did not think spending hours in an ER was in mother-in-laws best interests. Urologist found an appointment for her yesterday at 4:00. They will get a culture and I'll have the results Thursday. However, they found no bacteria, and basically told me the Assisted Living overreacted. This is the 2nd time the Assisted Living has "strong armed" us with the threat of the E.R.! It is just so frustrating. The cynic in me wonders if the patient is secondary and the Assisted Living primary motivation is " covering their assets". Anyone else have similar experience?

Blimey.

Sorry. Lost for words.

Just blimey.

I'm stuck at the 'catheterisation to get a decent quality urine sample' stage. They want to shove a catheter up an elderly lady's how's-your-father because they don't have the time, patience or skill to get a decent mid-stream sample?

Blimey.

Is your MIL fantastically combative about toileting, or something?

Yes, I’ve gone through similar stuff with my parents in assisted living. Overall it’s a great place but they do have strict policies about what triggers an ER or hospital visit. And yes, it’s a CYA dynamic much of the time.

I had poa and now guardianship for Dad. Mom died this past April. I had a good relationship with the admin folks. Some things were a definite ER trip. Mom would have a bad fall, nurse suspected a broken bone and off we go. Other times they would call me and say it was a minor issue, I should decide. I always said no.

The bigger problem for me was all the follow up visits that all these docs insisted on. The ortho Guy, the neuro Guy.....It was ridiculous. This was an 88 year old woman with dementia and broken bones who just wanted to stay in bed a be left at peace.

I put an end to those follow ups. Like we’re gonna do neuro surgery on this poor women. The AL folks were reluctant but cooperated with me. They know the reality but they gotta watch those policies.

Countrymouse, you crack me up! Windy ridge is right. It’s all because of the CYA policies that the facilities must abide by. My mom’s SNF was the same way.

It's so frustrating when they rush your parent off to an ER and don't even notify you. I had that with my mom in independent living. She had a nosebleed that the medication aid saw and they immediately called 911. Never called me (I lived and worked less than 1.5 miles away). They whisked her off to the ER and I finally found out about it after she was already there. I was SO angry. My mom had previous nosebleeds and all you had to do was have her lie flat and put some Vaseline in her nose. But they rushed her to the ER and it was 4 hours before I could get her home. She couldn't even remember why she was there.

After that, I put signs up everywhere in her room and made it very clear they were to call me before they ever took her to the ER again. SHEESH. Like Windy says, they want you to go to follow-up visits and when you do, they say, "Why are you here?" They never have any idea or seem to really care or have a plan. Taking care of seniors isn't for the faint of heart! You've gotta have nerves of steel.

You need to think of it from their perspective. If they didn't send a person to the ER and there really was a problem, then people would scream bloody murder. So for liability alone they need to call an ambulance. Of course, your mom or you as her POA and can refuse at that point but then the liability is on you. For many things, like falls involving any head injury at all, you are supposed to go to the hospital to get a CT scan to check for brain hemorrhage. Which is a concern for anyone over 65 even if it's a light head bump. Whether it's AL or they are in your home, you should be going to the ER. Yes, most people don't. That doesn't change the fact that people should.

If you are set on them not sending your mom to the ER for any reason, you should look into drafting a release with the AL facility releasing them from any and all liability.

Country mouse, her question was could she be forced. I said no. Sorry, maybe I should have said "if u have a POA". My further post was about my Mother not the OP.

Countrymouse, answering ur question about catheterization. The elderly do not void completely. The main reason for infections. The catheter is not so much for a sample but to get all the infected urine. This was done for my Mom. She was started on antibiotics, cranberry tablets, and probiotics. The cranberry tablets and probiotic was continued at the home. From Oct 2016 to Septb2017, when she passed, she didn't have a UTI again.

Thank you so much everyone for your responses and your understanding. My husband (her son) is POA and as such he did refuse the last time they tried to force us to take her to E.R. It was a Saturday in January and we believed sitting in a crowded ER for hours with people coughing and hacking would do her more harm than good adding to her anxiety and confusion. She is 86 years old and has Dimentia. You make a good point Countrymouse. I don't know why the staff can not provide better assistance to her in order to get a clean sample For the most part we're very pleased with care she receives. You made me laugh Countrymouse with the how's-your-father! I never heard that term before. You're right blannie - taking care of seniors is not for the faint of heart. We all are doing the best we can and we need to keep our sense of humor.

JoAnn, Thank you for your information on catheterization. What you said makes sense. We did know this.

The AL must have felt Mom needed a urine test. Using a hat was how they did Moms. Problem comes if they poop into the hat too. Then its a contaminated sample. I think the Nurse was a little pushy. An emergency room visit is expensive and time consuming.

There might be another issue and that's whether or not the AL nursing staff was skilled in obtaining a catheterized sample from older women. From what nurses have told me, it's harder to cath a woman than a man, and sometimes takes more than few tries.

Fortunately Mom has made it clear that she does not want anything done unless it will bring her back to a clear mental state. And she told her family doctor. One nurse at AL, thought it is awful that I have said I do not want her checked for UTIs as an accurate was is a struggle to obtain. I also told them the only reason to send her to the ER (after several visits to the ER because policy says if they hit their head they go, even if there is no neurological indications) unless she is in uncontrollable pain. Even with her living will stating she wants. One nurse challenged it and I had to get my brothers to back me up, or it could have been a drawn out battle. Some do not agree with my UTI stance, but my mom was not showing discomfort, (she usually gets agitated when in pain), only more confusion. UTIs, or Pneumonia are often cause of death in dementia patients and think it would be better to end life feeling like you have the flu, than like you are drowning. You do have a right to refuse, but the staff may make you feel guilty about that choice.

What about the cost of the ambulance service? My mom doesn't have medicaid so it cost $175.00 out of pocket every time she goes. 3 out of 4 times it was a fall, but nothing broken. It is darn if I don't, and darn if I do.

How about urgent care which is between doc visit and er. I really "like" it there since i can go If doc is too busy and i dont think i need er.

I p in a cup or wharever is necessary for what i feel is wrong.

I hope you have an uc available.

I think the over reaction is nuts!!! And reading some of the posts more common than I thought.
When I went on vacation and placed my Husband in the Memory Care facility where he went for Day Care I got a call about a "problem"
The facility called my Sister, I put her as a contact, I was out of the country and she could handle any problem that might have come up.....
My brother in law then contacted me that my husband had some sort of "infection" and that it needed to be treated. I gave approval. I was not too worried about cost, most of the medications were picked up by the VA or Medicare but I did wonder about cost.... I did not hear much after that ..until I get home and found out that this "infection" that "needed to be treated right away" was...Athletes Foot !!!!

Yes I would be wary of any request to transport to the hospital, wary of any facility doctor that may be padding the bottom line.

I work in an assisted living and memory care. It is neglect on both parties if proper medical care is not provided. I see families that don't care for their loved one on a daily basis. A lot of times we are their only advocate for pain and injury and especially decline in mental functions. I also have it from the other perspective that my own mother is in an assisted living. I see both sides, but in the end, the resident is number priorty.

I work in an assisted living and memory care. It is neglect on both parties if proper medical care is not provided. I see families that don't care for their loved one on a daily basis. A lot of times we are their only advocate for pain and injury and especially decline in mental functions. I also have it from the other perspective that my own mother is in an assisted living. I see both sides, but in the end, the resident is number priorty.

UTI in elderly people often causes mental confusion and can dramatically worsen early-stage dementia -- which can clear up only with prompt treatment. BUT many elderly people become 'colonized' by bacteria in the bladder and infections don't really 'go away' even with treatment. Often the best thing to do is to take a broad-spectrum antibiotic at a slightly higher dose than customary for a few days longer than customary and rely on the mental-status symptoms to tell you if it has 'cleared' or not.

I can't imagine wanting to catheterize a person with dementia against their will.

One issue with Assisted Living places is that there is often no real medic on-site especially after hours. The facility really DOESN'T want a Home Health Aide or Certified Nursing Assistant making the decision whether someone needs to go to the ER or not, because their liability insurer would throw fits, but the Resident (your mom) or the PoA can make that decision. They may need to call you every time, however.

IF ( IF ) she had to be catheterized for the urine sample, the PCP could order a Home Health agency to send a nurse (RN or LPN) to the ALF to catheterize.

This is the reason I moved my mom from her memory care facility. Too many trips to the ER. They are required to call for an ambulance if they think she needs to go or I won't take her myself (I did once). She did need medical attention ONE time and the whole ER wait unhinged her.

Daisy: I am glad that you pushed the urologist to get that appointment.  You have to be the patient advocate and yes, I understand that your husband has POA. The AL was in error,  BIG TIME and they rushed the process of getting a clean urine stream. Agree with Countrymouse. I had never heard of that ananlogy, Countymouse.

Daisy, I consult with a lot of SNFs and ALFs about their UTI prevention practices. There are some very good comments here about the seriousness of urinary tract infections among our elders (can cause dementia which can make it difficult for caretakers and family to provide care).

But the urine test is inaccurate over 50% of the time. Caretakers should diagnose a UTI based on symptoms without having to cath.

The BEST thing you can do for any elder is give them daily Dmanna for UTI prevention. Better than cranberry pills and easier to take.

My father's AL had a policy that anytime a resident fell out of the sight of the staff, they would be sent to the ER. After 3 visits in less than 2 months, with no injury more significant than a skin tear (my father is nearly 90 and has tissue paper skin), I spoke with his doctor who wrote a letter to the AL advising against sending Dad to the ER unless there was an indication of something more significant than merely a fall. The doctor also agreed to be available to any medical questions for the staff, or to examine Dad himself if the staff thought he needed to be seen. So far that arrangement has worked well.

If you put your mother on hospice care, then the Assisted Living place must call hospice personnel first to make a decision. With hospice, you eliminate the ER. REmember hospice care is not for immediate end of life, patients have been in their care for up to a year!

Josh, unfortunately, the older population does not have or does not recognize symptoms of UTI.

My inlaws were in Al and now in nursing home. They both have dementia. My MIL is incontinent and gets frequent UTIs.
Countrymouse, I always appreciate your responses but on the one with “Blimey” in it, I just have to pop my head up and give my opinion. When people have dementia and are incontinent and get frequent UTIs, sometime the ONLY WAY you can get a itinerary sample is via a catheter. It has nothing to do with incompetence or laziness. In my MIL’s case, she seems to have no sensation and it isn’t possible for her to remember or even think of sitting on the toilet, let alone doing a Clean Catch sample.
About the ER stuff: we get called a lot to take them. Sometimes we let the facility do it but sometimes we are able to take them to Same Day Care or do the ER thing ourselves. It seems to be their protocol to take them to ER rather than a clinic. But you don’t have to allow it, not do you have to do it even if it is needed, as they can call an ambulance to do it. Sometimes we let the ambulance take them and we meet them there, and then if possible, we bring them home rather than have them return by ambulance.