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We're accumulating a lot of clear x-rays and CAT scans at the local hospital. I'm thinking of asking the MC to call me to come see him BEFORE they ship him off by ambulance. Last night we spent 6 hours in the busy ER in the hallway between a young heroin addict with serious medical issues and an older cocaine addict who kept wandering around touching all the other patients. During all that time, I was trying to keep my husband lying on a hospital bed because he wasn't in any pain and couldn't remember from one minute to the next where he was or what was happening. Any advice?

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Ok, so, I'm sort of an 'expert' on falls in AL and Memory Care in general since my soon-to-be 95 y/o mother has taken 80 of them over the past few years (that we're aware of). EIGHTY. 40 falls since moving into Memory Care in June of 2019. Here's how they deal with all falls their residents take: the nurse assesses the resident; did they hit their head? IF they hit their head, an ambulance is called and an EMT does a further assessment and off to the ER they go. If they DID NOT hit their head in the fall, then the nurse does a full body assessment to see if there are any skin tears, bruises, bloody scrapes/cuts, etc. The resident is asked if they're in pain as well. The vitals are taken; if all is well, no further action is taken but the POA is called on the phone to be made aware of the fall. The resident is watched for the next 24 hours to make sure they're ok. That's it. IMO, that's the proper way to handle a fall; otherwise, I'd have taken 80 trips to the ER with my mother for NO GOOD REASON. These ER trips would have been traumatic for her and for me, and they'd have been expensive to boot. Find out what the policy is EXPLICITLY at your DH's MC and go from there. If he's prone to falls and their policy is to send the resident to the ER EACH and every time, regardless of whether they're hurt or not, I'd move him out of there b/c that policy is ludicrous IMO. It's the CYA principle taken to ridiculous new heights!!!

A few times, my mother complained the next day of pain in her arm or leg or whatever, so her PA ordered the traveling xray team to come to the MC to take an image; nothing was ever broken (believe it or not) in any of her falls. Early on in the AL, she broke a couple of ribs and a sternum bone or two, but she never pressed the call button for help, so the staff didn't know she'd fallen (she was able to get herself back up alone). During an admission for pneumonia, she had a CT scan and that's when the broken bones were discovered, in various stages of healing! Even if they were discovered during the actual fall, however, nothing could have been done for her in the ER b/c those bones aren't set in any way and just left to heal by themselves.

Good luck; I know how awful the whole situation is when a loved one falls.
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Reply to lealonnie1
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WearyJean Oct 26, 2021
Thank you Lealonnie. I always appreciate your wise advice.
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My mom would slide to the floor when being transferred from bed to wheelchair and the SNF nurse would send her to ER. So I had suggested as long as she didn’t hit her head or present any pain to not send her out. ER visits were an eight hour deal. It would take a few days for mom to acclimate herself and realize she was back at her facility.

So at the Care Plan meeting we agreed that if they could treat mom on site, UTI’s, etc, she would not go to the ER.
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Reply to LisaNJ
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They are covering their butts. In the 4 months Mom was in the AL, they sent her to the hospital 4x. I talked to them about it. They said she claimed pain. I told them don't they have pain when they fall? And a Dementia patient seems to express pain like a child. You know, one little scrape and they are dying. I told them to call me first. I lived 5 min away and have an RN for a daughter. I would determine if she went or not. Unless, she hit her head, then she went to the hospital.

I was told when Mom went to skilled nursing that they do not send residents out every time they fall. If they hit their head, yes, out they go. Otherwise, they observe the person.

I know, its a catch 22, damned if you do and damned if you don't. What if this fall "is" serious. I took on that responsibility. They do not go with the resident and I was the one that sat there, in an uncomfortable chair, for 3 to 4 hours.
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caroli1 Oct 27, 2021
JoAnn, were you usually in the ER got only 3 or 4 hr?? I am 77, and I can only remember one (1) time in my adult life that I was in the ER for fewer than 5 hr, no matter how obviously serious the issue was. The norm has been 7 or 8 hr. Luckily, I have not been to the ER many times, but once when my situation ultimately resulted in almost immediate surgery, the wait was 8+ hr, despite my cogently describing the situation (a failure of a recent fusion surgery), as did the person accompanying me, who was an aide. I realize, of course, that even a 4-hr wait with a disoriented loved elder is likely to be horrible for all concerned.
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You need to review the protocol from the facility about falls. This is probably part of their protocols. They need to have every person who falls assessed for injuries by a qualified healthcare professional.

While you are talking about falls with the administration, ask about their protocols for protecting people at high risk for falls. Every facility with population at risk of falling will have one. See if it includes: increased observation, low beds, mats by side of bed, call bell within reach, frequent toileting...
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Reply to Taarna
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I would find out their protocol and see what changes they are able to make for your husband at your request. Is he on hospice or could he be? I wonder if that would make a difference?

I think it is absurd to send someone to the ER JUST because they fell. My MILs sister used to get mad when she didn't call 911 when she fell. Then I'd go sit with her for hours and hours cuz it takes bloody hell forever at the ER even when they are NOT busy and she would whine and complain about being there so long. We finally got her trained that 911 was for actual emergencies. If you hit your head, are bleeding profusely or in major pain (after a few minutes not from the initial fall), then call 911. Instead, call us and we'll help you evaluate if medical intervention is needed.

It would be nice if MC could do something like that too! There is way too much cover-your-butt type of decisions made for patients. They are often expensive, time consuming and unnecessary.

Definitely let your wishes be known ASAP. Hopefully something can change. Also agree with other posters to brainstorm with facility to see if they have any ideas on WHY he is falling and if there is anything that can be done to help in that department.
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Reply to againx100
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We lost track of the number of times Papa fell, I stopped counting after fall #52 - he had Parkinson’s, which is a “Fall Down Disease”.

The nursing home suggested that they thoroughly exam him and then call us with their findings and ask us if we wanted him transported.

We would have lived at ER! Ask your nursing home to set up the same system.
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Reply to BeckyT
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They are protecting themselves from being sued by doing this. They need to “CYA” so to speak. But I agree with a previous comment asking why are there so many falls? Perhaps his doctor should be looking into his equilibrium and he may benefit from PT or OT to strengthen his balance and evaluate what’s making him fall so easily.
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Reply to Dizzerth
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Sarah3 Oct 26, 2021
And this debunks the idea my friends sibling had that they should put their mom into assisted living to prevent falls. Eye roll patients fall all the time in medical centers, skilled nursing and especially assisted livings
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My husband is in AL, but was encountering same...because it's their policy-which I asked for and  they never produced.  HOWEVER, when I reminded them that he is a no code, they were more ameanable if I agreed to keep a copy of POA on file with those directives.  There is a copy on file in the office now as well as on his fridge.  Our verbal understanding is that unless he's in pain or they see bones or cant manage bleeding from a minor wound, he is not to go to the hospital.  The risk to benefit ratio, especially with COV doesn't warrant.  His PCP agreed.  So far so good.
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Reply to onholdinmidwest
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We have had a few of those falls/ER trips also. But my mom starts up with the delirium so fast in the hospital setting, I had a sit down with the director and Memory Care manager and we came to the agreement, that minor falls that they saw, if her vitals were stable, and she was not in obvious pain didn't have major bleeding, didn't hit head, the on-site nurse would access and they would monitor, not call the ambulance for transport. They call me to inform.
Unattended falls, instead of auto transport would be assessed by EMT. They let me talk to EMTs and I make the call to transport or not.

Now she is on hospice, and they are called to assess if necessary; haven't seen how that goes yet, she hasn't had a fall since we started hospice recently. She does have a DNR.

Its not that I don't want her treated for an acute injury, but the whole ambulance ER thing is so traumatizing for her, that it's often not in her best interest. And one time she was transported for an unattended fall, because she was complaining about her leg, and I was concerned about her hip. Hip was fine, but she had broken ribs!
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Reply to Gracie61
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I would certainly get them to call you before having him taken to the hospital, but they may be complying with their insurance and not have a choice. Perhaps you can sign a waiver so they contact you and the decision is yours, but presumably you will want to see him before you decide which will take some time if he has damaged himself so think about the wording and when they should decide and when you should. If they pick him up and he can walk around with no pain (with a walker if he usually uses one) then that would seem a reasonable time for them to contact you first - it won't mean he hasn't damaged something but it probably isn't an emergency.
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