My husband was a temporary resident in a memory care ALF. He was in good health except from some chronic arthritis in his hips and neck which was treated with routine extra strength tylenol. One morning as he was getting ready to sit at the dining table for breakfast, the chair rolled out from under him and he fell on his butt. The staff helped him up and into a chair and he ate breakfast. But during the day he complained of hip pain....(remember, he has a hx of chronic arthritis in the hips!) The staff called me to explain what happened. I suggested they just give him another dose of the Tylenol and let him rest because I knew as a former RN that if he was able to stand and rotate his hip when they helped him up from the floor, the probability of a hip fracture was minimal.
I didn't hear from anyone the rest of the afternoon but got a call from the night nurse who said my husband was c/o hip pain and she was going to send him to the local free standing ED. I was against it and told her not to and suggested since its been 8 hours since his last dose of Tylenol, give him 2 tabs and let him rest. An hour later she called again and said my husband was really complaining and she called the local EMT. After some questioning about which hospital ED he was being taken to, I was given the location and told to stand by the phone for a call from the ED staff. I was dubious about the situation and called the ED myself and asked to speak to the aide who accompanied my husband. I was amazed when I was told no one from the facility accompanied him. I rushed to the ED and was welcomed by the physician and nurse on duty who informed me that all they were told was that "he fell." Before I arrived at the ED, they had done a complete work-up to rule out head injury, chest injury, stroke, etc etc. Since my husband is unable to provide any history due to his dementia, and all the EMT team told them was that "he fell," the ED team had to cover all the possible reasons why my husband fell. I related the fall incident repeating what I was told by the facility nurse and provided them with brief overview of his cognitive, medical and functional history. As a result, the physician ordered a flat plate of his hip which was, as I suspected, negative. My husband was discharged, he climbed into our SUV and I drove him back to the facility. He walked through the front door independently...still c/o aching hips!!!

But the purpose of this note is to express my surprise and shock when I found out that the SNF or ALF where the demented or frail elderly patient lives is not required to ensure that their resident is accompanied to an ED by a representative of the facility who can serve as an historian and advocate! The ED is a scary place for a kid and many adults, so just imagine how a lone demented patient must perceive the routine of an ED with no one to keep them calm, provide information to the treating medical team, and to serve as an advocate !! Just imagine being in a strange place and not understanding why? Just imagine having all these tests taken and you have no idea why? And imagine the ED staff's frustration at not having any history about the incident that resulted in the trip to the ED nor an understanding of the patient's combative behavior? I find it a morale dereliction of duty, a total lack of practical consideration and a financial waste to taxpayers and insurers.

This misadventure cost Medicare and the secondary insurer over $25,000. On that issue alone, CMS and other regulatory agencies should demand a change in state regulations governing practices in SNF and ALFs.....which are, after all, generally for profit corporations. No patient suffering dementia should be sent unaccompanied to an ED...never, no how, no way. If you've had a similar experience, I'd love to hear from you. Something must be done to prevent other residents and their families from this experience.

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My mother has pretty severe dementia and has been to the ER three times -- always unaccompanied. It wouldn't even occur to me to expect someone from the facility would go with her. They send her charts with her, and of course, the paramedics are with her. In this day and age, of course, the person accompanying her wouldn't be allowed in the ER with her anyway. Heck, they won't let me in, so a stranger wouldn't go in either.

I've never had to fill out any forms for her, as all the info they need -- full name, DOB, insurance info, Medicare # -- are all with the chart they send along. They also send her POA info which has my personal information on it as well.

They don't just up and send her to the hospital, of course -- they call me first, but the first time they sent her, the ambulance was rerouted to a trauma center, so I spent 90 minutes trying to find her at a hospital she wasn't even taken to. By the time I found her at another hospital, she was cleaned up, stitched up (she conked her head), admitted, and tucked into bed.

The hospital folks and the nursing home folks seem to have this down very seamlessly.
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Reply to MJ1929

Dear "stefanid,"

My experience is pretty much what "MJ1929" described. My mom is 95 with Alzheimer's and last April her ALF had a high number of COVID cases as well as deaths. I knew we wouldn't be able to even walk into the hospital much less go to the ER and eventually the COVID isolation wing. The facility sent all her information which they have when you first place them. That's why they require you to fill out all the information, emergency contacts/phone numbers, copies of their Medicare and Secondary Insurance if any. So when events happen and they need to send them to the hospital they send the paperwork with them. The facility didn't even send her with her purse which has all the id/medical cards. I'm sure my mom had no idea what she was there for because she was in such bad shape from the virus as well as severe dehydration/UTI and bi-lateral pneumonia. No one went with her from the facility. We waited outside the facility to follow the ambulance around the corner where the hospital was but, they went out the back way due to news stations waiting out front for a story.

At the end of December, her new facility where we had her placed in MC, had called me to let me know they had called 9-1-1 because she was unresponsive. They asked me what hospital I wanted her sent to and I told them. My husband and I tried to get to the facility to see her taken away but, just missed them so drove to the ER ourselves. She was already back in the ER rooms. I was there quick enough where they could ask me additional questions but, once again the facility sent all the appropriate paperwork I had filled out when I placed her there in May.

So this is the typical way they handle these types of situations. It's a reminder that once placed, you give them as much information as well as copies of id, insurance cards and anything else that may be helpful in case of an emergency.
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Reply to NobodyGetsIt

Echoing the choir here—my FIL was in a nursing home pre-COVID and was sent to the ER twice without someone from the facility. They really don’t have the staff, especially now that we are in COVID times, to accompany elders to the hospital. It’s worse with COVID as most facilities are dealing with staffing shortages. Your concern is definitely warranted. And unless he was on hospice the facility did the right thing sending him to be checked out. They have to err on the side of caution. Obviously they want to protect themselves but they are also responsible for providing proper care to the patients. If he had broken a bone or started bleeding internally and it was discovered late because they didn’t have him taken to the hospital, not only would your dad have suffered needlessly but you would also have a good malpractice suit on your hands!
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Reply to worriedinCali

No, my Moms was in an AL and LTC and no one ever accompanied her. I was called so I could be there with her. The AL sent her out everytime she fell. 4Xs out of 4 months. She never broke anything. ,"But she was in pain" Of course she was aren't u when u fall. Give her time and then evaluate. Head injuries they will send out for. I was so glad the NH was not so quick to send out.
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Reply to JoAnn29

He was in the care of an ambulance. No, the ALF would not accompany him. And yes, they MUST send him if he either has hit his head, or continues to exhibit pain. This is normal procedure. The very sad truth is that there may be times in his own home, his memory care facility, that your husband is confused and doesn't understand things. A staff member leaving ALF would mean there is one less person there; that cannot happen. And it is one more person in a hospital where likely even family would not be allowed to be with him due to current covid-19 restrictions.
My brother was in Assisted living on the other part of the state when he claimed to me he only had flu. The people in his ALF told me he had fallen three times, was getting up, was exhibiting confusion and had severe diarrhea. They explained to me the ambulance would be called and that he was on his way to ER; there was NO CHOICE in this matter. They told me I could speak with ambulance personnel. This was the beginning of the end of my brother's life. He had gone septic from a simple unhealing wound that turned to cellulitis on his lower leg. He thought it was flu. It would not have mattered what I said. THEY are there. THEY are responsible to check out the pain your husband had, that could have been anything. I am relieved that apparently there was nothing wrong. However, there might have been another situation, and you, like me, may have been facing down a dreadful loss.
Would you rather they took YOUR WORD about giving him a tylenol. If he had died that night, would you have blamed them or yourself.
I am just weighing in to say as a retired RN and as someone who had a loved one in care, I am on their side completely in this instance. I am sorry. I hope you can come to peace with this.
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Reply to AlvaDeer

My LO has always been transported to the ER of our choice, unaccompanied.

Pre Covid, I’d meet her there. More recently, she’s been entirely by herself.

In about 10 trips over 3+ years, we’ve NEVER had any kind of negative experience. My LO’S documentation has always been sent along with her, and she she is relatively sociable, but definitely not an adequate communicator.
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Reply to AnnReid

No one accompanied my mom to the ER, not from Independent Living, when she suffered a stroke and not from the NH when she fell.

These facilities do not have the staff to provide an "accompanier". Especially not now.
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Reply to BarbBrooklyn

The nursing home does not escort residents to the hospital. They call and tell you the resident is being sent and that is all. Doesn't matter if resident is confused, unconscious, or unable to speak for themself. I have experienced this numerous times but I communicate with the staff by phone to make sure they have patient history.

Most nursing homes barely have enough staff on hand to start with. They do send info with the paramedics about what is going on with the patients.

Right now, at least in my area, because of the coronavirus, no one can go in except the patient anyway. Even my primary medical care doctor wasn't allowed in with her father.
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Reply to mollymoose

I was confused when I first started to read your post; "My husband was a temporary resident in a memory care ALF. He was in good health except from some chronic arthritis in his hips and neck which was treated with routine extra strength tylenol." There was no mention of dementia and I wondered why is he in memory care.

It sounds like the facility should have been more clear. They were sending him to ER without a caregiver. Since this happened in the night, the facility has minimal staff; and with COVID that has even become more difficult to properly staff facilities.

He was there temporarily? That also is confusing.

With dementia, yes a privately paid caregiver or you should have gone with or meet him there.
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Reply to gladimhere

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