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.