Follow
Share

The Memory Care ALF where my father is living recently changed their policy to send any resident who falls unwitnessed to the ER, whether it appears they are hurt or not. Prior to this, when a resident fell, the nursing staff would notify the family and the PCP, evaluate them, and monitor them over the day for signs of head injury. If all seemed well, the resident would continue their daily routine. Now, they go to the ER regardless of any evidence of injury. My father is 89 yo, with moderate mixed dementia, and bad balance. He falls a lot. In the 6 weeks since this change in policy, he has been sent to the ER 3 times, where he can't answer the doctor's questions, and confusion is increased. So I have had to take off from work to sit with him while he is treated for nothing more serious than a skin tear. And of course there is the co-pay for the ER and the copay for the ambulance rides. Does anyone have suggestions for how to get the ALF to change this policy back to the old policy? Dad was living there under the old policy for 7 months, and all was well (although he did fall often). (The nursing staff also thinks it's an unworkable policy.)

This question has been closed for answers. Ask a New Question.
I share your concerns. I've dealt with the same thing with my LO. It seems ridiculous, but, so far, I haven't found a solution. I've asked the doctor if we can stop the ER visits just for precaution reasons. Not sure if it's going to happen. I recently read that a doctor can enter an order to not transport to ER unless urgent, but, that might not help, as they consider a fall urgent. What if they are on Hospice? Would they still transport to ER if there is a witnessed fall, with no apparent injuries?

 Maybe, some who know about this will chime in. I'd like more info on it.
Helpful Answer (6)
Report

While I agree these trips may be unnecessary, what if, in fact, the resident fell, hit their head, and then wasn’t evaluated until the next day when by that time he/she may have a slow intracranial bleed and by the next day showing signs of a change in mental status? By then it’s too late, the damage is done. 

Granted, the ALF is trying to avoid a lawsuit and rightfully so. What else could they do? Even if they had a RN 24/7 they couldn’t assess an intracranial bleed and an RN would prudently most likely send them to the ER for an evaluation. I know I would.

It is wishful thinking to assume staff in those facilities can watch every resident to prevent them from falling. That’s not going to happen. Unless the family private pay a “sitter” to watch the person and even that doesn’t guarantee it.

This scenario is just another “learn as we go” scenario as people are living longer and more seniors are placed in long term care centers. It’s damned if you do, damned if you don’t. One solution would be to have the family document in writing when their Senior should be sent to the ER but I am not sure anyone would or could  take liability to predict these situations.

As a RN I wouldn’t be comfortable assessing a person and deeming them to be injury free. I would send them out for evaluation. It’s not my job to diagnose.

What a dilemma. And I agree with everyone above as these trips are costing Medicare a lot of money. Plus I am hearing that county governments are now charging families for unnecessary use of ambulance services. But realistically no one can predict an injury by an incomplete evaluation, especially if the person is not familiar to the RN. 
Helpful Answer (6)
Report

Stupid policy, not in residents' interests. Needless trips to the ER are costly (to the resident) and disruptive (for the resident).

It is, of course, an a**-covering exercise. It avoids the possibility of angry and litigious family members demanding to know whether their fallen loved one was immediately taken to the ER, and ensures that the facility can always answer "yes, of course, our policy is for all unobserved falls to be followed by ER examination."

Get together with senior staff members and other residents' families and seek further discussions with the policy makers. Best of luck!
Helpful Answer (5)
Report

I agree, policy is expensive; keeps the facility off the hook but costs Medicare a ton of money. If they have 24 hour RN staff, they should be able to evaluate him to determine if he is injured. This also could be in reaction to a local law change as well, so I would check with the adminstrator to determine the reason for the policy. But my question is, could his fall risk be reduced in any way? Would he benefit from PT for strengthening? Does he need a rollator or if he has one, does it fit him properly and does he use it? etc. Not saying you have not already done these things but if they won't change the policy, and you don't want to move him, that might be only option.
Helpful Answer (5)
Report

My dad’s AL has a fall policy that if the resident hits their head they have to be checked out by the ER. If he falls without hitting his head which he has done as he gets up from his wheelchair and it scoots out from under his butt they check vitals then the resident is on 1/2 hr checks for rest of day.
Helpful Answer (5)
Report

That’s ridiculous policy and definitely a CYA. Talk to the local ombudsman and ask them to intervene. I just saw on the news last night that some insurance company is going to deny coverage for "unnecessary" trips to the er. The goal is to keep people OUT of the er, not fill it up. Tell the AL that it’s their responsibility to keep dad off the floor. I was a broken record at Moms NH and they finally took it seriously and got her fitted for a narrower chair that’s harder for her to fall from among other measures. But don’t assume that he will be belted into a wheelchair in a NH. That would be considered a restraint in NY and not happening. Turn the heat up on them to keep him off the floor.
Helpful Answer (3)
Report

Thank you all for your comments and suggestions. I've written a letter protesting the new policy directed at the local Executive Director, and my father's PCP has written a letter expressing his preference that Dad not be sent to the ER if there is no indication of injury, and offering his services if they want a reviewing physician (rather than the ER). So far, no response from the ALF. If these are ineffective, I will reach out to the other families (I know my father is not the only resident who falls) to try to organize a group protest of the policy.
Helpful Answer (3)
Report

Erring on the safe side would be a complete no-brainer if all trips to ER were definitely harmless. The trouble is that by the time an elder gets to the stage where stress and exertion are bad news in themselves, and say it might be 'flu season, or say you've got a fat-headed "I'm a senior medical student" (seriously, to my undisguised hilarity one young man did make the mistake of introducing himself to me like that) charged with taking bloods and apparently with Jackson Pollock as his mentor...

There is a risk that a trip to ER might be the first step on the slippery slope. I guess it partly depends on the reliable quality of your local ER.

By the time things started getting silly with my mother and we'd have been up and down the road to the hospital all day long...

Broken limb, actual blood, obvious stroke - ambulance.
Fall resulting in bruising or "oddness" - take to ER.
Fall, nothing to see but not happy - call for advice.
Fall, explained, no worries, no nearby hard or pointed surfaces - watch at home.

The ALF should quite rightly, I totally agree, exercise an abundance of caution. And any RN should quite rightly refuse responsibility s/he isn't confident accepting, I also totally agree. But this ALF seems to be safeguarding itself at the expense of its residents, and it isn't costing those residents nothing. I'd argue.
Helpful Answer (2)
Report

£1.49 billion in the year to March 2016, is the figure for NHS payouts on claims for negligence. The NHS has its own litigation service, the NHS Litigation Authority. In 2017, the reserve it recommended was £60 billion.

I don't know if that's for the UK or just for England. Technically, Wales, Scotland and Northern Ireland run their own (still national!) health services, but it may be that the NHS LA covers all of them. If it's the whole UK, that's for c. 70 million people; if it's just England, it's c. 55 million.

I think individuals are the same, really, in terms of feeling aggrieved and wanting something for it... I suspect the major difference is the number of jury trials of civil cases - the still quite paternalistic English legal system wouldn't *dream* of doing that with negligence, though it does for certain other civil matters like defamation - leading to settlements which are spectacular to the point of fantastic.

Also English people are brilliant at grumbling to no purpose. It takes quite a lot to make them sue, they'd rather just go home and feel sorry for themselves.

We do have some disgraceful law firms which advertise on t.v. and in the press soliciting claims for things like personal injury and mis-selling of financial products. Until, oo, I think it was the 1990s, lawyers were forbidden to advertise at all; and it is still seen as a mark of dodginess.

Hmm. £14.6 million was awarded in 2015 to the family of a boy born with cerebral palsy as a direct result of useless midwifery and obstetrics, to judge from the article. But that sum won't have been punitive, it will be actuarial - I think that's probably the other main distinction between the US's and UK's civil culture, here the courts' focus is still on restoring the plaintiff to the status quo ante as far as possible, there isn't the same emphasis on punishing the failings of the defendant.

Care homes, I haven't researched but I'd say, have to be utterly abysmal even to get reported, let alone sued. There is a hangdog, despondent attitude to standards in elder care that makes me froth at the mouth periodically. It isn't that I want to see more claims, it's that I wish people wouldn't be so bloody apathetic - and that they'd recognise that it is up to them to do something about the problem, if they care.

I think our employment tribunals might do brisker trade than the States'. I assume so because the government, last year or the one before, was trying to reduce it.

With things like train crashes, and the appalling Grenfell Tower fire, there have been moves to get prosecutions for corporate manslaughter but no convictions yet, I don't think (though watch this space with Grenfell; people are very upset indeed). Which leads me to reflect that if we're going to take these things more seriously, maybe we should be looking not just to the US but to China. They don't bankrupt their miscreants. They hang them.
Helpful Answer (2)
Report

Weary, you said in one post that your dad forgets that he needs wheelchair and/or walker and gets up and then falls. My LO did that too. She would get up out of her wheelchair and hit the floor AND she would get out of bed, forget she couldn't walk and hit the floor. What helped her A LOT was a belt alarm on her wheelchair. It doesn't keep her in the chair. All she has to do it is unsnap it and an alarm goes off. She is able to unsnap it, but, when she hears the alarm, she giggles and snaps it back. So, it works to keep her from getting up unattended. If she did try to get up, a staff member would be coming to assist her after hearing the alarm go off.

The same works for her bed. They put an alarm on her bed, so it goes of when she gets up. They can get to her and assist her or she'll hear the alarm and lay back down and wait for help.

They really aren't allowed to strap anyone in, since that is a restraint, but, if they can undo the belt, it's not considered a restraint. At least not in my state.
Helpful Answer (2)
Report

See All Answers
This question has been closed for answers. Ask a New Question.

Ask a Question

Subscribe to
Our Newsletter