Tiramisu Posted November 6, 2015 Share Posted November 6, 2015 My grandmother was brought by ambulance to the ER last night when her home health aide called 911 because she had mucus and vomited. It was very late and though my mom and I usually follow to the hospital, we decided to just wait to get more information. (Right now dh is sick so I need to be home for the dc, and my mom now recently got care of my nephew. Due to CPS rules, he can't be left alone or sleep at anyone else's house.) Since we have been through this multiple times, we just assumed the same routine would take place as when this happened previously: she would get to the ER, be assigned a one-on-one aide due to her advanced dementia, be admitted, etc. We both fell asleep and then I got a phone call from a medical transportation driver waking me up early this morning saying he drove my grandmother home and no one is there. He said he saw a key in the flowerpot and wondered if he could just let her in and leave her there. ?? My grandmother is in her late eighties with advanced dementia, can't walk without a walker and only with an attendant. The hospital has her record due to her frequent visits and sent her home without contacting anyone. Meanwhile, my grandfather is in rehab recovering from pneumonia, and there is no aide at their home because...my grandmother was sent to the hospital. Quote Link to comment Share on other sites More sharing options...
chiguirre Posted November 6, 2015 Share Posted November 6, 2015 :grouphug: 1 Quote Link to comment Share on other sites More sharing options...
Ethel Mertz Posted November 6, 2015 Share Posted November 6, 2015 Ugh! What a mess! Hope that things get straightened out and your day improves! Quote Link to comment Share on other sites More sharing options...
Hikin' Mama Posted November 6, 2015 Share Posted November 6, 2015 Very sorry that happened. Hugs. 1 Quote Link to comment Share on other sites More sharing options...
SparklyUnicorn Posted November 6, 2015 Share Posted November 6, 2015 crazy....I hope she is ok 1 Quote Link to comment Share on other sites More sharing options...
Bluegoat Posted November 6, 2015 Share Posted November 6, 2015 That is pretty unbelievable. I would be calling the hospital and complaining. As an aside, this is why I like the system where GPs are responsible for their patients in the hospital, so they have to be notified when people are admitted or when they are discharged. Issues are a lot less likely to be overlooked if someone intimate with your health care issues has to be involved. 4 Quote Link to comment Share on other sites More sharing options...
Butter Posted November 6, 2015 Share Posted November 6, 2015 I'm surprised they didn't call someone when they were going to transport her back home. Don't they need someone competent to go over the discharge instructions at least? 11 Quote Link to comment Share on other sites More sharing options...
Innisfree Posted November 6, 2015 Share Posted November 6, 2015 How awful, I'm so sorry! I would be talking to someone there later, after sorting out her immediate care. 3 Quote Link to comment Share on other sites More sharing options...
Kimberly in IN Posted November 6, 2015 Share Posted November 6, 2015 Wow. :grouphug: 1 Quote Link to comment Share on other sites More sharing options...
NoPlaceLikeHome Posted November 6, 2015 Share Posted November 6, 2015 Having worked in several hospitals for decades, I would never make any assumptions about safe care of loved ones despite the fact that there are many good nurses and doctors out there. Hospitals are usually short staffed and patient care suffers as a result. One on one care is virtually impossible in the hospital unless you are in a critical care unit and even then nurses often have 2 patients. You really need to be an advocate for your loved one and ideally be present. Some hospitals try to say visiting hours are over but if you call for the nursing supervisor and insist on staying you can get your way which I recommend. basically I would stay with a loved one if able to advocate and help your loved one. Yes they should have called someone but if you cannot go, I really recommend calling and expressing any concerns about your family member so that mistakes are not made. 5 Quote Link to comment Share on other sites More sharing options...
JudoMom Posted November 6, 2015 Share Posted November 6, 2015 That's awful, but I'm so thankful he didn't just leave her there. It sounds like your family has a lot on its plate; :grouphug: 1 Quote Link to comment Share on other sites More sharing options...
Ottakee Posted November 6, 2015 Share Posted November 6, 2015 Do either of you have medical power if attorney for her? If not, or if it isnt on file there they might not have even had the legal right to talk to you, esp if Grandma didn't ask them to call you. I would call the hospital and get that all set up. In our area we can even set it up so that 911 has an emergency contact person to call, etc. 1 Quote Link to comment Share on other sites More sharing options...
kroe1 Posted November 6, 2015 Share Posted November 6, 2015 Having records for someone is meaningless in a busy ER in the middle of the night. No one has time to read through 4 inches of charts. In addition, the social work charting does not filter back down to the ER department of any hospital where I have worked. If she was cleared to be discharged, and she knew her name and address, no one may have known how demented she really is. Patients always need a patient advocate, in my opinion. This is especially true now since HIPPA regulations do not allow hospital staff to call about patients anymore. The patient must specifically ask for someone to be called. In the future, you should always go, too, or have the aide go. At the very least, call the ER, ask for the nurse caring for your mom, and explain her dementia. Give them your phone number, and asked to be called when your mom is ready to go. No one will be checking back five visits ago to dig out that information from a lengthy chart. 6 Quote Link to comment Share on other sites More sharing options...
MedicMom Posted November 6, 2015 Share Posted November 6, 2015 Having worked in several hospitals for decades, I would never make any assumptions about safe care of loved ones despite the fact that there are many good nurses and doctors out there. Hospitals are usually short staffed and patient care suffers as a result. One on one care is virtually impossible in the hospital unless you are in a critical care unit and even then nurses often have 2 patients. You really need to be an advocate for your loved one and ideally be present. Some hospitals try to say visiting hours are over but if you call for the nursing supervisor and insist on staying you can get your way which I recommend. basically I would stay with a loved one if able to advocate and help your loved one. Yes they should have called someone but if you cannot go, I really recommend calling and expressing any concerns about your family member so that mistakes are not made. This. Hospitals are very different these days. Nurses are critically short staffed. I have seen elderly patients left by themselves for hours on end in an ER. The ER I am most familiar with lets patients know that they will likely be checked on only once an hour. There are too many patients and not enough staff. Around here a patient with advanced dementia and no one with her would have been an ambulance ride home and likely triggered a call to adult protective. I would call the hospital and ask to speak to the discharge coordinator for the ER to discuss your concerns. 1 Quote Link to comment Share on other sites More sharing options...
Tsuga Posted November 6, 2015 Share Posted November 6, 2015 I am so sorry that happened. Unfortunately I think this means you can no longer trust the hospital to "know" your mom's case--they just have too many patients. I hope your grandmother feels better soon. 1 Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 Do either of you have medical power if attorney for her? If not, or if it isnt on file there they might not have even had the legal right to talk to you, esp if Grandma didn't ask them to call you. I would call the hospital and get that all set up. In our area we can even set it up so that 911 has an emergency contact person to call, etc. My grandfather set up some POA's but they did not include medical. And then we found out the hard way that the ones he made weren't valid because he did them wrong. He will not consult an attorney about anything and it's caused a lot of problems. He he very headstrong and resents our interference. 911 and the hospital have my mom as a contact and have called her before. During her last visit, they called me, too. I don't know what went differently this time. Quote Link to comment Share on other sites More sharing options...
lauraw4321 Posted November 7, 2015 Share Posted November 7, 2015 Someone always has to go. If family can't, then a health aid. Hospitals are not safe for incompetent people. Period. Full Stop. 3 Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 Having records for someone is meaningless in a busy ER in the middle of the night. No one has time to read through 4 inches of charts. In addition, the social work charting does not filter back down to the ER department of any hospital where I have worked. If she was cleared to be discharged, and she knew her name and address, no one may have known how demented she really is. Patients always need a patient advocate, in my opinion. This is especially true now since HIPPA regulations do not allow hospital staff to call about patients anymore. The patient must specifically ask for someone to be called. In the future, you should always go, too, or have the aide go. At the very least, call the ER, ask for the nurse caring for your mom, and explain her dementia. Give them your phone number, and asked to be called when your mom is ready to go. No one will be checking back five visits ago to dig out that information from a lengthy chart. I suspect they could have only got her address from the paramedics who brought her in, because I don't think she could give it. In the future, I won't take it for granted that they see the right info; but having been with her for past visits, the ER nurse was able to pull up all her meds, etc., immediately on their computer system as I watched, so I assumed it would happen that way again. Obviously not. And you're right about the dementia. It's really true that they don't always understand how serious it is--even when I'm there to tell them--until she starts up and they have to call in security and need ten people to hold her down to give her a shot to calm her down. 1 Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 Someone always has to go. If family can't, then a health aid. Hospitals are not safe for incompetent people. Period. Full Stop. We don't have any great options right now because everything is up to my mom and me, and we are overloaded. My mom is so afraid of both losing her job and having my nephew go to foster care because of trying to meet my grandparents' needs. Earlier in the year, I spent so much time at the hospital taking care of my grandmother that I think the stress of it contributed to my two younger children developing emotional problems. My mother recognized it and now asks me not to go for my kids' sake. I don't know what the answer is. We've had scary situations in nursing homes, scary situations with home health aides, and now a scary hospital situation. My mom was actually relieved to hear that my grandmother was going to the hospital because she was uneasy with my grandmother being at home with an aide without my grandfather there because of past issues. We are in survival mode and over the last few months our priorities have had to shift to ensure the kids' welfare, my dc and my nephew, as sad as that seems. I don't think my mother or I will ever have a period full stop kind of life. I think we will always be left trying to manage chaos the best we can. Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 Having worked in several hospitals for decades, I would never make any assumptions about safe care of loved ones despite the fact that there are many good nurses and doctors out there. Hospitals are usually short staffed and patient care suffers as a result. One on one care is virtually impossible in the hospital unless you are in a critical care unit and even then nurses often have 2 patients. .... We have been extremely fortunate because our local hospital system provides one-on-one aides for patients when there is a safety risk. It's not nursing care; it's just someone to sit with them, help them eat, get to the bathroom without falling, etc. It's been wonderful. My grandfather hasn't needed it but my grandmother gets it every time. Quote Link to comment Share on other sites More sharing options...
lauraw4321 Posted November 7, 2015 Share Posted November 7, 2015 I sympathize - truly. I managed my grandfather's care while he was dying with three young kids (one still nursing). Home health aids like Home Instead or Visiting Angels will go to the hospital with loved ones. After my grandfather passed, I had to use them with my grandmother when she was snowed into the hospital and I couldn't get to it. Does your grandmother qualify for Hospice? Have you discussed what her wishes were with your grandfather, in terms of care? I would highly recommend ensuring that she has a DNR, DNI order in place. This is not out of a desire to be rid of her - it is out of a desire to reduce suffering. Any sane doctor would agree, if she has "advanced dementia." I would also discuss whether she would want a feeding tube, as many people with dementia eventually forget how to eat. I am so sorry. Dealing with fragile elderly relatives is so so difficult. I didn't mean to sound cold - I just know that hospitals are extremely dangerous places for those with dementia. Are there friends or neighbors who may even be able to take a turn at the hospital if it happens again? Church friends? But of course - do the best you can. Your children must come first. I have to remind myself that quite often. 1 Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 UPDATE: My grandmother was admitted after she was brought back to the ER. They plan to keep my her over the weekend and then try to transition her to the nursing home where my grandfather is in rehab. When my mom talked to the hospital social worker, she had no idea what had happened earlier in the morning. I called to speak to the nurse who was very nice and she warned me that we will likely be billed for the "medical transportation." 2 Quote Link to comment Share on other sites More sharing options...
Tsuga Posted November 7, 2015 Share Posted November 7, 2015 Oh dear. I am sorry this is happening. That must be so terrifying for your grandmother. Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 I sympathize - truly. I managed my grandfather's care while he was dying with three young kids (one still nursing). Home health aids like Home Instead or Visiting Angels will go to the hospital with loved ones. After my grandfather passed, I had to use them with my grandmother when she was snowed into the hospital and I couldn't get to it. Does your grandmother qualify for Hospice? Have you discussed what her wishes were with your grandfather, in terms of care? I would highly recommend ensuring that she has a DNR, DNI order in place. This is not out of a desire to be rid of her - it is out of a desire to reduce suffering. Any sane doctor would agree, if she has "advanced dementia." I would also discuss whether she would want a feeding tube, as many people with dementia eventually forget how to eat. I am so sorry. Dealing with fragile elderly relatives is so so difficult. I didn't mean to sound cold - I just know that hospitals are extremely dangerous places for those with dementia. Are there friends or neighbors who may even be able to take a turn at the hospital if it happens again? Church friends? But of course - do the best you can. Your children must come first. I have to remind myself that quite often. Thank you, Laura. All of this was so nice for you to share. My grandmother doesn't qualify for hospice because physically she is in reasonable shape. We do have a DNR after my mom learned of the trauma of CPR on an elderly body, even emotionally for the person performing it. We will do a feeding tube if that becomes necessary. My grandfather was as healthy as could be for a ninety year old, until my grandmother's situation began to wear away at him. He is failing fast, with nothing specifically wrong. It seems like everyone we know has a family and a very full life. I can't imagine who I'd ask, even at church. We had Visiting Angels before but my grandfather cancelled them because of hourly minimums. That was before my grandmother needed 24/7 care. I like the aides they have now for the most part, though we've had some issues showing up unexpectedly and seeing poor treatment. The biggest problem in sending them to the hospital is that they are not native English speakers and their communication abilities are limited. Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 Oh dear. I am sorry this is happening. That must be so terrifying for your grandmother. Yes, it must be. Everyday must be scary. She's fine in the morning but in the afternoon and evening, she never knows where she is. Even at home, she constantly asks when we will take her home. Changes in her environment make it worse. My mom told me they had to give her haldol today. That usually happens at least once during every hospital stay, when the ativan doesn't work, and she starts ripping things off and trying to escape. Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 A GOOD UPDATE: My mother called to tell me she just visited the nursing home where my grandfather is in rehab. He is very happy that my grandmother will be coming. He said, "It's time." I think he realizes that he is deteriorating and is relieved my grandmother will be taken care of, even though it's not officially permanent right now. Lots of hoops to jump through. This is the same nursing home where both of my great-grandparents were cared for and died in, along with other relatives, so he feels it's familiar and safe. Plus, they started to give him beer and crackers at night to fatten him up, and he is enjoying that. Thanks to everyone for your support and concern. 12 Quote Link to comment Share on other sites More sharing options...
Melissa in Australia Posted November 7, 2015 Share Posted November 7, 2015 :grouphug: Quote Link to comment Share on other sites More sharing options...
readwithem Posted November 7, 2015 Share Posted November 7, 2015 Yes, it must be. Everyday must be scary. She's fine in the morning but in the afternoon and evening, she never knows where she is. Even at home, she constantly asks when we will take her home. Changes in her environment make it worse. My mom told me they had to give her haldol today. That usually happens at least once during every hospital stay, when the ativan doesn't work, and she starts ripping things off and trying to escape. You may know this, but this is called sundowners and is very common in elders. You can google to find out more. :grouphug: to you and your mom. I was worn out just reading your post. I didn't make this up but I try to repeat it to myself (and others dealing with elders - I just said it to a friend last night) - we are doing the best we can with the best we know. 2 Quote Link to comment Share on other sites More sharing options...
KungFuPanda Posted November 7, 2015 Share Posted November 7, 2015 Is there any way that you could be added as an acceptable, occasional carer for your nephew? You and your mother have your hands full, but if one of you could keep the kids while one helps the grandparents it could be less stressful all around. 2 Quote Link to comment Share on other sites More sharing options...
Ottakee Posted November 7, 2015 Share Posted November 7, 2015 Is there any way that you could be added as an acceptable, occasional carer for your nephew? You and your mother have your hands full, but if one of you could keep the kids while one helps the grandparents it could be less stressful all around. That is a good idea. As foster parents we have a few our our relatives cleared for care. 1 Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted November 7, 2015 Author Share Posted November 7, 2015 Is there any way that you could be added as an acceptable, occasional carer for your nephew? You and your mother have your hands full, but if one of you could keep the kids while one helps the grandparents it could be less stressful all around. That is a good idea. As foster parents we have a few our our relatives cleared for care. My mom has wanted to keep us out of it because she has found the process very invasive. Besides the usual finger printing and background checks, which I have done before, they took pictures of every room in her house and even asked questions about whether her parents' moral beliefs. They are not even in the same house but it seems they are concerned for any family history of homophobia. We can still do occasional care but regular caregivers have to go through a clearance process and my mom wanted to spare us. As hsers, we could be open to misunderstandings since there have been children's in CPS custody in our state who have been abused or died who were somehow, but never clearly identified, as hsers. My sister is also known to attack people and accuse them of abuse so I prefer to stay off of her radar as well. We had to block her from our phone years ago because of vicious, middle of the night texts. Quote Link to comment Share on other sites More sharing options...
kbutton Posted November 7, 2015 Share Posted November 7, 2015 A GOOD UPDATE: My mother called to tell me she just visited the nursing home where my grandfather is in rehab. He is very happy that my grandmother will be coming. He said, "It's time." I think he realizes that he is deteriorating and is relieved my grandmother will be taken care of, even though it's not officially permanent right now. Lots of hoops to jump through. This is the same nursing home where both of my great-grandparents were cared for and died in, along with other relatives, so he feels it's familiar and safe. Plus, they started to give him beer and crackers at night to fatten him up, and he is enjoying that. Thanks to everyone for your support and concern. So glad to hear this! :grouphug: :grouphug: :grouphug: Quote Link to comment Share on other sites More sharing options...
readwithem Posted November 8, 2015 Share Posted November 8, 2015 A GOOD UPDATE: My mother called to tell me she just visited the nursing home where my grandfather is in rehab. He is very happy that my grandmother will be coming. He said, "It's time." I think he realizes that he is deteriorating and is relieved my grandmother will be taken care of, even though it's not officially permanent right now. Lots of hoops to jump through. This is the same nursing home where both of my great-grandparents were cared for and died in, along with other relatives, so he feels it's familiar and safe. Plus, they started to give him beer and crackers at night to fatten him up, and he is enjoying that. Thanks to everyone for your support and concern. That's great about his attitude and about the beer and crackers :) 1 Quote Link to comment Share on other sites More sharing options...
Acadie Posted November 8, 2015 Share Posted November 8, 2015 Thank you, Laura. All of this was so nice for you to share. My grandmother doesn't qualify for hospice because physically she is in reasonable shape. We do have a DNR after my mom learned of the trauma of CPR on an elderly body, even emotionally for the person performing it. We will do a feeding tube if that becomes necessary. So glad to hear things are in a better place. I have a background in health care, and thought I'd offer some thoughts on feeding tubes. Families almost always opt for feeding tubes, because that's what we do with our loved ones, nurture and nourish them, whether they're young or old. But losing one's appetite can be a natural stage of dying, as the body begins to shut down and the person is simply ready to let go. There are many times when feeding tubes save lives and the person returns to good quality of life, but I've also seen feeding tubes extend life for a long time with very poor quality and much pain when the person was ready to die. Amy 3 Quote Link to comment Share on other sites More sharing options...
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