[laurakoko]

Happened to us last week.

The 'granny' said she was going to kill the doctor... they dumped her off at the ER. Louisiana has some law that states nursing homes cannot dump for psych reasons unless acute (harming themselves/others) without fore-warning of 30 days..
Since she wasn't going to see the MD she "wanted to kill", until next week, we sent her back, and had time to find a place for I/P psych treatment. (Found a small loop hole THAT time)
(oh, she just said that, and didn't mean it...., she states)
After an investigation, the NH couldn't deal with her controlling personality, and telling what the staff to do anymore.
I hate dumping... it is wrong.

[Bird2]

Originally Posted by SriggRN320

Wow - this LTC nurse feels beat up on in here. OK - put the shoe on the other foot for a moment. You have a parent in LTC facility. How do you feel about your Mom/Dad being in the same facility where another resident just down the hall is hitting, swearing, sexually abusing, etc.. etc, other residents. You would be screaming "Lawsuit" so dang fast it wouldn't be funny if it was your parent that got hurt. No we can't just restrain them - that is highly against our regulations and we can't just chemically restrain them (ie: snow them) either - Also against regulations. Other LTC nurses posts are correct, we do try to eliminate other possiblilties, ie UTI, Resp, infect and the like. We also try to adjust psych meds at a slow pace, but this all takes time and in the mean time - IT'S YOUR MOM THAT MAY GET HURT. We have an obligation to provide the best care to all residents not just one. One of the first posts indicated that we didn't WANT to provide 1:1 care to problem residents. Have your ever been in LTC - please!!! If I provide 1:1 for even 1 hour - thay may be AT LEAST 20 residents not getting any attention for one full hour - AGAIN THIS COULD BE YOUR MOTHER UNATTENDED WHILE I HANDLE THE OTHER PROBLEM. As for education - in my state we are required to have an annual inservice (plus upon hire) regarding the care of specialized/dementia residents. We preach over and over about the correct way to approach a confused person, etc, etc. But we are not the only ones they come in contact with - ie: lots of times another resident purposely or inadvertently gets them wound up, heck I've even heard residents go balistic when the church group was singing X-Mas songs in the hall. And last but not least - we have received plenty of admissions from the hospital that told us what a "sweet LOL" so and so, only to find out from family later that the hospital had had a bunch of problems with them too. Sorry for the long rant, but it is very unkind to just blame the LTC industry for this problem. I understand your feelings too. I think the system is just broke and these poor folks fall through the cracks. I hear in ILL. they are thinking of passing a bill regarding criminal background checks on all pre-admit LTC residents to prevent convicted sex offenders from being admitted. Just goes to show, this whole dilemma will not end any time soon.

Thanks SriggRN320. I find it very offensive that the rants are often directed at LTC's. We are the most regulated in all of healthcare. I love working in Geriatrics and fortunately there are some of us willing to do it. When I did the LPN to RN transition I heard over and over from the other students to not work in a LTC because the real nurses work in hospitals. People can not get past the preconceived ideas about LTC's. Our local nursing programs are now making the students do leadship clinicals at the LTC's to try to get past the negativity. We have to protect our pts and get them the best possible care. BTW we already are doing background checks on all residents to check for sex crimes.

[ClaireMacl]

We get the family based "granny dumping" particularly around holidays, sooo many at Christmas. I remember one year, an old man was found sitting outside the hospital in a wheelchair in freezing temperatures by security, when questioned, the man said his family threw him out of the car and left him there. No contact numbers, the poor old man couldn't remember where he lived, nothing! Makes me mad.

Now, for the US long term care nurses, please don't take offense. In the UK, many nursing homes are staffed by unqualified nurses as it is not deemed acute care. Every day, we get ambulances dropping off patients from local nursing homes, either because they can't cope with them or because they called the on-call doc who didn't bother to do a thorough investigation (by phone) and instructed to call 999. The most frustrating thing for us is that patients from home should be directly referred to the medical team, which speeds things up by 50%, better for the patient and us... but 9 times out of 10, they arent!

Our confused, violent and abusive elderly patients aren't sent to the psych ward as it doesn't include elderly care at present, so they are sent to acute take wards... surely worse for the patient, staff and most of all, to the patients suffering from actual acute conditions and not exacerbations of chronic conditions such as dementia.

I just wish we could find a solution.

[11 to 7]

I'm in LTC also -- just posted about this problem. I had a resident the other night who chased me around the unit for an hour, if I had to pull her off of someone else, she would try to tear my hair out and scratch at my face and arms with feces under her nails. She grabbed my name pin and stabbed me wit it. As I've said, the nurse would not intervene. I understand that these kinds of incidents will occur on a locked unit, but something needs to happen before it goes on this long. That's why they get sent out -- Doc doesn't want to order a restraint, chemical or physical, because family gets upset. Nurse can't restrain without an order, so they CNA is left to defend herself. Once she gets seriously hurt (there's blood), they send them to the ER, where they are, of course, sedated, which could have been done at the LTC center if there had been a little more cooperation.

[oneLoneNurse]

I can't believe the nurse refused to do anything about the situation.

[snowfreeze]

Where I work granny/granpa comes with a child who has "cared" for this parent all their life. This child is usually unreasonable as far as listening to diagnosis and care of their loved parent. All they want is to do "everything" to keep mom/dad alive forever.

[Calgon-take.me.away]

I, too, have been a LTC nurse all my career. Prior to that, worked as a CNA for 20+ years, strictly in LTC also. We have certainly sent residents to the ER for "acute mental changes", only to have them return for the hospital with stage 2 and 3 decubs. Please, don't rip on me, I realize you also have a stressful job.
How about the family that drops their mother off at a LTC facility in a w/c in the lobby, a sack of clothes with her, mom has no short term memory, and the long term is no good either. No info on the family, no medical info to speak of and she is now your responsibility.
We have laws to protect animals from abuse, from starvation, and from being abandoned. We even have laws to prohibit us dumping our trash along side of the road. Yet, our most precious commodity, our parents, we feel that we can just drop them off at a nursing home, send flowers or a card on Mother's day and Christmas at best, and go about living our lives, as if she no longer exists.
I wish the public had access to this website. They might come to see all that we as nurses do. They have no clue!! I have had my wrist broken cause grandpap did not want to go to the bathroom, had a head laceration due to a gentleman breaking thru his restraints and smashing a metal napkin holder across my skull. I was on break at the time, had my back to the door and he can bursting in. To this day, I do not sit with my back to a door. Had my sternum broken when I was checking a resident's waist restraint and he nailed me with his heel of his foot and sent me flying into a wall. Yet, I still go back, everyday and try to somehow bring a sense of dignity to my patieints. Yea, I sometimes do take a bit longer with my med pass, last night for instance. One resident's room had on the doo wop on public TV, the oldies were playing and they were all singing along. One resident, newly admitted, double BKA, dialysis,blind, was just singing along, stumps just up in the air dancing. I grabbed her hand and we "danced" for 2 or 3 songs. Had the best time!!! I love my residents, love my job, and am so proud to say that I'm a Nurse

[EmerNurse]

I have to say that most of the dumping I see in my area doesn't come from LTC. It comes from privately owned ALFs that are "staffed" by, maybe, an aid or tech at night. Most of them are sent for psych reasons, not medical. Most of the time, it's because the patient hasn't been taking their meds for weeks on end, hasn't had them, or whatever. Now I always understood that ALFs were ASSISTED, in that someone would help make sure folks got their meds, located the resources to get scripts refilled, etc. Apparently not. At least in some of them. So these people get sent to our ER via BLS ambulance, perhaps they're hostile or disorganized, but they're nto a danger to themselves or others in the classic sense. Our intake is designed to handle immediate crises - the rest go home and are referred to outpatient community resources. But still they get sent here.

We also get the families who bring in their teenagers. "She's just out of control and her mother made me bring her." Not dangerous, not beating people up. Slammed the door and yelled at mom. Here they come to the ER.

ERs, these days, are the catch-all. If you can't handle it, send it to the ER, then it's their problem. Doesn't have to be medically necessary or a threat to life or limb for folks to get sent to us. The only requirement seems to be that whoever's got the patient now can't handle them.

It's not just LTC's or even mostly LTC's, if you really look at it. We're the catch-all for everyone.

Just as an aside, will someone explain to me how you can tell someone who has dementia or alzheimer's is suddenly also mentally ill? If someone is quietly confused and has been, how do we know they're suddenly also depressed? If someone has dementia and thinks I'm her little sister who died as a child in 1922, is that psychosis? or part of the dementia? Who decides what is mental illness and what is part of their chronic diagnosis?

Thanks for any info.

[Suesquatch]

Well, I can't talk about what we in LTC do because I've never seen us do it. I do, however, sympathize with adult children who have a demented, paranoid, incontinent bb and combative elder who they just can't handle anymore and for whom the county/state/nation/whatever can't find a bed. After perhaps months of waiting they have to "dump" or they will never be freed from what is often in insuperable burden. Yes, they love their parents, but they can't care for them. And a couple of hours a day of home care doesn't let the person who earns the necessary second income go out and earn it.

What we need to do is approach the entire problem of keeping bodies alive long after the brains have deteriorated. We need to deal with the ethics and no one wants to. We also have to deal with regulations that demand that we try to increase function in dying people.

[linzz]

Thank you Suesquatach. I am one of those adult children who had to deal with this issue. We did not dump our parent at the ER, but we had to go there to get help in any sort of timely way. My spouse and I were 100% burnt out trying to care for a parent. In Canada, the wait for services such as govt. funded LTC is huge and the red tape worse. We ended having to pay for a short stay at a retirement home, while we explored the care options, but this was not easy to do while raising young children, it was so expensive. So yes, the system is just as bad here in Canada at least it is where I live as there is a shortage of subsidized elder care.