Help with Elopement

Specialties Geriatric

Published

We have an elderly gentleman who came in with Parkinson's and was here for rehab. He's been with us a couple of months and wants to go home. He lives a couple of blocks away. His wife would take him home in a hearbeat but PT is blocking it and she is of a generation that will not disoneythe authorities and take him home AMA.

He. Is. Determined.

As his attempts to leave have escalated he has been medicated with Seroquel. Geri-chair with tray. Now he has become combative when he is rushed and wrestled into the chair and Depakote has been added.

I feel like Nurse Ratched. He is fine on certain shifts, but some nurses come in already high-strung and really escalate things by being unable to approach him calmly, and when he is surrounded by a bunch of people his behavior is certain to become combative from fear.

Help, please.

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Sheesh, if the guy wants to go and his wife will take him, what's up with PT?????? Do THEY have to wrestle with him daily??? I think PT should just let the poor guy go home.

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Specializes in Psych, M/S, Ortho, Float..

Time to have a heart to heart with PT. This situation is only going to get worse as you can imagine. If his wife wants him home and can provide the necessary supports, why not see if PT can be done in outpatient?

I'm sure that you have already tried, but this guy needs to get out of there. All the extra meds that are being given is not contributing to his wellbeing and will, in the long run contribute to further confusion and combativeness, leading to injuries to him and staff. Home would be a better place for him and the staff.

What is PT waiting for? Complete recovery? Sometimes that just isn't going to happen. Can he walk without falling when not sedated up the wazoo? Can he manage his ADLs with limited assistance that the wife could provide? Will his wife be safe with him? If all the answers are "yes" then he should be able to go.

As for the staff, they are reacting out of fear. They don't want to be injured so they take a pro-active stand and load him up with meds and tie him to the chair. Not always the wrong response, but in this case, perhaps not the best approach. See if you can address this. Is he sundowning? Maybe getting him to bed earlier may decrease his aggresiveness. Can wife visit when he is at his worst times and talk people down, including her husband?

This is one of the hardest situations to deal with. I think most people think he is ready to go, except the PT that doesn't have to deal with him when he is at his worst.

Wishing you the best.

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has this man been delcared incompetent? if not who the h#... is ordering these meds? and since when is PT the be all and end all of assessing for discharge?.....if he hasnt been declared incompetent i would consider this medicating assault.

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Is he private pay or Medicare?

PT is only waiting for his payment source to run out, and I'm sure your administrator is too. Be that as it may, the guy obviously wants to go home. It's time to take this to your manager and SW department, and call for a care conference with the goal of discharge. If the wife can take him home to a safe and manageable environment but your therapies and facility still remain unwilling, the doc may be willing to discharge him anyway.

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Is he private pay or Medicare?

PT is only waiting for his payment source to run out, and I'm sure your administrator is too. Be that as it may, the guy obviously wants to go home. It's time to take this to your manager and SW department, and call for a care conference with the goal of discharge. If the wife can take him home to a safe and manageable environment but your therapies and facility still remain unwilling, the doc may be willing to discharge him anyway.

geesh, i am usually cynical enough to catch that.....

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Specializes in Psych ICU, addictions.
Time to have a heart to heart with PT. This situation is only going to get worse as you can imagine. If his wife wants him home and can provide the necessary supports, why not see if PT can be done in outpatient.

I think it's also time to have a heart-to-heart with the patient and his wife as well, as they both need to be reminded of their rights. The patient has Parkinson's and that alone does NOT make him incompetent (unless there's another underlying condition you haven't mentioned). So if patient wants to go AMA, there is really nothing there to stop him from doing so.

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geesh, i am usually cynical enough to catch that.....

Working in LTC has made me VERY cynical. And since the OP, not someone new to this forum, states that it's PT that's getting in the way, I have to believe that this started as a reimbursement issue.

But reading about the medications they're giving him to keep him settled is making me uncomfortable. What was he like behaviorally before he was admitted? What docs are ordering these meds, and are the orders based on in-person physical assessment? Does the man need a psych consult? How are his labs? What's his Sinemet dosage? Is he sundowning? Is it reactive psychosis? Depression? Dementia? If he spends his downtime under chemical and physical restraint, how is his PT progressing?

I don't mind telling you that I'm concerned about the treatment he's getting.

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I'm upset and concerned.

He is not on my unit. PT is expressing fears that the wife will be unable to care for him. Not so. She will move heaven and earth to do so. They have also expressed that they think the violence is part of the disease process, with which I completely disagree.

He was, upon admission, a gentle, pleasantly confused elder.

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Oh, the social workers are with me and are trying to find a way to suggest AMA without getting, you know, fired.

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Specializes in Maternal - Child Health.

Clearly, this gentleman's best interests conflict with the financial interests of the facility.

Sounds like it's time to call the State Ombudsman before this man becomes permanently disabled from a drug-induced fall, or mental decline caused by unnecesary over-medication.

Bless you for your interest.

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Specializes in LTC, assisted living, med-surg, psych.

That poor man needs to be discharged before the facility kills him.:angryfire

I've seen folks in all kinds of shape go home with a frail elderly spouse and support from home health agencies, and many of them do just fine. (The ones who don't, usually come back to stay.) There is NO reason---other than financial---for the PT department to hold up this patient's discharge, and to do so is unconscionable IMHO. But first he needs to be withdrawn from the psych meds in order to fairly evaluate his cognition, and his home situation assessed to see if he really can make the transition safely.......right now he sounds too messed up from the drugs for anyone to determine how well he might do at home.

Yes, please continue to advocate for this man---his quality of life depends on it!!!

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