Dumping patients in the ER

[noc_owl]

I know it's nothing new, but I'm sick of people sending their elderly, usually confused, family member to the hospital for something like weakness or mental status changes and then either not show up after the ambulance arrives, or if they brought the patient they leave without notifying anyone of how to reach them.

So after the big workup that goes with that complaint, when the patient is ready for discharge, there is no family member to be found.

This patient took up a bed in the ER for 6 hours after discharge while we tried to locate family. The poor patient, who had a touch of dementia, cried and cried "I want to go home." At one point the patient even said "They just dropped me off and left me here!" That about broke my heart. The next shift after I left was able to finally get a family member who lived 2 hrs away to agree to come for the patient.

What do you do in this type of situation? (And yes, we did consult social services on this particular patient)

[dekatn]

I dont blame families for what they do, the elderly usually do need assistance.

Now however I do get tired of nursing homes sending people over because of constipation and they dont want to give an enema. Or they run a bit of fever and they refuse to give tylenol. Or any of a 100 things that nursing homes find to send their pts over to us. Usually in quite unclean condition.

I still remain the King Locally for reporting nursing homes to Adult Protective Services. Hopefully they will get cleaned up before I get there.

I know you aren't putting all of us under the same umbrella. I am all for reporting poor care. I work in a very nice LTC, If you ever get the chance, come by for a visit and I'll be glad to give you an enema!!!! Or, a tylenol prior to the enema to ease the discomfort!!!! Please don't slam me, I couldn't resist. I really do understand where you are coming from.

[noc_owl]

I know you aren't putting all of us under the same umbrella. I am all for reporting poor care. I work in a very nice LTC, If you ever get the chance, come by for a visit and I'll be glad to give you an enema!!!! Or, a tylenol prior to the enema to ease the discomfort!!!! Please don't slam me, I couldn't resist. I really do understand where you are coming from.

I think the nursing home dump is common in all ERs, and I know that LTC people get slammed a lot because of a few bad places. I do admire those of you who work ltc and take great care of the residents. It's a hard job. There are some great places out there too, but guess what - we don't see the patients from the good places nearly as much, and when we do they are not memorable because there is nothing bad to stand out. There are a few places around where I work that I hate to receive patients from because they are a mess. When receiving one of their patients they need diaper changed, they don't smell so good, they have skin breakdown, and if they had been seen in our ER within the last month they are still wearing our gown and name bracelet. (We sometimes send patients home in one of our gowns instead of putting them back in nasty smelly clothes after we get them cleaned up.) Unfortunately, those are the places that stand out in our minds the most.

But anyway, about the family dump, I do understand what one poster said about not knowing what the family members are going through. I'm sure they do have it rough. But I don't condone the use of emergency services to get a break from their family. There are others ways to get a break that don't suck up our resources and keep sick people waiting.

[dekatn]

I don't know why families don't try to get them placed in LTC or get someone to help out instead of just dropping them off and leaving!! That's cruel. In this day and time there are soooo many resources out there to help families in situations like this.

[EMTandNurse2B]

When I was doing my LTC med pass clinical rotation, one of my fellow students had a patient like that. She had MS, and wasn't very old. Her husband had been taking care of her at home, and one day up and left, taking their two sons with him. Someone found her at home in her recliner, confused and dirty and they called 911. Nobody ever came for her, so after she had been in the hospital for a few days (I think she had a major UTI after lying in her chair for a few days), they discharged her to the local LTC. Her chart had a little note that said the last anybody had ever heard of her husband was about a year earlier her parents had heard he and their sons were living in Texas (I'm in MI). At least this poor lady still had her parents to love her! I couldn't believe it, here she was still pretty mentally competant, totally abandoned, with no hope of ever seeing her kids again. This just broke my heart, and reinforced in me the reason I want to become a nurse.