We're not leaving until Mama's in a home

It didn't matter to this woman that her mom was discharged. She was done with being a caretaker. I just hoped to get through before this became another drop and run of an elderly person. Nurses Announcements Archive Article

We're not leaving until Mama's in a home

The phone in my pocket rings. I have been an ADN for all of three days now. I am still orienting, though my preceptor scheduled to teach a class while I covered the house. Her presumption of faith in me is both inspiring and terrifying. The er is calling. They have a patient that has been discharged, but the daughter is refusing to take the patient home, claming she cannot care for her mother.

My stomach knots at the prospect of confrontation. I do not feel ready for this. This was just supposed to be a summer job as a staff nurse in between sessions of my regular job as a school nurse. They offered me a hefty paycheck and the role of adn; nothing more, nothing less. This was what I had gotten myself into.

I calm myself and remind my already jarred nerves that I deal with difficult people and family members all year long at school. But there it's different. There I know the rules off the top of my head.

I walk past my preceptor classroom and hear her giving a brief lecture on central line dressing changes. I decide I better fully assess the situation before I call her out. It seems like she's on a tear anyhow about the order of betadine and alcohol.

The er is hopping. They could certainly use the space the now discharged woman is occupying. I slide up the counter to get the story from the nurse caring for the patient.

"Mrs. Taylor was brought in by squad earlier this morning. Daughter said she couldn't walk. Doc ran all sorts of tests - nothing physically wrong. Patient can walk too, just is a bit unsteady." I nod and jot a few notes on my worksheet.

"I just think the daughter's had it. I need you to tell them they have to leave." the nurse rattles off the info without ever looking up at me. It seems she's had it, too.

I glance through the chart and head in to the stretcher slot. The patient is a frail woman with a pleasant smile; the daughter is well dressed and has permanent frown lines etched into her skin. I explain that the patient has been discharged and the hospital has no reason to admit the patient and that they need to make arrangements to get home.

"I can't care for her, she has to stay." the daughter gives as her defense. "I brought her here cause I can't take care of her."

I look over the patient. She rolls her eyes in her daughter's direction. It's obvious she is even less comfortable with this confrontation than I am.

"You guys can do whatever you want - admit her, send her to a home. I can't care for her." the daughter repeats and flips her cell phone open to send a text.

I explain that the doctor sees no reason to admit and that I cannot just send her to a nursing home. Especially at seven o'clock on a Friday night. I gently offer to arrange for transport to bring the patient home via ambulance. This is quickly vetoed as the daughter states she can't get her to the bathroom by herself. As I debate offering to send home a bedpan along with transport, the daughter threatens to "shove her in the car" and "leave her there all night" with a promise to return first thing in the morning to the er to start the process over. I advise them both in no uncertain terms that a call to aps would be made should that be the case. I quietly wonder what she would have done to toilet her mom if she kept her in the car all night. My stomach knots again. Perhaps it's time to call out my preceptor, or at least go and hide in the morgue and cry for a moment.

I take a deep breath and offer to call the after hours social worker to see if she had any suggestions. The daughter agrees, though I am worried she will just leave the er and leave her mother behind. I get in touch with the social worker who agrees that the patient does not sound appropriate for admission. "i suppose," the social worker sighs, "if the daughter just leaves her here we can admit for observation. Medicare probably won't cover it, though." she warns.

Meanwhile, I have a surgeon that needs to book an or add on for the morning, three nursing units have a laundry list of items they need from central supply and I still have to think about staffing for the night shift. Taking a quick cry break sounds better and better. I shrug that off and instead opt for a quick scream inside my empty elevator car.

I fill out the booking for the or add on, dash down to central and find all the items with impressive speed and stop by the office and make a few last minute changes to the nursing assistant float pool assignments. After swallowing half of my coffee, I am ready to return to the daughter of the year in the er. I am still half expecting her to have left the patient high and dry. To my surprise, she is still there, frown lines visible from across the room.

We hash out the details of the case again. I explain to her that we can attempt an observational admission, but that it would likely not be covered by insurance. This calms the daughter down, but she it still not satisfied. A rapid response is called overhead. I explain to the woman I would return after I responded to the emergency and we could decide what they wanted to do then.

I meet my preceptor en route. "how is your night going?" she smiles, reading the stress on my face. I fill her in as we approach our emergency.

When the patient was stabilized, I made my way back to the er, expecting to now have to find a room for this unnecessary patient. Without checking in at the nurses station, I round the corner and find the stretcher empty and the patient's gown tossed onto the floor.

"What happened to mrs. Taylor?" I ask as I return to the nurses station.

"Daughter didn't say a word, walked her out about fifteen minutes ago."

I shook my head and walked away. I am angered by the attitude that one could drop their mother off at the hospital as cavalier as dropping a stray dog off at a pound. Mrs. Taylor had apparently avoided the nursing home for another day, though I imagined this would not be the end of this. I haven't seen them since, nor have I had a similar situation since, but I am positive it will not be the last attempted elder drop I see.

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Flare

About Flare, ASN, BSN

School nurse firefighter. Poet, patriot, Fire Chief and former roller derby. Queen of Quite a lot.

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Specializes in Oncology&Homecare.

From what I read this is more common than we would like to think. The largest group of aging people in the history of the world is crashing into the health care system. We will have to come up with creative solutions for keeping people at home while giving assistance to the people they live with. A nursing home is not appropriate in every situation. Insurance could be more flexible in providing home care assistants and adult day care. A nursing home is NOT a cheap solution. I am afraid this situation will get worse before it gets better. Thank you for shining a light on this troubling and tragic "new reality" for seniors.

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Don't be too quick to judge her, Flare. Walk a mile in her shoes first. You might have permanent frown lines, too.

Yeah, I know she used the ER inappropriately and had an unrealistic view of the whole matter. But she was likely at her wit's end and sees no end in sight. I fear for the safety of the mother, though. You probably should call APS into the matter.

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Specializes in Peds Medical Floor.

I work in LTC. Twice I've had people call late, both on a Friday night, and inform us they were dropping their mother off now because they couldn't take care of her anymore. The supervisor had to explain that you can't just do that. I'm not sure what she did after that, but I was shocked that people thought they could just drop their parents off like that. Like it was a hotel with empty rooms with people just sitting around waiting to take care of whoever dropped by. But taking care of a parent at home has got to be so stressful, especially if there's no support or anything.

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Specializes in Med/Surg, Academics.
I work in LTC. Twice I've had people call late, both on a Friday night, and inform us they were dropping their mother off now because they couldn't take care of her anymore. The supervisor had to explain that you can't just do that. I'm not sure what she did after that, but I was shocked that people thought they could just drop their parents off like that. Like it was a hotel with empty rooms with people just sitting around waiting to take care of whoever dropped by. But taking care of a parent at home has got to be so stressful, especially if there's no support or anything.

I guess I'm not shocked by it, considering there are Baby Safe Haven laws in most states.

I, too, would not judge the woman too quickly. Taking care of an aging parent is extremely difficult, and community services are limited to intermittent assistance, and voluntary services can cost quite a bit. Adult day care, for example, can be more expensive than infant day care. It really is a "walk a mile in her shoes" type of situation.

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Specializes in school nursing, ortho, trauma.

Certainly not judging the daughter. I've been in the role of full time care giver and I know how taxing it can be. That is why I didn't want to just grab a wheelchair and show the patient to the door. That is why I tried to find out of any possibility of admitting the lady, even as a observation. Please bear in mind, I was still orienting as an ADN at the time. I actually have run into the same situation in the 9 months since I started this per diem job, I am aware of more resources now and can offer better solutions.

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Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
Don't be too quick to judge her, Flare. Walk a mile in her shoes first. You might have permanent frown lines, too.

Yeah, I know she used the ER inappropriately and had an unrealistic view of the whole matter. But she was likely at her wit's end and sees no end in sight. I fear for the safety of the mother, though. You probably should call APS into the matter.

Right, for instance my mother in law who lives with us has dementia and is a complete burden. Was diagnosed twelve years ago, but walks, speaks a few words, feeds herself, won't allow bathing, and is only occasionally incontinent. My husband cannot work outside of the home because he babysits his mom all day. He cannot leave the home because she will walk out the front door and fall outside. I am the only breadwinner. At some point

she will have to go elsewhere. The money for ALFs and nursing homes is all spent and a house was sold to keep her in an ALF for 2 years. She has been in my home for 3 years. Her decline is ridiculously slow. She could outlive the both of us, lol. We are bored to death and we can't do anything without his mother.

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Specializes in Pediatrics.

I feel for the daughter, having been in similar shoes a year and a half ago. When my mom and I finally got my brother to the ER after 5 years of not leaving the house, we were not about to take him home again. It was, to us, a lucky break that he would get in the car and go to the hospital after 5 very frustrating years of trying to get him help.

Fortunately, the ER was able to help us.

I am glad that you now have more information to deal a situation like this.

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Right, for instance my mother in law who lives with us has dementia and is a complete burden. Was diagnosed twelve years ago, but walks, speaks a few words, feeds herself, won't allow bathing, and is only occasionally incontinent. My husband cannot work outside of the home because he babysits his mom all day. He cannot leave the home because she will walk out the front door and fall outside. I am the only breadwinner. At some point

she will have to go elsewhere. The money for ALFs and nursing homes is all spent and a house was sold to keep her in an ALF for 2 years. She has been in my home for 3 years. Her decline is ridiculously slow. She could outlive the both of us, lol. We are bored to death and we can't do anything without his mother.

So what would be the alternative in a case like yours?

Her money is spent, so she can't pay for care.

If she had no family to take care of her, where would she go?

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Right, for instance my mother in law who lives with us has dementia and is a complete burden. Was diagnosed twelve years ago, but walks, speaks a few words, feeds herself, won't allow bathing, and is only occasionally incontinent. My husband cannot work outside of the home because he babysits his mom all day. He cannot leave the home because she will walk out the front door and fall outside. I am the only breadwinner. At some point

she will have to go elsewhere. The money for ALFs and nursing homes is all spent and a house was sold to keep her in an ALF for 2 years. She has been in my home for 3 years. Her decline is ridiculously slow. She could outlive the both of us, lol. We are bored to death and we can't do anything without his mother.

In earlier times, it was common for the extended family to pitch in to help in cases like this. While this is still the case in some industrialized countries (Japan and Greece for example), the US has evolved well beyond such borderline communist practices. In most other industrialized countries, there is usually a fairly robust social safety net that offers substantial resources to families to help care for aging relatives. Of course, this means that means that these are socialist countries, where the population lives under the crushing burden of high taxes. Here in the US, we reject such an unfair redistribution of income and everyone in the country is gloriously free to spend all of their assets on health care.

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Specializes in Med/Surg, Academics.
In earlier times, it was common for the extended family to pitch in to help in cases like this. While this is still the case in some industrialized countries (Japan and Greece for example), the US has evolved well beyond such borderline communist practices. In most other industrialized countries, there is usually a fairly robust social safety net that offers substantial resources to families to help care for aging relatives. Of course, this means that means that these are socialist countries, where the population lives under the crushing burden of high taxes. Here in the US, we reject such an unfair redistribution of income and everyone in the country is gloriously free to spend all of their assets on health care.

Should I read this with the sarcasm that I hear in my head? If so, I totally agree with you. Well put.

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Specializes in Med/Surg, Academics.
So what would be the alternative in a case like yours?

Her money is spent, so she can't pay for care.

If she had no family to take care of her, where would she go?

She could go to a nursing home if she qualifies for Medicaid.

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