My first dump and run

[JBMmom]

I know as well as anyone that has worked in LTC that we should not put ourselves in the position of judging the families of those that require long-term care. The sweet old man that no relatives ever visit may have been an abusive father that severed his own family relationships with a heavy hand. The cute little old lady might once have been a raging alcoholic that showed her children no love stronger than her next drink. And family members may have exhausted all other options for care before ever considering LTC as the final and safest option for a family member in the progression of an illness when they find themselves at our door. However, it was heartbreaking to play a role in the scenario that recently played out at my facility, leaving us feeling more like workers in a kennel that found an abandoned puppy.

As often happens with multiple admissions in a day, the supervising nurse didn't have time to thoroughly read all the admission paperwork, just knew we had a new resident with the primary diagnosis of dementia expected to arrive late morning. Well, late morning came and went, then early afternoon. Not long before second shift two women came in and went to the empty room. An aide overheard the young lady tell the woman, "I have to go to the bathroom, I'll be right back." The aide went to tell the supervisor that our new resident had arrived, and the care giver went to the bathroom but she'll be right back. A couple minutes later, the supervisor headed to the room and introduced herself to the new resident, I'll call her Molly. Molly asked where the woman was they were coming to visit, and the supervisor was a little confused. Molly said her niece told her they were going out shopping but they were going to stop in and visit someone for a minute on their way. At this point the supervisor comes out to find out where the caregiver was and an aide on the other wing said she left a few minutes earlier (no one saw her use a bathroom). Now the supervisor tries to tell Molly that we're at "**" and we're a long term care facility and she's going to be staying with us for a while. Well, that didn't go well.

Molly is a very convincing dementia patient. We've all seen them, they appear to be as competent as you or I in conversation. And for about half and hour we were pretty sure that there was a mistake and she shouldn't be staying. She was angry, but appeared competent, and said either we were going to call her a cab or she was jumping out that second story window in her room because she was NOT going to stay here one single night. Fortunately our social services professional is fantastic. It fell to her to spend a good bit of time after that trying to explain that she was going to stay with us for her safety. There were many tears, some threats, and definitely no acceptance long term, but she agreed to stay the night. We got a wandergard on her by telling her it's the wristband she will use to get her meals. She spent her evening wandering the halls, with her pursue, sitting in different chairs so she could look out all the windows. She agreed that she could use some help getting changed and ready for bed, she goes to bed at 9pm by her account and in the morning she would take a cab back home.

As the supervisor completed the admission the paperwork stated that the family decided not to tell her ahead of time about relocating to our facility because she would probably refuse to get out of the car. I can't imagine that hearing the news from complete strangers was any more comforting to her, but maybe her reaction to family members was potentially going to be worse. I feel badly for all of them, but Molly most of all. I'm trying not to judge, but I wouldn't even do that to a pet, forget a family member. The son is supposed to visit at some point- apparently when they called he said he would come in a few weeks. We'll do our best to get Molly settled and I think for a while we'll just keep a box of tissues on us, we used a lot of them last night.

I wish none of you had similar stories, but I'm sure you do. Thanks for listening to mine.

[JBMmom, MSN, NP]

Thanks to everyone for sharing their responses and Vintagemother I truly do appreciate that many families have exhausted all other options and dealt with potentially years of issues while trying to provide care. My post was not written in judgment of the families, just sadness for everyone.

[CapeCodMermaid, RN]

I was sitting in the lobby one afternoon. An elderly man came in with an elderly woman, threw a suitcase in, said "I can't take care of her any more." and ran off. Luckily I was wearing my Keds and ran faster. The poor man was beside himself. His wife was significantly demented and he had reached the end of his rope. I told him we weren't a drop off center and didn't just take people off the street. I told him to call his doctor, tell him that his wife had mental status changes and probably a UTI. I told him to take her to the ER and after a 3 day stay we'd be able to take her. The poor man was on his own way out. So sad.

[Ruby Vee, BSN]

"Dump and run" used to happen when I worked Med/Surg, too. People would drop Granny off at the ER with some vague complaint and then disappear -- usually to go on vacation. They'd check in when they came back a week or two later. It happened frequently in the summer when school was out and again over the holidays. But we cannot begin to judge -- we don't know what went on in their lives before they got to that stage.

When my mother in law's dementia started to develop, she'd be absolutely hell on wheels over the holidays. Verbally (and physically) abusive (more so than usual) and absolutely a holy terror. The last time my sister in law invited her for Christmas, she came home from work and found Mamita chasing her 9 and 12 year old children around the house with a belt trying to "discipline them" for "being disrespectful." My SIL dropped her mother off at the airport with a hastily purchased one-way ticket back home and ran. With a year, it became obvious that Mamita was becoming demented -- which didn't improve her mood, demeanor or behavior. When each and every visit is excrutiatingly painful because your parent curses you continuously, compares you unfavorably with your siblings or tries to strike, bite, kick or spit on you, it's hard to work up enthusiasm for visiting. And when each phone call consists of them screaming abuse at you, phone calls aren't welcome, either.

I know a lot of people claim that "Mother wasn't like that. It's the Alzheimer's." Maybe that's true -- for them. It was not true in my mother-in-law's case, nor was it true for my mother. My mother was ALWAYS like that -- she just hid it better in the past.

[flashpoint]

We had a resident who seemed as nice as anyone could be. She was patient and kind. She would try to help other residents by pushing their wheelchairs, getting them coffee, and other things like that. No one could understand why her daughter never came to visit. I met her daughter after I left the facility and when she heard that I had worked there, she told me the reason she never visited.

Her mother never married. She was a single mom at a time when it was very unacceptable to be a single mom. Her mother liked to go out for supper and then to the bar. She brought different men home from the bar and when she was not in the mood for sex, she allowed the men to have sex with her daughter. The daughter said she was forced to have sex and lost her virginity at age 13. She was "an expert at oral sex" by age 14. She claims that she had gonorrhea when she was a freshman in high school.

I don't know if what she says is true, but if it is, I can see why she never visits.

[jdub6]

After years of always being there for her, it was surprising at first that he wasn't there, but he was definitely worn out. He was tired and drained--you could see it all over his face every day.

You know, one of our home pts did something similar to his wife. Very sad from both sides. Husband had cancer (possibly terminal? Not sure), wife had bad dementia, needed snf. No money for nursing home. Wife had been in snf for rehab, sent home after skilled days ran out. Husband had no other resources. Called 911, according to the hospital MD wife arrived nonverbal in the ambulance with a note from husband saying he could no longer care for her. In this case he was the dying one, but obviously caregiver fatigue/burnt/stress combined with his illness was just too much. And maybe he wanted to know she was safe before he died.

Almost makes you with there was a safe haven law for elders, but I'm almost certain our state/federal funding would be no match for all the takers. It's always sad when the family knows how awful it is but sees no other way out. And equally sad when the pt knows how awful it is, and believes their family just doesn't love them enough to care for them. The parents who always gave their children everything, and still would if they could, whose children barely even visit and would never even consider taking Mom home with them even though years ago when Mom was in better health she would have done it in a heartbeat for the adult child.

[Ruby Vee, BSN]

The parents who always gave their children everything, and still would if they could, whose children barely even visit and would never even consider taking Mom home with them even though years ago when Mom was in better health she would have done it in a heartbeat for the adult child.

You sound somewhat judgmental.

Unless you know these patients personally, you don't know that they always gave their children everything or that Mom would have "done it in a heartbeat" for an adult child. THEY may have told you that was the case. Perhaps one of the children even told you that was the case -- the favored child, whom Mom did give everything who now lives a few thousand miles away. While the child that lives right down the street and ran errands and did home maintenence for Mom for YEARS was lucky to get a phone call on his birthday -- and if he DID get that phone call was reminded over and over that he wasn't as wonderful as his sibling.

I've learned never to judge unless you've heard more than one side of the story. That child who wouldn't take Mom home with them may be protecting her young children from Mom who took it upon herself to "discipline" them with a belt. Or may be protecting herself from Mom with anger management issues who took after her with a scythe. Or may simply be protecting herself from Mom who never had a kind word for her in sixty years. Or perhaps that daughter has cancer and cannot care for her mother, and that daughter's family is overburdened caring for HER. You just never know.

[WKShadowNP, DNP, APRN]

keep a box of tissues on us, we used a lot of them last night.

I wish none of you had similar stories, but I'm sure you do. Thanks for listening to mine.

That made me cry. Unfortunately I've seen it in the ER too. Especially around holidays. But like you opened with, we don't know their history and what kind of relationship existed there.

But like you, we should be kind, always.

[OldnurseRN]

Actually we received a woman in a similar way. Her daughter brought her to our SNF/LTC from a locked geriatric psych ward! She was told she was going to "an appointment". She doesn't belong with us but, we have her. The worst part of this story is our facility doesn't give "psychotropic" medications! I honestly don't know how they get away with this!

[casi, ASN, RN]

We had one recently that when he found out his family was transporting him to LTC grabbed the steering wheel on the car.

[Career2_BSN, BSN]

"we trust that she is in good hands, call us when she passes"

My mouth just dropped.

[jdub6]

You sound somewhat judgmental.

Unless you know these patients personally, you don't know that they always gave their children everything or that Mom would have "done it in a heartbeat" for an adult child. THEY may have told you that was the case. Perhaps one of the children even told you that was the case -- the favored child, whom Mom did give everything who now lives a few thousand miles away. While the child that lives right down the street and ran errands and did home maintenence for Mom for YEARS was lucky to get a phone call on his birthday -- and if he DID get that phone call was reminded over and over that he wasn't as wonderful as his sibling.

I've learned never to judge unless you've heard more than one side of the story. That child who wouldn't take Mom home with them may be protecting her young children from Mom who took it upon herself to "discipline" them with a belt. Or may be protecting herself from Mom with anger management issues who took after her with a scythe. Or may simply be protecting herself from Mom who never had a kind word for her in sixty years. Or perhaps that daughter has cancer and cannot care for her mother, and that daughter's family is overburdened caring for HER. You just never know.[/QUOTe]

Perhaps I should have quoted the OPs very well-said disclaimer about there being two sides to every story. I assumed all of us responding here took that into account. I absolutely agree that there are two sides to every story, and while working in LTC I had to just sort of leave it at that, do my best for the resident and call it a day. Perhaps I should have been more clear, I AM talking about families that I know, in real life and not as patients. I am reluctantly admitting that I have reached the age of the "sandwich generation" and have seen so many families that I have known for years, where the adult children just can't be bothered with the patent, and others who help however is needed, even if that just means helping set up home services, without a second thought.

Please don't misunderstand, I am fully aware of the difficulties, the incredible amounts of money, and the lack of resources available for elder care. I don't judge anyone for having difficulty. And, yes, of course sometimes caregivers get cancer, etc. A ctually, I think I made that very point in the beginning of my post. But yes, I guess I do judge those whose families I have known personally, seen what the parents/elders have given and seen what the children have not. And, although I certainly don't take anything any family member tells me at work about family relationships as solid truth (and same with the pts), it doesn't stop me from being sad when 15 friends, relatives, even the other children of the pt tell me the same story about how Junior has put dad through horrible things so Jr could live off Dads social security, and then stories of what a great dad Dad was. Do I treat them differently for it, or assume I am getting the whole truth? No. Does it still tug my heartstrings? Absolutely. And, have I had the primary caregivers tell me themselves that the only reason they don't want to put dad on comfort measures is that they are hoping to get a few more days so they can get that last social security check? Yep. They even asked the doc to post-date the death cert when dad died as a full code a little too early.

Again, the OP very eloquently stated that, especially in LTC , you never know the while historic family dynamic. My impression was that this thread was for us to share stories that have saddened us, even with this in mind. I'm sorry if I offended anyone, and I'm not trying to start any fights here. I just honestly didn't see how my post was any different than anyone else's. Perhaps I should have re-stated the OPs disclaimer but I thought that would be stating the obvious at that point. (And, fyi, I have seen both sides of the fence...the biological daughter who grew up in foster care while mom did drugs, who is now the next of kin and being pushed to take responsibility for the mother who, per her perspective and the pts stories, never did that much for her. I am well aware of the difficulties on all sides of this topic. My understsnding was that this thread was to vent about those cases that saddened us, while knowing we may not have all the facts.)

[bluegeegoo2, LPN]

My Mother was one of those people that everyone thought was "Just the sweetest thing!" Well, I hate to be the bearer of bad news but she was The Devil. Had she made it to LTC, I would have been one of "those" family members who never called, rarely showed up, etc. I would have handled the very basics: New clothes when needed, sign consents for psychotropics, etc., but beyond that, no thank you.

It's because of the horrid relationship with that woman that I do not pass judgement on those whose behavior might raise an eyebrow or two. I know very well what several decades of abuse does to one's psyche and imagine that there are very valid reasons that some folks family members choose to stay far away. It does not serve us to apply our own ideas of care/concern for a family member to others. We simply don't know the horrors that people have had to endure.

Case in point: I have a resident who seems OK. Quiet, polite, mostly keeps to herself. She has 5 adult children, of which only one bothers to show up. She shows up begrudgingly, handles business and makes a hasty retreat. I don't recall how the subject came up, but she told me that when she and her siblings were young, they were all physically, mentally, verbally, and sexually abused by their father and their mother knew it and did nothing about it. In fact, "Mom" insisted they keep quiet. It also seems that "Mom" wasn't too kind a soul either with her own brand of abuses. This resident is far from the only one in that category.

I have heard variations of the same type of abuse at the hands of my "sweet little old lady/man" residents throughout my career, and am certain to hear many more.