"Granny-Dumping" in Psyche Unit

grannynurse FNP student · Aug 17, 2005

Just wondering if any of you all have experience with Granny-Dumping.
Evidently, there is quite alot of it.....it goes like this: understaffed nursing homes experience a resident who is "acting out" and having high-maintenance behaviors (requiring a 1:1 staffing) - they can't deal with it, so they "dump" Granny at the local ER. (Granny winds up on the psyche unit.)
Any thoughts?

Granny dumping has been around for years. Usually it was the children who dumped in the local ER.

Grannynurse :balloons:

Bird2 · Aug 17, 2005

Just wondering if any of you all have experience with Granny-Dumping.
Evidently, there is quite alot of it.....it goes like this: understaffed nursing homes experience a resident who is "acting out" and having high-maintenance behaviors (requiring a 1:1 staffing) - they can't deal with it, so they "dump" Granny at the local ER. (Granny winds up on the psyche unit.)
Any thoughts?

Wow I have never heard that term before. I can tell you that from my experience on the LTC side that we have extreme difficulty getting help for these residents. We will send them out when the are are danger to self or others and the psych units send them back so quick it is doubtful they gave them more than a once over. Facilities have to protect the other residents. We always check before sending them that they do not have a UTI which we will notice increased behaviors and are in contact with the Psych Docs and are often trying new prn orders to calm them. Do you have any suggestions how to handle it differently? Any would be appreciated because believe it or not we do not like sending our residents out of the building. We work in their home and it is more upsetting to them to leave the enviroment they are familiar with and it is very time consuming to do the pre and post hospitalization paperwork. I will say that we often call the family to come in and sit with them and if we truly can no longer meet the needs of the resident we help the family find a more appropriate facility such as a Dementia unit.

UM Review RN, ASN, RN · Aug 17, 2005

Just wondering if any of you all have experience with Granny-Dumping.
Evidently, there is quite alot of it.....it goes like this: understaffed nursing homes experience a resident who is "acting out" and having high-maintenance behaviors (requiring a 1:1 staffing) - they can't deal with it, so they "dump" Granny at the local ER. (Granny winds up on the psyche unit.)
Any thoughts?

My understanding of "granny-dumping" involves the family leaving a Jane or John Doe aphasic or confused patient at the ER, so as not to be responsible for the cost of care.

IMHO, if a nursing home has a patient who is acting out so severely that the staff cannot handle it, the psych diagnosis is one of the possibile diagnoses, and as such, it is not "dumping," it is an appropriate placement.

dekatn · Aug 17, 2005

Just wondering if any of you all have experience with Granny-Dumping.
Evidently, there is quite alot of it.....it goes like this: understaffed nursing homes experience a resident who is "acting out" and having high-maintenance behaviors (requiring a 1:1 staffing) - they can't deal with it, so they "dump" Granny at the local ER. (Granny winds up on the psyche unit.)
Any thoughts?

I work in an "understaffed" nursing home, understaffed according to the ones of us that work there, but not so according to state and fed regs. Until something is done to require owners of NH to increase staff it will remain this way, owners are not going to take money out of their own pockets to better the staffing on the floor until they absolutely have too. (which I don't see happening in my life time). If we have a resident, granny or grandpa, acting out and disrupting other residents, especially the A&O residents, they are the ones that complain and threaten to contact state. State comes in to check things out and want to know why we haven't done something to reverse the situation, they review the disruptive residents chart to see what kind of interventions we have implemented and the end results of interventions. Believe me, our staff goes above and beyond to alter behaviors, we have several staff members with psych backgrounds, but we have to protect our license and the integrity of our facility by doing whatever it takes to protect all our residents and see that they get the care that they pay for and desrve, if that means transferring a highly disruptive resident out of the facility for evaluation and treatment that we are unable to provide then so be it. At least we have done something to alter the situation. We don't mean to "dump" on anybody, I was under the assumption that we are all in this world together to make it the best place we can, all disciplines have to work together. Just remember, you have "granny" for a short time and then you can send her back where she came from. BTW, you should come and visit us sometimes at the NH and observe some of the "granny's and gramps" we get "dumped" on us! Those darn families just refuse to deal with them!

lil'nurse · Aug 17, 2005

I work on an acute psych unit in a hospital. We frequently get geriatric pts who have been acting out d/t alzheimers, demetia. We do "look them over" and do understand how difficult it is to deal with these patients. Unfortunately, we can't fix what's wrong with them except to give more meds which can have serious consequences to an elderly person. A lot of the time the nursing home won't accept them back into the facility d/t their assaultive behaviors, then it's up to the hospital and the county to work together to find a facility that is equipped to deal with them long term.

Jo Dirt · Aug 17, 2005

Just wondering if any of you all have experience with Granny-Dumping.
Evidently, there is quite alot of it.....it goes like this: understaffed nursing homes experience a resident who is "acting out" and having high-maintenance behaviors (requiring a 1:1 staffing) - they can't deal with it, so they "dump" Granny at the local ER. (Granny winds up on the psyche unit.)
Any thoughts?

Yes, have had this experience as well. Who can you blame, really? Though they don't generally go through the ER, they are usually just sent straight to the psych ward. We have also had many instances of "gramps" dumping.

CHATSDALE · Aug 17, 2005

There are problems for which there are no solutions..fed guidelines toward restraints have resulted in more injuries to the resident and to those who must come in contact with him including other residients and the staff

we have had to call police to come and get residents in the thros of anger or frustration that they cannot be redirected...we have had emt who refuse to transport aggressive residents

and families sometimes you find them just like the resident but some are just overwhelmed with children at home, making a living, and trying to reason with a parent who thinks that they a stranger

Blackcat99 · Aug 17, 2005

:angryfire I use to work at an LTC facility. We had an alert angry patient with an extensive psych history. This patient warned us ahead of time that she was going to explode if we didn't send her somewhere else immediately. The LTC contacted every state agency available and they kept telling her week after week that they were going to find her a new place to go. After 3 weeks, the patient finally exploded and started breaking out a lot of windows out at the LTC. It was a "miracle" that no other residents were injured during her rampage. Of course, once she exploded and destroyed the facility she found an "instant new place to stay." :angryfire

Nurse Ratched, RN · Aug 17, 2005

We get a lot of "pop drops" around the holidays and spring breaks when families who are otherwise caring for a loved one are going on vacation - usually brought to us under the heading of mental status change (and btw, we'll be in Florida for the next week.)

The ECF's for the most part are doing the best they can with what they've got in terms of staffing. It's rare that we can fix behavioral issues in geriatric folks beyond medicating them. I can get almost any Alzheimer's patient to do anything I need them to with enough time and patience. Unfortunately, that is a luxury not afforded to staff who may have dozens of residents to get up and giong/to meals/showered.

Straydandelion · Aug 17, 2005

Had to put my Dad in the hospital under "mental status change" because he could no longer walk and couldn't take care of him at home. Needed to find a Nursing Home for him to go to and NH's take patients directly from hospitals first, from home second. In the interrum while in the hospital, they found and corrected a PE, adjusted some meds and began PT which qualified him for skilled at least for a short time in the NH. He was sent back to the hospital twice from the NH for "mental status change" when had problems swallowing. Sometimes I think that is a convenient diagnosis (a catch-all) but it seems to help with Medicare requirements.

He was very irritable in the morning times, and when I went to see him, wasn't given or offered liquid or food until later then 10:30A and was very thirsty and hungry, if offered them earlier, wasn't irritable anymore. The CNA had 17 patients usually and no way could get to all in a reasonable length of time. I arranged to be there or have someone else there in the morning times for him. I HAVE heard of NH refusing some patients/asking them to leave due to history of violence, sometimes the psych approach, may be a last resort for some people?

Mister Chris, MSN, NP · Aug 17, 2005

Yes, "Granny Dumping" is, as pointed out previously, where the relatives literally leave the "gran" or "grandad", or any other "old relative" with a nursing facility as they cannot handle them, care for them adequately, or just find it an inconvenience. And yes this does frequently happen just before holidays! They somehow just happen to contract "something" and need care from a nursing/hospital facility. (Not always a genuine case of respite for their carers.)

It is sad but true. Having experienced many cases when I worked in a casualty unit in London and also Australia. "gran" just happened to get a bad 'turn' or a chest cold just before the Christmas, Easter, School or family holidays. They get admitted and in some cases no one ever comes to see them. In a few cases I have known there has been an application already filed for them to be admitted to an aged care facility! The whole thing was carefully planned, but still "dumping". In one case I experienced no one ever came to see them or make claim for them and the state had to take over their care and find somewhere for them to go once the hospital could do no more to improve their physical status. The only relatives had moved away!

The other side to this whole aged care problem is now in Australia, that there are no beds for any psychiatrically ill or dementure specific clients if they are over 60 to 65 years old. Psychiatric Units no longer cater for the elderly!

In the wisdom of the 'powers to be' once you get to that age you no longer have a psychiatric illness merely dementia and must be cared for in an old persons home. I was working in a psychiatric hospital specialising in psychogeriatrics when this situation arose and had to assist in sending all our elderly institutionalised (psycho)geriatrics to local, and some distant old peoples homes. It was heartbreaking to see these people who already had problems, moving to a strange environment after spending many years in an institution where they had security, space and familiar things all around them for many years.

Anyway (getting down off my soapbox!), dumping still goes on and will continue probably forever. Or until they bring in siome other way for people to 'dispose' of their elderly, debilitating parents, aunts, uncles, grandparents etc. etc. :angryfire :crying2:

Still love nursing even so.

God bless all you nurses.

Mister Chris :specs: