"Granny-Dumping" in Psyche Unit

Nurses Safety

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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?

Specializes in Psych, Informatics, Biostatistics.

I can't believe the nurse refused to do anything about the situation.

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Where I work granny/granpa comes with a child who has "cared" for this parent all their life. This child is usually unreasonable as far as listening to diagnosis and care of their loved parent. All they want is to do "everything" to keep mom/dad alive forever.

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Specializes in Geriatrics and emergency medicine.

I, too, have been a LTC nurse all my career. Prior to that, worked as a CNA for 20+ years, strictly in LTC also. We have certainly sent residents to the ER for "acute mental changes", only to have them return for the hospital with stage 2 and 3 decubs. Please, don't rip on me, I realize you also have a stressful job.

How about the family that drops their mother off at a LTC facility in a w/c in the lobby, a sack of clothes with her, mom has no short term memory, and the long term is no good either. No info on the family, no medical info to speak of and she is now your responsibility.

We have laws to protect animals from abuse, from starvation, and from being abandoned. We even have laws to prohibit us dumping our trash along side of the road. Yet, our most precious commodity, our parents, we feel that we can just drop them off at a nursing home, send flowers or a card on Mother's day and Christmas at best, and go about living our lives, as if she no longer exists.

I wish the public had access to this website. They might come to see all that we as nurses do. They have no clue!! I have had my wrist broken cause grandpap did not want to go to the bathroom, had a head laceration due to a gentleman breaking thru his restraints and smashing a metal napkin holder across my skull. I was on break at the time, had my back to the door and he can bursting in. To this day, I do not sit with my back to a door. Had my sternum broken when I was checking a resident's waist restraint and he nailed me with his heel of his foot and sent me flying into a wall. Yet, I still go back, everyday and try to somehow bring a sense of dignity to my patieints. Yea, I sometimes do take a bit longer with my med pass, last night for instance. One resident's room had on the doo wop on public TV, the oldies were playing and they were all singing along. One resident, newly admitted, double BKA, dialysis,blind, was just singing along, stumps just up in the air dancing. I grabbed her hand and we "danced" for 2 or 3 songs. Had the best time!!! I love my residents, love my job, and am so proud to say that I'm a Nurse

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Specializes in Tele, ICU, ER.

I have to say that most of the dumping I see in my area doesn't come from LTC. It comes from privately owned ALFs that are "staffed" by, maybe, an aid or tech at night. Most of them are sent for psych reasons, not medical. Most of the time, it's because the patient hasn't been taking their meds for weeks on end, hasn't had them, or whatever. Now I always understood that ALFs were ASSISTED, in that someone would help make sure folks got their meds, located the resources to get scripts refilled, etc. Apparently not. At least in some of them. So these people get sent to our ER via BLS ambulance, perhaps they're hostile or disorganized, but they're nto a danger to themselves or others in the classic sense. Our intake is designed to handle immediate crises - the rest go home and are referred to outpatient community resources. But still they get sent here.

We also get the families who bring in their teenagers. "She's just out of control and her mother made me bring her." Not dangerous, not beating people up. Slammed the door and yelled at mom. Here they come to the ER.

ERs, these days, are the catch-all. If you can't handle it, send it to the ER, then it's their problem. Doesn't have to be medically necessary or a threat to life or limb for folks to get sent to us. The only requirement seems to be that whoever's got the patient now can't handle them.

It's not just LTC's or even mostly LTC's, if you really look at it. We're the catch-all for everyone.

Just as an aside, will someone explain to me how you can tell someone who has dementia or alzheimer's is suddenly also mentally ill? If someone is quietly confused and has been, how do we know they're suddenly also depressed? If someone has dementia and thinks I'm her little sister who died as a child in 1922, is that psychosis? or part of the dementia? Who decides what is mental illness and what is part of their chronic diagnosis?

Thanks for any info.

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Well, I can't talk about what we in LTC do because I've never seen us do it. I do, however, sympathize with adult children who have a demented, paranoid, incontinent bb and combative elder who they just can't handle anymore and for whom the county/state/nation/whatever can't find a bed. After perhaps months of waiting they have to "dump" or they will never be freed from what is often in insuperable burden. Yes, they love their parents, but they can't care for them. And a couple of hours a day of home care doesn't let the person who earns the necessary second income go out and earn it.

What we need to do is approach the entire problem of keeping bodies alive long after the brains have deteriorated. We need to deal with the ethics and no one wants to. We also have to deal with regulations that demand that we try to increase function in dying people.

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Specializes in Geriatrics, Med-Surg..

Thank you Suesquatach. I am one of those adult children who had to deal with this issue. We did not dump our parent at the ER, but we had to go there to get help in any sort of timely way. My spouse and I were 100% burnt out trying to care for a parent. In Canada, the wait for services such as govt. funded LTC is huge and the red tape worse. We ended having to pay for a short stay at a retirement home, while we explored the care options, but this was not easy to do while raising young children, it was so expensive. So yes, the system is just as bad here in Canada at least it is where I live as there is a shortage of subsidized elder care.

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Specializes in Rehab, LTC, Peds, Hospice.

On our sub-acute unit, we had a gentleman drag his mattress down the hall, threaten to kill the nurses, and punched a cna for good measure. He was very big and could walk well, and did in and out of the other patient's rooms etc. , all the while saying very colorful, abusive things to the staff and residents. The nurses could not get near him to give him anything, and called the police and 911 for help. It was the end of my shift when I was leaving from another floor when this was happening, so I stopped to see if I could help. When I arrived, he was in a bathroom (not his own), yelling at the mirror and punching at his reflection. When the staff got near him, he would grab his recently placed suprapubic catheter and swing the bag at them like a rodeo cowboy.

Sometimes I have a knack for people like this. I talked to him very gently ( I have no idea what the heck I said now!) and eventually persuaded him to calm down. I was feeling pretty good about that until 911 and the police arrived and treated us like dirt and like we were 'wasting' their time. They made it very clear that we were bothering them. The fact that this man had no dx of dementia or any psych hx and was a new admit for the sp tube placement warrented sending him out anyway. (I heard he did get a dx of schizophrenia.) But I"ll never forget how we were treated by the 'rescuers'.

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Specializes in most of them.

Yes, except grandma ends up on a medical unit because there is no psych unit or the psych unit says it's dementia not a psychotic break. Either way equally fun.

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I am thinking that as a nurse, I have never "dumped" a pt. I do know that in long term care we are very restricted in the way we can treat pts. that get out of hand. No we can't give them meds to stop the behavior (chemical restraints) we can't take them to their room (isolation) and we can,t restrain them px. To get treatment for those pts. we usally have to send them out to be evaluated and let those who know more about it adjust the medications they are on. So don't look at it as dumping, look at it as asking for help in managing a pt. who needs more help than we can give.

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When I arrived, he was in a bathroom (not his own), yelling at the mirror and punching at his reflection. When the staff got near him, he would grab his recently placed suprapubic catheter and swing the bag at them like a rodeo cowboy.

Thank you for the insane mental picture of a crazed patient yelling YEEEEEEHHHHHHHHHHHHHHHHAAAAAAAAAAAAAAAAAAAAAA!!!! and swinging his pee bag like a lasso!

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Specializes in Rehab, LTC, Peds, Hospice.

I'll never forget it! I have too tell you though, that when crazy cowboy calmly got on the stretcher, and the 911 crew was looking at us like we were crazy, I got an insane urge to pinch him just to rile him up again.

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I'll never forget it! I have too tell you though, that when crazy cowboy calmly got on the stretcher, and the 911 crew was looking at us like we were crazy, I got an insane urge to pinch him just to rile him up again.

Awesome!

Withasmilepn: (Tiptoes up to patient)

Patient: Yow!!!!!

Police Officer: Why did that man just howl in pain?

Withasmilepn: No reason :devil:

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