...when a patient is brought to the ER (either by ambulace or family via personal vehicle) is elderly and unable to care for themselves anymore? I'm sure most of you vetran ER nurses have dealt with this one time or another.
Here's the situation: I worked in the ambulance last night. We were called to a residence because the family seemingly wanted their elderly mother who could no longer care for herself out of their house so that they wouldn't have to take on a new responsibility. She had been hospitalized about a month prior for an unspecified type of infection. She was discharged in care of her family. She wanted to return to her own home, but there was nobody to care for her there. (It is also not in the best of neighborhoods.) It seemed as if the family just wanted her out of their house, yet she was refusing to leave and per family she had been refusing their help, and they didn't have the guts to literally boot her out. She was AOx3 (family stated she is occasionally confused) and her own legal guardian. They said that if she didn't go to the hospital they would petition to have her put on the psychiatric floor. (But she didn't meet any of that criteria - she wasn't a threat to herself or others.)
Fortunately, with much help from the police, we were able to convince the patient to go to the hospital. What is the usual disposition of these type of patients?
Someone said that a social worker should have been called...I've worked in a lot of EMS systems, and not one of them had a social worker on staff. Adult Protection isn't interested at 3:00AM, and won't respond anyway just because the family doesn't want or can't deal anymore. EMS doesn't have the rescources to do what an ER can in this situation...all they can do is try to get the patient somewhere safe.
I know how frustrating it can be, I'm on the other side of the fence now in the ER. But a high at-risk patient is safer in the ER than being left with family that is done with them.
(Personally, I think it's a breakdown in our society...but that's a rant for another day...)
In reality, there usually isn't a social worker available at 3AM in the majority of ERs and the only option would be to call adult protective service anyway ("who isn't interested at 3:00AM"). The ER doesn't have the resources you think; and, as I said earlier, once the patient (who had to be convinced to come and did not wish to stay) was medically cleared, they would most likely have incurred an expense to be transported right back where they came from. The social worker consult would be requested in the morning, as would adult protective services (usually having social workers as investigators) & that social worker would have to go to the home environment anyway. So to inform adult protective services while EMS was in the patient's home environment, in this case, would have most likely had the same effect (in the end) as sending the pt to the ER and then having to send them home because IT WAS NOT AN EMERGENCY.
I do agree with you that there is a breakdown in society; and, there should be some realistic solutions to situations like this-the solution just isn't in the average ER in today's society.
I share your frustration regarding "dumps". Believe you me! But, let's get real. The ERs that we practice in are part of a goofy culture. There's a lot of learned helplessness out there. And, despite the huge amounts of tax dollars thrown at our various problems, it never seems to get to our problems. Does it? It isn't just police and EMS dumping on us, either. They'll come through triage as well. There wasn't any gas in any of the family vehicles so they had the neighbor lady bring them. Papa ain't right and no one can say for sure when he was last right. "He said a couple words on Tuesday." Next on the triage menu is the neighbor lady. She signs her five kids in for various minor complaints. (Here's the point of all this.) Where do you suppose I sent the neighbor lady, et al. Where would you have sent them? Right. Fast Track, or whatever you call it. Since when have ERs been about emergencies? You guys (excuse me, y'all) live or die by the survey they send to your patients. Oh, wait. They don't send them to all the patients. They only go to the ones that were discharged. You know, those patients that didn't have an emergency.
Sorry. Gotta have a shot at the original question regarding "the disposition". My experience has been that, most of the time, it turns into a "social admit". Often, this is preceeded by one or more spats amongst the warm and friendly healthcare people. We want them out of the ER so a floor bed and a social work consult it is.
Sorry. Gotta have a shot at the original question regarding "the disposition". My experience has been that, most of the time, it turns into a "social admit". Often, this is preceeded by one or more spats amongst the warm and friendly healthcare people. We want them out of the ER so a floor bed and a social work consult it is.
You have to remember that this patient had to be convinced to come to the ER & didn't want to be there. Without a medical problem being discovered, this type of patient would be sent home. In regards to it being a 'dump,' I was referring to the family and not about EMS. Their heart was in the right place wanting help for this person.
loricatus
1,446 Posts
In reality, there usually isn't a social worker available at 3AM in the majority of ERs and the only option would be to call adult protective service anyway ("who isn't interested at 3:00AM"). The ER doesn't have the resources you think; and, as I said earlier, once the patient (who had to be convinced to come and did not wish to stay) was medically cleared, they would most likely have incurred an expense to be transported right back where they came from. The social worker consult would be requested in the morning, as would adult protective services (usually having social workers as investigators) & that social worker would have to go to the home environment anyway. So to inform adult protective services while EMS was in the patient's home environment, in this case, would have most likely had the same effect (in the end) as sending the pt to the ER and then having to send them home because IT WAS NOT AN EMERGENCY.
I do agree with you that there is a breakdown in society; and, there should be some realistic solutions to situations like this-the solution just isn't in the average ER in today's society.