Anyone had luck with an ER dump?

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Anyone had luck with an ER dump?

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This seems like the only option left at this point and I feel bad about even considering it, but Mom can no longer be left alone for any length of time. She's fallen a few times, but not enough to warrant a hospital visit. We tried again having a caregiver come to the house when we would be away, but she refuses to answer the door even though we have tried to explain what is going on. We also tried having the caregiver come while we are home, however she will just go in her room until she leaves. Her Dr. has been of no help since her last visit and actually suggested she be seen by the nurse practitioner next time she comes. COVID doesn't help the situation, as it just makes things so much more difficult which we get but cannot continue on like this. TIA

Burnout Care Decisions Family Caregiver

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An ER dump will not work. Especially if that person is competent. The hospital will just send the person home.

On a side note, APS will NOT help at all if the person is COMPETENT. Been there, done that.

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Obviously it won't work if person is competent, but competent means that person can care for themselves. If mom (the mom in original post) can no longer be left alone, than person is not competent. If caregivers are unable to provide care anymore or provide proper care, hospital cannot just send person home. unsafe discharge.

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mstrbill

I hear you.

How about APS, Social Workers, Ombudsmans, Guardians, etc.?

My grandmother's son lived with her and APS was so fast to come into her home and tell my dad she could not live there any longer. My dad took her into our home for as long as he could.

However, where was APS when my dad contacted them when he could no longer care for her and the nursing facility was refusing to accept her?

Where were the professionals when my BIL got kicked out of a Memory Care Unit on Christmas Eve and dumped to a hospital? He was only there 30 days? When I contacted the Ombudsman, I was told what the facility was doing was "illegal." However, the Ombudsman changed his story to fit the Administrator so there would be no work for him.

My BIL spent 8 months in the hospital before he was placed into another facility. The doctors did an amazing job with him.

What was the APS, SW, Ombudsman, Guardian doing when they sent my BIL to a 1 star Memory Care Unit just a month ago to only get dumped to a hospital again? To tell me he "He was not aggressive" but to be dishonest when discharging him to the hospital and state "he was aggressive."

So, we do have a system for this but it is not being enforced. Most of them are lazy and don't care.

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Agreed, it seems they are there to work for the best interests of the facilities, not necessarily the patient.

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mstrbill

Yes, I hear and agree with you. What I am saying is, someone has a job to do.

There is a system out there that is suppose to provide help placing our loved into a facility. If the system was put into work the way it is designed to, there would be no need for a "ER Dump."

Hence, I know all about this dumping. "The system" dumped my family member on Christmas Eve and again last week to the ER.

Our help is not helping us.

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Hailey, what is that system? Or where is it? I didn't experience it nor did I have anyone help me through it. I think the lack of a system is something that needs to be addressed by our society.

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If people would do their jobs, there would be no such thing as an ER dump.

Where is the help?

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The Dr's and the nurses don't want to get involved, they don't feel it is part of their job and/or know there is no easy solution. They are good at handing out pamphlets. Then their default is to call APS. The job falls on the shoulders of a good social worker to find workable solutions for everyone. If the family can afford it, that means hiring in home help. If the family can't afford it or getting in home help is difficult for other reasons such as what appears to be the case here, there seems to be no other solution than getting help from the local hospital. Its terrible, but often its the best route to take. The hospital care coordinator has connections and the ability to get placement while the family member is too overwhelmed or runs into brick walls.

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I knew my dad needed help after my mom died. I told him that I was getting him a “cook”. Actually a caretaker.
She started out at 4 hours a day. Now years later she is up to 9 hr. Same lady. It needs to be someone that will interact and be kind and personal. And respectful. As my dad’s dementia has increased I had to tell him that the caretakers were my friends and that they were there so he would not be alone. If possible you may want to let your mom meet one or two of the caretakers and let her pick who she wants. Hopefully someone that has something in common with her that they can talk about. Some just want to play on their phones.

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If your mom is still mentally competent then they won't do a social admit in an ER. They will not hold her there against her will. You could call APS and ask them if a social worker will meet with you and her to explain why she has to let services come in to help her. I work for a woman now whose daughter was at the end of her rope because her mother was refusing to let any caregivers in to help her and she did not know what to do. I advised her to tell her mom that either she accepts workers coming in to help, or she's going in a nursing home. This worked. The other problem was that the mother did not mix well with the other caregivers who were sent to her place. She even called the cops on one. Her and I get along well enough and it works. I had to meet her several times with her daughter present before I started going there though. Your mom might be receptive to a caregiver if she's able to meet with them and you several times before she starts working for her. Try for private help though. No, insurance will not pay for it but you always get better quality people who are consistent. Good luck.

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I think you have to face the fact that she is a stubborn mule. If you do get a caretaker and she goes into her room, then have the caretaker follow her into her room and stay with here. She might give in when she is cornered in a tight space. And if she keeps it up, tell her she will be removed and put somewhere is she does not cooperate. YOU must take the bull by the horns and impress on her that she must follow the new rules - or else.

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An ER dump can be bad.

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Not really an answer here, but: One of the greatest gifts I've gotten from being my mom's caregiver is to understand the self-defeating futility of ego and pride, and unwillingness to accept our own aging and fear. Being a caregiver, I now understand that silly ego and pride could and will make my own future caregiver's life a boatload more difficult for them, which I, as a caregiver, now experience as selfishness, albeit unknowingly. I'm beyond grateful for this lesson.

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My wife refused to have help when I was in the hospital. She had dementia and could not be left alone. The caretaker came in with flowers that she said I had ordered for her. A few minutes of talking about the flowers and then all was well. The care person had found me passed out on a freeway shoulder the day before due to loss of blood after a botched surgery. My wife was with me when she stopped, ordered an ambulance, and brought my wife to the hospital. Family members stayed with my wife that night but arranged for the caretaker to enter our garage the next morning and left a key for her so she gained access. The rest is history.

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If mom's mind is good, then have a discussion with her. There WILL be someone with her when you are out. There may be a caregiver in the home to help you out with things and this caregiver will be entering her room to take care of tasks as instructed. You might discuss how rude she is being when she shuts herself in a bedroom while you are trying to get yourself a little help. Assuming she understands what you're telling her, you might even give her the 'it's either going to be this way with your cooperation or it's going to be in a facility where she has no privacy at all.

Remind her of previous falls and how she could end up permanently in bed if she injured herself and no one was there in the home when it happened.

If she handles this conversation with agreement, then test it out. Tell her caregiver is coming and you will be out of the house. Drive around the corner and wait. Caregiver can call you to let you know if mom opened the door or not. You can return immediately and open the door to have another conversation with mom.

You can also test out her willingness to meet the caretaker who comes while you're there. Or enter her room and introduce her to the caretaker. Perhaps do it around lunch time and force her hand a little by making her come out to each lunch with you and the caretaker. Actually even if she stays in her room, who cares. Tell caretaker to go on in and do what needs to be done (and to wear her thick hide in case mom says anything rude!)

Do you have a neighbor to leave a key with? Otherwise check into one of those key lock boxes like real estate agents use, changing the code as needed.

To do an ER dump, she needs a reason to be at the ER. If you're serious about it, then if she gets sick or falls again, take her. It would need to be something that would get her admitted so you could have the 'time for a facility' conversation with her doctor and/or the social worker at the hospital. If she's not sick enough to stay at hospital, they could even call a cab to send her back to your house.

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Good suggestions. I found out my mom's spoiled and selfish, though I understand it was the era she was born and grew up in (fka 'stubborn' ha-ha/not). It's hard for me to not be angry with her as a person for her ridiculous and imperious sense of entitlement and absurd and misplaced idea of pride, and the great burden she is to her children and everyone else. I feel sorry for her, and don't feel guilty about being angry. She's supposed to be the adult! I'm grateful I won't 'go out' likewise. Meanwhile, I/we keep trudging forward, a step at a time.

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Not sure if this was mentioned, but a discerning Dr. Should evaluate your mom. If she's deemed unable to care for herself, eat properly, make good choices about being medically safe, etc. The right doctor could diagnose her as ' "medically incompetent" on a signed written statement. This piece of paper may allow you to place her (in lieu of a POA or guardianship). TMy mom's Dr and I had to do this for my mom. Also, try looking into Adult Residential Care Homes if available in your state, they usually only have 5 or less patients and are sometimes less expensive than MC, AL, or NH.
Best of luck, don't give up. Take Care.

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Imho, use the services of her town's elder care dedicated person and social worker that they should have on staff. Prayers sent.

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Install an electronic lock on your door. Give the caretaker a specific entry code which you can delete later. That way the caregiver can at least enter if you mom doesn't open the door. As for the rest - good luck!

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Often times, hospital Social Workers can be a great help. They helped me find placement for my dad many years ago. Case workers have offices in hospitals and they are helpful. Talk to your local senior center in your town. They usually have resources and phone numbers that can help.

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Do you really think an "ER dump" in the present pandemic is going to help anyone? Hospitals are overwhelmed with sick and dying people from COVID and the majority of their energy and resources are going to treat those patients. Taking your Mom into that situation is just plain cruel--expose her to COVID, take resources, especially time, away from dying patients. Do you really have no other alternative? I think a lot of the ones sited below are great. Contacting Adult or Geriatric Protective Services in your county/state is a great place to start. Also try senior services for your county or town. It will take a lot of your time on the phone, but these people deal with these issues regularly and know what is available and how to go about getting help. Hoping for a reasonable outcome for you and your family.

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She wouldn’t be taking resources away from dying patients. And very few, if any hospitals, are overrun with COVID patients.

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Let the caregiver come and get a baby monitor that she can watch your Mom while she's in her room and the caregiver can be in another room.

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If you could have a caregiver come while you are there for short visits and get her comfortable with a particular caregiver she may get used to them and actually enjoy them. Sometimes a gradual change rather than a sudden change will work out better. Change is difficult for for all adults but is even more difficult and scary for elderly adults. Good luck!

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Yes. My mom would fight the idea of anyone coming to take care of her. I started with a house keeper and she accepted that, so the caregivers who came eventually also told her they were house keepers, which they kind of were. That they cooked and did light housework made it believable, but they also could watch out for her and make sure the medications were put in front of her and actually taken. My mom eventually accepted that she needed caregivers. She now even accepts that she needs to be in assisted living. She had always said she would never go, but there she is and very much happier than she was at home.

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Yikes! A nightmare..... scary, too, since my mom absolutely refuses to go to a facility, though she can do almost nothing for herself. "the best you can do is the best you can" - you said it.

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We tried that. My MIL actually decided she was going to leave and "never come back". We do not have guardianship over her and we had been trying to convince her that a nursing facility or retirement home would be best. But she refused to go. We called the police who convinced her to go to the emergency room instead of going to "die under the bridge". They kept her for a full 30 days, telling us she needed to be placed in a long term care facility. But since she was refusing to go, none of the facilities would take her. After the thirty days, they said that she had "timed out" and they released her. She still refused to live with us and ended up being homeless again for a while. We took her to two different ERs after that, when we could convince her it was for her benefit. The doctors all admitted that she needed to be in a care home, but none of them would actually put her in one. She is currently living with a man unknown to us, who tries to get access to her disability and other benefits every once and a while. I have a good relationship with the ladies at the local SS office, and they have been vigilant to keep him away from her money. We are her benefit payees, and are authorized reps on all her accounts and with doctors. Thankfully, we got this all set up before her mood changed. We have been making sure her living expenses are paid, she gets groceries, sees her doctor and picks up her medication. It's been several months and she has now forgotten about all of it. She calls us happily and is excited now to visit for the holidays. Sometimes, the best you can do is the best you can, even if it's not ideal.

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That sounds like just such an unbelievably hard situation for you. I am so sorry for all you have gone through and continue to go through.

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Is there a government social agency -- something named "adult protective services" which could help. If you explain to them that you can't care for her and she can't care for herself, maybe they know how to move her to a nursing home.

Medicaid will pay if she qualifies financially. If not, contact an elder law attorney to figure how how to get her qualified.

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Adult Protective Services is part of your local Area Agency on Aging. Senior Center can help clients get in touch. APS can only investigate elders at risk and make suggestions as to the proper care options. Unless declared legally incompetent, elder can refuse any care or housing options. Nursing Home social workers can walk you through qualifying for Medicaid ( all about assets)

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I can't imagine leaving my mom (dumping her off somewhere). I don't even like the term ER DUMP. If your Mom is not abusive to caregivers, but just isolates herself, that is better as she will have someone nearby. I can't imagine she'd be happier in a foreign environment (hospital) after being left with strangers by her family. It sounds like you are at a desperation point, and a social service agency for the aging might be a resource that can help you. Good luck!

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one more thing. We put in the RING camera in her kitchen and front door, it has helped us so much - we see and understand everything that happens when we are not there - you can put it in the kitchen and living room (not in bedroom or washroom or private area ie where she would change). I love this camera, it changed our lives (and no i don't work for them) You can feel safe with caregiver too because you see and hear everything. It puts all the pieces of the puzzle together for you. I promise you will love it. I put one in for my mother-in-law too and she is so happy because she sees her husband with dementia when she is shopping and feels so comfortable that he is safe.

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Glad to hear about your use of security cameras. When I was taking care of my mom in her home, I used cameras and door sensors to monitor her safety. I was so happy that I had made the decision to update her computer & WiFi network to make the setup possible. Before the cameras, I used an IPad positioned in her kitchen, but she had to accept the session. I also had smart plugs to turn on a series of low light string lights positioned at floor level because at the time, the IPad did not support night vision. Stick up motion detection lights allowed her to take her night time bathroom trips. It was a series of trials and errors, but it kept her for at least a year she would not have had in her own home. Many people will object and bring up privacy issues. But when the front door alert went off at a time she normally was sleeping, I was able to check my phone to see her naked standing in the front door because of the full moon shining through the small window in the door. She was repeatedly opening the door and setting off the porch light to find the source of the “light”. I immediately drove to her house (10 minutes away) and reassured her. Covered the small door window. Next day we put up stick on vinyl on the window of the front door leaving plenty of room for her to look out without the entire neighborhood viewing her upper torso!

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Sadly I have had to do this twice since the hospital sent him home saying he was doing amazing. He does belong to the veterans hospital currently he is getting more testing done and the clinicians there have been super helpful And admitted him to their hospital room I am currently waiting to hear back from some other long-term care homes which I’m praying will work out this time

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I would leave a key in a lockbox for the caregiver so she can go in; they are insured and work through agencies so will be safe. It is tough for the person to accept they need help so you have to frame it as if the government requires that she is safe at all times so it is necessary that someone is there when you are not. We find making up stories to satisfy our mother works (not always but just keep trying) and she has no choice but to eventually accept. Even if she sits in her room, at least you know she is safe. Let the caregiver do their job and she will give in. They always do. Good Luck tia. These are very hard times for us in this situation.

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First, think through what you're looking to accomplish with an "ER Dump."

If mom has the finances for AL, give yourself a pep talk and begin the process of moving her. Your quality of life matters just as much as hers. And keeping her reasonably safe matters most of all.

If she doesn't have the money, and you think that she'll qualify for Medicaid for long term care, call 911 for that next fall (I hope you're not lifting her from the ground yourself - how old are you? Protect your back). There could be conditions underlying the falling.
Once you get her into an ER, it's still a process. The ER doc has to admit her. You must hold the line about there being no one at home to care for her. Hopefully, if she is admitted, she'll be discharged to rehab, where real attention will be focused on whether or not she can live safely on her own.

It can work, but proceed deliberately and don't waiver; with your mom or the healthcare folks.

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You could check local assisted living facilities to see if they have respite care. COVID may be preventing respite care but it’s worth a try. I used respite care once for my mother and hospice paid for 5 days but your mother would have to have a qualifying condition for hospice. Good Luck.

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Having help come is probably best. Second best is respite in a residential facility.

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Personally I don't see anything wrong with having the caregiver come while you are at home and letting you LO go into her room. So what if she doesnt want to socialize with the caregiver. Are you worried something might happen while she is in Her room? At least there is someone in the house to make sure she doesn't get out. If something did happen while she was in her room... I am sure the caregiver could listen for any noises that might indicate a fall. She may eventually come out of her room. What about Adult Day Center? They are open here although I know many of them are not open. The Housekeeper solution sounds like a good idea as long as she knows she is to keep an eye on your LO. Let us know what you have decided and Good Luck.

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I had this thought too. As long as someone is in the house and monitoring the overall situation, then let her hide in her room.

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Get a key box like realtors use and caregiver can get in at anytime

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We also used a "lock box" to allow caregivers to come and go for my parents and an aunt. It has been a tremendous help. Dad passed but mom has a life alert necklace in case of a fall or emergency.

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Anyone had luck with an ER dump?

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