When the 911 call may be necessary but not sufficient. The news about the no-CPR policy in an independent living community in California brought me back. In the incident reported everywhere, the nurse claimed that the policy in independent living did not include providing CPR – and as a result, the elderly woman died. Years ago when my mother spent some time in an assisted living facility, 911 was invoked nine times within a single year before they ejected her to a nearby nursing home, claiming they could not provide care. Each of her ER visits involved either my sister or me – racing to the ER from work so that we could explain her history – one time we stopped a dose of Bactrim that she was allergic to – another time we interrupted her inaccurate description of her medical history cheerfully being offered to an intern who had not checked her chart and apparently did not know she had dementia.
Absent an advocate, 911 for memory care residents is a recipe for disaster. But what if we had lived a thousand miles away or more? Or were out of town? What if we had never considered that possibility and had no local backup? What was the contingency plan offered by the assisted living community to provide a proxy advocate? The answer is NONE that was described in the stack of papers we signed. So who would have met her, how would that trip to the ER been anything but a disaster in miscommunication and worse? Some hospitals offer volunteer advocates to at least be present to contact a family member who can provide long-distance advocacy. But this places advocacy completely outside of the assisted living community which has been entrusted with care. So is this a fundamental process and policy problem and how can family members who believe their loved ones are safe behind a locked door be confident that they are just as safe when 911 is called?
After the emergency fact, policy is articulated. If you further search about the California CPR incident, you can read Brookdale’s policy on CPR – which is broken down by state – and is clearly lawsuit-prevention-ready. In another scenario in my own town, a 90-year-old resident of a memory care unit was rushed via ambulance because a visiting home health nurse and the shift nurse concluded that the resident was at risk for pneumonia. So 911 was called, EMTs arrived – and the resident was in the ambulance before her own doctor or family (oout of town) was reached. EMTs in the ambulance listened to her lungs, declared them clear, but it was too late. Since an ambulance cannot be turned around, she arrived alone at the ER where, fortunately, a family friend met her and stayed with her for six hours and thousands of dollars of staff time and tests, all normal. The facility cited its policy to send memory-impaired residents to the emergency room unaccompanied.
What is the role of senior housing in reducing trips to the ER? Many expend energy and expound on the topic of reducing unnecessary trips to the ER and associated hospitalizations. But what is the official policy of the assisted living industry? The industry acknowledges that state-by-state rules put the industry in conflict with new health care regulations. Okay. And staffing limitations certainly make it difficult for AL or SNFs from sending a knowledgeable person along. But there is nothing in the rules or even its own policies that prevent it from having an on-call relationship with a home care agency. There is nothing in its policies that prevent communication with a resident’s doctor and family before 911 is invoked if the patient’s condition is not dire. Are limitations discussed, disclosed and understood when papers are signed at move-in? Thoughts welcome.