Welcome to another installment of the Top 10 Ways to Avoid the ER.
 Number 6 – Opt for comfort care
Okay, now I’m not saying if you’re a 38 year old with foot fungus that you should call hospice. But anyone that works in the ER can tell you that there are many debilitated, elderly people who are way past the point where an ER can help them. Nursing home patients who are demented, chronically ill, and have no quality of life often times are brought repeatedly to the ER for a variety of medical problems, or just a change in their mental status. Usually, their families say that they wan’t “everything done,” but I bet these patients (if they were capable of it) would disagree.
{ 2 comments… read them below or add one }
AMEN! As an ED nurse I see so many LOL and LOM’s who would be much better served by hospice. They come in once a week or 2 weeks w/ intractable pain from a chronic illness or cancer. They either A come from the nursing home filthy, with bedsores, and nasty mouths (I call it nursing home mouth, that yellow crusty, mucusy mess) for “confusion” or they just aren’t right today. Usually this is a way to dump them on us cause they are short today (cause we get 3-4 from the same place w/in an hour). Or they B come from home in varying states of care or neglect. In this situation I frequently take time to try to educated the family of how to prepare foods that mum mum or pop pop can eat, how to slip pills into apple sauce, simple stuff like that to keep the person on their meds. I am amazed at the number of people who admirably try to keep mum mum or pop pop home but have no idea how to truly care for an elder.
I am a huge supporter of the hospice philosophy and comfort care. As part of this I am against feeding tubes. They just prolong the agony, are a source of infection, and another painful procedure for the elder to endure. Quality of life and then death with dignity. That is my soap box speech for the day.
Great post! Nursing home dumps seems to be a problem where I work as well. I’ve even started to recognize some of the more frequent dumpees. They usually have neglected pressure ulcers and overall hygiene just like artillerywife describes. I feel so awful for them because that’s not how I’d want to spend my old age. One case both saddens and angers me in particular – I had a patient brought in for altered mental status and found several pressure ulcers, the most horrendous one being a stage 3 on his coccyx covered in crap. I got him cleaned, put on new dressings and even gave supplies to the EMS folk to bring back to the nursing home for that patient. She was brought back several days later with virtually the same problem.