What would you do with this patient?

[itku2er]

After having a discussion with a few freinds here is a senerio that I would like to know how you would handle it.

You are transporting a 83 yo male from a hospital to his residence he is AOx 4. When you arrive at the home and his primary care giver lets you in the house you notice the strong smell of dog urine, and when you get to the bed you are to put the patient in there is no covers on the bed only a mattress protector and you notice small black bugs on the pad.

Do you leave this patient in the unsafe unhealthy enviroment? What would you do if you were faced with this situtation?

[cosgrojo]

After having a discussion with a few freinds here is a senerio that I would like to know how you would handle it.

You are transporting a 83 yo male from a hospital to his residence he is AOx 4. When you arrive at the home and his primary care giver lets you in the house you notice the strong smell of dog urine, and when you get to the bed you are to put the patient in there is no covers on the bed only a mattress protector and you notice small black bugs on the pad.

Do you leave this patient in the unsafe unhealthy enviroment? What would you do if you were faced with this situtation?

Unfortunately there is not a lot that we could do for this patient. Patient is Alert and Oriented, wants to go home, wants to stay in this environment... your hands are tied. If you feel that this patient is not making the correct decisions based on pressure from the family or caregiver, than you must report it to the proper authorities based on your local protocols. You can not take someone away from their home against their will. It is sad that people live like this, but there are many out there that do so willingly.

People have a right to live like pigs. You can only actively get involved if you think that this patient is not mentating appropriately, or you think they are making this decision under duress from an outside source.

[Just Plain Ruff]

After having a discussion with a few freinds here is a senerio that I would like to know how you would handle it.

You are transporting a 83 yo male from a hospital to his residence he is AOx 4. When you arrive at the home and his primary care giver lets you in the house you notice the strong smell of dog urine, and when you get to the bed you are to put the patient in there is no covers on the bed only a mattress protector and you notice small black bugs on the pad.

Do you leave this patient in the unsafe unhealthy enviroment? What would you do if you were faced with this situtation?

First off I'm not going to leave a patient in this condition unless the patient tells me to leave them.

I'm going to call medical control and see what they advise.

If medical control says leave him then I'm going to leave him.

There is no way that this is a new occurrence and the dog urine smell proves it.

I'm probably going to remove the matress protector also and make the caregiver wash it.

People live like this every day but we just don't see it.

I'm then gong (damn I key, t won't work) to call the Elderly Abuse and Neglect hotline and hotline this household.

It appears to me that they are in over their heads and they need help.

Bottom line, If the patient tells me to leave them and they are A&Ox4 then I'm gong to leave them but I will express my concerns.

I'll bet the patient lives like this every day when he's not in the hospital.

Ruff

[itku2er]

No one asked the man if he wanted to go home he was kicked out of the hospital due to insurance not paying anymore. Shouldnt we be an advocate for our patients?

[Just Plain Ruff]

No one asked the man if he wanted to go home he was kicked out of the hospital due to insurance not paying anymore. Shouldnt we be an advocate for our patients?

Absolutely that is Why I said to get Social services or Elderly services involved.

Did you just run this call?

If so did you leave him?

Unfortunately, you did not give the info about him beng kicked out. That puts it in a different light.

Did he agree to stay at home and let you leave?

Did you discuss the conditions to the caregiver? (damn I key again)

Did you involve medical control?

[VentMedic]

If the patient was in total control of his life you might say he has the right to live however he chooses. For this situation it would depend on how much control and responsibility the primary care giver has. That would also determine how the Elder Abuse is viewed. However, it still requires a Social Services and welfare check to follow up. That report should be made as soon as possible as in immediately with the ambulance service supervisor to contact the Case Manager who was involved with the patient's discharge. Their name and number may be on the patient's paperwork.

As far as the A&O x 4 issue, even if this person is well oriented they will probably still tell you to leave them regardless of how bad the living conditions are as the unknown to them might be worst. At 83 y/o with failing health, few are going to say they don't want to be in their own home. As bad as this place might be, it is their security and still represents their independence or what is left of it.

Social Services may be able to arrange for home health visits to ensure the patient's living conditions are better as the primary care giver will then know someone is watching.

[P_Instructor]

Personnally, I would take the time to clean and linen the bed. This is the way I perceive the job, to help those in need. However, this also can be a potential elder abuse situation, that in our state must be reported. Do not confront, but realize the situation and try to do the best with what you have. If the primary care giver cannot do the job, or is unwilling, this needs to be reported. Provide what the patient needs. Yes, I know, not all services will do this, but do what you can for the patient.

[VentMedic]

No one asked the man if he wanted to go home he was kicked out of the hospital due to insurance not paying anymore. Shouldnt we be an advocate for our patients?

Again the Case Manager who was overseeing his case is accountable to ensure this person has a safe environment. At 83 y/o he is eligible for Medicare and a supplemental insurance. While options are often limited, no hospital wants the publicity of "kicking out the elderly" although many do fall through the cracks of the health care system. The person's living situation may not have been mentioned. We have had a few frequent fliers brought in from home several times by ambulance with no mention of the patient's living conditions until ONE lone EMT makes a report and a check is made. That one person was able to initiate a change for that patient and get the needed services. The others just hauled with blinders on because they didn't know the process, didn't want to take the time or didn't think it would make a difference.

Edited October 10, 2009 by VentMedic

[WolfmanHarris]

Well my approach would have to be a little different as

a) he would not have been kicked out from a hospital for insurance reasons.

had he been unable to afford a private NH, he would have been placed on a list for a public NH. Now while on that list it is common to run into pt's having trouble like this.

My approach would be the following:

- Ask if they would mind if I made a call that could arrange some further help for them (the exact wording of this depends on the pt. and how receptive I think they may be.)

- Contact the Community Care Access Centre (CCAC) hotline and make a Community Referral by EMS (CREMS)

- Establish whether they are already a client of the CCAC and to what extent. If they are a client I will be transferred to their case worker to discuss their needs vs. what I have experienced; if not I discuss openning a new file for them with an intake worker.

- Provide my suggestion on what they may need (meals on wheels, homemaking, etc.)

- CCAC follows up with a Social Worker visit to create or adjust a care plan.

- My direct exposure ends with the call, but as it stands now I receive a follow-up letter through work outlining the outcome.

So far I've only done this once (four months on the job). I had a hypoglycemic patient who lived with his wife. Place was a mess, smelled and she seemed unable to provide a good history for him or otherwise assist in their care. Pt. was known to my partner and to FD crew (first responder) and PD. After glucagon administration pt. began to express resistance to transport (but not refusal), so I dodged the issue as much as possible and transported to ensure we could get a meal into him and have a physician look at his current treatment plan.

After offload of pt. I called CCAC and found that he was currently receiving a once a week visit and was waitlisted for a NH bed. Chatted with the worker and explained that that needed to be changed as he would NOT accept a NH bed without a fight. He now receives more regulat homecare and to my knowledge is not currently slated for a NH.

Lots of detail I know, but I just received the follow-up letter last night so it's at the front of my mind.

Personnally, I would take the time to clean and linen the bed.

Agreed 100%. Regardless of the circumstances or the refusal, always attempt to leave the pt. better off than you found them.

[itku2er]

But should we just let it go after the proper people are notified? Don't we have a moral obigiation to follow up and see if they got the help they needed? In all honesty our system sucks it really does will this little man be one of the one's that falls through the cracks and is lost?