Friday, March 5, 2010

Retirement Home vs. Hospital

This is not a new story. The post, below, is from a Charge Nurse. You have a (for-profit?) Retirement Home sending a senior to the Emergency Department (ED). The ED does its work, determines there is no his fracture. But the 92-year old is, obviously in pain.
What is the best placement for them?
Is it back in their bed?
Is it in the hallway of the ED for 4 days?
Is it sitting in a hospital another 2 days, with visitation rules, and noises at all hours of the day and night?

This is a situation where family members have no power or control over their failing loved ones. Personally, I would have signed myself out.

You would expect that the senior would be a candidate for Alternate Level of Care (ALC), but wouldn't you think that extra care could be provided, as if they were in their own home, in order to make them comfortable in their own bed, where they are a tenant, according the the Landlord Tenant Act?

In my father's case, we hired extra help during the hours that the Retirement Home could not give him adequate care. But this is a sad case in which an elder in pain sits in a hospital bed while the Powers-That-Be argue over who should keep them.

This is my friend's post...she works in an ED in Toronto.

The Story of an Admission, by (Mostly) Numbers

torontoemerg | 05/03/2010 at 0842 
Age of patient: 92
Residence: retirement home
Reason sent to hospital: Fall, query hip fracture.
Number of actual fractures: 0
Reason preventing patient from being discharged: poor pain control
Number of consultants initially willing to assume care of patient: 0
Number of non-physician health care professionals involved in the arranging community supports to get the patient home again, and avoid admission: 5
Hours spent arranging community supports for this patient: 9
Hours personally spent trying to sort out the patient's discharge: 2
Number of baulking Home Care managers needed to irreversibly screw up the above arrangements: 1
Minutes needed for said Home Care manager to screw up above arrangements: 1
Number of services called to get patient admitted: 3
Number of physicians spoken to before finding one who would accept care: 4
Hours it took to find a physician to admit: 2.5
Number of physician hissy fits: 2
Days patient spent in the emerg before admission: 4
Days patient spent in the emerg after admission before getting a bed on the floor: 2
Acutely pissed off family members: about 20
Bottles of wine drank by myself when I got home: 1

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