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Mom recently fell and broke her nose. Although staff at hospital was kind, they have no idea about how to help someone with dementia. All they know how to help with is the medical part of an injury. With all the people suffering from dementia, you'd think there would be more resources from a hospital. Can the ER get specialized training or is that too much to ask?

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Curious, what was it that you wished that the hospital would have done differently?
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There are so many specialties for nurses these days and the staff in the ER are trained in emergency medicine.
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The hospitals where mom lives are not trained and, although helpful, they just don't get how to handle dementia patients. Granted, mom can be tough to deal with but it seems that most of the hospitals she's been to recently can only help with the physical aspects of why she came to them. Alzheimer's is physical and mental. Just wondered if anyone out there knew of a program that can give a broad-based training to ER's. They are compassionate, knowledgeable and kind but seem lost when we tell them about mom's dementia. That's all.
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It's a good point to be raised. When you deal with your loved ones with dementia you learn very quickly not to argue, correct and scold them. It ain't rocket science. Med industry folks are dealing with more and more of the aging population with dementia. You would think more of them would be given some basic training on how to deal with dementia.
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The frontline and triage staff you meet first at the typical ER/ED will probably be pretty wet behind the ears. I know this is a subject they're working on: at our local hospital, they use the "blue flower" system - it's a discreet signal that they stick over the patient's bed or on her notes so that anyone dealing with her knows that she has dementia. The Alzheimer's Society probably publishes something you could hand to your local ER team - it's all part of the general public awareness raising process. Which is a very long one, sigh...
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In Michigan, some of the ERs are staffed by contract physicians, not hospital employed physicians
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Mind you, I've met people who were supposed to have had training and are still clueless. As Windyridge points out, we've got the hang of it and it isn't rocket science; but don't forget we've had total immersion training - if you count up the number of hours, it probably equates to a full module before we even realise we've got started.
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It's all about the money. Dementia and Alzheimer's are specialized conditions no matter how more common they have become. The idea is to get them in and out as quickly as possible, as pressured by insurance companies. Baby sitting is not a priority, as one nurse told me once. Emergency rooms are based on triage, payment status first, the most critical second, all others can wait. Welcome to medicine.
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Knock on wood, all the times that my parents been a patient in the ER we have had excellent care. Never had an issue with not understanding dementia.

Yes there is a triage, and usually if one comes in by ambulance, they get first priority.... one will also get first priority if you walk into an ER having chest pains. Those who have sore throats or a sprained ankle will need to wait in line.

I have found one gets just as good care at the urgent care type walk-in clinics. We have a lot of those in my immediate area. And if the doctor feels this situation needs a higher level of care, they will call 911. Again, no issues with dementia.
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ER staff know more about dementia patients than you realize. Emergency departments are generally very fast paced and chaotic. The one thing that emergency staff don't have a lot of is TIME. That ER nurse that is caring for your Mom may also be caring for a critically ill patient near death and several other patients too. We all know that dementia patients don't do well being hurried or rushed. TIME is the one thing dementia pts need and it is often in short supply in the ER. When dealing with a dementia pt, ER staff count a lot on the family or caregivers to help out. Not because we want to but because we have to. As a ER Nurse and as the daughter of a dementia patient I would not take my Mom to an ER unless it was absolutely necessary. I would try to get urgent care from her primary care doctor or a walk in clinic where the pace is slower. If I had to take her to the ER I'd go prepared. I'd have a list of all her medications and diagnosis. If she was incontinent, I'd take a couple extra depends or two. I'd be prepared to wait and possibly wait some more. Critical pts take priorities in the ER. Care is not based on first come, first served. I wouldn't be afraid to ask the staff for some assistance with Mom, but again, I'd try and have patience. Changing Mom's wet depends, although important, does not take priority over giving a man with chest pain a nitro or giving a child with asthma a breathing treatment. I would also try and assist the staff as I could with Mom. Those little helpful hints that I've learned caring for Mom most staff appreciate.
By their very nature ER's are not the best places for dementia pts. But, they are a necessity at times. Don't sell the staff short. Most know how trying the visit is on your loved one and on you.
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It think it is generally recognized how bad hospitals are in general regarding dementia care, and ERs in particular.

There is a great book called "Improving Hospital Care for Persons with Dementia" by Silverstein and Maslow that has some great suggestions. It came out in 2006. Although we know what is wrong and have ideas how to fix it I don't see much improvement.

My suburb has a nationally acclaimed hospital. I've had minor surgery there and I would certainly want to use that hospital again. But they did a piss-poor job when Coy was in there. His doctor suggested that in the future I take him to a down-town hospital with less of a reputation but more experience with elders and therefore with dementia. That really was an improvement.

Also, if at all possible, persons with dementia should be accompanied by a family member at all times. Sad, difficult, but necessary.
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Er's, in general, do a good job, where emergencies are concerned. That is what they are there for. In order to have a patient admitted, they have to go through the ER, except when surgeries are scheduled. That is a given. When a dementia patient has a spell, you are forced to go to the closest ER where your family DR. is. Going anywhere else causes a huge hassle for all those involved. Our local ER, no matter what the problem, will involve a minimal 8 hr. experience, admittance or not. That is another issue. Most of the employees, in general, are helpful and caring, but they have to answer to and follow the commands of the financial guru's in charge and or insurance company's payment instructions. The employee's are understaffed, sometimes under paid and have their hands tied where extra care is sometimes warranted but not approved. They are expected and required to know about every expect of their craft, however, some expects, dementia, Alzheimer's, etc. are neglected and/or fall through the cracks of patient care and are left to caretakers and or relatives of those patients, due to care priorities. Argue all you wish, but unless you stand in our shoes and witness this neglect personally, statistics mean nothing. When addressed, administrators are all apologetic, but nothing changes. For caretakers, that is status quo and we are forced to accept it. We don't expect to be on the same level as a cardiac arrest or GSW patient, but maybe one employee trained on every shift in the dementia field would make life a little easier for the family involved.
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My sister is an ER physician and she and her team of nurses are far from "wet behind the ears" or clueless. It takes a certain type of person to become an ER doc or nurse. The ER is by nature a hectic environment where every second counts. My sister and her nurse colleagues spend many hours in continuing education to advance their knowledge and skills. But it sounds like you want these healthcare professionals to set aside their ER training, get more training, and slow down so that your loved one doesn't feel hurried. Do you understand the implications of what you are asking?
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I took my husband to the ER one night when it happened to be very quiet. I told the ER doctor that he had Lewy Body Dementia and I needed to stay with him. Doc was OK with that. He said, "Lewy Body Dementia. Hmm. I think I might have heard of that, but I've never dealt with someone who had it." I gave him the wallet card that identified drugs that LBD patients should NEVER be given (and that are commonly used in ERs). Also a chart of my husband's ADL baseline. Doc was very receptive to receiving this.

Hubby was having an episode of gout and his demeanor was calm. But if the pain and unusual environment had caused him to act out and he was given the wrong anti-psychotic it could have produced irreversible harm or been fatal. It happens. My husband's medical record lists those drugs as allergies. It still happens.
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(Seems there is a new length limit. I ran out of room.) As his caregiver I took responsibility to make ER doctors aware of this special circumstance. But it seems to me that this is something that should be included in ER training -- not how to take care of the dementia, but at least how not to put the patient at serious risk.

And, yes, I think persons trained in handling those with dementia should be available to consult on each shift! If someone comes in who doesn't speak English the staff calls an interpreter of Hmong or whatever is needed. Why couldn't a dementia behavioral specialist be called for that need?

I think I understand the implications of what we are asking. It would mean not simply a change in how ER staff are trained, but a shift in how ERs are set up and how hospitals run.

That ERs are terrible experience for persons with dementia is well known. This is not to blame the hard-working and dedicated doctors and nurses who staff them.
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You need to be an advocate for your loved one.
While the staff may know about Alzheimer's and various forms of Dementia it is up to you when you bring someone to the ER to inform the staff about the type of dementia and any "special" things that they need to be aware of.
If restraints will be needed inform them immediately so that approval can be obtained. Why insert an IV or a catheter if the patient is going to rip it out if not restrained.
If possible get the Social Worker involved so that if an over night is needed they can help arrange a "sitter" if needed.
Some hospitals have a decal like a purple angel or other logo to place on the chart so staff does not ask the patient questions but will ask family. (sort of ridiculous to ask a person with dementia what meds they are taking or when was the last time they got......???)
ER's are rushed and they are taking care of many at the same time so be patient but be assertive when safety or care is in question.
With any trip to the ER bring copies of POA for health care and if you have it a copy of DNR or POLST. If they do not have a copy it does not exist unless they have it in hand. (I was told this by an ER so I had copies made and kept them in the car as well as extra copies to give to paramedics if transfer was necessary.)
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I think more caregivers need training on how to handle an emergency involving a loved one with dementia because nothing about an ER is simple to shift. ERs are setup for and run by ER docs and nurses so that they can do their jobs and avoid medical errors. ER staff don't wait for an interpreter and won't wait for a dementia specialist. If there's time to wait for an interpreter or dementia specialist then it's not an emergency. Take your loved one to urgent care instead where staff can prioritize someone with a broken nose because they also have dementia. If there's no other choice but to go to the ER, a wallet card and letter from the patient's primary care physician are good ideas. A nurse may decide to call the PCP and inform them that their patient has landed in the ER.

But let's not gloss over the fact that family caregivers are often the problem. Often on the verge of burn out, a trip to the ER can send a caregiver over the edge and, unfortunately, the person with dementia picks up on it. So while I agree more training is needed, I think it's caregivers who should be getting it.
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I'm going to take issue with the concept that ER staff must "answer to and follow the commands of the financial guru's in charge and or insurance company's payment instructions".

The earlier comments that "payment status first, the most critical second" are the guidelines is reflective of one person's opinion and not reality.

Anyone who believes that payment status is the priority criteria needs to learn about Hill-Burton hospitals. And do some research on "triage" while you're at it.

Based on what a family member who has qualified as a Level I trauma nurse, and obviously knows more about hospitals than someone who makes unfounded judgments, standards of care established for ERs are established by medical professionals, and are very, very strict. Medical malpractice has factored into this over periods of years, as well as has tort reform. Standards of care exist for specific issues and treatment.

The "financial" and "insurance" "gurus" aren't calling all the shots, by any means.

I wish people who criticize medical professionals would do some research for local college requirements for nurses. The courses are very demanding, extensive knowledge is required, and performance is monitored literally constantly. Staff must be accountable, even when a patient is obnoxious.

Patients and their families can be ignorant, sometimes by choice, and can easily misconstrue situations b/c of that lack of knowledge.

ER staff are the frontline treatment specialists, the ones who need to triage the patients.
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Wait for a dementia behavioral specialist??? Your loved one will be dead and gone. We don't have one of those within 250 miles!! And, as far as a translator, we don't have those either. We use a phone language interpretation service. It's better than nothing but not much more and very time consuming. Too many people watch too much TV and it clouds reality.
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The three emergencies I was taught in nursing school that take precedence over all others are " breathing", "bleeding" and "broken bones"
Emergency rooms exist to treat just that "emergencies"
You are lucky if the MD who finally sees you is actually trained in emergency medicine. Many MDs and RNs work on contract and may rotate between several hospitals within the same group or even work for an agency. They may rotate betweens such area as ICU, ER, and OR.
Coming by ambulance does not necessarily mean you will be seen immediately. I was taken to a major teaching hospital with life threatening symptoms and joined the end of a long line of gurneys. I was fortunate because my transfer had been pre arranged and the wait was only minutes but I wondered about the other gurneys in the line.
Typically if an ER patient needs specialist care for example an orthopedic surgeon as long as the injury is not life threatening the wait can be extremely long especially if he is in the middle of a long surgery.
An obese woman may arrive complaining of belly pains and the nurses do the usual assessments and half an hour later are surprised to hear the crying of a new born. She may have had many children and this time had no idea she was pregnant. Whose fault is it that this was missed?????
I have said this before and say it again. it is very important for every patient to have an advocate who can insist on answers to questions. This is specially important for patients with dementia. A list of current medications is essential so caregivers please carry several copies plus insurance card and paperwork giving information about POA and DNR. In hospital DNR may need to be signed because the one from home may not be effective. As an aside I was invited to sign a DNR in the OR just before being anesthetized. When I declined I was asked what measures I would like taken. Luckily I don't have dementia so I referred them to my husband.
These days hospitals are a jungle and it is most important to advocate for yourself and your loved ones. If you have major allergies or drug interactions wear a medical alert bracelet or failing that write on an arm with magic marker. You can also write on a limb the type of operation you are having. Most hospitals do have good safeguards in place but I would rather be laughed at than have the wrong leg amputated. Remember Drs and nurses are people too and can't know everything.
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