Crisis Managed the Windward Way

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By Heather Arsenault, Aging Life Care Manager

Since I began working at Windward Life Care® as an Aging Life Care® Manager, I’ve gained a deep appreciation for the great work our team of care managers and home care aides performs every day to ease our clients through the joys and challenges of their later years. Of the many services we offer, one of the most valuable is accompanying our clients during their hospital and emergency room stays. I was reminded how essential a care manager’s role as a patient advocate can be during a client’s recent emergency room visit.

Our client “Mary” had fallen in the courtyard of her memory care facility. The staff found her on the pavement and called her primary Windward Aging Life Care Manager, Terry, and then had her taken to the closest hospital’s ER. Mary was complaining of knee and shoulder pain. Luckily, Mary was ushered into a “real room” at the hospital quickly, having been transported by ambulance.

At Windward, we have a system where every client has a back-up care manager in addition to their primary care manager. Since Mary’s care manager Terry was occupied with another client situation, and because I was her back-up and thus familiar with Mary’s situation, I rushed to the hospital to meet Mary at the ER—and I’m so glad I did. As good as the care at this hospital is, there are some things that a knowledgeable advocate can do for a client/patient in these situations that few others can. This is particularly true when the older person has dementia.

I first introduced myself to the nurse and told her I would be assisting Mary per her and her family’s request. I was able to provide important background information about Mary particularly regarding her memory issues and medications. The hospital then kept me informed regarding all testing: a CT scan (due to Mary being on a blood thinner) to check for bleeding, and X-rays of her shoulder and knee.

Mary asked questions that I was able to address when hospital staff was unavailable. She was very cold, and more than once, I had to ask the nurse for another blanket to keep Mary warm. Mary also repeatedly asked why her arm was constricted. I explained that it was the automatic blood pressure cuff doing this. When she needed her knee and foot rubbed, I was able to take care of that. And when she had to urinate (more than once), I was able to get the nurse, and they assisted her with the bedpan.

If Mary had been alone, she couldn’t have reached out to them herself; she wouldn’t have known what to do. Even though she had been a nurse herself, her memory was too impaired to allow her to advocate for herself. Several times she asked me where we were, and she had no recollection of the fall. While she was resting, I continued to ask the nurse when the doctor would be in to give us the results. I was also able to reach Mary’s daughter and update her on Mary’s condition, which she appreciated, and she was able to talk to Mary herself.

The emergency room can be a chaotic place, and this can be upsetting to older adults. At one point, a woman in her 30s, being held in the hospital for a psychiatric evaluation, was screaming obscenities and crying for over 45 minutes. Her room was near Mary’s, so Mary kept questioning what was wrong with the woman. She asked me, “Can you go help her?” I reassured her that the staff was helping her, though the situation was still upsetting to Mary.

The doctor finally arrived at 8:00pm (three hours after Mary had entered the ER). He said all tests, including the CT scan, came back negative. Mary tested positive for a urinary tract infection and dehydration, so they started her on antibiotics and fluids. Once she was stable, they were going to make sure she could stand up, and then they would transport her back to the memory care community.

Mary returned back home that evening. My final text to Mary’s daughter to update her on everything was at about 9:45pm. She thanked me for going to the hospital to help her mother on such short notice and especially appreciated someone being with her. We agreed that Windward would provide a caregiver to furnish one-on-one care for Mary the next day, to give her some additional support and attention.

When I left the hospital ER that night, there were at least 50 people waiting to be seen, including several older people by themselves. I am grateful that Windward staff can accompany our clients during these stressful hospital visits, providing advocacy, comfort to the client, and peace of mind to their families. It is an invaluable service we provide.

 

Windward Life Care’s interdisciplinary team of Aging Life Care® Managers has certification and professional training in a number of areas related to healthy aging, including nursing, geriatric care management, and social work. If you would like us to create a personalized plan for yourself or someone you care about, please contact us at (619) 450-4300 or [email protected].

*Out of respect of our clients’ privacy, some names have been altered.

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Emergency Preparedness Tips for Home and Family

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Wildfires are spreading through much of the state of California, with some families facing the need to evacuate their homes. Regardless of your proximity to the fires, it is important to put together a proactive emergency preparedness plan. Not only will you be ready to keep yourself and your family safe, but you can also watch out for elderly clients and neighbors who might need assistance in an emergency situation.

Emergency Preparedness Tips to Follow

Since September is National Preparedness Month, we wanted to suggest few things that can be done in your home. Follow these tips so that you are ready if a wildfire or other emergency affects your area:

  • San Diego Emergency Phone App: The city of San Diego has a free emergency app that can be used for notifications. You will receive text message notifications and instructions when there are emergency alerts in the area.
  • Phone Charge: Communication is important in an emergency. You should always keep your cell phone charged and have the charger on hand.
  • List of Essentials: Are there any essentials that need to be grabbed on your way out the door in the event of an evacuation? Have this list handy so that you don’t overlook anything critical like medications, medical equipment, and important papers.
  • Evacuation Routes: What is the best way to escape the area? Have a map of the local evacuation routes. Knowing multiple paths out of the neighborhood can be important if the emergency is blocking your normal roads.
  • Bring the Pets: Animals are a part of the family, so don’t forget to bring your dog or cat along. Be sure to have food as well as a crate or leash. Most of the emergency shelters in San Diego are pet-friendly.

Family Caregivers and Emergency Planning

While it is important to follow the general tips listed above, don’t overlook the importance of personalized preparedness when caring for someone with health challenges. It can be helpful to have copies of that person’s medication list and care plan,  as well as enough medication to get through the critical hours of the emergency.  The Alzheimer’s Association has prepared these helpful preparedness tips for caregivers of older adults with dementia. These suggestions can be used for people with other medical concerns as well.

If you need assistance in preparing for an emergency, such as wildfires or earthquakes, then Windward Life Care is here to help you find the right resources. Contact us to learn more about the services that are available.

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