Crisis Managed the Windward Way

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.