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Rosemary: That is the protocol, e.g. they will ask the patient or in your case the patient advocate (you) -- "Do you want to go to the Emergency Room?"
Myownlife: I, too, will disagree with you. My late mother raised her hand (non literal) and said "I have a UTI quite often." Also she went straight to the grocery store and bought herself cranberry juice since that was one holistic remedy.
There are now UTI home test kits available! No need to go to the ER. CVS Minute Clinic and Urgent Care centers can test for UTI. The wait there is not as long as an ER.
@Josh - I have to agree with Myownlife. UTIs in the elderly rarely cause clear physical symptoms. My M-I-L who is in Assisted Living with dementia has frequent UTIs and NEVER has any discomfort. The staff is tipped off by her behavioral changes - more confused and balance issues. I've worked in independent senior housing for the last 20 years and see this pattern frequently.
@josh... I am not going to argue with you. Those ARE symptoms of UTIs in elders, but many, many of the elders do NOT recognize them.
That's where the caregivers come in, being able to recognize the sometimes subtle differences. And yes, the alternative of not diagnosing and treating a UTI quickly can be the sudden onset of septicemia and death, more so in the elderly population or those with compromised health and immune systems.
@myownlife, Not sure where you are getting your facts. Elders do have and recognize symptoms of a UTI.
An article on this website lists ALL the symptoms of a UTI in our elders. It's definitely worth knowing, because the alternative could be fatal (speaking from first hand and second hand experience).
*Typical Symptoms of UTIs* Urine that appears cloudy or dark. Bloody urine. Strong or foul-smelling urine. Frequent or urgent need to urinate. Pain or burning during urination. Feelings of pressure in the lower pelvis. Low-grade fever. Night sweats, shaking or chills.
If you see any of these symptoms, it is critical that you start your parents on a daily 2 gram dosage of Dmanna (sugar that fights E Coli. bacteria) and 3 liters of water. This method prevents 80% of UTIs.
Glad I could help you and your families! Let me know if you have any more questions.
If you get to the point that she can go on hospice you have a lot more say in the matter. And I agree about the follow up. It took me a while to realize that it was rediculous to have follow up visits with a cardiologist when mom was already on hospice and I knew she wasnt going to be getting any better. She had CHF. But believe me, they wont ever tell you that! They want thos dollars the follow up visits give them....
My inlaws were in Al and now in nursing home. They both have dementia. My MIL is incontinent and gets frequent UTIs. Countrymouse, I always appreciate your responses but on the one with “Blimey” in it, I just have to pop my head up and give my opinion. When people have dementia and are incontinent and get frequent UTIs, sometime the ONLY WAY you can get a itinerary sample is via a catheter. It has nothing to do with incompetence or laziness. In my MIL’s case, she seems to have no sensation and it isn’t possible for her to remember or even think of sitting on the toilet, let alone doing a Clean Catch sample. About the ER stuff: we get called a lot to take them. Sometimes we let the facility do it but sometimes we are able to take them to Same Day Care or do the ER thing ourselves. It seems to be their protocol to take them to ER rather than a clinic. But you don’t have to allow it, not do you have to do it even if it is needed, as they can call an ambulance to do it. Sometimes we let the ambulance take them and we meet them there, and then if possible, we bring them home rather than have them return by ambulance.
If you put your mother on hospice care, then the Assisted Living place must call hospice personnel first to make a decision. With hospice, you eliminate the ER. REmember hospice care is not for immediate end of life, patients have been in their care for up to a year!
My father's AL had a policy that anytime a resident fell out of the sight of the staff, they would be sent to the ER. After 3 visits in less than 2 months, with no injury more significant than a skin tear (my father is nearly 90 and has tissue paper skin), I spoke with his doctor who wrote a letter to the AL advising against sending Dad to the ER unless there was an indication of something more significant than merely a fall. The doctor also agreed to be available to any medical questions for the staff, or to examine Dad himself if the staff thought he needed to be seen. So far that arrangement has worked well.
Daisy, I consult with a lot of SNFs and ALFs about their UTI prevention practices. There are some very good comments here about the seriousness of urinary tract infections among our elders (can cause dementia which can make it difficult for caretakers and family to provide care).
But the urine test is inaccurate over 50% of the time. Caretakers should diagnose a UTI based on symptoms without having to cath.
The BEST thing you can do for any elder is give them daily Dmanna for UTI prevention. Better than cranberry pills and easier to take.
Daisy: I am glad that you pushed the urologist to get that appointment. You have to be the patient advocate and yes, I understand that your husband has POA. The AL was in error, BIG TIME and they rushed the process of getting a clean urine stream. Agree with Countrymouse. I had never heard of that ananlogy, Countymouse.
This is the reason I moved my mom from her memory care facility. Too many trips to the ER. They are required to call for an ambulance if they think she needs to go or I won't take her myself (I did once). She did need medical attention ONE time and the whole ER wait unhinged her.
IF ( IF ) she had to be catheterized for the urine sample, the PCP could order a Home Health agency to send a nurse (RN or LPN) to the ALF to catheterize.
UTI in elderly people often causes mental confusion and can dramatically worsen early-stage dementia -- which can clear up only with prompt treatment. BUT many elderly people become 'colonized' by bacteria in the bladder and infections don't really 'go away' even with treatment. Often the best thing to do is to take a broad-spectrum antibiotic at a slightly higher dose than customary for a few days longer than customary and rely on the mental-status symptoms to tell you if it has 'cleared' or not.
I can't imagine wanting to catheterize a person with dementia against their will.
One issue with Assisted Living places is that there is often no real medic on-site especially after hours. The facility really DOESN'T want a Home Health Aide or Certified Nursing Assistant making the decision whether someone needs to go to the ER or not, because their liability insurer would throw fits, but the Resident (your mom) or the PoA can make that decision. They may need to call you every time, however.
I work in an assisted living and memory care. It is neglect on both parties if proper medical care is not provided. I see families that don't care for their loved one on a daily basis. A lot of times we are their only advocate for pain and injury and especially decline in mental functions. I also have it from the other perspective that my own mother is in an assisted living. I see both sides, but in the end, the resident is number priorty.
I work in an assisted living and memory care. It is neglect on both parties if proper medical care is not provided. I see families that don't care for their loved one on a daily basis. A lot of times we are their only advocate for pain and injury and especially decline in mental functions. I also have it from the other perspective that my own mother is in an assisted living. I see both sides, but in the end, the resident is number priorty.
I think the over reaction is nuts!!! And reading some of the posts more common than I thought. When I went on vacation and placed my Husband in the Memory Care facility where he went for Day Care I got a call about a "problem" The facility called my Sister, I put her as a contact, I was out of the country and she could handle any problem that might have come up..... My brother in law then contacted me that my husband had some sort of "infection" and that it needed to be treated. I gave approval. I was not too worried about cost, most of the medications were picked up by the VA or Medicare but I did wonder about cost.... I did not hear much after that ..until I get home and found out that this "infection" that "needed to be treated right away" was...Athletes Foot !!!!
Yes I would be wary of any request to transport to the hospital, wary of any facility doctor that may be padding the bottom line.
What about the cost of the ambulance service? My mom doesn't have medicaid so it cost $175.00 out of pocket every time she goes. 3 out of 4 times it was a fall, but nothing broken. It is darn if I don't, and darn if I do.
Fortunately Mom has made it clear that she does not want anything done unless it will bring her back to a clear mental state. And she told her family doctor. One nurse at AL, thought it is awful that I have said I do not want her checked for UTIs as an accurate was is a struggle to obtain. I also told them the only reason to send her to the ER (after several visits to the ER because policy says if they hit their head they go, even if there is no neurological indications) unless she is in uncontrollable pain. Even with her living will stating she wants. One nurse challenged it and I had to get my brothers to back me up, or it could have been a drawn out battle. Some do not agree with my UTI stance, but my mom was not showing discomfort, (she usually gets agitated when in pain), only more confusion. UTIs, or Pneumonia are often cause of death in dementia patients and think it would be better to end life feeling like you have the flu, than like you are drowning. You do have a right to refuse, but the staff may make you feel guilty about that choice.
There might be another issue and that's whether or not the AL nursing staff was skilled in obtaining a catheterized sample from older women. From what nurses have told me, it's harder to cath a woman than a man, and sometimes takes more than few tries.
Thanks GardenArtist. I'm told the procedure must be performed by an MD or a PA (we live in New York state). Also not all medical facilities have the equipment. Where we live it was either an ER or the Urology practice. Luckily it was accomplished quickly and in one try. M-I-L did not suffer. For that I am thankful.
The AL must have felt Mom needed a urine test. Using a hat was how they did Moms. Problem comes if they poop into the hat too. Then its a contaminated sample. I think the Nurse was a little pushy. An emergency room visit is expensive and time consuming.
Thank you so much everyone for your responses and your understanding. My husband (her son) is POA and as such he did refuse the last time they tried to force us to take her to E.R. It was a Saturday in January and we believed sitting in a crowded ER for hours with people coughing and hacking would do her more harm than good adding to her anxiety and confusion. She is 86 years old and has Dimentia. You make a good point Countrymouse. I don't know why the staff can not provide better assistance to her in order to get a clean sample For the most part we're very pleased with care she receives. You made me laugh Countrymouse with the how's-your-father! I never heard that term before. You're right blannie - taking care of seniors is not for the faint of heart. We all are doing the best we can and we need to keep our sense of humor.
Countrymouse, answering ur question about catheterization. The elderly do not void completely. The main reason for infections. The catheter is not so much for a sample but to get all the infected urine. This was done for my Mom. She was started on antibiotics, cranberry tablets, and probiotics. The cranberry tablets and probiotic was continued at the home. From Oct 2016 to Septb2017, when she passed, she didn't have a UTI again.
Country mouse, her question was could she be forced. I said no. Sorry, maybe I should have said "if u have a POA". My further post was about my Mother not the OP.
You need to think of it from their perspective. If they didn't send a person to the ER and there really was a problem, then people would scream bloody murder. So for liability alone they need to call an ambulance. Of course, your mom or you as her POA and can refuse at that point but then the liability is on you. For many things, like falls involving any head injury at all, you are supposed to go to the hospital to get a CT scan to check for brain hemorrhage. Which is a concern for anyone over 65 even if it's a light head bump. Whether it's AL or they are in your home, you should be going to the ER. Yes, most people don't. That doesn't change the fact that people should.
If you are set on them not sending your mom to the ER for any reason, you should look into drafting a release with the AL facility releasing them from any and all liability.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
CVS Minute Clinic and Urgent Care centers can test for UTI.
The wait there is not as long as an ER.
That's where the caregivers come in, being able to recognize the sometimes subtle differences. And yes, the alternative of not diagnosing and treating a UTI quickly can be the sudden onset of septicemia and death, more so in the elderly population or those with compromised health and immune systems.
An article on this website lists ALL the symptoms of a UTI in our elders. It's definitely worth knowing, because the alternative could be fatal (speaking from first hand and second hand experience).
*Typical Symptoms of UTIs*
Urine that appears cloudy or dark.
Bloody urine.
Strong or foul-smelling urine.
Frequent or urgent need to urinate.
Pain or burning during urination.
Feelings of pressure in the lower pelvis.
Low-grade fever.
Night sweats, shaking or chills.
*Lesser-Known UTI Symptoms in Seniors*
Confusion or delirium
Agitation
Hallucinations
Other unusual behavioral changes
Poor motor skills or loss of coordination
Dizziness
Falling
source: https://www.agingcare.com/articles/urinary-tract-infections-elderly-146026.htm
If you see any of these symptoms, it is critical that you start your parents on a daily 2 gram dosage of Dmanna (sugar that fights E Coli. bacteria) and 3 liters of water.
This method prevents 80% of UTIs.
Glad I could help you and your families! Let me know if you have any more questions.
Countrymouse, I always appreciate your responses but on the one with “Blimey” in it, I just have to pop my head up and give my opinion. When people have dementia and are incontinent and get frequent UTIs, sometime the ONLY WAY you can get a itinerary sample is via a catheter. It has nothing to do with incompetence or laziness. In my MIL’s case, she seems to have no sensation and it isn’t possible for her to remember or even think of sitting on the toilet, let alone doing a Clean Catch sample.
About the ER stuff: we get called a lot to take them. Sometimes we let the facility do it but sometimes we are able to take them to Same Day Care or do the ER thing ourselves. It seems to be their protocol to take them to ER rather than a clinic. But you don’t have to allow it, not do you have to do it even if it is needed, as they can call an ambulance to do it. Sometimes we let the ambulance take them and we meet them there, and then if possible, we bring them home rather than have them return by ambulance.
But the urine test is inaccurate over 50% of the time. Caretakers should diagnose a UTI based on symptoms without having to cath.
The BEST thing you can do for any elder is give them daily Dmanna for UTI prevention. Better than cranberry pills and easier to take.
I can't imagine wanting to catheterize a person with dementia against their will.
One issue with Assisted Living places is that there is often no real medic on-site especially after hours. The facility really DOESN'T want a Home Health Aide or Certified Nursing Assistant making the decision whether someone needs to go to the ER or not, because their liability insurer would throw fits, but the Resident (your mom) or the PoA can make that decision. They may need to call you every time, however.
When I went on vacation and placed my Husband in the Memory Care facility where he went for Day Care I got a call about a "problem"
The facility called my Sister, I put her as a contact, I was out of the country and she could handle any problem that might have come up.....
My brother in law then contacted me that my husband had some sort of "infection" and that it needed to be treated. I gave approval. I was not too worried about cost, most of the medications were picked up by the VA or Medicare but I did wonder about cost.... I did not hear much after that ..until I get home and found out that this "infection" that "needed to be treated right away" was...Athletes Foot !!!!
Yes I would be wary of any request to transport to the hospital, wary of any facility doctor that may be padding the bottom line.
I p in a cup or wharever is necessary for what i feel is wrong.
I hope you have an uc available.
If you are set on them not sending your mom to the ER for any reason, you should look into drafting a release with the AL facility releasing them from any and all liability.