| How to Prepare for a Trip to the Emergency | | | | Navigating the emergency room |
| Room With Someone Who Has Alzheimer's | | | | What happens first: Triage will likely be the |
| Dementia can complicate already-stressful ER | | | | patient's first stop in the ER. A staff member will |
| treatment | | | | record vital signs and a summary of his current |
| Preparing ahead of time | | | | medical issue and medical history. Make certain |
| Prepare contacts. Make a written list of contacts, | | | | this person notes that the person you're caring |
| including the primary caregiver and other family | | | | for has Alzheimer's disease -- in fact, tell this to |
| members or friends who help with care, who | | | | every new medical staffer you encounter. Explain |
| should be notified in an emergency. Keep a copy | | | | what stage he's in and that you're his caregiver |
| with you in case you get a call about the patient's | | | | (or his son or daughter, there to support and help |
| condition and can't come to his side yourself; | | | | him). The staff will likely do a brief mental exam |
| share copies with other caregivers and facilities he | | | | and then make a decision about the urgency of |
| frequents, such as an adult day care center or | | | | his situation. This will determine how quickly he will |
| church program. Note which people have legal | | | | receive medical care. A frail elderly person with |
| permission to be present when physicians and | | | | dementia is rated more urgent than a younger |
| other staff discuss his medical issues. | | | | person with the same condition, or than a peer |
| Prepare records. Anyone who accompanies the | | | | without dementia with the same condition. |
| patient in the emergency room should bring along | | | | Once you've left triage, if the issue is not |
| a copy of his medical records and relevant legal | | | | life-threatening and you aren't seen immediately, |
| documents. These include: | | | | you'll register him, which creates a hospital record |
| A clear summary of his medical condition (including | | | | and involves the presentation of insurance and |
| the Alzheimer's disease and any other health | | | | Medicare/Medicaid information. (In some cases this |
| problems) | | | | step may be completed at his bedside.) Then try |
| A list of all the medications, vitamins, and | | | | to find a relatively peaceful, quiet spot in the |
| supplements he takes, including dosages | | | | waiting area where you can sit down. |
| A list of any allergies | | | | Stay close. It's important that you or another |
| Contact information for his primary care physician | | | | trusted helper stay at the patient's side at all |
| and any specialists he sees | | | | times in the hospital. Any hospital setting, but |
| Insurance and Medicare, Medicaid, or HMO | | | | especially an emergency room, can be intimidating |
| enrollment card(s) | | | | and disorienting to him, and his response can |
| Relevant legal documents, such as a health care | | | | interfere with his care. An ER visit can involve a |
| proxy, advance health care directive or living will, | | | | lot of waiting (often several hours), many |
| power of attorney, and do-not-recuscitate order. | | | | questions that require remembering medical |
| Prepare for medical access. A companion who has | | | | history and other facts, and interacting with |
| the patient's verbal permission to stay by his side | | | | various strangers -- three situations that are |
| should have no problem gaining access. But you | | | | stressful to someone with Alzheimer's. |
| can't count on a verbal okay in a crisis or if he's | | | | What to say: When he's called to be examined, |
| already in mid- to late-stage Alzheimer's. If he's | | | | reintroduce yourself and, if necessary, briefly |
| confused or agitated or unable to grant | | | | explain again why you need to accompany him: |
| permission, the hospital staff may require that | | | | "I'm Mr. Smith's daughter and I have the legal |
| you present a legal document (such as a health | | | | okay to stay with him, because he has stage 2 |
| care proxy) that allows you to stay with him -- | | | | Alzheimer's disease." He may be examined more |
| another important reason to obtain this authority | | | | than once (for example, first by a resident and |
| soon after his diagnosis. It's best not to count | | | | then by an attending physician). Be patient and |
| solely the patient's spouse for this role, as she or | | | | don't assume that each new face knows about |
| he may be too upset in a crisis (or, in the event | | | | his Alzheimer's. |
| of a car accident, for example, also indisposed). | | | | What to do: One of your most important |
| Hospital policies vary. Make sure you let staff | | | | contributions will be to listen to the physician's |
| know the patient has Alzheimer's disease and that | | | | discharge instructions. The patient is liable to |
| you are a caregiver (or a son or daughter there | | | | forget or misunderstand them. You'll likely receive |
| in that capacity). | | | | a document describing them; you should read and |
| First reactions and dealing with an emergency | | | | be sure you understand them before you leave |
| room | | | | the hospital. |
| Reacting when an emergency happens | | | | Your role in the ER: |
| Consult if you can. If possible, call the patient's | | | | · To calm and reassure the person in your care |
| doctor about a medical problem before going to | | | | · To help answer questions from physicians and |
| the emergency room. Depending on the | | | | other staff |
| circumstances, a physician may be able to see an | | | | · To ask for assistance if there's a problem |
| urgent case in the office on short notice. Or she | | | | · To get attention if things seem to reach a |
| may have advice on how to deal with the | | | | standstill |
| situation or the ER specifically. | | | | · To listen to the diagnosis and discharge |
| Don't drive to the ER. Calling an ambulance is | | | | instructions |
| considered safest for someone with Alzheimer's. | | | | · To ask questions as needed for clarification |
| Confusion or agitation, which may worsen under | | | | Where to find help: Depending on the patient's |
| stress, can make the ride to the hospital | | | | condition and the nature of the discharge |
| challenging and dangerous (especially if you're | | | | instructions, you may want to inquire about |
| alone with the patient). Note: His insurance may | | | | discharge planning services. This hospital service, |
| cover some ambulance service providers and not | | | | usually provided by a social worker, helps you |
| others; it's useful to check what's covered now, | | | | learn how best to help the patient carry out |
| before a crisis happens. | | | | discharge instructions and handle follow-up care. |
| Bring essentials. Take the essential health and legal | | | | You will also receive information about other |
| records with you, as well as change in case you're | | | | resources, such as visiting-nurse or |
| in a hospital area where you can't use a cell | | | | home-health-aide services. |
| phone. (You don't want to leave him alone while | | | | You should feel free to ask for help from the |
| you step outside.) If you have time and it's | | | | hospital social worker (or geriatric case manager) |
| appropriate, bring a comfort item (such as a | | | | if, at any point during the emergency-room |
| family photo) along with his medications, a change | | | | treatment, the situation becomes overwhelming, |
| of clothes, and personal hygiene items (including | | | | or you need assistance advocating for the patient, |
| adult diapers, if used), in case the visit drags on or | | | | or if he must be hospitalized and you need help |
| he needs to be hospitalized. | | | | and advice. |