Unnecessary 911 Calls in Senior Communities

Mrs. Collister lives in an independent apartment. About two years ago, she began to have challenges finding words and later was diagnosed with aphasia, which is the loss of the ability to understand or express speech. Usually, aphasia occurs suddenly after a stroke or head injury. It can also come on gradually from a slow-growing brain tumor or a disease that causes progressive damage. Mrs. Collister’s aphasia is slowly progressing and is both frustrating and embarrassing to her. She knows what she wants to say but simply cannot get the words out.

Her family has taken many steps to maintain her independence while providing tools and resources to assist her with communication. One of the most important steps her family has tried to take is to maintain close and consistent communication with the senior community. Due to the continued staffing shortages and challenges, this is not as easy as one would think. Unfortunately, last weekend, Mrs. Collister almost ended up in the emergency department, as do so many older adults living in senior communities. Many families do not understand that most senior communities (including independent living, assisted living and nursing homes), as a default procedure, will respond to most issues by sending your loved one to the emergency department.

Mrs. Collister woke up late last Saturday morning and was extremely hot, in fact she thought she may even have had a fever. She couldn’t locate her thermometer, so she put on her robe and slippers and knocked on her neighbor’s door. She was hot, frustrated and having difficulty finding her words. Her neighbor couldn’t understand what she was saying or doing so she called down to the front desk stating that Mrs. Collister was knocking on her door and was confused.

The staff saw Mrs. Collister who did appear to look red, warm and was having difficulty getting her words out. They told Mrs. Collister to stay in her apartment, isolated, as she could be “contagious,” then they called 911.  Her daughter was then notified. Her daughter was able to call, utilizing face-to-face technology, to not only speak directly to the paramedic but to see and talk directly to her mom.  The first thing the paramedic said was how hot her apartment was, indicating the thermostat had been set on 82 degrees. It was hot indeed. Mrs. Collister’s daughter was able to explain her mom’s diagnosis and due to all the commotion, her mom was very upset, frustrated and embarrassed, making her communication even more difficult. The paramedic gave Mrs. Collister a glass of cold water while he sat with her and let her know that he turned down the thermostat, and then he took her vitals: NO fever, no issues; she was just hot. Things were quickly resolved and the paramedics left.

We must work on ways to prevent sending older adults to the Emergency Department too quickly. These visits to the emergency room often result in unneeded hospital admissions. By re-training and educating staff members on what to look for in true emergencies, we can empower family members in many cases to simply refuse to allow the transfer to the emergency department to even happen, unless it is truly necessary.

Additional Tips: 

• Upon admissions to any facility, make it very clear that keeping your parent out of the hospital, unless necessary, is the goal.

• Have it documented in the chart to call the designated family member prior to calling 911. It may not always be possible, but it may eliminate a trip or two.
• Let the facility know you want to be notified of all medication changes before they occur.
• Be willing to develop relationships with the facility. Be prepared at every chance to introduce yourself, re-educate all new staff about your loved one’s preferences, personality and needs.

• Take an interest in the staff and show them gratitude.

• Talk to a variety of staff regularly to get their input.
• Consider Hospice Care if appropriate. This tells the staff that the individual does not want to have life sustaining treatments.

Communication with the facilities is vital now, more than ever, for families. As we continue to face staffing challenges, the consistency of care has changed. Families can no longer assume that facilities are aware of your loved ones’ changes, will notify families of concerns, or are in the position to take steps to avoid calling 911 over issues that can be resolved proactively.