How many times has this happened to you?
80 ish patient falls at home, sustains some minor injuries. Maybe some rhabdo, a little dehydrated from lying on the floor overnight, "makes troponins", so gets renal failure from the ACE, a septic workup because they've become hypotensive from the beta blocker, then deconditioned from the 7 to 14 day hospital stay. Of course PT/OT recommends Subacute rehab or long term care.
Patient refuses, saying they want to die in their own home. So you sic the psych people on them to declare them incompetent, ship them off to the nearest facility, where they begin the ER/ICU/floors/SAR circuit, and they never get their wish.
Because God forbid, if your 87 year old patient dies peacefully in their own bed, the lawyers will get you...
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yep, been there.
actually had an elderly couple, neighbors hadn't seen them in a few days, authorities were called. wife on the couch in her on stool and urine. husband on the floor in the fetal position.
she had a fib and a uti. also some form of dementia.
he had a pelvic fracture, rib fractures, folate and b12 deficiency, anemia, and alcohol withdrawal.
no family around. neither in any condition to make decisions for the other, let alone themselves.
i believe both eventually ended up in a long term care facility.
The leading cause of death and injury in the US is it's health care system.
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