May 14, 2010

CANADA: 'Granny dumping' a burden for ERs

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CALGARY, Alberta / Calgary Herald / Health / May 14, 2010

Hospitals left to find care for elderly when family falters

By Tom Blackwell, National Post

Some come with notes pinned to their clothes or tucked inside pockets. Often, they are unable to explain who they are or where they came from.

Across Canada, hospitals have encountered a rare but troubling phenomenon: elderly patients abandoned by relatives or others in crowded emergency wards, with or without an acute medical problem, geriatric experts say.

“There probably isn’t an emergency department in the province or in the country or anywhere really that hasn’t seen this happen,” said Dr. David Ryan of the Regional Geriatric Program of Toronto.


Elderly people are being abandoned at hospitals across the country, geriatric experts say.
Photograph by: Canwest News Service files, National Post

Some come with notes pinned to their clothes or tucked inside pockets. Often, they are unable to explain who they are or where they came from.

Across Canada, hospitals have encountered a rare but troubling phenomenon: elderly patients abandoned by relatives or others in crowded emergency wards, with or without an acute medical problem, geriatric experts say.

“There probably isn’t an emergency department in the province or in the country or anywhere really that hasn’t seen this happen,” said Dr. David Ryan of the Regional Geriatric Program of Toronto.

“Sometimes it comes from that whole issue of elder abuse.... Sometimes, less often, it’s people who are misusing the system. There are stories that we hear from time to time about somebody who is dropped off with information on how to reach the family, but the family is gone and they’ve gone on vacation.”

The practice, nicknamed “granny dumping,” is an extreme example of the wider issue of senior citizens arriving at emergency simply because they or harried family members do not know where else to turn, say nurses and doctors. The problem is unlikely to go away as a growing number of Canadians enter old age, they suggest.

Ontario, like some other provinces, has implemented programs to ensure those older people end up where they will get the best care. Some health-care professionals complain, however, that there is a shortage of services to help people overwhelmed with the burden of caring for ailing older people, often incapacitated by Alzheimer’s disease or some other form of dementia.

“We all deplore the act of what they’re doing,” said Teri Hay, executive director of the Ontario Network for the Prevention of Elder Abuse. “[But] in some cases, family members are desperate. You could be caring for your parent, who might be cognitively impaired, at the same time you are working and raising your own family. To say the least you are tired and exhausted.”

Like other experts, Ms. Hay said dumping is an uncommon, yet undeniable phenomenon.

She recounted two cases in Toronto hospitals in the past year, where seniors were found in emergency waiting rooms bearing notes that included their names, but no telephone number or other contact information. They were unable themselves to explain their history, Ms. Hay said.

At Windsor’s Hotel Dieu-Grace hospital, Norma Mamaril, a geriatric-emergency-management (GEM) nurse, said she sees about two such cases a year. The most recent was a few months ago, when an elderly man arrived alone by ambulance with virtually no identification and speaking only Serbian.

Ms. Mamaril did some extensive “detective” work and determined that his wife had left him and moved to Quebec. When she tracks down the children of such patients, they often seem unwilling to get involved.

Coming from a Filipino background where families typically look after their elderly members at home, the nurse said she finds such attitudes mystifying. “I feel very sorry about the patients,” she said. “I always tell them ‘If only I could take you home.’ ”

Doris Flynn, a GEM nurse at Kingston General Hospital, said dumping, though “really rare,” often stems from some dramatic change in the person’s situation. She recalls a patient delivered to emergency by ambulance after the son who had been looking after her became incapacitated by drug addiction.

A Calgary woman said the patient in the emergency examining room next to her mother’s recently had been abandoned in the department, with a note pinned to her asking for help.

If such incidents are rare, it is much more common for family members to actually accompany elderly people to emergency when they can no longer care for them.

“It could be an elderly woman who’s looked after her husband for years as his dementia worsens,” said Chris Crooks, a social worker in the emergency ward of Halifax’s QEII Hospital. “She’s care-giving 24 hours a day, trying to keep it going and then it reaches the point where it becomes humanly impossible to do.”

Senior citizens can spend days in the department as staff find appropriate services for them, she said.

The Ontario government has implemented a number of measures to deal with such scenarios. They include a program that sends emergency-department staff to nursing homes to offer care, as opposed to the residents being sent to the hospital, said Dr. Ryan. The province’s community-care access centres, which oversee nursing homes and home-care services, have case managers stationed in some emergency rooms to coordinate placement of seniors, he said. [rc]

tblackwell@nationalpost.com

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