That's a good idea. I didn't initially consider that because this isn't really neglect or abuse in the traditional sense because the person is essentially abusing themselves
At least in England self neglect is still seen as a Safeguarding concern. Still can't force things on people (generally, unless it's due to MH or housing causes a risk to them or others) but the social services (APS in American) teams will work with them as much as possible
Off the top of my head (and I can't be bothered to check at the moment) but I'm pretty sure self-neglect is almost universally the most common case in APS's caseload by a wide margin. Anyway it's definitely not out of their scope.
Yes! I just did my training for my MSW placement (besides being an EMT, also a social work student). Self-neglect is the main APS referral for vulnerable adults, and an APS report is absolutely the right way to go. Their social workers have a whole range of options that they can offer.
Remember, just because you may not be a mandated reporter for a particular type of abuse/neglect doesn’t mean you can’t report it, just that you don’t legally have to. I’d argue here that OP morally has to, if they’re concerned enough to come on Reddit and talk about it, then reporting to APS is 100% the right thing to do.
I ended up filling a report. (Not super thrilled about having to drive in to work on my night off to do so but whatever). It definitely seems like the right thing to do. We'll see where it goes
In my state, it’s the top by pretty far, with financial exploitation following second. We have an extended family situation where we likely are going to have to get APS involved to protect this family member, as they won’t admit they’re no longer capable of living on their own. Heartbreaking, really.
> Heartbreaking, really.
Very. Wishing you all the luck: I went through one of those recently and even with a network of friends and family actively doing whatever they can it can be an indescribably slow, patchy and frustrating process. In hindsight it's easier to see how people who don't even have that network can end up as they do.
Thank you so much. It’s truly awful and is something I’ll remember as I age. That, and the importance of having an advanced directive, DPOA, and ensuring your loved ones know and will carry out your wishes.
APS is very unlikely to be able to do anything, but a referral for self-neglect wouldn’t hurt.
I was an APS investigator/case manager for a few years. Basically, they cannot force someone who is legally considered mentally competent to accept any assistance.
Adults have the right to make choices for themselves, even choices that will most likely have a negative outcome.
Occasionally, we could convince a person in a similar situation to go voluntarily, but it has to be their choice.
Agree APS. They’ve been extremely helpful every time I have called. Each time I filed a report someone contacted me to get some more information, then followed up with me once they took action, which was very nice.
Both times they did good work, the first time they got an older man with dementia (who’s son was trying and failing to care for him) placed in a decent care facility, the second they connected a quadriplegic that lived alone with home health services and a process for getting to a LTC facility.
So yeah, I think APS is a great resource. Even if there’s no way for them to help someone directly, they’re great at connecting folks with appropriate resources.
Adult Protective Services however be warned it may not be effective. Unfortunately these people have a right to live as they choose. Even if it means they have to call an ambulance every day to help get them out of bed. It takes a lot of effort to get them declared incompetent. We've had quite a few of them and the route we usually end up having to take is when the house becomes too much of a hazard we bring the fire marshal into condemn it. It sounds sad and horrible but once they have no place to go home to because it's been condemned then they start accepting help.
I'm sure a lot of people are going to tell me where heartless bastards but you have to understand some of these houses we've dealt with. Literally piss and fecal matter all over the place. Food items in various stages of rotting. It literally got to the point in some of these houses where as EMS we would not enter will attending firefighters in Tyvek suits and Scot masks. The air and some of these places were so horrible you couldn't breathe and you need to put yourself on oxygen while caring for the patient
Sucks to be in that position, Ive been in similar but not that rough. Your not putting your license on the line if your respecting a patient with capacity’s right to autonomy. Document that shit well, at the end of the day people have autonomy in all their medical decisions as long as they have capacity, have been disclosed the risks and can comprehend them. Call a sup quickly run your documentation before the transfer by them. Document your rational, patients comments, sending facility comments.
Your company could also do the right thing and refuse the transport, citing safety concerns for the patient ie, house catches on fire, and the patient is unable to exit the residence.
In my county, APS is awful.
We all have the right to make bad medical decisions about ourselves.
Luckily, in our system, we can call our "Paramedic Specialist" and get them to a) try to convince the patient and b) get the verbal refusal and confirmation of understanding on a recorded telephone line.
I've had to do it a few times.
I'll start with an explanation of my concerns and the risks as I see them, then ask the PS if they have something to add and if the pt has any questions, if they're still adamant about refusing, I'll get them to state the risks associated with their situation - including that without recommended help that they may die, their understanding that they have the right to change their mind at any time and call us back and then I'll usually ask again to be absolutely certain.
It's also the same protocol that I've used when our tough book shits the bed, and I need to document a normal refusal.
Edit: I realize that I misread the post, I would still go through the same process in your situation.
And to be fair to APS, they can't bring in resources that don't exist anyway. For example my state's Aging and Disability Services is suffering a serious labor shortage (oddly enough, funding isn't the problem, for once) and clients that qualify for and clearly urgently need home visits can end up waitlisted for six months or more, so APS caseworkers understandably aren't eager to make promises they won't be able to deliver on.
I apologize, I wasn't trying to assign blame. I was just stating the situations I've experienced. I mean even CPS, which has much more funding, can't handle everything they're supposed to do.
No need to apologize, I'll readily acknowledge that APS/CPS can be... a mixed bag. I just meant to clarify that my "keep your expectations low" applies regardless how the blame is allocated.
We do. She unfortunately did not live in our service area though. Was just being discharged from one of our hospitals. And the fire dept for her town who handles EMS doesn't have a community paramedic program
I would say you should start with filing an APS report. Additionally, if you have concerns about the transport, contact medical control. One of their jobs is to backstop you, so that you don't have to make the decision yourself.
Having said that, a person with their full cognitive faculties has every right to refuse medical attention. To quote one of my med control docs "Non-altered patients have the right to make bad decisions."
I once had a patient who was having a pretty decent STEMI. I tried every trick in the book to convince them to go to the hospital and they just stubbornly refused. No amount of "Look, see these lines here? See how they look like tombstones? That's because you're gonna die. That's not hyperbole, if you refuse, I'm gonna get a call in an under an hour to swing back here to do CPR because you'll be dead." Still refused. Called OLMC, and the doctor told him the same thing. Doc finally told me "Just because they're oriented, it doesn't mean they're smart, you can take the RMA." So I took the RMA AMA through OLMC.
30 minutes later, we rolled right back for the arrest. It's really dumb, but people have the right to be dumb. I don't like it either.
Department of Aging (or whatever the equivalent is in your state).
I have had to make reports to them before for older individuals not properly being cared for. Also had to assist them in bringing a pt to the hospital for evaluation once.
I once called APS twice in the same shift. For different patients. It’s the only thing you can do in this situation. It won’t fix everything and may take a few reports before a case is looked into, so it never hurts to call.
What do we do? Keep running on them over and over and over and over. No one with the ability to do anything actually cares. And no one who can push it to someone who can do something (read: admin) will because 1) they don’t care about the subject. 2) they don’t care about provider burnout and stuff. 3) more call volume = mo betta in their mind. 4) they have bigger things to worry about like persecuting people for minor scratches to rigs.
APS. But if someone is mentally competent, there's not much to be done. In the words of an APS representative who spoke at training, "People have the right to live miserably." Just because I find a house with shit, roaches, bedbugs, holes in the floor, and a falling in roof to be unsuitable for living doesn't mean I can force that standard on others. There simply is no legal path of action for someone like that. Personally I agree that people are allowed to live like that...but then they go and call 911 5 times a week and expose all of us to those conditions as well.
It's kinda like when people are med noncompliant and then go to the hospital when shit goes South health-wise. Like if you don't wanna listen to the doctor then don't go crying to him when your lungs are dying. Pretty annoying but nothing we can do.
Im assuming this is America. If she doesn’t qualify for Medicaid and isn’t wealthy this is the end result. People with no support structure failing to thrive at home, no HHA, no visiting nurse, etc. these things cost money and our society has decided these expenses are too much and should be covered by the infirm.
As far as being concerned about your license, don’t be. The ER doc is more aware of the situation and is more qualified to decide if they’re are competent to refuse care. It’s good that you tried getting her to change her mind as well, but don’t worry about it, the decision has been settled by the ER doc and you’re just following their order to take the patient home.
We have Community Paramedicine as an option, we can refer a person and they will reach out and try to get services going. Nothing like APS where I live.
In the US all we can do is call file a report with APS and hope the right thing is done. I've had one too many patients that shouldn't be living alone or that aren't being taken care of by their family.
We have a Community Health Alliance that includes city and county public health, ambulance service, fire department, etc. that we can refer reports to and those reports get assigned a case manager or community health nurse. Some things like lift assists, falls, and repetitive callers get referred automatically.
Just let people live how they want. AOX4 and you want to go back home and don’t want help? Fantastic!You have a great day ma’am call us if you need anything or change your mind.
We have APS, but the county of the state I live in is super robust with resources, fortunately. We have centers where social workers can help people get connected to Medicaid and Medicare funded programs like home health aides or hospice care or respite care and even food stamps. They have to want it, but if you file a concern report, the county absolutely takes it seriously.
We blanket refuse any AMA discharges from our hospitals. If they want to pay for our services as a stretcher transport, then we will give them a lift, but we require most of the bill as a down payment. Usually that helps keep these calls to a minimum, but for all the rest we use APS like others have suggested.
Adult Protective Services homie.
That's a good idea. I didn't initially consider that because this isn't really neglect or abuse in the traditional sense because the person is essentially abusing themselves
APS is absolutely the right call here.
Self-neglect is a thing
At least in England self neglect is still seen as a Safeguarding concern. Still can't force things on people (generally, unless it's due to MH or housing causes a risk to them or others) but the social services (APS in American) teams will work with them as much as possible
Off the top of my head (and I can't be bothered to check at the moment) but I'm pretty sure self-neglect is almost universally the most common case in APS's caseload by a wide margin. Anyway it's definitely not out of their scope.
Yes! I just did my training for my MSW placement (besides being an EMT, also a social work student). Self-neglect is the main APS referral for vulnerable adults, and an APS report is absolutely the right way to go. Their social workers have a whole range of options that they can offer. Remember, just because you may not be a mandated reporter for a particular type of abuse/neglect doesn’t mean you can’t report it, just that you don’t legally have to. I’d argue here that OP morally has to, if they’re concerned enough to come on Reddit and talk about it, then reporting to APS is 100% the right thing to do.
I ended up filling a report. (Not super thrilled about having to drive in to work on my night off to do so but whatever). It definitely seems like the right thing to do. We'll see where it goes
In my state, it’s the top by pretty far, with financial exploitation following second. We have an extended family situation where we likely are going to have to get APS involved to protect this family member, as they won’t admit they’re no longer capable of living on their own. Heartbreaking, really.
> Heartbreaking, really. Very. Wishing you all the luck: I went through one of those recently and even with a network of friends and family actively doing whatever they can it can be an indescribably slow, patchy and frustrating process. In hindsight it's easier to see how people who don't even have that network can end up as they do.
Thank you so much. It’s truly awful and is something I’ll remember as I age. That, and the importance of having an advanced directive, DPOA, and ensuring your loved ones know and will carry out your wishes.
It's failure to thrive when there's not an external factor
APS is very unlikely to be able to do anything, but a referral for self-neglect wouldn’t hurt. I was an APS investigator/case manager for a few years. Basically, they cannot force someone who is legally considered mentally competent to accept any assistance. Adults have the right to make choices for themselves, even choices that will most likely have a negative outcome. Occasionally, we could convince a person in a similar situation to go voluntarily, but it has to be their choice.
Unfortunately all you can do is file a complaint with APS and document everything.
Agree APS. They’ve been extremely helpful every time I have called. Each time I filed a report someone contacted me to get some more information, then followed up with me once they took action, which was very nice. Both times they did good work, the first time they got an older man with dementia (who’s son was trying and failing to care for him) placed in a decent care facility, the second they connected a quadriplegic that lived alone with home health services and a process for getting to a LTC facility. So yeah, I think APS is a great resource. Even if there’s no way for them to help someone directly, they’re great at connecting folks with appropriate resources.
Adult Protective Services however be warned it may not be effective. Unfortunately these people have a right to live as they choose. Even if it means they have to call an ambulance every day to help get them out of bed. It takes a lot of effort to get them declared incompetent. We've had quite a few of them and the route we usually end up having to take is when the house becomes too much of a hazard we bring the fire marshal into condemn it. It sounds sad and horrible but once they have no place to go home to because it's been condemned then they start accepting help. I'm sure a lot of people are going to tell me where heartless bastards but you have to understand some of these houses we've dealt with. Literally piss and fecal matter all over the place. Food items in various stages of rotting. It literally got to the point in some of these houses where as EMS we would not enter will attending firefighters in Tyvek suits and Scot masks. The air and some of these places were so horrible you couldn't breathe and you need to put yourself on oxygen while caring for the patient
I've had some coworkers tell me about having to do this, too.
Sucks to be in that position, Ive been in similar but not that rough. Your not putting your license on the line if your respecting a patient with capacity’s right to autonomy. Document that shit well, at the end of the day people have autonomy in all their medical decisions as long as they have capacity, have been disclosed the risks and can comprehend them. Call a sup quickly run your documentation before the transfer by them. Document your rational, patients comments, sending facility comments.
Your company could also do the right thing and refuse the transport, citing safety concerns for the patient ie, house catches on fire, and the patient is unable to exit the residence. In my county, APS is awful.
We can refuse to take people home who can’t take care of themselves and don’t have anyone to care for them. APS also needs to be involved.
We all have the right to make bad medical decisions about ourselves. Luckily, in our system, we can call our "Paramedic Specialist" and get them to a) try to convince the patient and b) get the verbal refusal and confirmation of understanding on a recorded telephone line. I've had to do it a few times. I'll start with an explanation of my concerns and the risks as I see them, then ask the PS if they have something to add and if the pt has any questions, if they're still adamant about refusing, I'll get them to state the risks associated with their situation - including that without recommended help that they may die, their understanding that they have the right to change their mind at any time and call us back and then I'll usually ask again to be absolutely certain. It's also the same protocol that I've used when our tough book shits the bed, and I need to document a normal refusal. Edit: I realize that I misread the post, I would still go through the same process in your situation.
Do you have community paramedics in your area? Maybe put her on that medics case load.
IF there's a visiting nurse service, that's probably not a bad idea either.
Also, APS might be able to get this ball rolling, especially if there's a pattern of reports. (Keep your expectations low, tho.)
Initially I had written that I don't have much faith in APS, but I can only speak about my state and didn't want to shit on them everywhere.
And to be fair to APS, they can't bring in resources that don't exist anyway. For example my state's Aging and Disability Services is suffering a serious labor shortage (oddly enough, funding isn't the problem, for once) and clients that qualify for and clearly urgently need home visits can end up waitlisted for six months or more, so APS caseworkers understandably aren't eager to make promises they won't be able to deliver on.
I apologize, I wasn't trying to assign blame. I was just stating the situations I've experienced. I mean even CPS, which has much more funding, can't handle everything they're supposed to do.
No need to apologize, I'll readily acknowledge that APS/CPS can be... a mixed bag. I just meant to clarify that my "keep your expectations low" applies regardless how the blame is allocated.
We do. She unfortunately did not live in our service area though. Was just being discharged from one of our hospitals. And the fire dept for her town who handles EMS doesn't have a community paramedic program
I would say you should start with filing an APS report. Additionally, if you have concerns about the transport, contact medical control. One of their jobs is to backstop you, so that you don't have to make the decision yourself. Having said that, a person with their full cognitive faculties has every right to refuse medical attention. To quote one of my med control docs "Non-altered patients have the right to make bad decisions." I once had a patient who was having a pretty decent STEMI. I tried every trick in the book to convince them to go to the hospital and they just stubbornly refused. No amount of "Look, see these lines here? See how they look like tombstones? That's because you're gonna die. That's not hyperbole, if you refuse, I'm gonna get a call in an under an hour to swing back here to do CPR because you'll be dead." Still refused. Called OLMC, and the doctor told him the same thing. Doc finally told me "Just because they're oriented, it doesn't mean they're smart, you can take the RMA." So I took the RMA AMA through OLMC. 30 minutes later, we rolled right back for the arrest. It's really dumb, but people have the right to be dumb. I don't like it either.
We have community paramedics in my county
Department of Aging (or whatever the equivalent is in your state). I have had to make reports to them before for older individuals not properly being cared for. Also had to assist them in bringing a pt to the hospital for evaluation once.
I once called APS twice in the same shift. For different patients. It’s the only thing you can do in this situation. It won’t fix everything and may take a few reports before a case is looked into, so it never hurts to call.
What do we do? Keep running on them over and over and over and over. No one with the ability to do anything actually cares. And no one who can push it to someone who can do something (read: admin) will because 1) they don’t care about the subject. 2) they don’t care about provider burnout and stuff. 3) more call volume = mo betta in their mind. 4) they have bigger things to worry about like persecuting people for minor scratches to rigs.
APS. But if someone is mentally competent, there's not much to be done. In the words of an APS representative who spoke at training, "People have the right to live miserably." Just because I find a house with shit, roaches, bedbugs, holes in the floor, and a falling in roof to be unsuitable for living doesn't mean I can force that standard on others. There simply is no legal path of action for someone like that. Personally I agree that people are allowed to live like that...but then they go and call 911 5 times a week and expose all of us to those conditions as well. It's kinda like when people are med noncompliant and then go to the hospital when shit goes South health-wise. Like if you don't wanna listen to the doctor then don't go crying to him when your lungs are dying. Pretty annoying but nothing we can do.
If it’s that bad, I make a call to the local APS unit and report my findings and let them sort it out.
Adult Protective Services and hope for the best.
APS
"See you tomorrow"
Adult protective
Self neglect is grounds for investigation
Im assuming this is America. If she doesn’t qualify for Medicaid and isn’t wealthy this is the end result. People with no support structure failing to thrive at home, no HHA, no visiting nurse, etc. these things cost money and our society has decided these expenses are too much and should be covered by the infirm.
As far as being concerned about your license, don’t be. The ER doc is more aware of the situation and is more qualified to decide if they’re are competent to refuse care. It’s good that you tried getting her to change her mind as well, but don’t worry about it, the decision has been settled by the ER doc and you’re just following their order to take the patient home.
We have Community Paramedicine as an option, we can refer a person and they will reach out and try to get services going. Nothing like APS where I live.
In the US all we can do is call file a report with APS and hope the right thing is done. I've had one too many patients that shouldn't be living alone or that aren't being taken care of by their family.
We have a Community Health Alliance that includes city and county public health, ambulance service, fire department, etc. that we can refer reports to and those reports get assigned a case manager or community health nurse. Some things like lift assists, falls, and repetitive callers get referred automatically.
We have Adult Protective Services in Texas.
Just let people live how they want. AOX4 and you want to go back home and don’t want help? Fantastic!You have a great day ma’am call us if you need anything or change your mind.
We have APS, but the county of the state I live in is super robust with resources, fortunately. We have centers where social workers can help people get connected to Medicaid and Medicare funded programs like home health aides or hospice care or respite care and even food stamps. They have to want it, but if you file a concern report, the county absolutely takes it seriously.
We make that bitch walk and if she can't we take her back to the hospital, get bitched out, and sleep easy.
We blanket refuse any AMA discharges from our hospitals. If they want to pay for our services as a stretcher transport, then we will give them a lift, but we require most of the bill as a down payment. Usually that helps keep these calls to a minimum, but for all the rest we use APS like others have suggested.