A Compassionate Guide: How to get a dementia patient admitted to the hospital?

Over 6 million Americans are living with Alzheimer's dementia, a number that grows each year. Knowing how to get a dementia patient admitted to the hospital is a critical skill for family caregivers facing a medical crisis, providing both guidance and authoritative support during a time of great stress.

Quick Summary

Navigating a healthcare crisis with a dementia patient requires understanding specific procedures for hospital admission, which depends on the severity of the medical issue and their cooperation. The process involves contacting healthcare providers, assessing the situation, and considering legal authority.

Key Points

• Know the difference: Understand the distinction between typical dementia symptoms and a true medical or psychiatric emergency requiring hospitalization.

• Have documents ready: Keep a current list of medications, health history, and essential legal documents like a Power of Attorney for Healthcare easily accessible.

• Assess urgency: For immediate danger, call 911. For non-emergencies, consult the patient's primary care physician for a direct admission referral.

• Understand legal roles: Clarify your legal standing (POA vs. guardianship) to make medical decisions on the patient's behalf.

• Practice de-escalation: Use calm, simple language and avoid confrontation when a patient resists hospitalization.

• Communicate with staff: Inform all hospital staff about the patient's dementia and baseline behaviors to facilitate better care.

• Plan for discharge: Begin discussing post-hospital care needs and arrangements with hospital staff and social workers early in the process.

Understanding When Hospitalization is Necessary

Caregivers must differentiate between common dementia symptoms and a genuine medical emergency requiring hospital admission. What seems like a sudden change in behavior could be a sign of a more serious underlying issue, such as a urinary tract infection (UTI), a stroke, or medication side effects. Being able to recognize these signs is the first and most critical step.

Medical Crises and Urgent Needs

Certain conditions demand immediate professional medical attention. These include, but are not limited to:

• Acute illness: A sudden, significant change in physical health, such as a high fever, severe pain, or difficulty breathing.
• Injury: Falls and other accidents that may cause fractures, head trauma, or other serious injuries, especially if the person cannot clearly communicate their pain.
• Stroke symptoms: Sudden onset of facial drooping, slurred speech, or weakness on one side of the body.
• Infections: Symptoms of infections like pneumonia or severe UTIs, which can rapidly worsen in older adults and cause delirium.

Behavioral and Psychiatric Emergencies

Sometimes the need for hospitalization is not physical but psychiatric. A sudden escalation in challenging behaviors can indicate an emergency:

• Severe aggression or violence: Posing a danger to themselves or others.
• Intense agitation or psychosis: Hallucinations, delusions, or paranoia that become unmanageable at home.
• Suicidal ideation: Any indication that the individual is considering self-harm.
• Wandering that leads to immediate danger: Leaving the home and being unable to find their way back, especially in severe weather conditions.

The Step-by-Step Process for Admission

The path to admission can vary depending on the urgency. Following a clear procedure can help streamline the process during a stressful time.

1. Initial Assessment and Preparation

Before making the call, assess the situation calmly. Gather vital information to provide to medical staff:

• Current symptoms: Detail the patient's symptoms, when they started, and any potential triggers.
• Health history: List all current diagnoses, allergies, and recent health changes.
• Medication list: Have a complete, updated list of all medications, including dosages and frequency.
• Legal documents: Locate the Power of Attorney for Healthcare and any advance directives.

2. Contacting Medical Professionals

• For emergencies, call 911 immediately. Clearly state the situation and mention the patient has dementia to ensure responders are prepared.
• For non-emergencies, contact their primary care physician. A doctor can often provide a direct referral to a hospital, which can simplify the intake process.
• Consider a mobile crisis team. In some areas, these teams specialize in de-escalating psychiatric emergencies and can assist with hospital transfers.

3. Navigating Legal and Consent Issues

If the patient lacks the capacity to make their own decisions, you will need to demonstrate your legal authority. Having documentation ready is crucial.

• Health Care Power of Attorney: This document gives you the legal right to make medical decisions on their behalf.
• Guardianship: If there is no POA, legal guardianship may be necessary. This is a court-ordered process that may be initiated in an emergency.

4. Handling Resistance and Aggression

It is common for dementia patients to resist hospitalization due to fear, confusion, or paranoia. De-escalation techniques are essential:

• Use a calm, reassuring tone.
• Explain the need for the hospital visit simply and honestly.
• Avoid arguing or confronting them directly.
• If calling 911, let the dispatcher know the patient is resisting to prepare EMTs.

Legal and Ethical Considerations

Hospital admissions for dementia patients involve specific legal and ethical concerns that caregivers should be aware of.

Power of Attorney vs. Guardianship

A Power of Attorney for Healthcare is a voluntary appointment by the patient when they still have capacity. A guardianship is a court-ordered process when the person is deemed incapacitated. It's vital to know which legal standing you have before a crisis occurs.

The Role of an Advance Directive

An advance directive, or living will, outlines a person's wishes regarding medical treatment. It can guide medical staff and family members on the patient's preferences, which is especially important if the patient is unable to communicate.

Navigating Involuntary Commitment Laws

In cases of severe behavioral or psychiatric emergencies where the patient poses a danger to themselves or others, involuntary commitment may be necessary. This is a legal process, often initiated by a physician or court, to ensure the patient's and public's safety. Each state has specific laws regarding this procedure.

Comparison of Admission Pathways

Feature	Emergency Room (ER)	Direct Admission	Crisis Stabilization
Urgency	Severe medical or psychiatric emergency.	Planned, non-emergency admission for a known issue.	Acute psychiatric or behavioral crisis.
Timing	Immediate.	Scheduled in advance.	Often immediate, but in a specialized setting.
Process	Arrive via ambulance or private vehicle. Triage determines priority.	Doctor referral with pre-approved hospital stay.	Contact mobile crisis team or designated facility for evaluation.
Pros	Immediate access to life-saving care.	Smoother process, less wait time, pre-planned.	Specialized care for psychiatric needs, avoids general ER stress.
Cons	Long wait times, stressful environment for patient, risk of 'ER delirium'.	Requires prior planning and coordination with doctor.	May not have resources for concurrent medical issues.

What to Prepare for the Hospital Visit

Preparation can significantly reduce stress and improve the patient's care.

Essential Documents and Information

• Identification (driver's license, insurance card)
• Legal documents (POA, advance directive)
• Detailed medication list
• Contact information for all relevant doctors
• List of baseline behaviors and recent changes

Tips for a Smoother Hospital Stay

• Bring familiar items: A favorite blanket, a family photo, or a specific pillow can provide comfort.
• Assign a consistent advocate: Try to have one family member be the primary point of contact for hospital staff to ensure clear communication.
• Communicate with staff: Inform nurses and doctors about the patient's dementia, their communication style, and what calms or agitates them.
• Discuss discharge planning early: Talk with social workers and hospital staff about the patient's post-hospital care needs.

For more detailed information on communicating with healthcare providers, the National Institute on Aging offers valuable resources for caregivers.

Conclusion

Navigating the process of getting a dementia patient admitted to the hospital can be challenging, but understanding the steps and preparing in advance is crucial. By identifying the need for hospitalization, gathering the necessary information, understanding legal requirements, and communicating effectively with medical professionals, caregivers can ensure their loved one receives the best possible care during a difficult time. Remember, your calm and informed presence is one of the most important factors in a successful outcome.

Frequently Asked Questions

What is the fastest way to get a dementia patient into the hospital during an emergency?

In a medical or psychiatric emergency, the fastest and most appropriate route is to call 911. Be sure to inform the dispatcher that the patient has dementia so the responding team is properly prepared.

Can a dementia patient refuse to go to the hospital?

Yes, they can, if they are deemed to have the mental capacity to make their own decisions. However, if they are considered a danger to themselves or others, healthcare professionals may be able to initiate an involuntary commitment, often under specific state laws.

What if the dementia patient becomes aggressive or resists during the admission process?

If the patient becomes aggressive or resists, do not engage in a power struggle. Use a calm voice, avoid physical confrontation, and allow EMTs or trained healthcare professionals to handle the situation. Inform the dispatcher or staff about the patient's resistance beforehand.

Do I need a Power of Attorney to admit a dementia patient to the hospital?

It is highly recommended. A Power of Attorney for Healthcare gives you the legal authority to make medical decisions. If you do not have this, the hospital may require a court-ordered guardianship, especially if the patient is unable to give consent.

Should I go to the emergency room or seek a direct admission for a dementia patient?

Go to the emergency room for any life-threatening or immediate crisis. For non-urgent issues, seeking a direct admission through the patient's primary care physician can be less stressful and potentially faster, as it avoids the emergency room triage process.

What information should I bring with me to the hospital?

Bring the patient's identification, insurance information, any legal documents like a POA, and a complete, up-to-date list of all their medications, including dosage and frequency.

How can I help make the hospital stay less stressful for a dementia patient?

Bring familiar objects like a special blanket or photo. Inform staff about the patient's routines, triggers, and calming techniques. Having a consistent advocate present can also reduce confusion and stress for the patient.

What is 'ER delirium' and how can I prevent it in a dementia patient?

ER delirium is a state of severe confusion and altered consciousness that can be triggered by the unfamiliar and loud environment of the emergency room. You can help by trying to stay calm, advocating for a quiet space if possible, and bringing familiar items to provide comfort.