My LO's AL procedure is to automatically send the resident to the ER if they hit their head. Otherwise I'm guessing it depends on whether there's an obvious injury, abnormal vitals, or the resident/POA requests it. How do you determine what to do if there's nothing obvious & the facility leaves it up to you? This happened tonight. My LO told them to call me because her POA is out of town on vacation. I got them to try to call her POA, and since I haven't heard anything more I assume they reached him. I AM a family member but being a circumspect non-POA, I am not comfortable with making such decisions. Back to the question: Should every fall mean a trip to the ER? How to decide?
Causes vary: from trips & slips, loss of balance, legs give way or loss of conscience.
Results of fall varies too.
Obviously as you said, head strike, injury or loss of consciousness needs medical assessment & treatment.
As for the rest, it's a case by case thing.
If there an RN on staff at the AL? If so, RN will assess if Dr or ER is required. If not, a call can be made to the AL Dr or if this was left up to me, I would call a nurse 24hr call line to discuss. They seem to always say when I have called 'if any doubt, go get it checked out'.
Take extra care if someone cannot verbalise well - tell you what happened, seems in any way confused, cannot describe pain. Take more care if osteoporosis or blood thinning meds are in the picture.
Even if no ER is required, a visit sooner (rather than later) by the AL Doctor could be arranged for piece of mind.
Falls in the elderly need attention because it doesn't take much for them to have a bigger or undetected injury. And, if they have any amount of cognitive or memory impairment, they are less able to identify how they fell, what they hit on the way down or other pains they are having. I know it's also a financial consideration for many people, but I'd err on the side of safety if it were me.
My opinion is...
If your loved one is cognizant enough to tell the staff who to call in a case like this then they should be the one to determine if they want to go to the hospital or not.
Does your LO have a POLST (more detailed than a DNR)? That details what treatment they want and for how long if any treatment is chosen.
IF there were a head injury (we are not talking an open bleeding wound that would necessitate a trip to the ER) what would the treatment be? Most likely a Wait and See approach would be taken. That can be done at the AL. Without the probably 4 to 6 hours in the ER, the MRI, X-ray that would be done.
If she is on Hospice the Hospice IS the 911 call and unless they think it is necessary there will be no more trips to the ER. (because it is me, a proponent of Hospice, it might be worth it to have her evaluated for Hospice. All the supplies would be provided and you would have another set of eyes on her watching for changes that her day to day caregivers might miss.)
I would say no to an ER trip.
My Husband "fell" 9 times and I did call non emergency for a "Lift Assist" and they came, helped him up and asked me if I wanted him transported to the hospital and each time I said no. They did not question my decision, I signed a release form and they were on their way.
Loss of confidence not so good - but with staff to closely supervise should be able to build that up again.
If you want a more positive spin, call this *increased caution* instead.
The little loss of confidence/increased caution my LO now has is better (for everyone) than any impulsive leaping out of the chair..