Wow, I just spent 8 hours in a non busy ER, with my Father as the pt.  This was one of the most frustrating visits, I've ever had.  My 93 yo Father with Alz, CVA, Prostate CA, etc etc etc, developed a fever (99.9) with increased confusion.  My Mother (his wife of 67 years) and husband also went.  My Father is facing end of life issues, and we want him kept comfortable.  He has developed pneumonia now.  I had a NP who was hell bent on admitting him, even after she said that the IV AVelox was equally effective when given in pill form.  Even after explaining that we could give him the avelox, and nebulizer treatments at home, she was trying to shove a hospital admission down our throats.  The first thing they did was throw 3 Liters of O2 NC on him, even though the pulse ox showed NO WAVE form, and his hands were like ice.  I took the O2 off, and warmed his hands up placing it on his thumb and his sat stayed at 93-94%.  When the NP came in, she said well he needs to be admitted because he needs O2, ( she hadn't noticed I took off the O2) imagine her face, when I told her he didn't need it and was satting fine without it.

We are completely set up to care for him at home, I just can't write my own scripts for albuterol and avelox.  We don't want him dying in a hospital alone, but to be with his family, and what will be will be.  We're at peace with that.  We have visiting nurses, and have been trying to get hospice (but it's been like pulling teeth).  I was amazed at how they tried to guilt us into an admission, and continued to talk down to us.  I don't know if this is because we took him to the closest hospital (which happens to be catholic??) or if it was this NP's own personal bone??

So what are you facing now with signing him out AMA..what will the insurance complany say?

i am suprised that they assured you that it would be paid for, did the NP tell you that? i am just curious to see how this pans out because any pt that wants to leave AMA where i work always says that insurance wont pay. so keep me posted, i want to see how it works out.

that is so interesting. i always wondered the truth about that. please give an update as to if that holds up. thanks!

The ER must have been told to admit, admit, admit.

It's funny you say that, because that is exactly what my husband said. 

I have healthcare POA, and my Mother has durable POA. We are all in agreement that if something happens, we want him DNR (and expressed that to the hospital)  When we lived in NC, I saw all kinds of pts placed on hospice, but here in PA most of the hospice pt's that I've come across have be terminal/end stage CA.  I am going to push hard (again) for it when I go see his FP MD this week and I am going to write a letter of complaint to the hospital.....

First thing they did was shove a foley cath in him, and the ER tech, was going to cath him sitting up.  I said when he reached to put on the sterile gloves, please lay him flat (he's got prostate ca)......  When they did the Blood cultures, they had the bottles uncapped and lying in his bedsheets between his legs for at least 10 minutes, they made no attempt to swab them with alcohol or any prep.  I have always treated the culture top as a sterile field, because you can contaminate your specimen that way. 

The long and the short, he's home.  He actually walked into the bathroom and showered with minimal help.  He's eating, drinking, pooing.  I've been giving the PO avelox, and neb tx, and he seems greatly improved.  No more fever, and good color.  Right now, he's drinking a milkshake.

I guess I'll find out about the insurance.  But if it is kicked back, I am going to make a very big stink.

very poor technique on the foley and blood cultures ...our techs have lab carts and the bottles never leave the sterile field on their carts.  the blood that is drawn comes to the culture bottle and not the other way around EVER you are correct .  Serious trouble there !! my oh my NOT GOOD! and furthermore if your father is DNR that should be #1 on careplan what is wrong with those guys???PA has very troubling issues here.  My aunt was given a toxic drip of 7% sodium which fried her brain she went into terminal seizures and ended up a vegetable at 52 yrs old.  She was not a cancer pt but was treated as a terminal cancer pt per her wishes and her dtrs. the staff put her on a morphine drip and she slipped away after 3 days it was what she wanted.  I have not doubt those idiots in PA would not have let that happen .  I learned right there sometimes it matters not what is in writing but  the quality of professionalism of the staff MD included!! You will do well to get a MD who is one your side esp if you need to go back to the ER.... which i hope is not going to happen! glad to hear your dad got out of there in one piece thanks to you!!good work... GO POPS!