Question

Helen, who is 92 years old, is admitted through the hospital emergency department (ED) following a fall from her bed in the assisted-living facility where she lives. This was the third time she came into the hospital with this complaint in the past 2 months. Although previous examinations and tests showed no fractures, the ED physician felt that because of her age and the bruises that are beginning to appear on her arms and face, she should be monitored and evaluated more closely. She has a supplementary private insurance and is covered under Medicare parts A and B with a supplement from a Medicaid Diversion Program in her state since she is living in an assisted-living facility and not in a skilled nursing facility. Helen seems a bit confused but reports that the paramedics who brought her to the hospital were nice and it was a “fun ride.” She is obese and requires major assistance to transfer to the ED stretcher, despite her residence in an assisted-living facility. She has one daughter who lives out of state and is caring for a spouse with a chronic illness. The daughter is available by phone but can only manage to visit her mother every 2 months and has been assured by the staff at the assisted-living facility that her mother is well and happy. Helen is taking an anti-hypertensive medication that controls her moderate hypertension and receives a narcotic analgesic for joint pain when she requests medication at the facility. When asked about her pain level, she states, “my knees and back are killing me.” After a complete physical examination, including several tests and administration of morphine sulfate, she is scheduled for return to the assisted living facility via ambulance. Total cost for this ED evaluation, including tests and transportation, is in excess of $10,000.

• Discuss the ethical, financial, treatment, and additional issues that surround this case.

• Relate the case to the principles of distributive justice.

• What are your concerns about the bruising?

Answer 1

1. Issues that surrounds the case

I) Ethical issues

a) Inability to discuss issues

b) Poor decision making

c) Over or under treatment of patients

d) Lack of interest in the family members regarding older patient health

Financial issues

Helen will not face any financial issues because her Medicaid Diversion Program cover adult day health, assisted living services, case management, chore services, consumable medical suppilies, transportation services, etc

Treatment issues

The treatment issues in old age patient are hypertension, diabetic mellitus, poor wound healing, poor treatment compliences,obesity, etc. Mrs helen have treatment issues such as the hypertension and obesity that may affect her prognosis along with the change in body systems.

Additional issues

Poverty, ageism ( discrimination of people based on age ), abuses such as physical, sexual, emotional abuse, neglect, etc

Mrs.Helen faced indirect physical abuse because she encountered falls three times may be because of the staff negligence.

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3. Concerns with bruising

Bruising happens because of the damage of blood capillaries under the skin, it will occurs easily to the older people because of decrease skin elasticity and adipose tissue under it. Bruising will be recovered naturally by absorbed into the circulation within few days to weeks. If it is sever it can be managed by applying a frozen compress along with elevating the affected extrimities above the heart level. So helen was discharge from the emergency department following examination and observation.