In Your Face

Ernie Bitmann lives by himself, and spends his days in a wheelchair. His home is a low-rent, street-level apartment. Ernie survived a stroke a couple of years ago, the residual effects of which make it impossible for him to manage many of the things we all take for granted: his grocery shopping, his house-cleaning, his personal hygiene and even the answers to your simplest questions. You’re seeing him tonight because, as usual, he’s fallen and he can’t get up.

Ernie gets help from a visiting caretaker three times a week. The caretaker keeps his place clean and she’s a big help to him, but she’s not there on the weekends or at night. You’re his next resort, and you see him about as often as the caretaker does. You’ve done everything you can to prevent his falls—eliminated trip hazards, moved his furniture for him and bought him night lights. But he keeps falling, so he keeps pushing the button on his emergency medical alert device.

Ernie’s pleasant enough, and it’s easy to serve him, but he belongs in a 24/7 assisted living environment. Indeed, he wants that for himself. But he’s on Medicaid, and his daughter uses her durable power of attorney status to keep him where he is, 100 miles away from her. You’ve contacted her several times about her dad’s situation. At first, she pretended to welcome your advice. Then she started telling you she had made better arrangements for him. More recently she’s stopped taking your calls or returning your messages. You get it. She’s stonewalling you. She knows you will keep on responding to Ernie’s alarm. Evidently, it’s working just fine for her.

Q. How can we fix this? Ernie’s good for three wake-ups a week and, let’s face it, one of these nights, he’s going to break a hip. That may put an end to his falls, but it could also kill him.

A. You’re absolutely right. Hard to say for sure what’s going on with the daughter, but her efforts to manage her dad’s situation are clearly not effective. I think it’s time to contact your town’s Adult Protective Services agency, if you have something like that. If Ernie’s current living situation poses a threat to his health and he wants a change, they may have the statutory authority to overrule the daughter’s authority. If you don’t have an APS agency, you should arrange a meet with the PD. Maybe you should meet them at Ernie’s place even before your next call there. Explain his situation to them, and solicit their help.

Q. We’ve called APS, and they promised to intervene, but nothing changed. Ernie still lives alone in the same little apartment, and we still see him three times a week for the same non-medical issues. We’ve got to do something. Any other ideas?

A. Collapsing social services systems have been expanding our responsibilities for years. But other agencies are shouldering added duties as well. So, it’s possible they’re not sure how to proceed. I would have another talk with the APS people. Get to know their names and their direct phone numbers. See if it would help for you to send them your observations in writing, perhaps every time you get a call. It’s possible consistent documentation from qualified observers would help them to build a case on Ernie’s behalf. But do ask them, and be sure they understand Ernie’s predicament.

Q. It seems wrong not to be able to correct this situation. We know it’s not Ernie’s fault, but by consistently responding every time Ernie calls, we’re enabling him to stay right where he is.

A. I sympathize with you. Really, I do. But regardless of what seems obvious, if the daughter’s not communicating with you, you’re forced to guess what’s happening at her end. We’re EMS—Emergency Medical Services. There’s nothing in our training that qualifies us to administer Emergency Medical Justice. And we’re not omnipotent (although sometimes that might be helpful.)

This is frustrating stuff, I know. But I think it has to be enough for us to just go to work at the beginning of every shift and try to do the very best thing we can think of, for everybody we meet. We simply may not be able to help everybody.

And that has to be OK.

Thom Dick has been involved in EMS for more than 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO.