Mom's sick. At what point do we call the doctor?
Often, we wait it out. Sometimes things resolve, but sometimes we want them to resolve so much so that we don't realize it has been too long. Like new parents, we don't need to call the doctor every time there's a squeak. We don't, however, want the squeak to turn into a siren.
Mountain or molehill?
You know Mom. You know her resiliency. If she is very sensitive to any small disturbance in her health, even the slightest bump, bruise, cough, or sneeze is a potential ICU admission, keep that in mind. If Mom is tough as nails, and when she partly severed her finger chopping wood said, "It's nothing dear, just get me a Band-Aid," you must take that into account as well. Knowing what they can tolerate, how they see their symptoms, and if everything is a major deal or if nothing is, that will be your compass.
What's wrong?
Assess the symptoms. Are they interfering in the activities of daily living? Does Mom want to stay in bed much of the day, or more than usual? Is her appetite down? Is she short of breath? Is her energy zapped? If your answer is yes to any of these, a visit to her primary care provider (PCP) is needed; if you have other data (fever, wheezing, changes in thought process, weakness, unsteady gait), a visit is necessary.
If the symptoms are not that severe but are relentless, meaning over three or four days, a visit is recommended. If you were dealing with a robust middle-aged person who had a reserve to heal from this type of illness, it might not be an issue. But an elder, with other medical concerns, is more fragile and needs medical attention.
Sometimes, the popular view is that "it's a virus and has to run its course." If you have been watching your senior get sicker and weaker, advocate for them. If there is extreme chest congestion, is a chest x-ray advisable? Ask their PCP what diagnostic tests could be run. Ask how they determine whether something is a virus or a bacterial infection. If you have been to multiple office or clinic visits, and the symptoms persist, more passionate advocacy may be necessary.
If the issue is not of an infectious process, if it's cardiac or mental status, chest pain, extreme shortness of breath, acute changes in speech, mobility, or thought process, immediate medical care is warranted. If there is significant effort involved in transporting your loved one or a notion that their condition may worsen en route to the Emergency Department, call 911. Be safe, not sorry.
Worse?
If your loved one is under medical care for an existing condition and it is apparent that there's a complication, do not wait until 4:45 p.m. when the PCP's office is closing. Giving them time to respond to your call is essential. Collect your data and document what is going on to help them see a clinical picture. "Mom doesn't look good" is not helpful. "Mom is feverish, pale, has chills, and seems newly confused," gives them the data they need to provide a helpful course of action. Many times, chemo, medication, or simply the advancement of an existing condition requires emergency or urgent care. Your PCP may be able to triage your situation over the phone, recommend a treatment or medication, or direct you to seek emergency care.
Who else can help?
If you have visiting nurses, palliative, or hospice care at home, calling the agency who is providing your services is a good source of help. You will most likely speak to a licensed clinician who can help you determine the best response to the symptoms your loved one is experiencing.
Plan ahead. Better to call and not need the help, than to wait and find yourself in a crisis. Call early in the day so that you can follow the plan of care recommended to you by your treatment individual. Ask questions. Don't hesitate to bring your concerns forward. Colds and the flu can turn to nasty infections that are much more difficult to treat and recover from. If you are worried, you very well may have something to be worried about. Keep track of the data, communicate effectively, and advocate. Your loved one is counting on you.
Joanne MacInnis, RN, is the founder and president of Aberdeen Home Care, Inc., of Danvers, a concierge private duty home care agency in business since 2001. With 35 years of nursing practice, management and administration experience focused on home care and hospice, Joanne and her team specialize in advising and supporting families addressing the elders in their lives retain dignity and quality of life.
