A Change in Care
When Mom was moved the other day to the skilled nursing facility just across the parking lot, apparently, none of her other records were moved with her. She wasn't there 10 minutes when the nurse came into ask her all of the questions the hospital had been asking for 8 days. Questions from "Do you have any allergies?" to "When was the last time you used the bathroom?" And then the questions got a little scarier - "Do you know if you were given the I.V. today?" Exasberated by this point, I asked the nurse, "Wasn't all of that included in her medical records that was just sent over here?" She shot me a dirty look, "Well, yes, but...." At dinner, they brought my mother an unappetizing looking bowl of low sodium soup and some no-sugar jello. She wanted the poke cake her roommate received. I told the nurse, "She is not on a low sugar diet." Again, the dirty look and "Well, that's not what the hospital has down." I told her to call her doctor, because I had watched her eat pudding, ice cream and even a piece of strawberry shortcake at the hospital.
Sure enough, she brought the cake in after speaking with Mom's doctor. I stayed with her until her meds were given that night. The next morning, a male nurse came in and hooked up an I.V., when he came back, my mother asked about it since they had been giving her antibiotics to her in the evening. He left the room and came back, "Oh, yes. These are the ones you're supposed to receive at night."
It is because we couldn't give these medicines to her at home that she is even still in the place, so we want to make sure she gets them on schedule and because the schedule was thrown off yesterday, I'm not sure what she got and what she didn't.
And yesterday, at breakfast, lunch and dinner, she had to continue to argue with them about her diet. Each time, having to wait 15-20 minutes for her food while they checked their records again.
This place isn't bad and this kind of thing isn't unusual when a new patient comes in. It is also why I am against the rule of Medicare deciding when a patient must be turned over to a nursing home, rather than the doctor making individual determinations based on his patient's needs. My mother, to our doctor's knowledge at this point, is not going to need long term care. She just needed 5 more days of I.V. therapy to make sure they have a staff infection under control.
All of this upheaval was created because Medicare refused to allow her to stay in the hospital for 5 more days - even though her doctor said that was best.
And the worst part of it was that Mom fell into a very dark depression yesterday. A depression that if it had happened to other elderly folks who didn't have a caring doctor with an excellent bedside manner, probably wouldn't have come out of it.
This is part of the reason why Muriel R. Gillick, MD, Hebrew Rehabilitation Center for Aged, Department of Medicine, in MA wrote in 2002 that the most elderly and frail patients shouldn't be moved from location to location:
"During a single illness episode, the sickest, frailest older patients are often treated in multiple distinct sites, including the emergency room, the intensive care unit, a general medical floor, and a skilled nursing facility. Such frequent transfers involve changes in physician, changes in nursing care, the rewriting of orders, and physical dislocation, all of which can adversely affect outcomes. This system, although efficient, increases the chance of medical errors, promotes delirium, and undermines the doctor-patient relationship. Partial solutions include a team approach to care, an electronic medical record, and substitution of home for hospital care. A more comprehensive solution is to create a geriatric hospital for treatment of the most common medical and surgical problems and for provision of rehabilitative or skilled nursing care. Designing new institutions for geriatric care will require new legislation and a new set of regulations but should be considered for the oldest and frailest patients."
My aunt said the other day that this country has a lot to answer for in the way we treat our elderly, our babies and our veterans.
Amen to that.
Sure enough, she brought the cake in after speaking with Mom's doctor. I stayed with her until her meds were given that night. The next morning, a male nurse came in and hooked up an I.V., when he came back, my mother asked about it since they had been giving her antibiotics to her in the evening. He left the room and came back, "Oh, yes. These are the ones you're supposed to receive at night."
It is because we couldn't give these medicines to her at home that she is even still in the place, so we want to make sure she gets them on schedule and because the schedule was thrown off yesterday, I'm not sure what she got and what she didn't.
And yesterday, at breakfast, lunch and dinner, she had to continue to argue with them about her diet. Each time, having to wait 15-20 minutes for her food while they checked their records again.
This place isn't bad and this kind of thing isn't unusual when a new patient comes in. It is also why I am against the rule of Medicare deciding when a patient must be turned over to a nursing home, rather than the doctor making individual determinations based on his patient's needs. My mother, to our doctor's knowledge at this point, is not going to need long term care. She just needed 5 more days of I.V. therapy to make sure they have a staff infection under control.
All of this upheaval was created because Medicare refused to allow her to stay in the hospital for 5 more days - even though her doctor said that was best.
And the worst part of it was that Mom fell into a very dark depression yesterday. A depression that if it had happened to other elderly folks who didn't have a caring doctor with an excellent bedside manner, probably wouldn't have come out of it.
This is part of the reason why Muriel R. Gillick, MD, Hebrew Rehabilitation Center for Aged, Department of Medicine, in MA wrote in 2002 that the most elderly and frail patients shouldn't be moved from location to location:
"During a single illness episode, the sickest, frailest older patients are often treated in multiple distinct sites, including the emergency room, the intensive care unit, a general medical floor, and a skilled nursing facility. Such frequent transfers involve changes in physician, changes in nursing care, the rewriting of orders, and physical dislocation, all of which can adversely affect outcomes. This system, although efficient, increases the chance of medical errors, promotes delirium, and undermines the doctor-patient relationship. Partial solutions include a team approach to care, an electronic medical record, and substitution of home for hospital care. A more comprehensive solution is to create a geriatric hospital for treatment of the most common medical and surgical problems and for provision of rehabilitative or skilled nursing care. Designing new institutions for geriatric care will require new legislation and a new set of regulations but should be considered for the oldest and frailest patients."
My aunt said the other day that this country has a lot to answer for in the way we treat our elderly, our babies and our veterans.
Amen to that.
posted by Kerri Fivecoat-Campbell at 6:53 AM
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