We discharged a patient last week to short-term sub-acute rehab in a nursing facility. Usually this would be the end of my involvement, except I got paged by a family member who had been very involved in the patient's care (and not in a way that made me want to stab him!), and ended up giving the rehab facility a call on the patient's behalf to push to make sure they were following the plan we'd sent the patient out with, and taking care of his needs appropriately.
And... now I understand why my parents are afraid of ever ending up in a nursing home.
(1)
"One of the things the family member told me he's concerned about is the diet his father's being served. As the social worker said in the discharge, he's supposed to be on a cardiac and diabetic diet, so I just want to make sure that's what he's getting."
"Oh, yes. Our cardiac diet is the same as our regular diet. And the diabetic diet here means we do not give him the ice cream."
"Yeah, we're hoping to keep his salt levels managed."
"We follow all state regulations for the diet."
"It's just that I was told that he was getting some meals that didn't seem particularly heart healthy-- meat loaf, chicken parmigiana, clam chowder, things that apparently he was finding very salty. So I just want to make sure."
"We don't add salt to our products, but many of the products do come with salt in them. The soup is from a can, and I believe there is salt added."
"Canned soup is very salty, sure."
"And the meat loaf, I'm not sure how much of that we prepare on-site and what packaged products we're using."
"Is there at least a way for him to get the nutritional information so he can make appropriate choices?"
"No, we don't provide that information to patients. But we follow all appropriate laws and regulations."
"Is there a dietitian on staff?"
"Sure."
"And he believes these meals are appropriate for patients with these restrictions?"
"We follow all laws."
(2)
"The family is also concerned about wound care. The patient apparently says he was woken up at 2 AM to have his dressing changed, but the nurse didn't have the right supplies, and left his wound uncovered until the day shift came in, hours later?"
"That does not make sense."
"I know. It didn't make sense to me either. It seems really inappropriate."
"No, it doesn't make sense because there wouldn't be anyone on staff to deal with any issues at 2 AM. I don't know who would possibly come into his room at 2 AM. No one would be able to address a wound at 2 AM."
"So no one is available for medical emergencies?"
"No, our PA is here from 9-3, Monday to Friday, so all issues are dealt with then."
"Wait, is there even a doctor? It's just a PA?"
"The doctor comes on Tuesday mornings."
"What?"
"This complies with all regulations."
"So a doctor hasn't even been involved in his care yet, since he came in last Thursday?"
"No, the doctor will see him on Tuesday, if he has time."
"And how is his therapy going?"
"I don't see any record of any therapy yet."
"Yeah, that's what the family said too."
"Would you like me to arrange therapy?"
"He's supposed to be there for therapy, yes."
"I'm not sure that was in the chart."
"What?"
"I do see something about an allergy, though."
"Yes, he has an allergy to penicillin."
"Oh, I'll write that in. It just says allergy, but doesn't have the details."
"That's an important detail."
"I'm writing it down."
"Thanks."
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Is this real life??? No wonder my parents told me if they paid for college I could never put them in a nursing home...
ReplyDeleteAmen!!
DeleteAs a hospice nurse for many years, I visited several dozen nursing homes in and around our service area, 97% of all the long term care facilities operated in this manner. None have physicians that live at the facility, that will never happen, but all have physicians that visit on a regular basis, it's the law. Orders are always misplaced, not followed, followed incorrectly or altered to meet the needs of a facility. I've even seen medication sheets where meds were signed off by nurses as given for days on end only to find out it had never even been ordered by the pharmacy. Very scary stuff.
ReplyDeleteI have to say, the best nursing homes or long term care facilities are those owned and operated and managed by nuns. Very little gets by the nuns and they are there to make sure the residents receive the most optimal care at all times. If you have to choose a facility, try to get into one run by Catholic sisters. Usually, there is waiting list of months/years. The Little Sisters of the Poor, is the BEST!!!
Horrifying. And the blame for hospital readmissions is exclusively placed on hospitals? Awesome.
ReplyDeleteThis is very disturbing. And yet, I think it's what we all fear about nursing homes - but never want to believe is true.
ReplyDeleteMy mom made me promise her that I would never send her to a nursing home, for these very same reasons.
ReplyDeleteMy mom worried and worried about it too. But thankfully, she died comfortably at our home on hospice. I NEVER ever would have put her in any nursing home no matter what I had to sacrifice, even if it meant giving up everything, I would have for her. Afterall, both of my parents gave and sacrificed for us so much as kids.
ReplyDeleteFor the most part, the nurses and CNA's do a great job in all of them...they really do love and care about their residents, it's just they are understaffed and overworked...mistakes do happen. It's never intentional. Overall, the conditions aren't horrid by any means in most of them...and truly, I doubt it will ever improve from where it is today, the bottom line is profit.
My mom works in a nursing home, in fact she's gone through several in her life. She wanted to be a nurse, but with that plan cut short, she chose to work in old folks' homes for the same ideal of work- looking after people.
ReplyDeleteUnfortunately, the lack of money (both for the homes and for the employees) and the low prestige of the job tend to mean low quality resources and a high turnover of young, uneducated staff. To be blunt, the places are failing businesses where frequently staff are more interested in catching cigarette breaks together or tapping on their phones, than treating the residents with respect and empathy.
I will never, ever ever send my parents to a nursing home. As a nurse who admits patients from these places into acute care, and discharges them back to these places when they are stable, I would never do it.
ReplyDeleteMy parents have given so much to me and continue to - I could never repay them, no less send them to live in a nursing home. I know I should never say never, but
In the short time I was working at a hospital, I saw patients come back from these places 2 - 3 times, and one gentleman looked like he had aged 10 years. It's horrifying. Disheartening.
I will do my damned best - I will work 3 jobs, I dont care - to make sure that if they need care, they receive it in their home, or in mine, when the time comes.
My grandfather spent the last few years of his life in a nursing home. His care was . . . adequate, but I think this was because either my mother or my aunt, one or the other in alternation, visited him every single day he was there. Even on Saturdays when we don't drive, they walked the two miles there and back. I think that because the staff knew that there was someone taking an active interest in his care, that they might have paid more attention to his needs than to some other resident who maybe didn't have family in the area.
ReplyDeleteAs far as "We follow all laws"... my next comment to the idiot you were speaking to would have been, "So you're saying, you do the bare minimum necessary to prevent being sanctioned by the state regulatory authority, and no further?"
I also think that my next call would have been to the patient's family to recommend that they yank him out of there post-haste and find somewhere else to put him where someone will actually realize what he's there for in the first place. Also tell the insurance company (Medicare, or what have you) not to pay for services not rendered. That's probably the only way to get these people's attention.
I am a physical therapist who works in a sub-acute rehabilitation/ long-term care facility, and I'm very disappointed at the experiences of the doctor and the other commenters. The nursing home I work at has multiple diet options that are carefully monitored by the staff dietician for nutrition and the speech therapist for consistency. We (rehab staff) evaluate every patient within 24 hours of admission to the facility. I love my job and enjoy every opportunity I have to provide assistance and dignity to my elderly patients. I would recommend for anyone considering sub-acute rehab or long term placement to do your research and ask around for recommendations, but please know that some nursing homes are excellent choices for those who need the assistance.
ReplyDeleteEmi care homes
ReplyDeleteAs a nursing care ability would be your household's home for years, it's best to thoroughly determine the ability and what it has to provide.
Increasing variety of old individuals is a growing issue these days. Due to the atomic family concept, the variety of adolescents reduces and the variety of old individuals increases. As a result, the variety of individuals who need to take care older individuals reduces
ReplyDeleteThankyou for this post - your article is really sensitive towards the subject of quality care for people with mental health needs. This care home can provide information about what help they can provide.
ReplyDeleteShameful. What kind of a nursing home is this? Inappropriate and the government must close this one. More people will be hesitant to send their elderly parents to this kind of facility.
ReplyDelete