I was asked to put my concerns about Dad’s experience at rehab to give to some higher up person. It took me a while with how busy life is, but here is the summary. Hopefully, it will make others aware of what to advocate for if they are in our medical system.
“Thank you for taking the time to look at my concerns. The reason I have taken the time to put this together, is that I have a true concern and passion for helping to improve the quality of care in our medical facilities. My dad went to your facility on Saturday, Nov 25 of this year and I am hoping my observations will spark some changes that will improve future patients’ experiences there.
Overall, most of the staff were pleasant, which is important for people to feel comfortable. However, it is even more important that they are effective in giving patients what is needed. Overall, there is a severe lack of information available- for patients, their families, and even the staff. Every day I walked in and had to start an investigation to find out who Dad’s nurse and aide were. Not only did he not know, but it would take several attempts with different staff to find out as well.
A very simple solution would be to have small dry erase boards in every room like most facilities have. Rehab doesn’t need the large ones with tons of information, but just a small one for nurse/aide information. Having one in the nurses’ station would be helpful as well. Staff literally just looked at me and said, “I’m not assigned to him. I don’t know who is or where to look to find out.”
Another solution, would be to train staff to develop a much better attitude for helping. In other words, staff should really be saying, “I don’t know the answer but I will find out for you.” And then they actually find out and return with the information. This seems like common sense, but it was completely lacking there with the exception of one or two nurses that would put the effort in. I would literally spend a significant amount of time walking around your halls trying to find things out.
Along those lines, there also was no atmosphere of team work. Nurses would not do “aide work” even if they were with the patient. Aides wouldn’t help if asked if dad wasn’t “their assignment.”(And then they were unable to tell me who he was assigned to!) I have been with Dad in several facilities and a sense of teamwork is definitely possible. Not surprisingly, those few who were helpful, were also the same individuals that would find out answers for you.
Someone mentioned at one point that the schedule was supposed to enhance continuity of care. I honestly don’t remember two days in a row where he had the same nurse or aide, much less several days in a row. Perhaps it happened for a day or two, but it definitely did not seem like there was continuity of care.
At one hospital, at shift change, every nurse comes in with the next nurse on shift and introduces the patient to the nurse. That is incredibly helpful and creates a warm and safe feeling of trust in the care being received.
I recognize that some of my frustrations are part of the bigger mountain of a problem with the medical “rules” in general that seem to lack the patient’s well-being as the priority. When medical systems became businesses, the focus shifted on making money, away from patient health. It is maddening when you are a caretaker/advocate for someone and come up against this. Over 98% of patients do not have an advocate to help them. I have to consistently be the squeaky wheel in order to get simple things in place.
For example, I discovered (rather than anyone on Dad’s medical team) that he did not require a sling. This was crucial information that would change the entire course of rehab. I let the unit nurse know and she said she would check the orders and call who was necessary and get back to me. It was MY follow up that took several phone calls back and forth with doctors and your facility that finally got “orders” changed but it took two and a half business days to make it happen. That might not sound like much, but when it is your quality of life and treatment that is at stake, that can feel like a lifetime. One day after the sling issue was resolved, I arrived to find Dad wearing the sling again. He said “the woman said he had to wear it.” Of course, it took me running around the hospital to find out what was going on. I finally got to the nurse on duty who said she didn’t know who did it but they must not have read the orders. She had absolutely no concern in finding out who it was so it could be addressed. And she missed the point completely that medically, this was actually something that would set Dad’s therapy back if he continued to wear it. No follow through, no concern. And what if I wasn’t there?
Dad also came in to your facility with stitches in his head. I started the very first day of admission to ask staff to make sure they were removed on the day they were supposed to be. It took a ridiculous amount of bugging and nagging to make it happen. What needed to happen was that a doctor literally spend several seconds looking at his head in order to give permission to the nurses to take them out. Taking them out was only a matter of minutes as well. At one point, the excuse was that the doctor that was in that day, was not the doctor that could be billed for it. That is ridiculous. Again, the facility’s profit is the concern, not the patient’s care. The billing is not the patient’s worry. If your staff can’t take five minutes (literally) to do something so simple for the good of the patient, there is a very serious problem.
One morning, I arrived at 9:10 am to find my dad on the toilet, still in a hospital gown. He was furious. After investigating, I found out that the aide who put him on the toilet went on break, leaving him there and not telling anyone. He had been waiting quite a while. When there is no teamwork, the other staff isn’t going to answer a call light if it’s not their assigned room. I have no idea why he wasn’t dressed either.
The same day, I found his room in bad condition. The bed was a mess. The tray table had red thickened liquid dried on which couldn’t even be removed with soap and water. The same stuff was on the floor, also dried on. Urine was in the urinal, which causes the room to smell. Most disturbing of all, was the used diaper in the middle of the floor. I showed the room to the nurse who said she reported it. It was absolutely inexcusable.
Another time, I came in to find Dad’s dirty clothes lying in the closet in several places. There was no dirty laundry bag. I was doing his laundry daily so I set about trying to find one of the bags. I can’t even tell you the frustration with the amount of time I spent literally walking around the entire building trying to find someone who knew where the bags were kept. And because no one is in the mind set of trying to find things out for you, I went from place to place. After I finally got the answer, I actually returned to every one of the staff I had asked and told them where the bags were kept so the next person that needed one wouldn’t go through that.
One day Dad had an appointment off site. I was told transportation could be provided. I set it up, and thankfully, I got an erroneous bill before the appointment for another transportation cost. When I called to find out about it, they agreed it was in error, but informed me that the upcoming ride would be $110!! I canceled the ride and took him myself. The person who set it up didn’t seem concerned that I didn’t know. I would think that when you are providing services that are extra expenses, it should be protocol that the patient is fully informed before signing up.
Dad was discharged on a Saturday morning. I knew how things had gone, so I started preparing for this on Thursday. For two days I talked with several staff members to make sure that everything was in place. As a single mom and Dad’s primary caretaker, I had limited time and I needed to get him at 9 am. I checked and double checked with charge nurses and social workers. I was reassured repeatedly there would be no “hiccups” with discharge. The paperwork was ready, notes were left for staff, and everyone was informed. I stressed over and over how important it was for discharge to go smoothly.
I arrived on Saturday to find that absolutely everyone had paid me lip service. No paperwork was printed. No notes were left. The weekend staff had no idea he was being discharged and nothing was ready. I was in tears. The level of stress that caused me was totally unnecessary. It was sad that I felt I had to check and triple check everything days in advance because of the lack of follow through, but to find that I wasted my precious time anyways was infuriating.
I would be happy to discuss any of this further. My heart is not in the place of complaining for the sake of complaining, but for the hope that things can be improved. Your staff could do a much better job and have more satisfaction personally and professionally by taking better care of the patients in their care.
Thank you for your time.”
After what seemed like forever, Dad returned to his apartment last Saturday. Of course all the preparation was for naught because the promises made to me on Friday were only empty words. When I arrived to get him, the staff had no idea he was being discharged and the paperwork wasn’t even printed out. After several hiccups, he was finally in his own apartment.
It’s been a bit of a roller coaster since then. Three hours after going home, I came back to visit him and he was shaking like a leaf with a fever. After consulting with a nurse, he took some Tylenol and seemed back to himself. The next day, the visiting nurse came to see him. His blood pressure dropped from 120 down to 80 (top number) when he went from sitting to standing. I almost had a heart attack myself when she said she had called in to see if he should be sent to the hospital. Thank God the answer was no. We both would have freaked out.
The next morning we were able to meet his new doctor. I asked if we should increase his low blood pressure med. She suggested we keep an eye on it this week before adjusting anything. Later that day my boyfriend and I were going to walk the dog when I got a call from Dad. He wasn’t feeling good. We went right over and he said he was feeling dizzy. He tried to get up from his chair and almost fell. Thank goodness I caught him. I had my boys come over right away to stay with him while I worked. Then we went back later. He was already sleeping by 8 pm but he seemed stable.
Tuesday came and the visiting nurse called and said his BP was low. She said she would let me know how it was on Thursday. That brings me to today. I went to see Dad in the morning and his PT person happened to come at the same time. I told him it was good timing because Dad was struggling to stand up from the chair. The visiting nurse and her assistant showed up too. This time Dad’s BP was 80. When he stood up, it dropped to 60/40. Seven different medical people later managed to convince Dad to go to the emergency room. He did not want to go and I didn’t blame him. We both had a good cry. They suspect he is dehydrated.
As I write, I am in the emergency room with him. His blood pressure is up to 119 with no intervention, not even fluids. There has been no doctor to see him yet so I have no idea what is happening. The best case would be some IV fluids and back to his apartment. My heart breaks for him. He’s a good man who has lived a good life. He has been ready for what is next for well over a year. Instead, this is his sixth hospital visit in the last 14 months.
The folks where he lives have been great. It is obvious that in the short time Dad has lived there, he has made an impression. He is so well liked and everyone is so concerned for him. They are responsive. I told them all that there is nothing to increase your appreciation more than to be forced to be somewhere else for a while. Here, people do their jobs well and still have common sense and compassion.
Say your prayers for us. Exhausted doesn’t cover it. And whatever I feel, I am quite sure Dad’s suffering is much worse. It’s physical, but it is also just so very emotional.
After a very emotional and exhausting week, Dad is coming home tomorrow! I know it could have been a much longer time, but it felt like it was a really long road. It was weird leaving rehab today, knowing that on a Saturday morning none of them would be there when he is discharged. After a while, it feels like they are family. The physical and occupational therapy department were really great with him. They liked working with him too because he is just a nice guy and they appreciate him. It sort of reminded me of when I left Hospice after Tim died. These are people you start to see every single day, and suddenly you know you will probably never see them again.
Plus, there is the connection of feeling grateful to someone who has helped the person you love. When someone takes good care of your family, your child, whoever, there is a warmth toward them that doesn’t go away. There were obvious problems that I’ve blogged about previously, but there were many who did their jobs extremely well.
Dad is counting down the hours. They are letting him out at 9 am to accommodate my schedule because I have a hellish day tomorrow. I need to get him all packed up, transported home, unpacked, and have his meds ready for the week, all before 11 am. I appreciate them getting him out earlier for me.
My sister from Tennessee and I talked about the need for someone to keep an eye on things for the next week. The assisted living home where he resides think it’s a great idea as well. Truth be told, I think Dad does too. No more falls. He needs to be careful. Sometimes he still struggles with buttons or shoes. Someone should be nearby when he showers, just in case he loses his balance. We can hire staff to handle those things, but it’s frankly a ridiculous amount of additional money. I’m hoping we can handle it ourselves.
Monday he meets the doctor at his living complex. I’m hoping we like her. After that, I will have to buckle down and help him with all his Christmas preparations. We’ve done what we can already, but there will be plenty of last minute things. Too bad hardship doesn’t check in with your schedule. It always seem to happen at the most difficult time. But there is no one that can control that. And in a self-centered society that promotes individual happiness, the art of sacrifice is sometimes a lost virtue. I’ve been studying a psychologist who bucks that bologny and pushes for putting others ahead of yourself. It’s refreshing to read him.
Thanks to all of you for your prayers and support and visits and love and the countless hours listening to me vent. And yay to dad, who does his best to push on, even though he has been ready for a long time to be done with this side of heaven. Love you, Dad!
This week I had one of the best weekends of my life. I was totally burned out and exhausted from everything going on around here but I came back with my heart full and ready to tackle things again.
I went to Georgia to see my daughter Emily. The occasion? The birth of my granddaughter Sabrina! I couldn’t wait to get my hands on her. As you can see from the pictures I had received, she is utterly perfect and the wait to go was torture.
Miss Sabrina, like most newborns, was not sleeping through the night. In fact, she was eating every 90 minutes, even though she is formula fed. Emily was as exhausted and burned out as I was. I got to spend the last couple of nights with Sabrina in the same room with me so I could get up with her. We discovered using a pacifier would hold her off and then she would eat more when it was time. One night she actually slept five hours!
I need lots of sleep. A good night for me is eight to ten hours. While I was there, I didn’t get much more than four hours of sleep and it didn’t even matter. I decided after spending the first night with her cuddled up on my chest for most of it, that we were bonded for life.
But I got much more than I bargained for. Emily’s partner also has five children. I discovered all five of them were going to be there for the weekend as well. Aubry told them that she would share her grammy. “You can kiss my grammy if you want.” Before 24 hours was over, the younger ones were calling me Grammy. In one trip I went from two grandkids in Georgia to eight! I couldn’t help but look around their beautiful house and remember that when I was young, this what I had envisioned for myself. It’s not what happened, but this is happening now and it’s beyond lovely.
The dad would tell the girls to go chill out and give me a break. I told him that I live with all boys who hang out upstairs and don’t think it’s cool to be with me. I am often very lonely. I was loving having them fighting over my attention. I didn’t need a break!
They had to take turns, but I got my hair done, my make-up put on, and had several different nail creations. I’m not used to girls! Emily just kept telling me how brave I was. It’s true, some of the end results were a bit frightening. I decided when the bright red wouldn’t come off my nails, that I would show them off proudly as the sign of a good grammy.
My sister and her family even came up from Tennessee for a night. That night there were nine kids! And my great-nephew is unbelievably cute. What a weekend it was. I came back and went directly to rehab to find my dad doing incredibly well. He looks like himself, is smiling and joking. We are talking about discharge next week!
Talk about blessed. What a week!