Recently I wrote about my mom who is experiencing the challenges of aging with some dementia, frailty, and regular hospitalizations and rehabilitation stays to address some chronic health issues and strengthen her 95 pound stature. She will turn 93 this August, and is still excited about decorating her new assisted living apartment that she hopes to move into in a few weeks.
With my mom’s decline in health, and the proven decline that has become evident every time she has a hospital stay, mostly due to disorientation and atrophy from being in bed, we made the decision to not have hospitalizations any more as it does not improve her quality of life. Please note this is not a comment on the hospital, it has to do with the revolving door effect of emergency admittances and in-patient stays on an elder.
The situation with my mom is not unlike those who are also in her age bracket with similar declining health issues. One must be a realist and we all know as we age, the body just “ain’t what she used to be.” It is difficult to watch loved ones lose their vibrancy and resiliency.
For the past five weeks or so, my mom has been in a local rehabilitation center in order for her to have the physical therapy she needs after numerous hospitalizations, to become strong enough to go back into an assisted living facility. We feared she would have to stay permanently in the nursing/long term care wing of the rehab, but after much understandable protest from my mom, we agreed she could move to an assisted living and receive the extra help she needs.
Unfortunately, after a wonderful day of visiting her soon-to-be new home at the Willows of Wildwood Assisted Living, my mom had a relapse of not feeling well and took to staying in bed at the rehabilitation center where she is still receiving care. She was having chest pains but X-rays and other tests ruled out a heart attack. Low-grade fever, weakness, and no desire to eat or drink in any quantity had caused further health issues.
I often say, and it is part of my business, that elders have to have an advocate no matter where they find themselves, be it in their own home, hospital or rehab, or assisted living or nursing home. Someone has to be looking out for their interests and care, to ensure there is not apathy or neglect of their needs. I am this person for my mom, and for others where the adult children live out of state and want the assurance of having their parent being supported in various ways.
This past weekend, after urging the rehab to investigate my mom’s health issues further, blood work was taken. I was there at 2 p.m. on Sunday when the results came back, showing dehydration, increased white blood cell count indicating there may be an infection, and also comments on an earlier chest X-ray that had been done, with a question of if there was a problem. I asked the nurse at the rehab to call the doctor and ask for an IV for my mom, in order to give her a boost because of the dehydration. Dehydration is very common in elders who are prone to not having enough fluid intake, and with my mom’s low grade fever, not feeling well, and lethargy, an IV drip can help provide the nutrients needed to gain strength and overcome the dehydration symptoms.
The nurse did call the doctor, and I checked back with her at 4 p.m. to see if the IV drip had been approved. The doctor had not returned the call. I called back again at 6 p.m., still no return call. I called again and again and also called the doctor’s office myself and left a message with the on call service. I debated with the staff that my mom needed this IV and also that I had concerns that the doctor who is responsible for her care was not returning calls. While I realize the nurse cannot do anything without a doctor’s order, I wanted the doctor called regularly until there was a response. This is a licensed nursing care facility, and a doctor assigned to it, in order to provide direction to the staff, was not responding. I had no patience any longer.
The nurse and I had a verbal tussle. She told me I could send my mother to the hospital if I wanted her to have an IV immediately. I reminded her that we have a “do not hospitalize” order because it causes further decline in my mom, and she is already in a nursing care facility that is licensed and able to provide this IV without disrupting the patient by calling an ambulance and hospitalizing her. Additionally, the cost of hospitalization is far greater than providing her an IV in her room where she has become comfortable and is oriented to the staff. All I wanted is for the doctor to call back and provide direction to give my mom an IV for dehydration. It is not a complicated request or remedy.
As I mentioned, it was 2 p.m. when the lab results came in showing that there was dehydration. It was 8:45 p.m. when I finally heard, because I called again, that the doctor had responded-seven hours later. This is outrageous. Not only that, but his direction was to continue to try and have my mom drink more fluids, which they have been trying to do since her initial admittance. He told them to take more blood tests on Tuesday.
Really? Tuesday? My mom is lying in her bed dehydrated, is 95 or so pounds, is weak, and has little desire to eat or drink. She needs nutrients put into her. By Tuesday, she will have lost more weight and become disoriented. This facility has the ability to provide a solution, in the immediate, where she is comfortable and secure, without the disruption of ambulance and emergency room and upset. And we waited seven hours for a response from the doctor assigned to my mother’s care.
So I will be continuing this effort to get my mom what she needs, where she is. If I was not here, if I was not visiting and calling and advocating, and yes, sometimes being aggressive in my demands, there would be no voice for her care. And I know this is not uncommon, as people share their own stories with me of elder care, or lack thereof. It should not matter that we have a no hospitalization order for my mom, she should be able to get what she needs and is entitled to right in the skilled nursing home facility. The cost of moving her to the hospital, both in terms of dollars to the Medicare system and to her emotionally and physically is not necessary. And the question remains, why does it take seven hours for the assigned doctor or his substitute to respond to a phone call with a request about a patient?
I will be reviewing the recent federal rating of this nursing home/rehab, as well as others in the local Villages area, in the near future. While the staff overall have been exemplary, one should not have to be forced to make a case to have their loved one receive some basic intervention in a health care facility.
Next week I will be writing about how to interview caregivers for those who receive in home support or have a health care agency coming in to provide services. Recently the Villages- News.com reported on the theft of personal possessions by a home aide. Let’s talk about the precautions that can be taken to minimize this happening to you or your parent.
For questions or further information, or if your loved one needs an advocate in the hospital, long term care facility or at home, call Jane Bloom, The Other Daughter, 352-391-0899 [email protected] or check out my website www.theotherdaughter.org