Patient Advocate Issues

When you’re ninety to ninety-five years old who will watch over your best interests? The duty falls heavy on my heart ensuring that my mother and her sister are well cared for at the skilled nursing home where they live. 

For the previous ten years, they shared a home in the country with a fenced yard, private bedrooms, bathrooms, and a fully equipped kitchen, where they shared meals, watched television and spent quality time together.

In 2014, a nasty fall while taking care of her cat sent Louise to the hospital. She needed physical therapy, rehabilitation and rest. A month later, there was an opening for a bed and Mom joined her at the skilled nursing facility. At eighty-nine, unable to hear well and finding it hard to remember her address or dial the phone made it unsafe for her to remain alone. The potential for disaster became clear after a grease fire in the kitchen nearly took its toll. When it came to taking prescription medication, meal preparation, kitchen cleanup, shopping for groceries, or performing household chores, things were no longer simple for these two home-bound ladies. They tried to manage for a time with a home health aide and maid service. Ultimately, it was clear the best solution was to take a room at a skilled nursing facility where they would have a full time staff of nurses, dieticians and aides.

It's been fourteen months since they moved in. This week at the quarterly family conference to discuss how things are going with residency, satisfaction on food service, meals, their treatment by the nursing staff and their medication issues, I had a list of concerns to bring to the table.

Last Wednesday, I arrived at 8:00am for breakfast with the ladies. Mom had already finished eating, yet, Louise was still not at the table an hour after her usual time. Heading down the hall to find her, an aide yelled that Louise was "on the way". I found the door to their room open and the bathroom door open. My thoughts went to the privacy, dignity and respect this lacked. Louise was on the toilet crying saying she needed help to get up and back into her wheelchair. She had been sitting there for an indeterminate time, long enough to become agitated and distressed. She told me she had a bad headache and her eyes were runny. Standard procedure is to get the residents up and on the toilet where they hand them a warm washcloth to clean up before getting dressed. She was already dressed but had not washed.

The problem touched me on several levels. No, she had not pushed the nurse call button. She is afraid of technology and doesn't want to bother anyone. Whoever put her on the toilet already knows she's there and knows she needs help. Wouldn’t they check on a patient after a while? Some training on compassion might help matters.

Directed at the food service manager was the issue that her apple juice had been poured an hour earlier and set out at the table next to my mother. There were two flies sitting on the glass. Had I not been there, she would have consumed that tainted juice and never known. I suggested they serve the resident after they arrive or at least put a protective cover like cellophane wrap on the glass. Also requested was that Mom’s daily food menu have a notation about black pepper allergy and no onions and remove the note that says, “No bananas.” She likes bananas. This is the second request to change her food preferences.

Mashed potatoes with black pepper

A week before this meeting, Mom asked if there was a chance they could move back to the other wing where they spent the first months before moving to long-term resident’s wing. Her belief was they received better service and treatment in the other location. When questioned at the meeting, she meekly said, “No, they're treating us better now that they are getting used to us.” In one week, I was doubtful that things had improved much; rather, she didn't want to make a fuss and have people angry with her.

The last topic was on concerns over the added medications in the past year of residency. When admitted to the facility in April 2014, Mom was taking only three prescription drugs and two over the counter pills (for acid reflux and a laxative). 

Med List March 2014

A three page report received from the insurance company listed more than a dozen prescriptions in the past month. The staff printed out a list of her current medications and we reviewed these medications line by line. 

For a fact, she currently has nineteen medications on the list, some taken daily, others, on an as needed basis.

My primary concern is about drug interactions and side effects of the added drugs which include:

•  Increased risk for heart attack or stroke 
• Increased blood pressure 
• Increased heart rate and heart palpitations 
• Breathing problems, upper respiratory tract infection (which she had when taking this Rx in the past) 
• Cough (the issue for which the product was prescribed) 
• Muscle pain 
• Shakiness, nervousness, dizziness

Results: Six medications that were duplicates have now been eliminated (or DC, discontinued) including one for Hydrocodone (Tier 2 Narcotic Drug for pain) which I have asked twice to be removed due to ongoing issues with dizziness. Once I spoke to the Doctor directly and he said he would mark this as an allergy so it would not be ordered again. At a later time by phone I requested the same thing with the physician’s assistant. The medication appeared on the list of current prescriptions today. I was assured the order would be discontinued.

Overall, I was pleased that they took time to address each of my concerns and (hopefully) will take action to remedy these issues.

The main point is to bring awareness that although the competent care of a loved one is something to be expected, for the patient advocate it's an ongoing process requiring constant vigilance. We’ll see if any of the changes actually take place.