Thursday, July 23, 2015

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.


  1. First of all let me say bless your mom and her sister. They look good for their age and thank the Lord for looking after them. I am glad the people there are addressing your concerns. I remember back in NYC my friend's mom was put in a home and it was terrible. If you cannot do for yourself or at least sit for long periods of time they put you into bed and just leave you there. The food was not good quality and my friend had to keep getting her meds changed because of side effects and because some didn't mix well together. Blessings to you and yours.

  2. Thank you for you sweet thoughts, Rasma. They live in a nice place and the people are very loving, for the most part. My concerns are about the excess medications they are prescribing for the ladies. I'm sorry to hear about your friend's mom and the treatment of their patients. Blessings back your way and hugs.

  3. Hello Peg, I have many thoughts concerning this. The best is that your Mom and her sister are so very lucky that they have an advocate like you looking out for their interest. For the most part, I sense, that they are receiving good care. That is what I feel, from your reports.

    There are not really any good answers to the questions of care, and compassion for those that end up in homes. You seemed to be lucky to have found one with fairly good care givers.

    It must be heart wrenching for you.

    You look so relaxed in the new header photo. Cool!

    1. Hi Mike, So good to see you today. Thanks for reading this blurb. Most of it would be familiar to you after reading my other stuff. Yes, you're right. This home takes particularly good care of the ladies and for that, we're grateful.
      PS I had to delete the ebook services link because it was generating some posts about car auto. Not sure why. Also deleted most of the Amazon links that required an update to the new format.

  4. Amazon makes changes, they do not realize how the ripple effect causes so many issues.

    Glad your loved ones are being well cared for.

    1. Yes, true. The code changes to the html were not within my tiny grasp of techno babble. I also deleted my cover photo after doing an analysis on my blog page. Slow loading photos etc. causes issues.

  5. Oh Peg,
    I truly don't know what attracts uncaring people to the health care profession.
    I admire and love you for the advocacy and determination that you consistently show in assuring the best for these sweet ladies.
    Hope things have greatly improved and please give them hugs from me. Love, mar

    1. Mar darling, you are the sweetest nurse I know and there are many who truly provide caring and loving attention to the ladies. It is the rare instance where I see neglect and it's on a small scale, although disturbing at times. We remain grateful that our loved ones have a wonderful place where they have twenty-four hour care and that issues are resolved promptly.
      Thank you for your sweet thoughts and caring nature. You serve as an example of what nurses need in the way of compassion.
      Love, Peg.