We have moved my Dad, 89 years old, to live with us. About 6 weeks ago he developed a cough and started to get a bit sluggish. We ended up taking him on a Sunday afternoon to the ER which diagnosed it as pneumonia (after the mandatory CAT scans, etc. for everything else). He spend 4 days in the hospital and then was moved to a very well known and respected nursing home/recovery center/hospice, etc. The official reason was the move was for therapy for the stumbling gate of someone with Parkinsons. He went in using a cane. He was there for 22 days and I could not see that therapy was doing much good. He came out using a walker. The first days at home were tough. My day began with 1 1/2 hour of mopping urine, throwing sheets in the washer/drier, showering, changing to clean clothes, etc. When I got him, they gave me four punch out sheets of medication. I got to the last tablet on one medication (which he did not use when he went in) on Thursday night and called the 800 ohone number for a refill. They only refilled for people in the center, not discharged people. Nobody ever told them that when I got him out. The next day I got in a four hour exercise trying to get a doctor to write a prescription. I was unsuccessful. Even the doc in a box would only write it if he became the primary patient which meant blood tests, etc. Finally Friday night I threw up my hands. He took the last pill Friday night. He had an appointment to see his regular internist on Monday. By Monday he seemed to be doing better. His internist said that the drug was a sedative and to quit using it. By Tuesday he only used the walker folded up and moved it on its wheels as he walked.

In short, he spent 22 days on a new mediation which turned out to be a sedative and totally negated the reason - physical therapy - for being there in the first place.

About ten years ago we were taking care of my younger brother who had MS and diabetes. There is a program called respite which pays for a very short stay in a nursing home just for a break. We used it to take wife's visiting friend to Las Vegas, Bryce and Grand Canyons. I took my brother there on Friday afternoon and went to pick him up first thing Monday morning. I took one look at him (I am not medically trained), stuck him in the car and took him right to the ER. His blood sugar was so high that they could not measure it. It pegged their devices.

Moral - be very careful of nursing homes and their medications when loved ones are involved.

Thanks for the posting Arab Nights. I have heard a LOT of horror stories about nursing homes and hospices and such, cases of patients who upon admission were able to talk coherently and walk on their own, and in less than a week they were vegetables. From the hospice/nursing home staff point of view, it is a lot easier to care for someone who does NOT wander around or want someone else to talk with, so the are very happy to dope the patients to the point that they are bedridden and just waiting to die.

I've been through similar things with my Mother starting last September.

Rule number one of doctors for you RIGHT NOW is demand to know what every pill does.

My Mother got worse on atypical-antipsychotics and I almost had to write it in her chart myself to stop them. I had full power of attorney and the nurses and doctors would ignore me.

So I read them the riot act and since I was there every other day, they finally gave up and talked sense to me.

Doctors are the worst. They float in and think they are gods and know it all. I tend to take them down a peg first and then get polite. A doctor won't die if you insult him/her or badger him/her. They might even listen.

I hate to say it this bluntly but if your Dad is incontinent use adult diapers. Do that at night especially because those wet sheets cause rashes and bed sores. Even sweating will cause bed sores. Part of the routine should be to examine his skin where sores can form - hips, ankles, elbows, the inside of knees, buttocks where the hips are when he sits and lays. Look for bruises and ask why.

I have spent over 40 years in a wheelchair and have had my battles with bed sores. I've kept them under control. It's part of my morning and night.

If you have steps then find a way to remove them. No falls, period.

Talk to therapists and find out there goals - not just what they tell you but watch them to see what they actually do. You can tell if physical therapy is doing good of nothing at all. As you already found out.

You can ask me here or in a private message.

Thanks Dave. We bought him adult diapers. There had been no need before. Also bought bed and seat protectors. The problem with adult diapers is when the person takes them off at 1 am .................................

I am thinking going to the hospital and telling them that do not and will not have my permission to automatically move him somewhere for "rehabilitation." Anybody know any suitable threats to get the hospitals attention?

Its always good to tell a doctor "your fired".

followed by under your breath comments like incompetent boob.

River

In my neighborhood, many oldsters stay in their otherwise empty 4 bedroom home

and have live in Mexicans who do better work than the "professionals".

For example, one person to help with personal care, nutrition, housecleaning, and

somehow bring a + atmosphere to a otherwise stale atmosphere.

Moi

Managed my mother that way for some time,

the Anglo was dealing Meth from the house.

OK people. Step one: Calm the F down. As a former nurse in one of these facilities I can address what you're running into with the staff. Generally, it's a LACK OF STAFFING. I cared for each and every one of my patients on a personal level, the problem is I had so many I didn't have the time to care for them properly. That is incredibly demoralizing and frustrating to the people who work in these facilities. Those front line workers are 98% of the time doing the best they can with the pitiful amount of resources they have been given. Remember, these places are first and foremost a BUSINESS. I was subject to insane and completely unreasonable conditions in which to perform the job/tasks I was mandated to do by the state where I hold my nursing license because the facility wouldn't pony up the dough to provide us the tools we needed to properly perform the job with which we were tasked.

I've also had my own family members in such a facility. So I also get this from the point of view of the patients family member. It's a crappy place for a person to end up. My patient load was 35-1. In a hospital medical/surgical ward, the state mandated ratio is no more than 5-1, there is no such mandated ratio in nursing homes except a formula that mandates 3.2 nursing hours per patient, per day. Since CNA's are cheaper (and cannot hand out medications) and can be counted in the 3.2 hours, nursing homes overload on those instead of nurses who can do more than bathe, clothe, and feed the patients. This is in California. During my 8-hour shift, assuming I would be able to provide direct care for about 7-hours. 1-hour was reserved for paperwork, calling doctors about patient conditions, etc. This leaves me 12-minutes per shift to provide care to each patient - All their medication given to them, bandages changed, Colostomy bags changed, emergencies taken care of, etc.

Twelve. Fucking. Minutes. Per. Shift.

Here is what my typical shift looked like.

1. Get to work, spend 30 minutes getting a report on the present condition of 35 patients from the off-going nurse and counting the narcotic medications in the medication cart.

2. Since my shift started just before breakfast, check the blood sugar level and blood pressure of all the diabetic patients and those requiring blood pressure medications.

3. Pray that none of my diabetics need their insulin. Because that is about a 5-minute process for each injection by the time I check their sugar, write the result in the record, get out the syringe, alcohol swab, insulin vial, and draw the insulin. Normally I'd have about 10 diabetics and 15 blood pressure management patients. See what happens if ALL 10 of my diabetics need insulin. And I'd have to do this for them all TWICE during my shift.

4. Once I get them all taken care of, start passing out medications to each patient. Hope that all of them don't have medications on this pass. By law, I legally had an hour before, and and hour after the recorded time to give the medication. This essentially leaves me a 2-hour window in which to give a medication, but they are not all written for the same time. That would be too simple. So I would often need to visit patients twice during the round. Hope the patient is somewhere I can find them, because otherwise I'm walking all over the facility (tick-tock) looking for them. If I have to do that, I have to LOCK MY CART, because legally I cannot leave it unattended and unlocked. This requires taking any medications off the top and putting them back in the locked drawer.

5. Take a 10-minute break after all medications are passed. Deal with emergencies, etc. If I have a couple extra minutes call the doctor, because Mrs. Smith's daughter is screaming at me to give them a new medication they are not prescribed because she took it at home and it made mom feel better. She thinks nurses can prescribe medications, something not in the scope of my practice.

6. After resisting the urge to strangle Mrs. Smith's daughter, try to get through to the doctor to get a telephone order for the medication and remove it from the locked and sealed emergency medication kit. document it, lock and reseal the kit with a numbered zip tie. Lock the medication room.

7. Give Mrs. Smith the medication, hope she doesn't cheek it and later feed it to the facility cat. (I actually saw this happen with thyroid medication... The cat foamed at the mouth for an hour...).

8. Mr. Jones is having a back spasm. His anti-spasmodic medication is a narcotic and is PRN (given as needed). I have to drop what I'm doing (lock everything up, see step 4 above). Document this, sign for it in three different places. Pray that Mr. Jones actually takes the pill.

9. Tie my dick in a knot because I've need to pee very badly for the past 3-hours.

10. Oh dear... Mrs. Robinson, bless her 104-year old heart, just died in her sleep. I really liked her because she wasn't a pain in my ass like half of my other patients and Mrs. Smith's daughter, who now insists her mother needs a Flinstone's chewable vitamin which is not prescribed, is now threatening to SUE ME because I'm not giving it to her because "You don't need a doctors order for it, it's an over the counter medication..." which if I did it her way would result in my license getting suspended and loss of my job/only means of support without being able to collect unemployment insurance. I really want to cry, because I actually cared for and loved Mrs. Robinson, but I can't, I don't have time to mourn her passing because I have to call her doctor, call her family and inform them she's passed, and call the funeral home she chose to come pick up her corpse.

11. Go on my lunch break. Unlike most people, I only get 30-minutes instead of a full hour, and at that I usually only get to take 15-minutes because someone will inevitably need something immediately, a patient somewhere is coding out requiring my presence break time or not... I don't want to let them die so I can eat lunch, so I run out and assist. Oh shit... I didn't eat lunch because I rushed to provide emergency care, but now I have to get back out on the floor because my assigned break time is over.

12. Perform my (patients) lunchtime medication pass to ALL 35 patients. Repeat ALL OF THE ABOVE, including the blood pressure and insulin checks.

13. Oh fuck! My relief just called in sick. Now I have to call all my other overworked colleagues who happen to have the day off and hope one will come in and cover their shift. It's Saturday, so odds are none will because we only get one weekend off out of 5, but I try nonetheless. I can't locate anyone. So now I have to work another 8 hours on top of my shift I just did. Yes, I'm getting paid $50 an hour for that extra shift, but damn, I'll only have 8-hours off until I have to come back and do again, assuming the relief after the second shift doesn't call in otherwise I'm in for a triple (24-hours on). I can't just leave, that's considered abandoning care and is immediate loss of your professional license.

Repeat this for two years and you might be able to understand why one day after my shift was over and my relief came on the clock, I quit on the spot. I was literallly ready to kill myself because of the stress.

So, yelling at the front line staff isn't helping your cause. While I can understand your frustration at the level of care your loved one is receiving, I'm begging you not to yell at them, GO yell at the facility Administrator, the Director of Nursing (DON), they are the ones with the power to fix the underlying problems, not the front line staff. They're doing the best they can with the pathetic resources those other folks gave them to work with.

Now that I've droned on, here is how you could get my attention even in that frazzled environment.

First and foremost - DON'T THREATEN TO SUE ME. The second you do that, I shut up, cease communicating with you, and your family member suffers even more. Why? If you're threatening to sue me, you've just threatened my livelihood which means I'm going to have the absolute MINIMUM, state-mandated interaction with your family member to avoid potentially giving you and opening to do what you just told me you were going to do.

Second, say please and thank you. As beaten down as I was, a family member that said these two things got much better service from me and others because I felt they at least recognized I was in a stressful and difficult situation, just as they are with their family member at the time.

Third, unless your family member is having an actual emergency, don't insist that every little thing that is going on in their situation is an emergency. Just because your person is having an issue doesn't mean medically that it is more important that the issue another patient is having at the same time. We have to perform triage and address the most acute and life threatening issues first. A patient in respiratory distress is going to get taken care of before I grab your mom a cookie from the kitchen.

Fourth, Know we expect you to have disagreements with what is going on. Please also communicate in a calm manner what you're observing. We are so busy, busy, busy, that you may be seeing something going on that we do need to be made aware of. Remember, we're not wanting to be adversarial with you, we want to help if we can and within reason.

Fifth, we're human, just like you. Please treat us as such. We're not pill throwing robots. Often the reason we are not literally dropping everything is because we have certain tasks that are mandated that we perform by the state who issues our license.

I rambling, but just keep in mind that a bit of kindness will get you A LOT further than the "suggestions" I saw people making here. I always wanted to help and do what I could to make a patient recover, or if there was virtually no hope they could, at least not suffer unescessarily.

Want things to change? Don't yell at the staff. Lobby your state legislators, congress, the president or governor. Staffing levels are the issue, and those will not change as long as businesses are only looking at profits and treating patients and staff like disposable commodities.

--LT

Now that I wrote that... Arab Nights...

I really do hope you get a positive outcome for your dad. Dealing with the healthcare system is certainly trying your patience I'm sure. As you saw with what I wrote above, it got on my nerves almost every day.

With what you're telling us here, it sounds like he should be been taken off the sedative, which would have required a doctors order. Usually those are given because the patient is anxious or has another underlying behavior condition making them uncompliant with their care.

He's there for rehab, he's not going to be able to participate well if he's drowsy or in pain. If you're his "Responsible party" (read, make his medical decision when he can't and are actively doing so) be aware of what medications he's taking, it's your right to know. Legally, staff cannot show you the actual medication administration record kept on the cart because there is information about all the patients there, but you can get the same information from the chart, which is specific to each patient in a separate binder, in most facilities.

Generally other than maintenance medications, our patients could not be discharged until these medications were stopped. For example, in California you cannot be discharged from a nursing home to anywhere other than a hospital if you have an IV.

LT - I didn't complain about the nurses. The doctors drove me crazy.

I had one or two nurses that I didn't care for but most worked very hard to keep the patients comfortable and well and busy.

SO please don't think my complaints were about the nurses and aides running around helping patients. My complaints were with bosses and doctors.

Arab Nights -

In Pennsylvania a hospital cannot transfer a patient without the family's permission. That being said, the insurance companies only pay so many days in the hospital. So I had some control. It was three hospitals , one rehab and two nursing homes. If you have more family to help, get them to do so. I had a brother with four kids. One of the kids stepped up and between the three of us, we kept things aimed at getting our Mom (and Grandma) a decent outcome.

If you can - get there and spend hours at a time. Watch the therapy sessions. Watch what the staff does. IF you don't like it, don't get mad but be forceful and tell them you want better service. Ask them what they expect and what is the best outcome. Sadly, your Dad may not get to the best outcome but that's the price of being 89.

My Mother did good until the dementia led to paranoia and delusions. I knew that she was forgetful and one of her Granddaughters paid the bills with my blessing. I could understand the 50, and 70 year old memories that she would suddenly remember and think were still around but that reached a point where she required professional care.

My Mom was 90, two months from 91 when she went out of the house for What I consider wasn't a good reason, fell and required 3 stitches in the back of her head. She told me two stories - one was a dog came at her, the other was a horse came at her. I think she tripped on a curb. . . was at the point that the family was going to get her a companion or an apartment at an assisted living facility. For years I paid for monthly cleaning ladies. From the first hospital she went to rehab and that was OK for a while but her dementia grew faster than before.

Falls do that. Concussions do that. Especially for the elderly. Whatever you do, eliminate falling hazards from your house. Any house. get rid of tripping hazards, put in lift chairs. and please, no one tell me that a stair lift is too expensive. The last nursing home bill I paid was $7000 a month (that's seven thousand a month).

Please, I"m saying this because you're doing anything wrong. You are doing your best to care for your Dad.

From when my Mom fell until she passed away, it was the hardest time of my life. Now that, (and I've never been this frank before and because you've never met me in person you couldn't know) I broke my back at 21 and that was an easy rehab and return to college compared to this.

MOI - I wish I could have afforded home health care. Worse yet, I could not take my Mom to my house and I couldn't start a small business of paying nurses and attendants and companions at her house. Besides, I lived an hour away from my Mom and if I would have had to be there, it was an hour. Also, I couldn't take care of my Mom. Just can't physically do it.

Dave (imported) wrote: Thu Aug 14, 2014 8:51 pm LT - I didn't complain about the nurses. The doctors drove me crazy.

I had one or two nurses that I didn't care for but most worked very hard to keep the patients comfortable and well and busy.

SO please don't think my complaints were about the nurses and aides running around helping patients. My complaints were with bosses and doctors.

Arab Nights -

In Pennsylvania a hospital cannot transfer a patient without the family's permission. That being said, the insurance companies only pay so many days in the hospital. So I had some control. It was three hospitals , one rehab and two nursing homes. If you have more family to help, get them to do so. I had a brother with four kids. One of the kids stepped up and between the three of us, we kept things aimed at getting our Mom (and Grandma) a decent outcome.

If you can - get there and spend hours at a time. Watch the therapy sessions. Watch what the staff does. IF you don't like it, don't get mad but be forceful and tell them you want better service. Ask them what they expect and what is the best outcome. Sadly, your Dad may not get to the best outcome but that's the price of being 89.

My Mother did good until the dementia led to paranoia and delusions. I knew that she was forgetful and one of her Granddaughters paid the bills with my blessing. I could understand the 50, and 70 year old memories that she would suddenly remember and think were still around but that reached a point where she required professional care.

My Mom was 90, two months from 91 when she went out of the house for What I consider wasn't a good reason, fell and required 3 stitches in the back of her head. She told me two stories - one was a dog came at her, the other was a horse came at her. I think she tripped on a curb. . . was at the point that the family was going to get her a companion or an apartment at an assisted living facility. For years I paid for monthly cleaning ladies. From the first hospital she went to rehab and that was OK for a while but her dementia grew faster than before.

Falls do that. Concussions do that. Especially for the elderly. Whatever you do, eliminate falling hazards from your house. Any house. get rid of tripping hazards, put in lift chairs. and please, no one tell me that a stair lift is too expensive. The last nursing home bill I paid was $7000 a month (that's seven thousand a month).

Please, I"m saying this because you're doing anything wrong. You are doing your best to care for your Dad.

From when my Mom fell until she passed away, it was the hardest time of my life. Now that, (and I've never been this frank before and because you've never met me in person you couldn't know) I broke my back at 21 and that was an easy rehab and return to college compared to this.

MOI - I wish I could have afforded home health care. Worse yet, I could not take my Mom to my house and I couldn't start a small business of paying nurses and attendants and companions at her house. Besides, I lived an hour away from my Mom and if I would have had to be there, it was an hour. Also, I couldn't take care of my Mom. Just can't physically do it.

My Mexicans are not paid on the same scale as nurses, trained & certified attendants

nor working for an agency that skims cream from their labor.

And they train up on checking blood sugar and insulin with ease. Responsibly.

Culturally they have a tradition of in home care of their elderly so they seem to grasp it culturally or innately.

Moi