Even after having been inside the nursing home industry for 12 years first as an adult daughter of someone with an Alzheimer's related disorder, then as an Assistant Administrator and Activities Director, it never ceases to amaze me when I meet with roadblocks to care of a Dementia client.
Earlier in the week I located my tickler file to remind me of an upcoming care plan conference for a client I placed in long term care about one year ago. Since I had not heard from the social worker at the facility, I left a voicemail message which she ignored. On Thursday, I heard from the client's psychologist who sees him twice a week stating my client was moved from his wing to another wing where the nurses don't know him and he is very depressed. I immediately called and left another message for the social worker. Yesterday, I finally heard from the social worker who apologized for not inviting me, stating they had the care plan conference yesterday and she forgot to invite me. How could she forget to invite me when my name is on his Face Sheet as the in-town contact; when I have a valid HIPPA form in his chart, and my business card has been given to her at every single care plan conference I have attended previously? Because I know this resident is bipolar, has dementia, is a holocaust survivor and we have been providing care management for him for the past four years I very explicitely spoke to everyone involved to make sure I was invited to his next case conference. Didn't happen!
In speaking with the social worker who apologized for forgetting stating she has 120 residents (when I had done care planning for 170 and didn't forget to invite GCMs when the nearest family member lived up north) she stated they moved my client because he was hitting the nurses on his wing and was very disruptive. Even moreso, this would have been an important conference to attend but I doubt they wanted my input so she claimed to have sent the invitation to the out of town family member instead.
In speaking with the client's out of town daughter she said the social worker called her yesterday, informing her of the change, about his being abusive, about having punched a female resident in the face. Now, I understand the laws that regulate nursing homes in Florida and am fully aware of the requirements by the Agency for Health care administration (AHCA) which clearly are there to protect residents rights. If a female resident had been punched in the face by another resident, this would have required an investigation by AHCA and my client would have been admitted for psychiatric observation under the Baker Act which is the law in Florida that protects someone who is a threat to himself or others. Under this admission, his medications would have been regulated and he would be monitored until able to return to his home. This didn't happen.
For adult children interested in knowing more about nursing home selection, please visit this recent informative interview by Meredit Viera of the Today Show at:
http://today.msnbc.msn.com/id/29636865/
Agooddaughterbuzz The buzz about elder care management - www.AGoodDaughterKnows.com
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Dear Olga, Thanks so much for sharing this story. I can read and feel your frustration and also your sincere concern for your clients. I am thinking about why this would happen. First, I am afraid that nursing homes are dealing with patients who do not or cannot interact with staff.. Therefore, the patients become things rather than individuals who just need to be kept clean and safe - there isn't much "in there" anymore, so what's the point? Also, I am guessing the care givers are poorly paid and poorly trained and you get what you pay for. The paperwork involved for senior care can also be overwhelming so that the social worker probably his piles of papers and miles of patients - its the old story of too many cases, overworked social workers. I'm not excusing the behavior, just thinking about why it happens.
ReplyDeleteWhat is the solution, do you think? Somehow, the patient has to be seen as a real person,not just a wrinkled body in a bed. How can we do that? As a Senior Move Manager, I advise the children of my clients to get to know all the staff as well as possible. Make sure there are lots of pictures of family in their rooms so the staff knows they are still connected to then outside world. Tell the staff stories about these seniors so they become real people once more.
I remember visiting one of my very first senior clients. She was this tiny little woman living in a tiny, cluttered house. Turns out she had been a pilot and had flown her veterinarian husband all around the state as the "flying vet". She had the most amazing and exciting stories to tell! She was transformed from a little old lady into an aviatrix in a heartbeat. I left feeling very privileged to know her. How many of your clients have amazing life stories that could be told? Do you think that would be helpful? This makes me wonder if there is a great educational opportunity here! I'd love to talk to you about it in more depth.
Thanks for posting this experience, Olga! My parents both lived--and died--in nursing homes. Despite every effort by my family, both were mistreated by the staff of every home they lived in. Perhaps, if they were still alive, we could have had the option of in-home health care or another option, but this excellent service wasn't available to us.
ReplyDeleteTheir situation motivated my wife and me to start this website: http://www.greatplacesinc.com . It's a labor of love, a memorial, and hopefully, a useful resource.
Marilyn,
ReplyDeleteI couldn't agree with you more. I am going to take your advice and especially since he is in a new room and Passover is around the corner, I will pickup some photos and momentos from the home he shared with his wife and will use these to decorate his new room. I will also spend the day with him interviewing him to share with the
Activities Director. Perhaps she will start a Resident of the Month column in the community newsletter and will post his story as the first article. Thanks for all of your insight. You are a great motivator.
Laurence,
ReplyDeleteWow! What an archive of jewels you posses in those articles. I've just gone through your website "Great Places" and am very impressed. How does our agency get listed under zip 33431? It is true that anyone who goes through a caregiving experience is changed forever by it. Thanks for your comment.
Nice Info. I'm using this service for 2 years, www.callcarenet.com And these guys are awesome.
ReplyDeleteI would imagine your frustration with this situation. I had a similar situation where the hospital social worker called me the day before (in the evening) to schedule a treatment plan meeting the next day at noon. In this case, it was not feasible. The family was upset that it was scheduled on such short notice and they live at least 80 miles away. With GCM's penetrating the market so rapidly, there may be a slight discomfort with clinicians in the SNF's or hospitals. It's really unfortunate because I personally view myself as a resource to both families, facilities and other professionals, but sense discomfort when facilities are being held accountable.
ReplyDeleteThank you for your support. I also sensed discomfort since day 1 of my client's admission to the facility but worked hard to be seen as partnering with the facility and not to be seen in an adversarial role. In working towards my client's best interest I am going to take a proactive role and support him as needed to make the transition to the new wing as the family has decided not to move him out of the facility at this time. "When life gives you lemons, you make lemonade"
ReplyDeleteWhat an informative resource you've provided in the Today article. I counsel family caregivers and will definitely be using that article when I talk with them about nursing homes.
ReplyDeleteThank you Missy for your comment.
ReplyDeleteGlad it was helpful.
Olga Brunner