Thursday, October 9, 2008

I Think I Screwed Up!

My mother was transported from the hospital to a rehab today where she will be spending the next 3 weeks rebuilding her strength and ability to walk again. I wanted to be there for my mother so I followed the rig from the hospital over to the facility. The driver was driving fast but I stayed right on him even through lights just turning red... but I cleared them. I had to park farther away but caught up with them in the lobby.

I worked in ED registration and closely with the emergency department for 20 years. I worked in my Lifeline job for almost 5 years. I have had plenty of experiences working with the elderly population. I have seen a lot.

But nothing prepares you for when it is your own parent suddenly in that position. I always felt sorry for the elderly people brought into the ED from a nursing home. I always hated if I heard someone refer to them as a GOMER (get out of my emergency room )... geriatric patients with multiple problems. I didn't hear it much.. but some people said it and I always worried the patient heard. One doc actually made fun of an elderly woman that was thought to be totally gorked but tears ran down the side of her cheeks. :( That being said...staff was really good with patients... but sometimes things slipped out when they shouldn't have.

And it seemed that these elderly people from the nursing home rarely had any family come in to the ED to meet them... and they'd be lying there alone. Sometimes they were shipped back out and sometimes they were an admit.

While working in my Lifeline job, the coordinator of our program and I covered 3 counties and serviced people in their homes and apartments as well as assisted living and retirement homes. I have to say that all the retirement homes or assisted living places were good to excellent... from what I could tell.

Today... the 1st thing that struck me was the large number of people sitting in wheel chairs, not communicating with each other in the front lobby that we entered through. It was pleasant looking, light and airy and so I was encouraged that her room would be too.

Um... I HATE my mother's room! They have 3 beds in a 2 bed room. She has the middle bed which in my opinion is the least private. They don't offer a telephone or TV... but she is lucky because she actually has a donated one in the room. But there is hardly room for it. Her roommate by the window has to negotiate a wheelchair between my mother's bed and the nightstand supporting the TV. You can bring your own phone and set up installation with the phone company and pay accordingly. (doing that tomorrow) You can bring your own TV.

There is a big bright window in the room. Her other nightstand is on the other side of her curtain because everything is off kilter having a 3rd bed in there but I am going to ask the social worker to take a look at it tomorrow because they just have all 3 night stands on the wrong side of the beds. obvious! I'm sorry...I am ANGRY about something... I'll get to that. Also...her bed does not elevate with push buttons but has to be cranked from the front.

C'mon! We just got a hospital bed for her that looks exactly the same but has a remote.

So what that means is my mother is totally at their mercy for changing bed positions. Now it is a rehab and the goal is to get her out of bed and moving around. But for now... she can not support herself standing up... let alone walk. (I actually do not understand how she could have lost her ability to ambulate since last Thursday.) They will start rehab with her tomorrow and so hopefully... she will be able to go back to her apartment in 3 weeks.

I liked the nurse who did mom's assessment. However... I thought she was insensitive about protecting my mother's dignity because she immediately stripped her naked to do perform her assessment of mom's over all condition... but neglected to pull the curtain around her on the window side. That window is huge. Now maybe she knows no one can see in the ground level window but I am sure my mother did not and quite frankly... nor did I. When the nurse walked away...I saw my mother pull a sheet over her lower exposed region. She may even have felt awkward in front of me because she is very modest and even I...her daughter never saw her naked until recently. Her breasts were still exposed as she lay there unable to situate her self more modestly.

I am ashamed to admit...I was a bit slow on the uptake of that and should have immediately jumped up and pulled the curtain closed while politely commenting that she would appreciate her privacy being protected. With everything going on... I was still processing.

I also liked the clothing lady. The clothing lady showed me around, was good with my mother, answered my questions and introduced me to the social worker, whom I then met with. I liked the staff I met.

I asked the social worker that in the event my mother had to stay would she then go to a different room. She said they don't like to uproot the patients when they become familiar with staff and their surrounding area and room mates. I can not picture my mother in that middle bed with that set up for the rest of her life if she is unable to regain her strength enough to come back home. I can not.

So I was comfortable at that point with leaving my mother. She was joking with staff. I figured she'd rest and have dinner. Then I would come later with the rest of her things.

She was sleeping when I walked in the room. I woke her up and the first thing she said rather dejectedly was "I don't think they care about anyone here." Why mom?" It turned out that no one brought a bedpan when she told them she needed one and so she wet the chuck under her and her hospital gown. (She is on strong diuretics!) She pressed the bell again for someone to help her and no one came. I walked in about 7:45 pm and she rang the bell around 5pm. So she was sitting in her urine and wet bedding and gown for a FRICKEN TWO HOURS AND 45 MINUTES when I got there!!!

I immediately went to the nurses station and politely yet assertively asked for someone to please help her. She still had to wait. One nurse did poke her head in to say she was sorry and that the girl would be there soon. She said she had told someone and thought it had been done and she could see how old the urine was by the way the bedding looked.

I believe we had to wait past 8pm before the girl came in to clean my mother up. So She was at least sitting in the wet bedding and gown for THREE HOURS!!!

The girl that came in was alright. Didn't seem very motivated though. And then my mother had to void again. She said it to the girl who had just cleaned her up and the bedding too. But she didn't get a bed pan. She was just going to put the depends on her. WHAT? And I was thinking...and LEAVE her in them too?

So I asked her to get a bed pan because she is going to have another accident. She moved so slowly looking through the drawers and then slowly out of the room. If that were me..I'd hustle to get a patient one! And my mother couldn't wait and so the bedding had to be changed again. And my mother felt awful about it.

I stayed until 9pm... until I felt comfortable leaving her... which I really don't. I made sure they knew I'd be around at different times stating I had an odd schedule. I just don't want them thinking they can count on family visits being predictable... for obvious reasons.

I stated that my mother has always raved about nursing care in the hospital and this is the first time I ever heard her say she didn't think the staff cared about anyone and she hasn't even been there 24 hours yet. in reality that incident happened after only 3 1/2 hours of being there. Another nurse apologized profusely...and said it usually isn't like that, but some people work harder than others. She also told my mother sweetly that they want to take good care of her.

I believed her.. but actions will speak louder than words.

If my mother ends up needing long term care... I just can not picture her in a place like that. I can not. So...I am going to call the other places the hospital social worker recommended and go check them out. Maybe I will put her on a waiting list.

I only went with this one because I wanted to keep continuity with her physician... and if she had to be hospitalized she'd go back to the hospital she likes.

In the end it is my mother's decision but I think I need to investigate all the options. Maybe I need to give it a chance. I did like most of the people.

I have a meeting with someone over there tomorrow and then I will follow up with the social worker.

I wanted to take Saturday off to do some important things that NEED my attention and now...I don't know if I should skip a day going over there. I can't bare to think of her being neglected. The staff that was on tonight didn't have any kind of pad on her nor did they know she was not able to walk yet. Don't they take report????


Elaine said...

The first nursing home my father was in looked nice, but I went once and found him in NAPPIES! Now my father was a very proud man who had had a career to a high level before retirement on medical grounds. He was not able to go to the toilet on his own but could walk with a little assistance.

He was NOT incontinent, but nobody would take him to the toilet (or even give him a urine bottle).

When I visited he asked if I would take him to the toilet and so I did. I was horrified by what I found when I got there and took down his incontinence pants.

He had an ENORMOUS pressure over his sacrum.

Well, we got him out of there as quickly as we could and the next place not only did not make the pressure sore worse, they actually CURED it.

Oh I am so sorry to have run off like this, but your story just struck a chord. And it was over 20 years ago.

I wish you all the best with your mother.


SeaSpray said...

Hi Elaine-I am so sorry your Dad went through that.

It sounds like they just wrote him off and did what was easiest for them.

I know they must be overworked and understaffed... but 3hours? I don't believe there is a good excuse.

I think some patients don't realize they have a right to ask for help or they don't want to keep bothering staff. I know you can get patients that will make staff crazy and maybe they get jaded towards all if they burn out or perhaps they develop favorites. This end of things is all new to me.

She was much better off yesterday and seemed happy with staff.

I did take today off-I do feel guilty about it-but I have to break a bit too because I am so behind on our things and I still have to do much in her apartment. If she is able to come home...she will not let me have the free reign I do now for cleaning and cleaning out things.

Although...she is going to have to let us do more when she comes home. I think she knows that now. I hope so.

I cross that bridge when and if I get to it.

I am so glad you got him into a better place.

She likes the food and I am glad she is getting good nutrition. i was worried about that but again...she refused to let me do certain things.

I think it is bad enough having your parent in a nursing home...but to be worried about the quality of just too much.

Thanks Elaine. I am hugging you back. :)