Hospital "Care" (Update, Post #57)

[Reefgazer]

They claim they don't use these drugs as chemical restraints, but use them because the person is "agitated". But that's a very broad term open to interpretation. For example, when my dad had the diarrhea pain, they claimed he was "agitated" from the pain, but I was sitting there with him and he was asleep and only grimaced when his stomach roiled. so they claim that they are not using them as chemical restraints, but for patient comfort. In fact , they're included in the comfort care they offered my father.

 

One thing to consider is to ask for their policy on the use of chemical restraints. It would be interesting to see if they have one. I know there are policies against using them in nursing homes. Psychotropic medications can be used as part of a full care plan for psychiatric patients but they are not to be used to control behavior in other patients. Instead, a full care plan should be developed that works to alleviate the problems. Chemical restraints should only be used if the person is a danger to themselves or others.

[TechWife]

They claim they don't use these drugs as chemical restraints, but use them because the person is "agitated". But that's a very broad term open to interpretation. For example, when my dad had the diarrhea pain, they claimed he was "agitated" from the pain, but I was sitting there with him and he was asleep and only grimaced when his stomach roiled. so they claim that they are not using them as chemical restraints, but for patient comfort. In fact , they're included in the comfort care they offered my father.

 

 

Oh, gag. I wonder what they would do if you asked for a psych consult to address the agitation? That would probably blow their minds. 

[Katy]

There are large legal issues with chemical restraints as well, at least in every state I've ever nursed in.

[sarasue7272]

My advice to all: never leave your loved one in a hospital alone. Seriously, depending on their condition, not even for a few minutes. Someone should be with them at all times. Write things down, question everyone. That is a time to BTB. Be the bitch. Don't care about strangers thinking you are crazy. There are a lot of great nurses and doctors, but it only takes one idiot to do serious harm. One orderly to put a tiny sticky bandage on a huge bed sore, not a huge deal but it was a pretty big wound and it could have kept my husband from being moved to a great hospital for real treatment. One nurse/dr to give my cousin a drug that would have caused her to bleed to death. My aunt, who is a nurse, would not allow it and didn't close her eyes the rest of the night in case they came back.

So yes, guard them like a junkyard dog.

[NorthwestMom]

Ok, only have a second but I just wanted to point out that Zyprexa is actually contraindicated in the elderly and can cause early death: http://www.rxlist.com/zyprexa-drug.htm

 

My mom was prescribed it a year before she died and then went downhill rapidly in a similar manner to your father.

 

If you decide to seek a lawyer, even to write a letter regarding the use of chemical restraints and that you do NOT give permission for that, the lawyer should be made aware of their use of this drug, as it may be legally negligence on their part.

 

:grouphug: :grouphug: :grouphug: :grouphug: :grouphug:

[Reefgazer]

Update (sort of):  So I left NY and came back to Virginia on Thursday and when I left, dad was doing well, eating soft foods again, alert, and telling me he wanted to go home because he's been here long enough.  One day gone, and dad needed a catheter for fluid retention and decreased kidney function, which he tried to pull out.  That earned him wrist restraints (which I understand because he can't be doing that stuff).  But apparently, that also qualifies in their book as "agitated" and the doctor prescribed another med that has made him sleepy and so now he can't interact with us, can't eat, and can't make his wishes known because he's so drugged again.  I asked my sister to get the name of the med tomorrow and check to see what it did (I think she said it was a painkiller that began with the letter B or V, but I need to wait for confirmation on that). 

 

Every time he begins to get better, they knock him out so he can't eat or drink, so he's going got starve to death there.  Where do I go from here?  How can I prevent this cycle of him feeling better-drug him, repeat?  Should I hire an elder care lawyer?  I already posted a claim to the NYS Department of Health, but they don't open until Monday and I can't imagine as a state agency they are going to move with the necessary speed.  I don't know how to put a stop to this drugging.

[hornblower]

Given that your father is suffering from cognitive decline / dementia what I think I'd be tempted to do is hire a personal aide (well, actually you'll need 2-3 to work shifts) to be with him 24/7 and keep him calm and not agitated. If you or another relative cannot be there to keep him calm, to stop him from pulling things etc, this will continue happening. There is not enough staffing for someone to sit and watch him and distract him and keep him from creating a problem for himself.  

He needs someone to watch over him & keep him from ramping up because that will cause a cascade of interference. 

[hornblower]

There was another issue that was raised several times I think in this thread - about elders going into the hospital able to walk & more or less caring for themselves & coming out incapacitated. 
 

This is precisely what happens to elderly people if they're stuck in bed. They lose muscle mass in just a few days. There are studies showing seniors lose muscle mass faster than adults (& honestly even in regular adults, muscle loss is extremely fast) 

The only way to prevent is to a) minimize the length of the hospital stay; b) get the patient moving as much as possible while there. This will mean family or a hired aide to help and walk with them / their walker etc.  You can also try to arrange physio but again, you'd probably have to pay for it privately and make arrangements for it to be allowed. 


Add to this the fact that with the crappy hospital food that they may not be eating (or may not be able to eat - my MIL couldn't eat her food because with her arthritis in her hands she couldn't manage to open the pull tabs on some of the packaged foods she was given. She was also quite weak & tired & was just giving up. We needed to arrange to be there at meal times and help her with the meal. We also brought food from home because she didn't like much there.)

Add not being able to sleep well because of the noise & being woken up for vitals. ... They're being exhausted while in hospital.    Our current mode is get them stable & get them out, or arrange private care or resign yourself to having to be there with them...

 

Edited June 11, 2016 by hornblower

[StephanieZ]

I am so sorry this is happening with your dad. A friend's very elderly (90s) mother died in the hospital after a series of similar "mishaps" related to her care. In her case, it really appeared that the medical staff felt like it was "her time" to die and really made no effort to maintain her quality of life or life at all. 

 

IMHO, it would be best if you could make sure a family member is with your dad 24/7 while in these types of care settings. I know that can be nearly impossible, but that's what I'd try to do. My dad died due to medical errors in hospital, and so since then, I've simply been 100% committed to making sure I am with my immediate family members whenever they are inpatient anywhere. I have had to fight for that right at times, but I've been successful in insisting . . . by simply telling them that I will be there until/unless they have me physically removed. So far, that's worked for me. My mom is gone, now, too, so next would only be my kids or dh . . . I am quite confident that if I were physically removed from their sides, I'd have our lawyer on the phone immediately, and I wouldn't relent until I or a privately-hired trusted caregiver were there 24/7 to make sure medical errors or simple neglect didn't harm my family member. 

 

My experiences with medical care are also one reason I cared for my mom in our home during her Alzheimer's and end-of-life care instead of even considering institutional care. No way, no how, not if I can prevent it. No one will love or look out for your loved one better than someone who LOVES them.

 

 

((((hugs))))

 

[shawthorne44]

Is there a rehab place he could be moved into?   

Also, I wonder if it is legal in your state to put a hospital nanny cam in?  

[Katy]

It's not just the staying in bed and losing muscle function.  It's hospital pneumonia.  Your circulation is remarkably better if you are up and moving around.  Staying in bed can lead to pneumonia solely because circulation declines so much that fluid builds up in your lungs.

[TechWife]

Update (sort of):  So I left NY and came back to Virginia on Thursday and when I left, dad was doing well, eating soft foods again, alert, and telling me he wanted to go home because he's been here long enough.  One day gone, and dad needed a catheter for fluid retention and decreased kidney function, which he tried to pull out.  That earned him wrist restraints (which I understand because he can't be doing that stuff).  But apparently, that also qualifies in their book as "agitated" and the doctor prescribed another med that has made him sleepy and so now he can't interact with us, can't eat, and can't make his wishes known because he's so drugged again.  I asked my sister to get the name of the med tomorrow and check to see what it did (I think she said it was a painkiller that began with the letter B or V, but I need to wait for confirmation on that). 

 

Every time he begins to get better, they knock him out so he can't eat or drink, so he's going got starve to death there.  Where do I go from here?  How can I prevent this cycle of him feeling better-drug him, repeat?  Should I hire an elder care lawyer?  I already posted a claim to the NYS Department of Health, but they don't open until Monday and I can't imagine as a state agency they are going to move with the necessary speed.  I don't know how to put a stop to this drugging.

 

You don't have to wait until Monday to get a solid response to your concerns. I'm furious on your behalf right now and am typing quickly. My thoughts are all jumbled up on it, too. 

 

You have two major issues going on: their inability/lack of willingness to communicate with your father and the issue of them defaulting to the use of chemical restraints. 

 

You need to escalate this, as I'm sure you already know. 

 

I think that you need to question the use of physical restraints and chemical restraints at the same time. If you haven't already, start calling the medication "chemical restraints" in front of them. Use of this terminology should make them take notice. 

 

The hospital has a patient advocate (they are required to by law). Tell them that they aren't communicating with the patient even though they have been instructed many times in how to do so. It seems that they are willfully neglecting offering him the best care because of their lack of communication skills. Use the words "chemical restraints" and "physical restraints" and ask why he has both. Ask what medications they typically try for "agitated" patients and why they are pulling out the strong stuff before trying the more milder options. Why not try something simple for anxiety first? Tell the patient advocate that your father's condition deteriorates when on these medications and that you think he is being medicated inappropriately. Ask for a pharmacist to consult on the case with other recommendations. Ask for a geriatric specialist. If they insist his agitation puts him or their staff at risk, insist on a psychiatric consult. Working together, a pharmacist, geriatric specialist and a psychiatrist should determine what the best course of action is for managing his health conditions and his supposed agitation. Their treatment should not cause him to get ill - if he can't eat, he's going to get ill. You honestly should get some good, solid response from the patient advocate. 

 

Contact your state ombudsman for help in getting answers. You can do this at the same time you call the patient advocate or you can do this if the patient advocate doesn't get appropriate responses, it's up to you. You may have already done this by contacting the state department of health, I'm not sure. 

 

You can file a "quality of care" complaint with the hospital's QIO. Follow the links from this page to find out how to do that for your particular state and hospital. 

 

If you do not get action - and by action I mean a concerted effort from the hospital staff to 1) communicate with your father in a way that he can understand and 2) treat him for his current diagnosis with appropriate medications, eliminating, or at the very least minimizing, the need for physical and chemical restraints, then go to the office of the medical director or hospital CEO (or call them, even) and insist that they get involved in solving the problem. Tell them their staff has not been responsive to your concerns. Mention that you are considering filing a complaint with the Joint Commission (see below). 

 

Another option is to file a report with the Joint Commission - you can do this online here. These complaints are investigated and can even trigger a hospital wide audit. 

 

Ugh, I'm just furious for you. If I've been unclear, let me know and I'll try to help. 

 

The advocacy options are, in summary: 

Patient Advocate

State ombudsman

Hospital Medical Director

Hospital CEO

Joint Commission

 

ETA: If they don't have a patient advocate in house on the weekend, they should have one on call. 

Edited June 11, 2016 by TechWife

[littlebug42]

I agree with what techwife wrote above and so much of what has been said throughout this thread, but as someone that works at a hospital, I wanted to offer another point of view.  So much of what is being described above is what many patient's families demand from us as health care workers.  Patient is any pain - fix it.   Patient is agitated - fix it.   We see so many elderly patients subjected to so much testing, meds etc because that is what is demanded by the families.  Fix it.  Oh, and don't forget to fix it fast.  That is a whole other kind of pressure put on these docs and the facilities. 

[lauraw4321]

Have you asked for a hospice consult? I agree that someone needs to be with him 24/7. someone needs to be in the room when the hospitality rounds and say "We want him out of here. How do we do that?" And have them make a plan. Ask who needs to dign off ( social for example) and ask for their name and when they round. Expect it to take at least 3 more days from that point. Be at the hospital every time they round and say "what is delaying us from taking him home?" Ask for specific issues and wrote them down. He will not be ambulatory, so skilled nursing or hospice facility may be your only choice unless you can convince them he's safe at home.

[TechWife]

 So much of what is being described above is what many patient's families demand from us as health care workers.  Patient is any pain - fix it.   Patient is agitated - fix it.   

 

There is a difference between wanting something "fixed" and drugging someone into a stupor. 

[Innisfree]

No answers, but I am so sorry for what your father and your family are experiencing. How awful. It shouldn't be this way.

[Lanny]

To OP (TechWIfe):   I read the Update in Post #57.  Sad.  The only possibility might be to move him to a different facility. However, if you know the story about "The Grass is greener on the other side of the mountain", moving him would be a giant leap in faith. Would the care in another facility be better than where he is now? Would the care in another facility be  worse than where he is now? Only God knows the answer to that.  I don't think an Attorney would help and I think that just might exacerbate things and make the  people (eg: management especially) hostile to your dad, which is the last thing you would want to do.  Bad situation. If he is in an area where there are M.D.s who are Board Certified in Geriatric Medicine, one of those, in charge of your Dad, would probably be the best thing you could get for him.  Geriatric Physicians are, from what I've seen on TV, few and far between.  GL to you and your Dad!