Nursing Homes and Rehab What Caregivers Don’t Know – The Caring Generation®
The Caring Generation® – Episode 51 August 12, 2020. On this caregiver radio program, Pamela D Wilson, caregiving expert talks about Care Transitions: What Caregivers Don’t Know About Nursing Home Rehab. Dr. Lynn Flint in the Division of Geriatrics and Hospital Medicine at the University of California at San Francisco shares her research article “Rehabbed to Death.”
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Nursing Homes and Rehab: What Caregivers Don’t Know About Care Transitions
00:04 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host, Pamela D. Wilson, is here to focus on the conversation of caring. You are not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.
00:48 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host on The Caring Generation radio program, coming to you live from the BBM Global Network, Channel 100, and TuneIn Radio. The Caring Generation focuses on conversations about health, well-being, caring for ourselves and loved ones, all tied together with humor and laughter that are essential to being a caregiver. During this program, we will talk about care transitions. For example, your elderly parent is in the hospital. Mom or dad are discharged back home or to a skilled nursing community. The first tip and what caregivers don’t know about nursing homes and rehab is that regardless of the name used—nursing home, skilled nursing facility, SNF (abbreviated SNF), rehab—the name and the characteristics of the building and the services are similar. Nursing homes and rehab use different terminology to market their services because the word nursing home is viewed so negatively. The bottom line is that a nursing home is a nursing home. Whether the building is old, dated, or brand new, or called by a different name. The federal regulations that monitor care standards for nursing homes and rehab are the same. In my opinion, the difference is in the staff, their longevity, staff training, and the dedication to the care of the residents.
02:12 Pamela D. Wilson: When I was responsible for the care of my clients, there were some nursing homes and rehab that were in old buildings, not at all remodeled. But the care commitment of the staff was amazing. It was off the charts positive. The physical appearance of nursing homes and rehab or really any type of care community can be a factor that sways family members to make poor decisions based on the visual appeal of a building. More important is to make a factual evaluation based on facts and criteria to evaluate nursing homes and rehab and understand what care transitions mean. This evaluation falls into the category of what caregivers don’t know. Our guest for the health and wellness segment of this caregiving radio show is Dr. Lynn Flint. She will talk more about nursing homes and rehab, including her research article called Rehabbed to Death. Dr. Flint is an Associate Professor in the Division of Geriatrics at the University of California at San Francisco. She is also a palliative care consultant and nursing home primary care physician at the San Francisco VA Hospital.
03:19 Pamela D. Wilson: The second point about what caregivers don’t know about nursing homes and rehab, is that once admitted, your elderly parent may only be in that nursing home for a short stay of seven days or sometimes even less. The timing and length of the stay in nursing homes and a rehab depends in part on the health condition of your elderly parents or a spouse, and the health goals to be accomplished. The staff of nursing homes and rehab are in regular contact with your parent’s health insurance company to make sure that the care provided qualifies for financial reimbursements. At some point, your elderly parent will be given a discharge notice, which means that it’s time to return home or go to a care community. Let’s talk more about the idea of care transitions and why a smooth care transition is important to the health and well-being of an elderly parent. In simple terms, care transition means the transfer of mom or dad from one location; for example, the hospital to another location or to their private home or to a nursing home. Health risks occur for all aging adults. However, those risks are greater when aging adults that have higher care needs or more diagnoses are transferred to nursing homes or rehab.
04:40 Pamela D. Wilson: Why do these transfers even happen? One of the main reasons is that your parent or an older adult has declined in physical or cognitive ability, such that they can’t easily take care of themselves at home. Maybe mom or dad needs more medical care as a result of a surgery, may be a heart attack or a hip fracture, and that medical care can’t be provided at home. We add to the need for medical care the fact that mom or dad may be more physically weak. They may need the assistance of staff at a care community to provide hands-on care, maybe help with bathing, standing, transferring, or mobility, so that they don’t fall. In my opinion, aging adults who have some type of care plan when health issues arise are the lucky ones. In other situations, the elderly can be sent to the hospital for normal things like a suspected urinary tract infection or a breathing concern. The hospital staff will work to treat, and their goal usually is to send the elderly person back home as soon as possible with the hope that they don’t return back to the hospital.
05:56 Pamela D. Wilson: The third in major concern in the list of what caregivers don’t know falls into the category of care transitions and the idea of being discharged from nursing homes and rehab in terms of a terminology that’s “sicker and quicker.” There are times when a condition other than the obvious, a urinary tract infection, or a breathing concern happens. You, as the caregiver, might be aware of this medical concern because it happened before, and you might try, like I did many times, to negotiate with the staff of the hospital to admit your elderly parent instead of sending them home quicker and sicker. Because it’s important to know the cause of why they went to the hospital. What’s the cause of their illness?
06:39 Pamela D. Wilson: When an infection is present, that illness can quickly proceed to sepsis, which is deadly. If you missed the radio show with Dr. Bernardo Reyes, you’ll want to listen to this caregiving podcast that answers the question, what is sepsis? Dr. Reyes discusses the risks to the elderly of infections that quickly turn into sepsis, especially for the elderly in nursing homes and rehab. Or in the best-case scenario, what happens is that the elderly are sent to the hospital. They are evaluated, and if rehab is necessary, then they’re transferred. But the cause of that illness or infection was identified and investigated, and they’re receiving treatment. So there’s no rush to receive treatment. No rush to discharge, it’s done the right way.
07:26 Pamela D. Wilson: There will be some other times when an elderly parent lives in a nursing home, and they transfer or care transition to the hospital. This is the subject of our conversation coming up in the next segment of the program with Dr. Lynn Flint from the University of California at San Francisco. She’s going to talk to us about care transitions to nursing homes or rehab and things that caregivers should know. Through our conversation, you’ll learn right now what caregivers don’t know about talking to doctors about specific options for treatment when health issues are getting worse—when they’re advancing. We’ll also talk about how going back and forth between the hospital and a nursing home for medical care, might not be in the best interest of your mom or dad. And in the second half of the program, we’ll continue to talk about why care transitions can go off track so that you can advocate for yourself if you are the aging adult or advocate for an elderly parent if you are that caregiver. I’ll share steps to learn to advocate and to manage care.
08:32 Pamela D. Wilson: For elderly people who are admitted to the hospital, having a care plan that addresses resolving health concerns that sent you to the hospital, it’s very important. Because many times there’s this ping-pong situation where an elderly parent goes to the hospital. They come home, and the next day they’re going right back. So simple actions that people can take to avoid hospitalizations, can include things like taking medications, exercising, eating healthy, attending follow-up appointments with your primary care physician or the specialist who manages all of your medical care. All of these are so important. Practical tips for caregivers and aging adults are on my website, www.PamelaDWilson.com. You can check out my Caring for Aging Parents Caregiving Blog, there are a lot of articles, videos, and information there for you that’s very helpful. This is Pamela D. Wilson. You’re with me on The Caring Generation, live on the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.
11:53 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host on The Caring Generation radio show for caregivers, live from the BBM Global Network, Channel 100, and TuneIn Radio. Joining us is Dr. Lynn Flint, Associate Professor in the Division of Geriatrics and Program Director for the University of California at San Francisco, integrated geriatrics and palliative care fellowship. Dr. Flint, welcome.
12:17 Dr. Lynn Flint: Thank you. I’m happy to be here.
12:20 Pamela D. Wilson: So my first question for you is, skilled nursing homes are sometimes called post-acute care, and they have short stays and long stays for people who are admitted. What’s that difference specific to physical rehab?
12:35 Dr. Lynn Flint: This is a great question. I’m so glad that you asked it because the terminology is so confusing in this area. So a skilled nursing home, also known as a skilled nursing facility, and what we call in the field “SNFs,” S-N-F.
12:54 Dr. Lynn Flint: These are Medicare-certified nursing homes. So that means that Medicare has certified that facility to provide short-stay care for a skilled need. Including maybe an IV therapy, intravenous therapy or wound care or physical therapy, physical rehabilitation, like you asked. That’s for people who come in after their hospitalization generally and need a short stay in the nursing facility for that rehabilitation. When you think about a nursing facility for a long stay, that’s really for people who have ongoing need for assistance with their activities of daily living. And while those residents can still get physical rehabilitation, it’s generally sort of a lower intensity, and the goal is more about maintenance, functioning, and not really about getting people functional enough to go home or go to another place.
14:04 Pamela D. Wilson: And I found you through an amazing article, it was called Rehabbed to Death. Can you explain that cycle? What does that look like?
14:11 Dr. Lynn Flint: Yes. So it’s a really familiar cycle, I think, for a lot of people. Clinicians who work both in the hospital and in the nursing home side, we see this really—it feels very, very common when you’re doing this work. And it’s really the phenomenon of an older adult who may have several chronic conditions and may already need help with perhaps one activity of daily living. One thing that they sort of do to get through the day, and then they become hospitalized for something simple. Maybe it’s a lung infection, pneumonia. Nowadays, actually, we’re seeing this happen with COVID. Due to that, people will come in with COVID, and actually, be able to get through it. And then have more deconditioning, more weakness in their body just from being in the hospital and not moving around as much as they normally would. And when people are unable to get home because they need that extra help and they really need more rehabilitation to get the strength back, we will often send them, transfer them to a skilled nursing facility for rehab. Sometimes they also have ongoing nursing needs that are still being done to sort of finish up treatment for whatever illness they have. Maybe they’re finishing an intravenous antibiotic, for example, they’re finishing a course, something like that.
15:40 Dr. Lynn Flint: In any event, we often see that people will go out to the nursing home, and then they’ll have a complication, and it might be related. It is often related to the original hospitalization. And that complication, which might be another infection or a side effect from a medication change or a fall, or confusion. One of those things might send them back to the hospital. And so they’re already less strong than they were at home and now they’re coming back to the hospital again, and they face even more deconditioning related to that new hospitalization. They are then referred back out to the nursing home again. And some people just get stuck in this cycle where they’re going back and forth and back and forth, and they ultimately never make it home. They stay in the nursing home for the rest of their lives. And this phenomenon, we’ve seen time and time again. And the thing that is troubling to me is that I feel that patients and families really need to have the opportunity to talk about the chances of getting better and the risks of getting stuck in this cycle and kind of how they would approach that if they were to get stuck in this cycle themself.
17:01 Pamela D. Wilson: And your article gave some statistics, I think I have these, so 26% for hospital discharge to nursing homes and 22% readmitted to the hospital. So how could families have these discussions, is it with the doctor from the nursing home? Who would begin this conversation?
17:18 Dr. Lynn Flint: That is a great question too. I think it’s really—I think it’s the responsibility of everybody. Frankly. I mean, I think the doctors—what often happens is there’s a lot of pressure in the hospital for the doctors to discharge people and when the discharge process is happening, we often will find, “Oh, there’s a bed available for this patient in this nursing home,” and because there’s so much pressure to keep hospital stays short, people want to jump on that opportunity and transfer the patient right away, and often there’s not time to really thoroughly discuss what does this mean? That your illness and your hospitalization has really contributed to you being so weak that you can’t make it back home. So I think it’s the responsibility of the doctor and the discharging team. But I think it’s also something that—I’m so glad that we’re talking about it here because I think it’s something that caregivers can also advocate for, it is sort of more communication around what does this mean? How much strength can we expect my loved one to get back, etcetera? What are the goals that we’re trying to reach with this stay? With this stay and the hospitalization?
18:39 Pamela D. Wilson: I think those conversations are so important. We are going to head out to a break. Listeners, we will continue our conversation with Dr. Lynn Flint after this break. You can find podcasts of this radio show on my website pameladwilson.com on the Caring Generation page, click on the Media tab, and then The Caring Generation radio show. This is Pamela D. Wilson on The Caring Generation, live on the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.
21:21 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host for The Caring Generation on the BBM Global Network, Channel 100, and TuneIn Radio. We’re back to continue our conversation with Dr. Lynn Flint on the subject of her research article called Rehabbed to Death. Dr. Flint, earlier, you talked about the fact that sometimes hospitals are in a rush to discharge people so that they will just find an open skilled nursing bed, and they put them in there. But how often does the opposite happen where maybe, not going to a SNF is not obvious, and family members are saying, “Oh, you have to send them, because I can’t take care of them at home and I work.”
21:58 Dr. Lynn Flint: That is such a great point. And we see that too. I mean, I think the bottom line is that the whole system is not set up to support caregivers and support older adults to remain in their homes and their communities. The hospital, like I said, is under pressure to shorten their stays. Of course, families are squished between taking care of their kids and their parents and need to go to work and don’t have the time or the finances to provide hands-on care for their older parents who need that help. And so, we also see that and of course, depending on the clinical situation with the patient, with the person who needs the help, we may be able to have them go out to a nursing home on a short stay, and Medicare will cover that for some period of time. But it doesn’t cover long-term care and does not cover that. Thus does not cover that nursing home care forever, and so that’s really a short-term fix. And of course, there’s major gaps in the system in terms of providing long-term supports for people to be in their home.
23:19 Pamela D. Wilson: Is there any type of system in the hospital so that, let’s say, mom or dad is there, and there’s a daughter who is the caregiver—any type of communication with the daughter saying, “Your parent is going home, we want to train you on these things. You have a follow up doctor appointment.” Does that ever happen? And how important is that from stopping that person from coming back to the hospital?
23:41 Dr. Lynn Flint: So I think that that is crucial, and it should be happening every time there’s a caregiver situation. And we do have the Care Act in most of the states in the country, which requires hospitals to record a primary caregiver and provide education on caregiving needs after—as somebody is transitioning out of the hospital. But the hospital is a fast-moving place, and it doesn’t always happen that family members get updated as regularly as we might like, or they might like. And this is a particularly acute issue right now with the COVID pandemic because in many places visitor restrictions are very, very strict and so, it’s not like family members can just come into the hospital and visit and be at their loved one’s bedside all the time to kind of run into the nurses and doctors as they’re coming in to provide care. So I think that this is an area that we could always improve upon.
24:47 Dr. Lynn Flint: I really think that if you have an older adult who has a caregiver in their life already that that caregiver should be updated very regularly, if not daily, by the medical team. Or at least a conversation at the beginning of the hospitalization about how these updates are going to be provided. What are your communication preferences? And I think that is an area where caregivers can really advocate for themselves and say, “I really need to have an update every day or every other day, and here’s the best way to contact me,” and sort of help guide the clinicians to provide that guidance.
25:27 Pamela D. Wilson: So what advice would you give to caregivers who have a parent going into the hospital about what they should do in those conversations? So, for example, will a doctor call a family member in the evening if they’re working during the day? What’s the flexibility of the people in the hospital to communicate?
25:46 Dr. Lynn Flint: That’s such a great question. You know, it’s variable. It depends on how the hospital works. Some hospitals are really run—many hospitals nowadays are run by kind of a day team and a night team. Oftentimes, it’s the day team that has the real intimate details about everything that’s going on day-to-day with the patient, and the night team is really there to manage any emergencies or urgent things that come up. But I think that it’s important for caregivers to really ask for what they need around communication. I also think it’s really important for caregivers to be flexible. You know—hospitalization even if it’s the fifth one in a year—it’s still a critical time for their loved one. And if there are ways for the caregiver to be flexible also, and make the time to talk with the treating team who knows their loved one best. Then they’re going to get the best most useful information. So I think it’s a little bit of a negotiation at the beginning about how that communication is going to go.
26:57 Pamela D. Wilson: And I know we’re running short on time, but you’re a palliative care specialist, so how do you talk to families about, maybe it’s not the best thing to keep sending your parent back and forth between the hospital and the nursing home?
27:09 Dr. Lynn Flint: That’s such a great question, and gosh, we could talk for another three hours about that question. [laughter] Typically, if we think that someone’s in a situation where going back and forth to the hospital really isn’t—we suspect that that’s not something that’s meeting that person’s goals, we will call what we—we call it on our side of the work, a goals of care conversation, and we’ll call in caregivers and family members, and bring the patient in too and really try to give them information about their prognosis, and then talk to them about what matters most, and then that helps us make recommendations about where they should go next both physically and sort of what should the care plan look like to help them meet those goals within the context of that prognosis.
28:08 Pamela D. Wilson: And can caregivers, if a parent goes to a hospital, can they say, “Hey, is there a palliative care department?” How do they get to somebody like you?
28:17 Dr. Lynn Flint: That’s such a great question too. Yes, that’s another great way for people to advocate for themselves and their loved ones in the hospital is to ask for palliative care I would say, especially in the inpatient hospital setting, the majority of hospitals in the United States have a palliative care service, and it happens all the time that family members ask for that, and honestly, the clinicians taking care of the patients in the hospital are always really relieved and happy to have our help. And so, another really great way for families to advocate for themselves and their loved ones.
28:54 Pamela D. Wilson: And do you know, is that available also in a nursing home setting?
29:00 Dr. Lynn Flint: You know, it’s available much less in the nursing home setting. I would say that it is really infrequent actually, that that sort of consultation service is available. I think people are actively working on how to get more palliative care into the nursing home setting.
29:16 Pamela D. Wilson: Okay. And are you okay if I share your article in a link in the transcript of the show?
29:23 Dr. Lynn Flint: Yes, absolutely. I’d be happy for everybody to read it.
29:26 Pamela D. Wilson: Wonderful. Alright. Doctor, thank you so much for joining us. Listeners, you can catch all of the podcasts of these shows on Apple, Google, Spreaker, and other podcast websites. This is Pamela D. Wilson, your host on The Caring Generation live on the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.
32:03 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host on the Caring Generation radio program for caregivers and aging adults. Live from the BBM global network Channel 100 and TuneIn radio. We’re back to talk about care transitions from hospitals to nursing homes, and rehab, and more on the topic of what caregivers don’t know. Number four in the list of what caregivers don’t know about care transitions is that care for mom or dad, as we talked with Dr. Flint, should be organized and coordinated through all steps of care by all healthcare providers. Care transitions and care coordination is the first point where information can fall apart. Let’s say that your parent took medications before going to the hospital, and you’re looking at the medication list from the hospital discharge paperwork, and you realize that there are some medications that aren’t on that list. The doctor or somebody changed your parent’s medication. They didn’t have a conversation with you, and now you’re worried.
33:00 Pamela D. Wilson: At this point, it may be too late to do anything. Especially if the doctor who changed that medication isn’t working. But you can look at getting the medication corrected. What you want to make sure is that when those orders that aren’t correct go to the nursing home, you follow through. So this is another item on that list of what caregivers don’t know. It’s up to you to backtrack to solve that medication issue. So number five for what caregivers don’t know about nursing homes and rehab is the idea of soft skills that are as equally important to the hands-on care that your parent is receiving. One of the biggest assumptions that caregivers and aging adults have is that the healthcare system will tell you everything that you need to know. Sometimes they’re rushed. So that is not true.
33:46 Pamela D. Wilson: The healthcare system will give you information that you ask for. But they may not be thorough unless you are asking more questions, and unless you want to become more involved in your care or the care of an aging parent—it’s up to you to seek that education and information. So using that inaccurate medication list as an example, what steps do you think might correct or avoid that problem? What do you think about requesting a copy of the medication list for your parent before they go to the hospital? What about asking about which medication has changed, and why? Another step in the list of what caregivers don’t know is to ask to meet with that staff at the nursing home when your parent is admitted to review the medication list so that if there were errors, you can get them corrected before they cause any further issues.
34:35 Pamela D. Wilson: As you can see this little activity alone, it can be a learning opportunity about managing medications for an elderly parent during a care transition. From the hospital to nursing homes or rehab, where unexpected things can certainly happen. In addition to this aspect of a communication glitch, lack of family caregiver education is an issue. Language barriers and health literacy can be issues. So if your primary language is not English and you don’t understand what a doctor is saying, don’t be embarrassed to say I need a translator. I need someone who speaks my language because if you don’t ask, you don’t know if they can provide somebody, and if you don’t understand important information, you could be placing the health of yourself, your elderly parent, a spouse at risk.
35:26 Pamela D. Wilson: Number six related to care transitions, nursing homes and rehabs, and what caregivers don’t know is exactly that—the danger in not knowing what you don’t know. This falls into that area of health literacy and advocacy. Health literacy is the ability to obtain, read, understand, use healthcare information so that you can make good decisions and follow treatment instructions. When you combine all of those with the idea of being proactive, you can actually stop or slow health declines for your parents. Health professionals use a lot of terms in conversations that consumers don’t understand. I call that medical speak. Those terms are often related to goals for making healthcare decisions and following through. And what caregivers don’t know is that aging parents may have more difficulty with this because of health factors that relate to their memory. Care transitions for older adults can be more challenging because your parents may understand less about their medical conditions; they may not remember information.
36:29 Pamela D. Wilson: They may not understand the consequences of not following through with treatments. Care transitions from hospital to nursing homes, and rehab, it can involve medical care, follow-up treatments, changes in medication. When any of those fall through, the risk is that your elderly parent will go back to that hospital for the same reason they originally went. And what caregivers don’t understand sometimes is that elderly parents may need more help than you originally think. Being proactive to make sure that care transitions proceed to returning home is the goal. There are some elderly parents who will go to nursing homes and rehab on a temporary basis, and sometimes to Dr. Flint’s point, they never leave because they have another health issue. So instead of returning home, mom or dad may go from the rehab unit to the long stay unit, and that can be a shock.
37:20 Pamela D Wilson: Number seven related to care transitions, nursing homes and rehab, and what caregivers don’t know is that long-term care—so a long stay in a nursing home—it can mean a shared room. Some insurance plans will reimburse for a private room when it’s a short stay situation—when your parent is expected to go back home. But private rooms in nursing homes and rehabs, those are—those are very rare. Because a lot of times, there just are not a lot of private rooms, especially in older buildings. Sharing a room on the long-stay wing—meaning be forever wing of a nursing home is common.
38:00 Pamela D. Wilson: And it can be part of accessing Medicaid. Which is a public benefit to pay for care. Another aspect of what caregivers don’t know about care transitions is that Medicaid planning and applications can be completed several months in advance if you are aware that your elderly parent is running out of money to pay for care in a nursing home. So if you suspect that’s about to happen, don’t wait. After this break, we’ll talk more about Medicaid, and I’ll share some more insights about what caregivers don’t know about nursing homes and rehab. But getting that Medicaid application done as soon as a parent goes to a nursing home can be extremely important, especially if there is not money to pay for more than a couple of months—and a couple of months in a nursing home, it can have a high price tag, imagine $10,000 a month.
38:50 Pamela D. Wilson: And imagine the nursing home asking you to pre-pay two months or three months so that they can complete the Medicaid process and then your elderly parent can stay on the long-stay wing. And as a caregiver, we’ll talk after the break, but you will be surprised the amount of care that you may be providing to help your parent get the care that they need in a nursing home just because the care staff is so rushed. You can follow me on Facebook, join my online caregiver support group. It is called The Caregiving Trap. There you can meet other caregivers in similar situations. My Facebook page is PamelaDWilson.page. This is Pamela D. Wilson on the Caring Generation, coming to you live from the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.
42:03 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, author, and speaker on the Caring Generation coming to you live from the BBM Global Network, Channel 100, and TuneIn Radio. Information for corporations and human resource departments about caregiving training, education on-site, online, through webinars, video conferencing, talent optimization programs, and virtual training programs is on my website at www.PamelaDWilson.com. We’re back to talk about care transitions and what caregivers don’t know about nursing homes and rehabs. Let’s first talk about short-term rehab with the expectation that an elderly parent will be released and returned home. Number eight of what caregivers don’t know is that nursing homes hold meetings called care conferences, to which the resident is invited, and that family can attend. Be sure to ask about the date of the first care conference for your elderly parent or spouse immediately when they are admitted. The information discussed at these meetings includes goals for care and timing about when your elderly parent or spouse can be discharged back home so that you are not surprised.
43:12 Pamela D. Wilson: Many caregivers are shocked when nursing homes tell them that elderly parents are ready to go home. What caregivers don’t know is that mom or dad may have known, but they forgot to tell you. A formal notification is usually provided to the patient three days in advance, who is your mom or dad. And if you don’t believe that your elderly parent will remember these discussions, request that the nursing home staff or the hospital staff also contact you about important details, deadlines, discharge dates. Be very proactive. Don’t rely on the community staff to contact you. Sometimes they get busy. It’s up to you to contact the hospital and the nursing home staff on a regular basis. Some caregivers also think that nursing homes, when a parent is there for a short stay, are a forever place for an elderly parent that gives the caregiver a break. Unless your intention at the start is that this rehab stay will be permanent, you might be surprised when that care staff starts talking to you about sending your elderly parent home. What caregivers don’t know is that ongoing communication is extremely important with the care staff. If you visit frequently, you may notice that care does not always happen. Mom or dad may not have received their bath today. They may be missing meals. Hair might not be brushed. Teeth may not be brushed.
44:31 Pamela D. Wilson: The number nine idea about care transitions is that caregivers—as caregivers—you will help more than you ever imagined when elderly parents need more hands-on care, especially when your elderly parent may not fully physically recover and they may need long-term nursing home care. But you take them home first to see if that is something that will happen. Both situations are very emotionally difficult. A lot of caregivers—you’re working. You might be stretched for time. You’re wondering how you can find more time in your day to devote to caring for elderly parents, and you’re seeing that mom or dad need a great deal of help, and you’re not sure what to do.
45:14 Pamela D. Wilson: If your parents are in a nursing home, you may find yourself doing a long list of things like taking favorite foods to the nursing home for mom or dad. Bringing clothing home to wash. You might be helping with bathing in the nursing home and other personal care tasks. Sometimes it’s almost like you have become a care extension of the staff of the nursing home, and while you might think that this is a bit strange, this happens all the time. What caregivers don’t know is that moving a parent or a spouse to a nursing home, it may not provide that relief from caregiving responsibilities that you imagined. The responsibilities just transferred to different activities.
45:57 Pamela D. Wilson: As a caregiver, it’s important to meet the nursing home doctor. And another item on the list of care transitions and what caregivers don’t know is that mom or dad will usually give up a primary care doctor in favor of a nursing home doctor. And that’s really just for ease of access. Changing doctors—transitioning to a new doctor. It can be difficult. Especially if your parent had a very positive, long-standing relationship with a personal physician that they really liked. The upside though, of having a doctor on-site in the nursing home is that if the health of your mom and dad—if it changes quickly—That doctor or another doctor is usually on call. And they can respond quickly. The downside, though is again, that you and your parents have to get to know a new physician who may seem or you think is rushed or impersonal or who may not care like the old doctor. And that can be shocking. So another question to ask is. Is the doctor seeing your parents—
47:03 Pamela D. Wilson: who does that doctor represent? Do they have their own practice outside of the nursing home, are they representing the nursing home? Because there could be a conflict of interest there. So if the doctor is paid by the nursing home, even though they see your elderly parent, that could get a little tricky. Especially when your parents have chronic health issues, and that nursing home may be penalized for sending your parent to the hospital or not providing good care. I’ve had many clients in situations where, honestly, I didn’t get along with the doctor in the nursing home. Because I felt that it was easier for them to not be interested and not solve concerns, and in some situations, they started talking about hospice care, which is end of life care.
47:48 Pamela D. Wilson: So they wanted to say, well, your client is old and they’re sick. Why don’t we just stop treating them? And that was in conflict with what my clients wanted. My clients wanted to continue to be treated. So that’s what I fought for, and I usually came out on the winning side. But sometimes doctors fired me. I fired them. And it happens. So realize that this is a possibility. Care transitions are an important time to manage, monitor, and oversee the health care of elderly parents. Being an advocate for elderly parents in nursing homes and rehabs is extremely important. As a caregiver, if something happens, you must act quickly. You must take charge and make sure that you are doing what your elderly parent wants—make sure that’s clear to the care community staff.
48:37 Pamela D. Wilson: And here’s one thing to remember, if you’re caring for an elderly parent out of love, that does give you permission to be a little more persistent than other family members who are less involved. Especially if you have the power of attorney. Establish relationships with the day-to-day care staff who are the CNAs. They probably know more about your mom or dad than anybody else in that community. Make sure they have your contact number.
49:00 Pamela D. Wilson: Let them know that it’s okay to call you if something goes wrong. I will tell you these dedicated care staff. They can be a blessing when you have concerns that your elderly parent may not be getting the time and attention that they should be getting. I have come to know so many care staff over the years, and truly they are an unrecognized invaluable source. They are not thanked enough. They are definitely not appreciated enough. So if any hospital care staff, nursing home staff are listening, I appreciate you—and caregivers I also do. More practical tips, more solutions, and support for caregivers are in my book, The Caregiving Trap: Solutions for Life’s Unexpected Changes. It is on my website. You can go to the how I help tab or the education tab and look for my book at www.PamelaDWilson.com. Also, you can follow the radio show on all your favorite podcast sites, Apple, Google, Spreaker, Stitcher, and others. This is Pamela D. Wilson caregiving author, expert, and speaker, you’re with me on the Caring generation live from the BBM global network, channel 100, and TuneIn radio. Stay with me. We’ll be right back.
52:28 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host on The Caring Generation radio program for caregivers and aging adults, live on the BBM Global Network, Channel 100, and TuneIn Radio. Visit my website www.PamelaDWilson.com for helpful information and online caregiver support. You can also check out my online virtual program for caregivers, called Taking Care of Elderly Parents: Stay at Home and Beyond. Coming up next week, we will continue to talk about care transitions and medical aspects of care. What happens if a loved one is in the hospital or a nursing home, and mom or dad wants to leave against medical advice. That acronym is AMA. It means leaving a care community against the recommendation of a physician. Is this possible? Yes. Should you? That depends. The special guest for next week’s show is Dr. Sharmila Dissanaike, she’s Chair of the Department of Surgery at Texas Tech University. She’s going to talk about preventing burnout among physicians, a very common issue that can result in less-than-average care for all patients, especially aging adults—mark your calendar to join me.
53:41 Pamela D. Wilson: Number 10 on the list of care transitions, nursing homes and rehab, and what caregivers don’t know, is the idea of regular, ongoing, and change of condition contact. In my experience monitoring care for clients, I always found that I was the person who knew my client the best. What does that mean? It means that, as a caregiver, you can notice any type of small change in condition that can result in a bigger problem. As we talked, care staff in nursing homes and rehab get busy. You know this, because you may already be showing up to complete the tasks that they don’t have time to perform. There’s also an issue called patient rights. Have any of you heard of patient rights? Do you know what that means? So, here’s an example, and this is a true story. I showed up one day to visit one of my clients at 11:30. She was still in bed. She never got up to go to breakfast, and when I woke her up, she said, “Oh, I just don’t feel good.” She was wheezing. She didn’t look very good. So I went to go find one my CNA friends, and I said, “Why didn’t she get up for breakfast?”
54:50 Pamela D. Wilson: And she said, “Well, she didn’t feel good. She didn’t want to go eat, and you know that’s her right to refuse.” So, of course, my first thought was, “Well, why didn’t you call me?” But that wouldn’t have gone anywhere. So I ran, and I got a pulse oximeter. Which is a device that you can put on somebody’s finger that reads their oxygen level. I went back to my client, her pulse oxygen levels were in the upper 80s, and for her, that was low. Because she had regular concerns about bronchitis and pneumonia. So, I quickly had her sent out from the assisted living community to the emergency room. These are things that are important for you as caregivers to recognize. Ask for the help, ask for the education that you need from family members in the workplace. If you have future ideas for programs, send those to me. God bless you all, sleep well tonight, have a fabulous day tomorrow and a great week until we are together again. This is Pamela D. Wilson, caregiving expert advocate, author, and speaker.
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