Medical care rant....

[Melaine]

Sorry, I know this will get long.

On Saturday night around 10pm my 85 year old grandma fell and broke her hip. She lives by herself, a couple of hours away from any family. She has someone who lives down the street who comes to help her every day and watches in on her (wonderful lady!). So fortunately she was able to call her and they went in to the ER. My parents are about 3 hours away and started driving immediately when they got the news.

Because of the nature of the break, she wasn't put in any kind of cast, but given prescriptions. She was discharged at 1:45 AM on Easter Sunday morning. My parents were there by then and begged for her to stay at least overnight because of the pain she was in and how difficult it would be to take care of her at home. Everyone was completely shocked that she was sent home. This was a policy issue, even though she has good insurance and isn't pressed for cash. She wasn't allowed to stay regardless.

When they got back to the house around 2AM, the neighbors helped them, and it took almost 5 people to take her in. My mother says grandma was almost screaming in pain, even though she has an extremely high tolerance IME. She is not heavy at all, but they had to get her up stairs and down several halls.

Because it was the middle of the night, and Easter Sunday no less, they weren't able to get any of the "prescriptions" for tools to help her cope with the situation. No potty chair or shower chair. They were having so much trouble trying to figure out how to help her get to the bathroom, that they finally brought a loaf pan in from the kitchen and my dad held her up so that she could relieve herself in the bedroom.

Yesterday my dad went out to Walmart trying to find a TV for her room because moving her is out of the question. My mother has a very important medical appointment tomorrow so she has to drive back three hours to go to it, and will come back to help grandma after that. On Tuesday, my dad will have to leave for a follow up interview several hours away. They are very stressed to have to deal with this with all the other things going on right now. My mom is terrified I will go into labor and she will not be able to come (I admit I am kind of nervous about this too). Grandma has to see the doctor on Wednesday and my mother said that they probably needed to call an ambulance to get there without her being put through excruciating pain to move her.

My mother was almost in tears talking to me about it because my grandfather was a doctor and would have been so horrified of the care his wife was given at a hospital he worked at for decades. Things have just changed SO much. I know our medical system is flawed but hearing the way this situation was handled was truly shocking to me. I'm not sure why I posted, I guess just to vent a little and because I keep having pregnancy insomnia and waking up at 4:30.

[WatchingThemGrow]

That is crazy, Melaine! Why in the world would they think that releasing an 85yo patient at 1:45am on a major holiday weekend would be okay??? it's a double whammy that it was your grandfather's hospital! Seems like when that happened to my grandma, they put her in a rehab facility. Is there one she could go to for a little while until she stabilizes?

[liz]

Write a letter to the president of the hospital. It probably won't help you (sorry to say), but maybe it will help someone else in the future. Sometimes what makes sense on paper (regarding the hospitals "policy") doesn't make sense in real life. Honestly, I am shocked and saddened to hear that they let your grandmother go. As PP mentioned, a rehab or nursing facility might be a good choice for a few weeks. The hospital should really have helped you with that...see if there is a social worker or someone you can talk to. good luck and PT to your grandmother.

[Melaine]

Thanks guys. My dad is already planning letters to the hospital and to editor of the paper. Also, my mom will be calling about some kind of further care, she does have long-term care insurance (I'm sure that is the wrong term, but it covers paying someone to help her during the day and stuff like that). Of course, they weren't open yesterday on Easter Sunday. Just talked to my dad this morning and my grandma somehow tried to get up and go to the bathroom by herself last night and she ended up kind of stuck with her legs half off the bed and finally they woke up and helped her. Of course, my dad has to leave for work and my mom is off to her appointment so they are hoping that the lady who helps her and the neighbors can help her while they are gone. My moms other two siblings are several states away and 95% of her care always falls to my mother.

It's just unfathomable to me that this would happen.

[KrisM]

That is crazy! I can't believe anyone thought releasing her was a good idea. What kind of policy is that? I hope you get some answers about why this happened.

I hope your grandma recovers well.

[wellyes]

I've seen much more compassion from ER docs when treating my kids for much less serious issues. I'm sorry. Both the treatment from the hospital and the lifestyle changes this will require.

[MamaMolly]

Oh honey, I'm so sorry! It must be awful. Your poor grandma! I think your mom needs to phone her sibs and tell them it is time to get on a plane. This is NOT something she can do on her own. P&PT That your grandma is not in pain and heals quickly.

[Melaine]

I know...I feel bad that I can't help! If I weren't 36 weeks and if I hadn't been having PTL, I would go myself and I could at least help with some stuff.

I imagine my aunt will probably come down at some point, but she was just here for a couple weeks so not sure when she will come. My uncle doesn't really seem to feel any family responsibility and hasn't visited in years, so I doubt he will come.

[crl]

Oh I am so sorry! That's terrible. :grouphug:

Catherine

[BDKmom]

What a terrible situation! P&PT to your whole family for having to deal with this.

[Puddy73]

How ridiculously awful! Sending p & pt that the situation improves.

[KathyN115]

Could you call your Grandma's primary care physician for help? The fact that they sent you home is horrible!!! Especially since she lives alone - hello!!!!!

Next time, just say no. Refuse to take her home (Obviously let her be part of the decision making process before-hand). If you can't care for her at home, or if she can't care for herself, what are you supposed to do? If she is under their care, for a broken hip, it is up to them to find a safe place for her to go. It was just bad timing, late at night on a holiday weekend. I would actually take her back to the ER, or have her go by ambulance, and let them deal with it like they should have.

So sorry that they treated your family like that!!

[carolinamama]

I am so sorry this happened to your grandmother. How awful for your whole family.

People really have no idea what is really going on in our healthcare system right now and it's not pretty. But I'm going to stop there.

Hoping your grandmother has a full recovery.

[mom2binsd]

That's insane!!!

I know this is a BP, but I couldn't not write, I work in rehab and I've never heard of someone being sent home in this situation....that's what rehab/nursing homes are for, they take admissions 7 days a week.

Honestly, I'd get her an appointment with a good ortho doctor today, he will probably order Physical therapy and given the set up of her home a short stay at a nursing home where she can get daily PT will be very beneficial.

[maestramommy]

Hope your dad nails them to the wall with his letters. That was just insane.

[jerigirl]

Call her primary care doc to help, contact the hospital's patient advocate, head of nursing, chief of staff, CEO, whatever it takes. That is ridiculus! Does she not need surgery to reset and pin or plate the bone, or something? This does not sound right to me! I also agree that I would get an appt with an ortho doc ASAP! (was she seen by one at the hospital?)

[Melaine]

my mom just confirmed that the doctor refused to refer her to a rehab facility, for no apparent reason.

[AngB]

No new advice to add but wanted to say I'm sorry you are going through this.

[mom2binsd]

She needs to get a new doctor, as she will very likely need therapy or she will not heal properly and will fall again unfortunatetly. I hate it when people get bad care.

[Melaine]

No new advice to add but wanted to say I'm sorry you are going through this.

I think she will see her primary physician on Wed....it was the ER dr. that wouldn't refer her.....my mom was gone all day but will be calling around tomorrow to see what can be done. It's just so nuts to me that the ER dr. Wouldn't refer her? Why???

[maestramommy]

I think she will see her primary physician on Wed....it was the ER dr. that wouldn't refer her.....my mom was gone all day but will be calling around tomorrow to see what can be done. It's just so nuts to me that the ER dr. Wouldn't refer her? Why???


is this another one of those insurance/medical group things? The ER doc isn't in your medical group, so can't make decisions that only the PCP can make? Absolutely maddening, isn't it?

[carolinamama]

She needs to get a new doctor, as she will very likely need therapy or she will not heal properly and will fall again unfortunatetly. I hate it when people get bad care.

:yeahthat:

I am livid for you guys. Again, I am so sorry.

[Nu_mama]

So sorry to hear that your family is having to deal with this! I was shocked to hear they discharged her like that.

[dogmom]

If you are interested in why this decison was made I'd be happy to explain it to you. If you just want to bitch I understand. There is sense in the decision, it was not wrong. But I understand this is the BP area. Let me know.

[Melaine]

If you are interested in why this decison was made I'd be happy to explain it to you. If you just want to bitch I understand. There is sense in the decision, it was not wrong. But I understand this is the BP area. Let me know.

No, I really want to know! Because I don't understand at all....partially because I wasn't there to talk to anyone and even my parents didn't get there in time to talk to the doctor on call, she was discharged before they made it into town.

[BabyMine]

The only thing I can think of is that there wasn't anything they could do that couldn't be done at home. I'm not saying it doesn't suck but just an idea on why the Dr. decided to discharge her. Staying in the hospital longer isn't always a good thing. With her age and a staph infections in hospitals it's probably the best thing they discharged her.

[Melaine]

The only thing I can think of is that there wasn't anything they could do that couldn't be done at home. I'm not saying it doesn't suck but just an idea on why the Dr. decided to discharge her. Staying in the hospital longer isn't always a good thing. With her age and a staph infections in hospitals it's probably the best thing they discharged her.

Maybe but at least the hospital she wouldn't have had to pee in a loaf pan. I just don't get why they wouldn't have referred her to a rehab facility.

[zag95]

Wow. Just wow. Everything you have described is totally incredible.

Did they not refer her because she is elderly, has medicare or because they don't think they can do anything? Sounds like someone on the ER staff needs to take some classes in geriatric care and compassion.

You don't send an 85 yr old woman with a broken hip home in the middle of the night on a holiday weekend. Not sure what they are taking at that hospital.

I would harass the PCP. See if she can go to the rehab center for a few weeks- I think that would be what I'd push for. Another option would be for her to hire an aide to be with her - for a few hours during the day, and a few hours at night (when she may need to get up, etc.)

What was the reason for no surgery? Concerns regarding going thru the surg, age???

So sorry that your family is dealing with this. Is there someone in your grandma's community that can also help with things while your parents are gone?? (Like a church community)

Good luck- hope your dad gives em H**l!!

[elephantmeg]

This is crazy. We always admit those pts unless they are already bed ridden and from a nursing home and the family doesn't want to do surgery. But generally medicare rules are you have to be in the hospital for 3 days before you can go to a skilled nursing facility (SNF) and it really does take a couple days to get all the info to a nursing home/SNF and get a bed (at least around here). I would call the hospital and talk with the patient representative AND call her PCP and see what he recommends re getting her to a SNF.. I'm sorry you are going through this



That's insane!!!

I know this is a BP, but I couldn't not write, I work in rehab and I've never heard of someone being sent home in this situation....that's what rehab/nursing homes are for, they take admissions 7 days a week.

Honestly, I'd get her an appointment with a good ortho doctor today, he will probably order Physical therapy and given the set up of her home a short stay at a nursing home where she can get daily PT will be very beneficial.

[mackmama]

This is shocking and abhorrent. I'm glad your dad's going to write the paper. I'd also call the local news. I'm so sorry and feel so badly for your grandma - and your parents who are trying so hard to help her. Please be gentle on yourself for not being able to be there. You are sending her love and need to take care of your growing babe. Hugs to you all, and I really hope your grandma heals quickly.

[R2sweetboys]

I am absolutely disgusted with the way this hospital treated your grandmother! What would they have done if she didn't have family to care for her?? It sounds like this doc KNEW that and took advantage of it. At the very least, she should have been admitted so she could receive PT and OT to learn how to function at home with a broken hip. I used to be a social worker at a long term care facility and worked on the Skilled Nursing Unit.(rehab) A hip fracture in someone her age can lead to a quick decline in overall health. She should have been given her "three midnights" at the hospital(while getting PT/OT and pain management) so that she could qualify for Medicare coverage in a Skilled Nursing facility. If she is admitted from home, I'm pretty sure she will not be covered by Medicare and it would be VERY expensive out of pocket. I'd be inclined to get her back into an ER and admitted if at all possible. See what her PCP thinks. I'm so sorry that she was treated this way and that your family was left to pick up the pieces. :shake:

[California]

That is truly, truly absolutely awful and there is no way it can be justified. (A doctor trying to avoid medical expenses is not a legitimate or humane justification, if that's what it turns out to be.) My grandma broke her hip and there is no way we were set up to care for her at home-- and we have three nurses in the family! She stayed at the hospital and then moved to rehab, and then came home to a hospital bed, special potty chair, walker, and physical therapy.

Do you have any family or friends in the medical field? It sounds like you need an advocate who can help your family navigate the system to get her better care.

[Melaine]

Ok, I don't know the how and why but Grandma will be admitted to a rehab facility tomorrow, thank goodness! It is still regretful that she had to come home for the three days but hopefully things will go better from here on out. I'm sure my parents will still pursue some kind of explaination from hospital though.

[VClute]

No, I really want to know! Because I don't understand at all....partially because I wasn't there to talk to anyone and even my parents didn't get there in time to talk to the doctor on call, she was discharged before they made it into town.

I want to know, too! I'm a nurse and ive never heard of anyone being sent home with a broken hip! I know a cast cant be done, but why not surgery? Ive never heard of anyone regaining any kind of mobility without pinning or a complete replacement, and without mobility, you cant just go home! The only thing I could think of is that the hospital didn't have an orthopedic on? Our hospital is often without neurology or neurosurgery... I really want to know how this could happen!

[annex]

FWIW, almost the exact same thing happened to my 90 year grandmother in Florida (about 10 years ago.) Weekend (not a holiday), she fell, they x-rayed her at the ER, and then discharged with a known broken hip into the care of my 72 year old aunt with her own medical issues who wasn't able to care for her. I'll be curious to see what the explanation is from the poster who mentioned they knew why this kind of discharge happens.

[dogmom]

OK, here it goes, the explanation, not that anyone is going to be satisfied with it.
First, it’s not a broken “hip”, it’s actually a broken head of the femor. And yes, actual pelvic fractures aren’t always operated on. Whether or not you operate on them depends on various factors. So I don’t know where the other nurse practice, but many people do not get surgical intervention. (http://orthoinfo.aaos.org/topic.cfm?topic=A00392 for more information)

Next, the Emergency Department:
The ED is not part of the hospital as far as many regulation (federal and state) and insurance/Medicaid/
medicare reimbursement. It is basically an outpatient clinic attached to a hospital as far as they are concerned and governed by different rules. Once a patient crosses the threshold and actually gets “admitted” to the hospital they are assigned an inpatient bed. To get an inpatient bed you need to require hospital level care. Things are not what they were like when your grandfather was practicing. Additionally there are many state rules that don’t allow ED to go on devert (i.e. sent non-emergency ambulances to another hospital) so they can’t close their doors. An Easter Sunday sounds like a classic day to have an overflowing ED with people piling out the door. They also get cited for keeping people to long in the ED, partly because if your grandmother is lying on a stretcher for an extra 8 hours so it’s the am and your parents can get stuff arranged there is someone out in the waiting room not getting seen. It’s called triage. They did what they needed to do medically for your grandmother, it was time to move to the next patient. There was nothing else to do for her in the ED. Most ED can give some medication for patients on the way home. I’m sure she was in pain, but medicated pain is a double edge sword in the elderly. I’ve seen more than one 80 year old get one Percocet and they look like they have Alzheimer’s. Tylenol is often the first line drug of choice after orthopedic surgery with judicious use of opiates. It doesn’t help if you relieve the pain and the patient gets confused, gets up and then falls and breaks the other femur. (Of course if that happens in the hospital that’s all our fault according to the state and feds because we are supposed to prevent all falls without restricting any movement.) Admitting her to the inpatient side was (1) nothing the hospital was ever going to get paid for and (2) many studies show your grandmother would more likely do worse in the long run due to various factors.

No on to, Why the Hospital is a Crappy Place for someone in their 80s:
I’ve seen plenty of completely intact elderly that come into the hospital and within 48 hours loose so much ground. That completely independent and intact 85 yo can become completely confused in an unfamiliar place with different routines a couple of new meds and lack of sleep. The decide to get up to go to the bathroom, the chair that is usually there isn’t, down they go, another injury, and it’s the staffs fault because there isn’t a person standing there all the time. When we first came up with set times for hospital stays for certain medical diagnosis that insurance would pay for there was all this ranting that the elderly would do worse, they would get sent home to soon, they would die. Studies were done, but they came out with a different conclusion. Because we were forced to get the elderly up and moving faster we did, they got home quicker, and they did better because we avoided hospital complications. In the end, as a group, they did better.

Who is in hospitals now:
We have a saying for the last decade or so which is basically true. The people that used to be in the hospital are now at home. The patients that used to be on in the ICU are now on the regular floors as the patient’s in the ICU used to be dead. As someone that works in the ICU I can attest to this. This shifts the acuity of all the patients in a hospital to the sicker side. If I compare the patients that used to get sent to rehab 20 years ago when I started to now the look like night and day. Much of it is the population is getter older in the hospital and we are keeping sicker people alive for longer. My hospital runs at 95-99% capacity all the time, it is insane the moving patients around. Sometimes it’s over 100%. It’s a very complicated system with not enough capacity at peak times. It is a bunch of things, and not just people in the ED without insurance (those poor people I hear getting blamed all the time). It is families that insist I keep some alive for weeks in my ICU. It’s people who keep going around demanding risky surgeries that will not end well. It is doctors that can’t say, “No, I can’t do anymore for you that will be in your best interest.” It is bad communication, repetitive tests, procedures that we shouldn’t do. People insisting on tests and procedures because they read something on the internet and they want it. It all means the system is over burdened.

The part you really aren’t going to like:
In the end your grandmother has decided to live on her own in her 80’s in a living arrangement with stairs. Any senior that age, no matter how independent or fit he or she is, is only one fall away from not being able to function. I don’t know what conversation went on between the ED staff and your grandmother. Often someone that age just wants to go home, and she may not tell you or your parents what was actually said. In the end it is not the hospitals responsibility that your grandmother is living on her own in and there are no relatives around to help her. I realize this is a grey area. But I’ve had people in the OR not being able to come up to the ICU because I can’t get my ICU patient out because the floor patient’s family hasn’t come to pick them up because they have to do it later in the day. You see it as a horrible hospital forcing your grandmother out at 1:45 in the am. I look at it as a hospital staff that has nothing more to offer your grandmother for care at this point who needs that stretcher for someone I can help and someone it is my fault your parents are not in town yet. Your grandmother had someone to go. She said there was a neighbor. Your parents were coming. There are a lot worse off patients with a lot less resources that manage to make do every day that the hospital staff sees all the time. So from their perspective your grandmother was probably in better shape that many people they deal with. The hospital is responsible for the entire community, they need to weight different and competing needs to make the decisions. Although some of you may use this as a cautionary tale for why your parents should move out of the house they don’t need any more.

In the end people are wringing their hands because things like health care reform might lead to rationing. There already is rationing and there has always been rationing of health care. All we can hope are that the decisions get based on some kind of medical algorithm based on research and science and not emotion and politics.

[Melaine]

I understand why she did not get surgery. I do not understand why she wasn't immediately referred to a rehab facility. (This was not a case of her requesting to go home, she was not alone and did have a care-giver with her who asked that she stay.)

As to why she is living alone in a home with stairs, don't get me started. It's a constant frustration to me. I'm hoping that after this incident something will change. Her mother lived alone until she was about 95!

[carolinamama]

OK, here it goes, the explanation, not that anyone is going to be satisfied with it.
First, it’s not a broken “hip”, it’s actually a broken head of the femor. And yes, actual pelvic fractures aren’t always operated on. Whether or not you operate on them depends on various factors. So I don’t know where the other nurse practice, but many people do not get surgical intervention. (http://orthoinfo.aaos.org/topic.cfm?topic=A00392 for more information)

Next, the Emergency Department:
The ED is not part of the hospital as far as many regulation (federal and state) and insurance/Medicaid/
medicare reimbursement. It is basically an outpatient clinic attached to a hospital as far as they are concerned and governed by different rules. Once a patient crosses the threshold and actually gets “admitted” to the hospital they are assigned an inpatient bed. To get an inpatient bed you need to require hospital level care. Things are not what they were like when your grandfather was practicing. Additionally there are many state rules that don’t allow ED to go on devert (i.e. sent non-emergency ambulances to another hospital) so they can’t close their doors. An Easter Sunday sounds like a classic day to have an overflowing ED with people piling out the door. They also get cited for keeping people to long in the ED, partly because if your grandmother is lying on a stretcher for an extra 8 hours so it’s the am and your parents can get stuff arranged there is someone out in the waiting room not getting seen. It’s called triage. They did what they needed to do medically for your grandmother, it was time to move to the next patient. There was nothing else to do for her in the ED. Most ED can give some medication for patients on the way home. I’m sure she was in pain, but medicated pain is a double edge sword in the elderly. I’ve seen more than one 80 year old get one Percocet and they look like they have Alzheimer’s. Tylenol is often the first line drug of choice after orthopedic surgery with judicious use of opiates. It doesn’t help if you relieve the pain and the patient gets confused, gets up and then falls and breaks the other femur. (Of course if that happens in the hospital that’s all our fault according to the state and feds because we are supposed to prevent all falls without restricting any movement.) Admitting her to the inpatient side was (1) nothing the hospital was ever going to get paid for and (2) many studies show your grandmother would more likely do worse in the long run due to various factors.

No on to, Why the Hospital is a Crappy Place for someone in their 80s:
I’ve seen plenty of completely intact elderly that come into the hospital and within 48 hours loose so much ground. That completely independent and intact 85 yo can become completely confused in an unfamiliar place with different routines a couple of new meds and lack of sleep. The decide to get up to go to the bathroom, the chair that is usually there isn’t, down they go, another injury, and it’s the staffs fault because there isn’t a person standing there all the time. When we first came up with set times for hospital stays for certain medical diagnosis that insurance would pay for there was all this ranting that the elderly would do worse, they would get sent home to soon, they would die. Studies were done, but they came out with a different conclusion. Because we were forced to get the elderly up and moving faster we did, they got home quicker, and they did better because we avoided hospital complications. In the end, as a group, they did better.

Who is in hospitals now:
We have a saying for the last decade or so which is basically true. The people that used to be in the hospital are now at home. The patients that used to be on in the ICU are now on the regular floors as the patient’s that used to be in the ICU used to be dead. As someone that works in the ICU I can attest to this. This shifts the acuity of all the patients in a hospital to the sicker side. If I compare the patients that used to get sent to rehab 20 years ago when I started to now the look like night and day. Much of it is the population is getter older in the hospital and we are keeping sicker people alive for longer. My hospital runs at 95-99% capacity all the time, it is insane the moving patients around. Sometimes it’s over 100%. It’s a very complicated system with not enough capacity at peak times. It is a bunch of things, and not just people in the ED without insurance (those poor people I hear getting blamed all the time). It is families that insist I keep some alive for weeks in my ICU. It’s people who keep going around demanding risky surgeries that will not end well. It is doctors that can’t say, “No, I can’t do anymore for you that will be in your best interest.” It is bad communication, repetitive tests, procedures that we shouldn’t do. People insisting on tests and procedures because they read something on the internet and they want it. It all means the system is over burdened.

The part you really aren’t going to like:
In the end your grandmother has decided to live on her own in her 80’s in a living arrangement with stairs. Any senior that age, no matter how independent or fit he or she is, is only one fall away from not being able to function. I don’t know what conversation went on between the ED staff and your grandmother. Often someone that age just wants to go home, and she may not tell you or your parents what was actually said. In the end it is not the hospitals responsibility that your grandmother is living on her own in and there are no relatives around to help her. I realize this is a grey area. But I’ve had people in the OR not being able to come up to the ICU because I can’t get my ICU patient out because the floor patient’s family hasn’t come to pick them up because they have to do it later in the day. You see it as a horrible hospital forcing your grandmother out at 1:45 in the am. I look at it as a hospital staff that has nothing more to offer your grandmother for care at this point who needs that stretcher for someone I can help and someone it is my fault your parents are not in town yet. Your grandmother had someone to go. She said there was a neighbor. Your parents were coming. There are a lot worse off patients with a lot less resources that manage to make do every day that the hospital staff sees all the time. So from their perspective your grandmother was probably in better shape that many people they deal with. The hospital is responsible for the entire community, they need to weight different and competing needs to make the decisions. Although some of you may use this as a cautionary tale for why your parents should move out of the house they don’t need any more.

In the end people are wringing their hands because things like health care reform might lead to rationing. There already is rationing and there has always been rationing of health care. All we can hope are that the decisions get based on some kind of medical algorithm based on research and science and not emotion and politics.

Thank you for typing this out so accurately after I basically took the easy road several pages upthread. As a fellow ICU nurse, this is the exact stuff I see daily at work and the public needs to realize when they utilize our strained healthcare system. I spent 2 hours yesterday caring for a pt on a floor because he needed ICU care and we didn't have a bed available yet because of the backflow of moving pts out of the ICU. This left my very sick primary patient without me (thank goodness for a great charge nurse) and me caring for a patient in area not equipped to handle a crashing pt. Did I mention that I wasn't the only unit RN out on floors running pressors and staving off intubation on a floor? We make due, but it is the way it is.

Again, I'm sorry Melaine for your grandmother's situation. But I think we will all see more and more of that in the future.

[scrooks]

I do not understand why she wasn't immediately referred to a rehab facility. (This was not a case of her requesting to go home, she was not alone and did have a care-giver with her who asked that she stay.)
!

Dogmom, your response was great. Very informative. Thank you! But i wonder the same thing tht Melaine does....why wasnt her grandmother referred to an appropriate facility, one that could care for her?

[dogmom]

Dogmom, your response was great. Very informative. Thank you! But i wonder the same thing tht Melaine does....why wasnt her grandmother referred to an appropriate facility, one that could care for her?

To go to an acute care rehab you need to be able to (1) have a need that cannot be done outpatient, so lots of rehab (2) have a reasonable expectation of recovery and (3) this is what gets the older people, be able to participate in 3 hours of physical therapy a day. Many elderly have a combination of weakness from their illness/disuse in the hospital and some need for rehab, but they cannot participate in that level of acute rehab. So those people need to be referred to a nursing home or skilled nursing facility, that involves screening, case managers, and then an open bed. (Guess what, those places are full also!) So it's not like her grandmother could hang out 3 days in the ED while getting placement.

It sucks, but I think people just don't realize how freaking sick some of these patients are in the hospital and how far they are from what you think sucks. Her grandmother was not in immediate danger of serious injury or death by going home, that is where the line is drawn now. Not, how will she manage to get to the bathroom? Talk to some visiting nurse, there are way more people living in the community everyday with these kind of situations, I don't know how they do it. She had a caregiver. If she was alone and by herself with no one I suspect the situation would be different. Also none of this changes the math of number of patients and number of bed/stretchers in the hospital/ED.

[maestramommy]

Thank you dogmom for taking the time to type out that complete response. Being a nurse must be absolute hell sometimes.

And, this makes me so glad my parents live in a one story house, even though they still appear to be pretty spry. My dad just turned 80 and has slowed down quite a bit in the last year.

[gatorsmom]

To go to an acute care rehab you need to be able to (1) have a need that cannot be done outpatient, so lots of rehab (2) have a reasonable expectation of recovery and (3) this is what gets the older people, be able to participate in 3 hours of physical therapy a day. Many elderly have a combination of weakness from their illness/disuse in the hospital and some need for rehab, but they cannot participate in that level of acute rehab. So those people need to be referred to a nursing home or skilled nursing facility, that involves screening, case managers, and then an open bed. (Guess what, those places are full also!) So it's not like her grandmother could hang out 3 days in the ED while getting placement.

It sucks, but I think people just don't realize how freaking sick some of these patients are in the hospital and how far they are from what you think sucks. Her grandmother was not in immediate danger of serious injury or death by going home, that is where the line is drawn now. Not, how will she manage to get to the bathroom? Talk to some visiting nurse, there are way more people living in the community everyday with these kind of situations, I don't know how they do it. She had a caregiver. If she was alone and by herself with no one I suspect the situation would be different. Also none of this changes the math of number of patients and number of bed/stretchers in the hospital/ED.

Wow, thanks Dogmom, these have been really informative posts. They provide a great insight into how our medical system works. Although I no longer have to worry about how to deal with my parents or aunts and uncles (because they all have plenty of local kids to help), it does make me think about how over-taxed the system will be in 15 years when my ILs will start to face more of these serious health and independance issues.

[ellies mom]

I'm a nurse in a skilled nursing rehab facility. So, I get a lot of patients like your grandmother.

We simply aren't set-up to take an admit at 1:45 in the morning, any morning, let alone Easter weekend. There are typically two ways that you get admitted to our facility. Either you know you are going to have a surgery that will require more care than you can get at home or will require a lot of PT/OT and you can pre-register and everything will be ready for you when you get here. Or a hospital or provider sends us a sheet with basic information about your condition and needs and our administrator/admit people decide whether or not we can meet those needs (or have a bed). Only then does the admit process begin. And the people who make those decisions aren't here in the middle of the night.

[speo]

I want to thank you, dogmom, for your posts also. They have been informative!

Sorry Melaine about your grandmother. I hope she mends quickly!

[VClute]

But I still don't understand something. Did your grandmother REFUSE surgery? I'm not an ED nurse, but I work on the medical/surgical floors of our local hospital. I've admitted hip fracture patients who were then not cleared for surgery for one reason or another, but they were admitted to be evaluated for surgery at least, and because they were admitted, they then had the advantage of having case managers available to help sort out skilled nursing placement. I've even admitted patients who were diagnosed with debility or generalized weakness specifically so they could be placed.

Did your grandmother refuse surgery outright? If so, I can see the scenario playing out as dogmom illustrated (and dang, we do the same bed-shuffle you described) Otherwise, I'm still shaking my head over that one.

[Melaine]

No, she definitely did not refuse surgery but was told she did not need it because of the nature of the fracture?

[dogmom]

When you do surgery to "fix" a hip fracture you are trying to stabilize the break in the head of the femur that fits into the hip socket. Depending where and how complete the break is you have different options. It can range from completely removing the head of the femur and hammering a steel head into the mid femur to screws and rods. These are not subtle operations. My guess is your grandmother had a non-displace fracture that did not effect the blood vessels, which is another concern. So, with an 80 something bone that may not hold the fixation in place because it's not as strong, and a failed or infected hip hardware is ugly. With a not that bad fractur, the risk involved in the surgery, including the infection risk, is just not worth it. I've seen the orthopods doing these kind of operations, when they start hammering away to get these plates and screws in you feel it in your bones. It is just so brutal.

If you do an image search on Google for hip fracture you will find different pictures. Many of them from law offices. (That should tell you something.) It will give you an idea of the surgery. I know people want things "fixed" by the doctor, I really do get it. But with my experience if someone said, "Your loved one does not need that surgery really," I'd be thanking my lucky stars, because I know the post-op course. When my grandfather fell when he was 91 and broke his arm they just put it in a sling, didn't even cast it with his diabetes. He also broke his ribs and they gave him percocet for pain. He went from being 91 and driving to my Dad sleeping on the couch because he was so confused my Dad thought he was senile. Called the PCP, the PCP said stop the percocet, and after a day or two my grandfather was back to his old self. Less is often the best course with someone over 80.

[California]

As a side note, stairs are not the only danger. When you are in your 80's and not so flexible or strong, even the edge of a rug can poze a hazard.

After reading dogmom's post it seems very likely to me that my grandparents received better care during their various ER trips because they had two daughters and a son-in-law who were nurses and knew how the system worked. One thing I have learned from them is to plan ahead- that way when this sort of emergency happens or the elderly person needs additional care, decisions aren't be made under so much stress.

Glad to hear your grandma is going to get some rehab help. It's very hard work but hopefully will help her recover.

[VClute]

dogmom, I want to be you when I grow up. :) I did not know until this thread that there was a such thing as a femoral break that did NOT require surgery to fix. It's one of the things I love about nursing (and this board) - I learn something new every day.

I swanny, they could make a whole new world of stuff I don't know. I agree, though, that people with medical personnel (currently practicing) advocating for them tend to get more attention than those who don't. I see part of my job as a nurse being a translator for the doctors and being a tour guide of the modern medical system. Even so, if it's busy (and really, when isn't it?), I know there's a lot that gets lost on the typical patient or family member. :(