Quick Back Story:
Mom is a 55 y/o woman with brittle type II diabetes, in stage 4 kidney failure. She has been transferred between a CT main hospital and a rehab hospital for the last 8 months. She has relapsed 4 times, going back to the hospital from the same rehab hospital over the last three months. The most recent relapse resulted in Mom going back to a main hospital for 3.5 weeks with renal issues; she's been transferred back to the rehab hospital as of last night (7/27/2019). This return was exceptionally concerning, and I'm asking for feedback on these concerns and if they're valid or if I'm blowing up at something that is standard practice (in CT or other states).
CONCERN ONE: Mom had a "do not cancel" form signed by me as her care giver/assistant (working on POA) so that if she left the rehab, her bed would still be there. When she went back, her room was changed and her belongings (clothing, photos etc) were moved and now some have gone missing. Should they have called me to let me know of the room change?
CONCERN TWO: Mom is on a strict med. schedule (antibiotics, insulin, etc.). When she was transferred, the rehab did not have the meds. she needs, including antibiotics, and has gone at least 2 doses without. They are waiting for "prior authorization" from the insurance company to be able to get the meds. My thoughts is that the prior authorization, and securing the meds. should have occurred before Mom's transfer so that it was ready upon patient arrival but the supervisor just shook her head at me, and told me that's not how it works. The supervisor said that because they don't have a pharmacy on site, the patient has to be there in the rehab hospital and then med. authorization occurs. She didn't see a problem with the "process" or that is causes patients greater harm to miss doses of meds. Is this standard?
CONCERN THREE: The facility was obviously understaffed; it was evident when the Director of Facilities Management delivered Mom's lunch to her room, and when the nurse didn't get to check Mom's blood sugar for the first time of the day at 12:25pm. Additionally, work culture seems to be terrible. A CNA, nurse, and housekeeper all dictated to me that they did not feel supported, they are understaffed, and two of them said they are considering leaving the facility. In my conversation to the supervisor, I explained (without naming names of folks I spoke with) the concerns among the staff I interacted with. I told her that it was concerning that the Director of Facilities Management was delivering meal trays, not dressed in scrubs, and not "gowned up" for Mom's room (Mom has CDiff and staff must gown up to enter, and then remove the gown to not spread CDiff to other patients), that it took 35 min. to have Mom's blood sugar tested, and other issues (her room wasn't clean, pillows were left on top a commode, her missing belongings). The supervisor told me that I just didn't understand how it works and that staff members will volunteer on their day off to help out at the facility. When I asked her if she thought it was acceptable for staff members to come in during their time off to volunteer so the facility is barely functional, she said she saw nothing wrong with it. I know a lot of facilities have volunteers who do just that - volunteer. But to have staff members/employees come in during their time off and volunteer to barely keep the place running seems unacceptable and like a giant red flag to me.
Do I need to just lower my expectations, or are these reasonable concerns? If there's any advice on these concerns, I am absolutely open to it. Thank you!
One situation was that mom takes seizure meds that has to be ‘brand’ name per her doctor’s orders.
The NH’s don’t generally use brand name meds so they wanted to give mom generic. They didn’t have the meds at the NH. They told me to bring mom’s brand name meds from home so she could continue to take what she always did. I agreed. She was only there for three weeks. In a temporary situation it doesn’t matter. Permanently though is a different story.
The other situation with meds was that an LPN, gave mom a double dose of her Parkinson’s meds so she could save a trip to give her the following dosage. That bothered me and I did what you are doing, reached out to the forum to ask for opinions and suggestions how to handle it. I received good advice as to what to do and I did address it because I didn’t want it to happen again to mom or to any other residents.
I am pleased to say they addressed it with that particular LPN and said they were going to use it as an educational opportunity to share with entire staff. I was satisfied. Give them a chance to make it right if you wish, otherwise move your loved one to another facility if you feel it is best.
I have friend who is an RN and she told me that sometimes staffing does take liberties with meds that they shouldn’t. Her dad was in a NH and when issues weren’t resolved she didn’t hesitate to move him to a new NH.
The hospital should have sent enough meds for the standard procedure to not leave mom without medication.
I am always concerned with any environment that the employees feel comfortable complaining to customers, it tells me that the problems stem from the top.
I recommend moving mom.