One of the underlying questions that is not addressed in this article is Why did Sylvia Bailey suffer for so long with a fractured leg? Why was she denied investigation and treatment? Her condition was not invisible, there was an incident leading up to her pain and she was able to articulate that she was in pain.
Why did no one act?
The facility had caregivers, a physiotherapist, a doctor and nurses. They all interacted with her.
We have found that this failure to act is not uncommon. Being an advocate for Clients, to assist them to get the care that they deserve, is an important part of our role. The reasons that professionals who are charged with the responsibility to care for others, in fact are getting paid to do just that, don't, are complicated.
From what I have been able to glean from my 30+ years of working and volunteering in health care settings, failure to act is a learned behaviour that is developed in a setting where there is a pervasive culture of not acting.
In these kinds of settings, I often find that there is little or no leadership and no accountability. In some circumstances it is that the medical staff are intimidating and discourage staff from contacting them outside of regular visiting hours-even though they are supposed to be on call. Add to this that many facilities now hire Registered Practical Nurses for roles where they once hired Registered Nurses.
Many "in charge" positions are held by people who are newly graduated. The newer graduate will not have the experience or confidence to suggest to a doctor or administrator that care should be delivered differently. Also, the workloads in a facility setting may be very heavy. Care decisions that allow staff to get their daily assignments done are favoured over those that may take additional hours to complete and have them at odds with an unhappy physician who has been paged in the evening.
If you are a family member who is concerned about the care your relative is receiving in a facility setting, you should speak to the person in charge of the delivery of that care. If you do not feel that the issues are being addressed, document your concerns and ask to talk to the next senior person in the organization. Be polite, be firm, be reasonable, be an advocate.
Friday, July 29, 2011
Thursday, July 28, 2011
Does the Health Care System really need more money-or does it need to use the money it has more wisely?
Today I received a phone call from a senior who had recently undergone back surgery for degenerative disc disease. She is home from hospital, lives alone in a highrise apartment, and receives two one hour visits each week from the CCAC for assistance with bathing.
She is using a walker now due to poor balance. She is not receiving assistance from a physiotherapist either at home or in an outpatient setting. She has not been given any direction in terms of a follow up exercise program. She still requires medication for pain, and some days are better than others. She does not have children to assist her, although she stated that her neighbors have been very generous with offers to assist with grocery shopping.
What's wrong with this picture?
Back surgery is an expensive, invasive and serious undertaking. As taxpayers, we should consider it an investment in a person's wellbeing. We have the right to expect that the person receiving the benefit of the surgery, actually benefit. This means that once a person is discharged home to the community, some basic care and supervision and support should be offered to keep that person as safe and independent as possible. We don't see this happening very often.
The cost of providing home health care compares very favourably to providing hospital or facility based care. The VIP program offered by Veterans Affairs has demonstrated the tremendous beneficial effect, both financial and psychological, for those receiving even minimal support at home. For those not familiar with this program, it provides housekeeping and in some cases caregiving support to Veterans who wish to live at home. The annual costs are within the $3,000-$5,000 range. This compares incredibly favourably with the approximately $1,000/day to keep someone in an acute care setting. (And yes, there are many seniors who are being "held" in an acute care setting who could safely live either at home or in a long term care setting.)
This way of doing "business" is costing us a fortune and is not providing favourable outcomes for the Client. It doesn't make any sense.
Back to our caller...with continued support and a small investment in her continued wellbeing, we have the opportunity to keep this senior safe, happy and independent at home. It's a win-win situation; makes great economic sense and gives a senior her choice to stay home safely.
She is using a walker now due to poor balance. She is not receiving assistance from a physiotherapist either at home or in an outpatient setting. She has not been given any direction in terms of a follow up exercise program. She still requires medication for pain, and some days are better than others. She does not have children to assist her, although she stated that her neighbors have been very generous with offers to assist with grocery shopping.
What's wrong with this picture?
Back surgery is an expensive, invasive and serious undertaking. As taxpayers, we should consider it an investment in a person's wellbeing. We have the right to expect that the person receiving the benefit of the surgery, actually benefit. This means that once a person is discharged home to the community, some basic care and supervision and support should be offered to keep that person as safe and independent as possible. We don't see this happening very often.
The cost of providing home health care compares very favourably to providing hospital or facility based care. The VIP program offered by Veterans Affairs has demonstrated the tremendous beneficial effect, both financial and psychological, for those receiving even minimal support at home. For those not familiar with this program, it provides housekeeping and in some cases caregiving support to Veterans who wish to live at home. The annual costs are within the $3,000-$5,000 range. This compares incredibly favourably with the approximately $1,000/day to keep someone in an acute care setting. (And yes, there are many seniors who are being "held" in an acute care setting who could safely live either at home or in a long term care setting.)
This way of doing "business" is costing us a fortune and is not providing favourable outcomes for the Client. It doesn't make any sense.
Back to our caller...with continued support and a small investment in her continued wellbeing, we have the opportunity to keep this senior safe, happy and independent at home. It's a win-win situation; makes great economic sense and gives a senior her choice to stay home safely.
Tuesday, July 26, 2011
"Nursing Home gave Tylenol" -Addressing the incidence of Falls
This article sadly states that the resident, Sylvia Bailey, "had fallen from her wheelchair four times in the past year, hitting the floor so hard she had a permanent dent in her forehead."
Nobody, never mind a frail senior, should be falling repetitively and hitting their head. And yet I hear from family members regularly that amongst the other ailments a senior might have, that the senior has fallen, often more than once. People should not be falling. If someone falls, we need to know why. We need to know if they've suffered any harm and we need to do something to make sure that it doesn't happen again.
A fall is not an isolated event. It is the result of a lot of things that have gone wrong. When I conduct an initial assessment for a new Client what I often discover is that someone has not been eating well, that they are not taking medications as prescribed, that they are dehydrated, that their blood pressure is too low or too high.
I find cluttered environments, risky behaviour (like climbing on small ladders to reach a shelf), poor footcare, inappropriate footwear, an absence of assistive devices or misuse of assistive devices, overuse of sedatives , analgesics or other medications, a lack of medical follow up for underlying conditions-and these are just for starters!
Falls are a complicated issue. They happen often. They are not inconsequential. Many are preventable. Falls cause pain, suffering, debilitating injuries and they negatively impact quality of life.
To begin to recognize contributing factors and reduce the incidence of seniors falling, I have the following advice: We need to see falling as unacceptable. We need to see falls as preventable. We need to investigate possible contributing factors each time there is a fall and we need to address these issues to reduce the risk of a fall happening again.
But the first thing that we need to do is to pay attention. If a senior falls, we need to care.
Nobody, never mind a frail senior, should be falling repetitively and hitting their head. And yet I hear from family members regularly that amongst the other ailments a senior might have, that the senior has fallen, often more than once. People should not be falling. If someone falls, we need to know why. We need to know if they've suffered any harm and we need to do something to make sure that it doesn't happen again.
A fall is not an isolated event. It is the result of a lot of things that have gone wrong. When I conduct an initial assessment for a new Client what I often discover is that someone has not been eating well, that they are not taking medications as prescribed, that they are dehydrated, that their blood pressure is too low or too high.
I find cluttered environments, risky behaviour (like climbing on small ladders to reach a shelf), poor footcare, inappropriate footwear, an absence of assistive devices or misuse of assistive devices, overuse of sedatives , analgesics or other medications, a lack of medical follow up for underlying conditions-and these are just for starters!
Falls are a complicated issue. They happen often. They are not inconsequential. Many are preventable. Falls cause pain, suffering, debilitating injuries and they negatively impact quality of life.
To begin to recognize contributing factors and reduce the incidence of seniors falling, I have the following advice: We need to see falling as unacceptable. We need to see falls as preventable. We need to investigate possible contributing factors each time there is a fall and we need to address these issues to reduce the risk of a fall happening again.
But the first thing that we need to do is to pay attention. If a senior falls, we need to care.
Friday, July 22, 2011
Toronto Star report - "Nursing home gave Tylenol to resident with broken leg"
On Thursday July 21, The Toronto Star reported a sad case where a nursing home resident suffered a fall, which resulted in a broken leg which was never diagnosed or treated. The resident suffered terribly. She subsequently died.
I wish that I could say that this was an unusual occurence, that everything that went wrong for this resident was an anomoly and that most Nursing Home residents get superb care. Sadly, I cannot. We have assisted and advocated for many Clients over the years so that they might receive the care that they need and deserve.
So many things went wrong for this resident. Opportunities for improving the lives of residents can be highlighted using this scenario as an example. Over the next week, I will tackle some of the important issues that have been revealed through this sad experience.
Pain
The article begins with "For 24 days, Sylvia Bailey screamed in pain from an untreated broken leg.."
Nobody should be in pain - especially when the pain is excruciating and unrelenting. We have the means to keep people comfortable while we sort out why they are uncomfortable. It is every resident's right to be free of pain to the best extent possible.
In this case, there was a strong possible cause to the resident's pain. It is absolutely unforgivable that an effort to investigate was not made immediately.
If you find yourself in this position, where your loved one is uncomfortable and is not being attended to in a compassionate manner, you must insist that those charged with the responsibility for their care, act. You must make a fuss.
One of the most important roles we have at Eldercare Home Health is as an advocate for our Clients. We ask questions, suggest direction and insist on feedback and action in a timely manner. You need to do the same.
No one cares more for your loved one than you do. When that loved one is a frail senior, and when that frail senior is in pain or is suffering in any way, don't be shy, don't worry about stepping on the staff's or the doctor's toes. Be polite. Be firm. Be an advocate.
I wish that I could say that this was an unusual occurence, that everything that went wrong for this resident was an anomoly and that most Nursing Home residents get superb care. Sadly, I cannot. We have assisted and advocated for many Clients over the years so that they might receive the care that they need and deserve.
So many things went wrong for this resident. Opportunities for improving the lives of residents can be highlighted using this scenario as an example. Over the next week, I will tackle some of the important issues that have been revealed through this sad experience.
Pain
The article begins with "For 24 days, Sylvia Bailey screamed in pain from an untreated broken leg.."
Nobody should be in pain - especially when the pain is excruciating and unrelenting. We have the means to keep people comfortable while we sort out why they are uncomfortable. It is every resident's right to be free of pain to the best extent possible.
In this case, there was a strong possible cause to the resident's pain. It is absolutely unforgivable that an effort to investigate was not made immediately.
If you find yourself in this position, where your loved one is uncomfortable and is not being attended to in a compassionate manner, you must insist that those charged with the responsibility for their care, act. You must make a fuss.
One of the most important roles we have at Eldercare Home Health is as an advocate for our Clients. We ask questions, suggest direction and insist on feedback and action in a timely manner. You need to do the same.
No one cares more for your loved one than you do. When that loved one is a frail senior, and when that frail senior is in pain or is suffering in any way, don't be shy, don't worry about stepping on the staff's or the doctor's toes. Be polite. Be firm. Be an advocate.
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