Transitioning to the Hospital

The son of an 89 year old female called me regarding his mother, her hospitalization and transition into a short term care facility. She was also experiencing ongoing complications with a UTI. The son lives in New Hampshire with his wife. His mother lives alone and in his eyes has been doing well and hasn’t had any problems until now. She went to a wedding with her son and when they brought her home she collapsed. They brought her to a local emergency room where she stayed until 9 pm and was then transferred out to the short-term care facility. The family would be paying out of their pockets because she did not get admitted. The cost would be $250.00/day for two weeks then the cost would almost double.

When she arrived she was confused. The confusion continued with her escalating to a urinary tract infection on day 4. She was treated for the UTI but they had taken her off her long acting pain medication because of the confusion. They believed the confusion was a result of the narcotics. When they recognized the confusion was from the UTI they forgot to put her back on the long acting pain medication. She remained in bed for 10 days. Records from physical therapy indicated that she wasn’t willing to participate in physical therapy. She had stopped eating and they started IV therapy on her. She also had a history of osteoporosis and had fractures that were recognized on x-ray when she went to the ER but there were no new fractures. Her pain was from the fractures and arthritis

 

Story Details

Client  89 year old female
Issue  Confused and in pain
Situation  Poor care/long term care facility
Outcome  Discharged to home w/24hr care

The family hired us on day 10. When we began working with the patient we checked on her records.  We found that there were no labs from the ER and wondered what they had done for labs and urinalysis while there. We called the ER and had the urinalysis faxed over and found that she indeed had a UTI when she was at the hospital. There was no information sent when she was transferred. The facility also didn’t seek them. Both the hospital and the short term care facility were to blame for the lack of information.

The family requested that she go to the hospital. She was transferred on day 11 but was not admitted. She returned to the facility and we followed up the next day.  At this time we discussed pain management with the physician. She was transitioned to having a pain patch with medication for breakthrough pain. In two days she was in therapy and participating. By day 4 of the patch she was not complaining of any pain and within one week was a one person transfer. There was a care conference with family and staff on day 16 with plans to discharge to home. On day 20 the physical therapy department came to assess her home; with the son; and was signed off to be able to go home safely with help. On day 24 she was discharged to home with 24 hour care and able to stand with little help and roll herself in the wheel chair, use the walker to go the bathroom and dress herself, without any complaints of pain.

Pain management is a problem in the elderly. It is often not assessed well and encouraging patients to move isn’t done. There were issues with staff not wanting to move her.  There were also issues with staff leaving her food tray on her table where she couldn’t reach it, then taking it away before she could finish her meal. She was hungry whenever her son, family or we went to visit. She had lost 14 pounds in the first 10 days being there. This should have been a red flag to get nutrition involved. When nutrition got involved and found that she didn’t like the food they rearranged her diet by giving her what she liked. One of her complaints was simple, she didn’t like eggs and got them every morning. She wanted to have oatmeal. Oatmeal was given and she started to regain her appetite. She has regained 4 lbs since the diet change.

The family is very happy with the intervention and has hired our service to continue to monitor her at home until they can find a community for her near them in New Hampshire.  We are also helping them with locating a suitable community near them in New Hampshire.

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