Do you feel like your acute rehab floor gets patients who have absolutely, positively NO business being in intensive inpatient rehab? It seems like more and more of our admisssions are just hot messes who end up going acute and leaving us in a day or two because they aren't good candidates for 3 hours of therapy a day. Some are very sick and just need more time to stabilize before coming to us (of course, people just don't get the time they need in the hospitals anymore before being kicked out) but some are just not good candidates.
For example: 99 yr old lady with extensive cardiac hx who fell and broke hip. First day in rehab, 1 hr of therapy left her in bed on O2 unable to wake up to eat or anything. MD came and said "oh, she's just old" No **** sherlock, maybe she should just go home with an aide to enjoy her final days. 2nd day, she couldn't do all of the therapy. When family asked about maybe doing 'light' therapy in the bed, MD said "if she can't stand the therapy, she needs to go to a nursing home" which scared the family so they shut up. 3rd day, I walk in and pt looks like c r a p - ran full cardiac workup which was negative, but it was apparent something wasn't right with pt. The MDs came and made some med changes, but again just said "she's old" I put her on hold from therapy and kept a close eye on her. In the afternoon, she had acute neuro changes (slurred speech, change in pupils) so we took her to a stat CT and sure enough, she had a big bleed. Pt went to ICU then hospice then passed a week later.
Why was she put in rehab in the first place? 99 years old? Cardiac hx? Why not just go home with her aide (family had $$$ - pt had a private aide) and enjoy her last days/months/years?
I was her nurse on day 2 and 3 - wish I could have done more. I feel like I did everything I could - called the MDs, got testing done, talked with the family, comforted the patient. I know it was her time, but I feel like the therapy killed her.