here's how medicare works. grandma gets admitted to the hospital for an emphysema attack. grandma stays for a few days getting medical therapies. every day grandma is hospitalized she gets weaker and weaker and weaker. it has now been 4 days and grandma is now ready to go back home and smoke, but she's too weak to hold her own cigarette. so where is grandma supposed to go?
Happy hospitalist is an ignorant SOB who believes that as a physician, all others are beneath him. He may have valid points, but his pomposity hides any point he tries to make. In his little world, he has all the answers, and no one else- and this includes nurses, PA's, NP's- has the ability to formulate an opinion.
Personally, I find all his posts incredibly offensive, correct or not.
Nurse K?
Just kidding. Anyhoo just wondering if you were around for the code/ambu bag blunder years back... I cannot stand him either. I have been mean to him Couldn't help it
Happy is just such a loser that even when there is something important that he could write about, he ends up being completely overcome by his need to assassinate his own character. Someone once called him an asshat. First I had heard the term :) isn't it great?!
The patient hasn't been out of bed for a year. You and I know that the patient never will. Does insurance allow for this patient to go directly from the hospital to a long term care facility? Or does the rehab diagnosis have to be made first; and when the patient fails, then will insurance pay for the long term facility care? I'm just wondering if there is possibly some compassionate reason people like that are being ordered gait training. There is still a grain of hope in me that there is someone juggling insurance mandates to eventually get a patient where it is they really need to be.
I have read other writings from "Happy". He is abrasive in his writings and usually gets someone angry with how he worded his articles. I usually have to look past the abrasiveness and try to think of his intent. He always welcomes all comments in his blog. It makes for a very interesting blog to read.
The article is not that far off. SNF nurse here, Currently I have 2 patients both with G-tubes, unresponsive to verbal stimuli, opens eyes occasionally. They are on the SNF hall with orders for PT and ST to evaulate and treat.
Specializes in ICU,ED, Corrections, dodging med-surg.
All the more reason to discuss with your loved ones the possibility of you laying in a bed, unresponsive, being fed through tubes as maybe not the way you want to live out your last days. If you keep me alive at all costs, it just may come to haunt you. Bring on the comfort measures as I transition out of this world and God Bless those employees in LTC. I tried it for a week and was too traumatized by what I witnessed. It takes a really special person to work in LTC.
The patient hasn't been out of bed for a year. You and I know that the patient never will. Does insurance allow for this patient to go directly from the hospital to a long term care facility? Or does the rehab diagnosis have to be made first; and when the patient fails, then will insurance pay for the long term facility care? I'm just wondering if there is possibly some compassionate reason people like that are being ordered gait training. There is still a grain of hope in me that there is someone juggling insurance mandates to eventually get a patient where it is they really need to be.
The way it works for the private insurance companies I case manage for, is first there is a PT and OT eval done and the patient must meet criteria. They must be able to attend PT so many hours daily and for so many times per week. I get updates from the case managers and the therapists every other day to make sure they are progressing and the goals are being met. The admission to the Acute or subacute rehab facility (or skilled nursing) must be medically necessary....That's where I come in. In this case, if the pt has not been out of bed for a year, they would not meet criteria and the admission would not be authorized for acute/subacute care because there is nothing that the person could rehab from. This would be a custodial care case, or long term care, as in nursing home. My insurance companies do not cover custodial/long term care.
I work for 60 privately funded insurance companies, I don't know how Medicare handles it. I know they don't pay for long term custodial care.
Pfft. I never take happy hospitalist that seriously and in some ways, his sarcasm indicates that he does have respect for nurses. (and yes I have read more than one of his articles) Thought he offers up one way of looking at the issue in this article which is to say there are always two ways of looking at any issue as evidenced by folks on this thread who see it another way entirely.
I wonder how much of this could be avoided if doctors would have training and actually have the difficult conversations with familys. I know how very hard it is to say to someone, "Your mom isn't going to get better. She is dying. The best we can do is keep her as pain free and comfortable as we can while she is still here." I know that deer in the headlights look is hard to deal with when directed at you. I have had people ask me if I was going to just "let mom die." Well, yes, I am actually. Lets talk about this. Communication is just as important as any medication that is ordered. So many times physicians (and nurses) forget that.
Specializes in Professional Development Specialist.
I work in a SNF, and it is NOT like long term care. Yes, we have a nursing home unit in a seperate part of the building, but to say they are the same shows a lack of understanding. IMHO the SNF has a valuable purpose in the medical community. Patients come and recover their strength. They do a lot more than 14 minutes of therapy a day. They get strong and go back to their lives.
He really doesn't seem to offer any actual solutions except having a relative step up. But the patients I see need to still be monitored very carefully in most cases. If sent home there's a good chance they would be readmitted to the hospital. Instead they stay in the SNF, get the medical care they need and therapy at the same time.
Sometimes we do get patients with no rehab potential. But that's an abberation, not the norm. Sometimes families do push for "one last chance" for their loved one. But if the Md at the hospital isn't comfortable having end of life conversations with families, we do it. The patient then pays for their stay privately, or they go home with family.
I think having a family member "step up" is an overly simplistic answer. How many people who don't work in healthcare are able to take weeks or months off work to provide 24 hour at home care to a family member? And if that family member is too heavy for them to lift and requires incontinence care and someone to be sure they are changed and toileted overnight? And what happens when that patient is going downhill but the non-medical family member doesn't realize it because no one is monitoring them medically except the nurse that comes in once a week? Suddenly a case of PNA or a UTI that could have been treated with abx is now another acute care stay in the ICU for sepsis.
My father was in the hospital a while back and from day one, every single person that came in to the room told him his best option after discharge would be to go into a rehab facility.
They pushed it so hard and my parents were so distraught and overwhelmed. They wanted to trust what the drs. were telling them but the choices they were being given were unimaginable to them.
But I just kept insisting that he didn't need to go into rehab and that he would not do well there. I was astonished at how much resistance I got from the staff when I said we weren't going to go that route.
I have seen it happen so many times that patients get dumped in SNFs because the hospital doesn't know what to do with them other than get them out as soon as possible. I've worked in SNF for years. There are patients that genuinely need to be there and do well, but not everyone needs to go into a facility and I wonder if hospitals push so hard because they want to relieve themselves of any liability for whatever happens after the patient is discharged. Well, I guess that's a big duh.
At any rate, we got him home with home health. After a two weeks of care, which included PT/OT, he was free and clear to move on with his life. Yes, he still has a lot of medical issues and needs a lot of follow up, but if he had gone into a SNF he would have been stuck there for weeks, and he would have been at risk for more medical complications. Not to mention the emotional distress of being stuck in that roller coaster ride that is known as skilled nursing.
Fortunately, my family had insurance for that. It's awful what happens to people who can't afford any other options.
And the irony is that all of those people pushing to send him into rehab would not be caught dead working in a facility like that, and look down on the people who do.
They get strong and go back to their lives.
netglow, ASN, RN
4,412 Posts
Nurse K?
Just kidding. Anyhoo just wondering if you were around for the code/ambu bag blunder years back... I cannot stand him either. I have been mean to him
Couldn't help it 