Help with Elopement

[SuesquatchRN]

We have an elderly gentleman who came in with Parkinson's and was here for rehab. He's been with us a couple of months and wants to go home. He lives a couple of blocks away. His wife would take him home in a hearbeat but PT is blocking it and she is of a generation that will not disoneythe authorities and take him home AMA.

He. Is. Determined.

As his attempts to leave have escalated he has been medicated with Seroquel. Geri-chair with tray. Now he has become combative when he is rushed and wrestled into the chair and Depakote has been added.

I feel like Nurse Ratched. He is fine on certain shifts, but some nurses come in already high-strung and really escalate things by being unable to approach him calmly, and when he is surrounded by a bunch of people his behavior is certain to become combative from fear.

Help, please.

[SuesquatchRN, BSN, RN]

I'm angry, Marla.

I don't buy that it's money. We can fill beds in a heartbeat. I think it's power.

[sharpeimom]

working in ltc has made me very cynical. and since the op, not someone new to this forum, states that it's pt that's getting in the way, i have to believe that this started as a reimbursement issue.

but reading about the medications they're giving him to keep him settled is making me uncomfortable. what was he like behaviorally before he was admitted? what docs are ordering these meds, and are the orders based on in-person physical assessment? does the man need a psych consult? how are his labs? what's his sinemet dosage? is he sundowning? is it reactive psychosis? depression? dementia? if he spends his downtime under chemical and physical restraint, how is his pt progressing?

i don't mind telling you that i'm concerned about the treatment he's getting.

my grandmother had parkinson's disease, and while she wasn't senile or delusional, she was not her usual self after a certain point in the disease. my grandfather died very suddenly and grandma came to live with us. that was when parkinson's drugs were in their infancy. she began taking simitryl (sp.?) when it was an experimental drug. while it greatly diminished her tremors, helped her aphasia, and made her far less rigid and stiff, it did require many many meds adjustments and it did change her basic personality somewhat. this gentleman sounds as though he needs to have his meds evaluated by a neuropsychiatrist or a neuropharmacologist, as a first step. in my opinion, many of the emotional changes seen in parkinson's patients aren't caused just by the disease, but rather are caused as meds side effects. this gentleman is on so much stuff that i feel it is pharmacutical assult. does the wife have a medical poa for him?

i'm upset and concerned.

he is not on my unit. pt is expressing fears that the wife will be unable to care for him. not so. she will move heaven and earth to do so. they have also expressed that they think the violence is part of the disease process, with which i completely disagree.

he was, upon admission, a gentle, pleasantly confused elder.

is there some way some agency like the area for active aging could be tipped off and they could help the wife be sure everything were in place to care for him at home? what about a home assistant or caregiver to help her? parkinson's does not automatically render one incompetent! because of her generation, the wife needs some help and encouragement to take her husband home so they can be together for whatever time they may have left.

kathy

shar pei mom:paw::paw:

[SuesquatchRN, BSN, RN]

She has POA.

I think the social worker may work her magic. I'll see her tomorrow.

Thanks, all, for your input.

[CapeCodMermaid, RN]

If the man goes home and can't manage, he can always come back to the facility and pick up his medicare days where he left off...if he comes back within 30 days. Certainly he and his wife deserve a chance to fail at home. I worked with an MDS coordinator like that. She thought she had the sole decision making for anyone on Med A as far as discharge plans. It's the wife's decision. Let him go.

[MauraRN]

I agree with you Sue. It does sound like a petty power play; who stands to gain kudos for keeping a lucrative patient in the facility? Glad you have "magical" social workers, they can often make things happen without some PT dope losing face.

Otherwise, how is your new nurse manager gig going?

MauraRN

[SuesquatchRN, BSN, RN]

I love it, Maura, but I'm really tired. I am often the only RN in the facility - every third weekend one of the NMs covers - and it keeps me busy with 120 residents and patients. I have some super nurses and CNAs, so that helps a whole lot. But this is way different than pushing a med cart around, and right now, exhausting, because I am playing catch-up and still looking for a groove. It'll come.

Thanks for asking!

A coupld of funny stories. This weekend a gentleman came in looking for his mother and I came out of my office in my white scrub dress. He said, "You're obviously the nurse on duty in this unit!" which really cracked me up. WHo said uniforms don't count? And I call everyone by their honorific - Mr or Mrs. Only ONE has told me to use her given name. They don't have much left and like the respect shown. Hey, they're my seniors. They're not my peers.

:)

[wonderbee, BSN, RN]

A complete abuse of Medicare and the medical system in general. I've seen this kind of thing before. It's not limited to extended care facilities. It's rampant in psych and home health as well though the patients in home health do not suffer as this poor man who has become a prisoner of the system. Load 'em up with mood altering meds, immobilize them and watch them die of pneumonia. Fee for service encourages this crap. All we can do is advocate, advocate, advocate.

[SuesquatchRN, BSN, RN]

I got more information today. They go to Florida every winter and the wife is still determined to take him.

Nope. That can't happen.

[wonderbee, BSN, RN]

Aww Sue, that's too bad. This couple's life has changed and she's just not having any of it.

[SuesquatchRN, BSN, RN]

Aww Sue, that's too bad. This couple's life has changed and she's just not having any of it.

Yeah, she can't accept that she can't leave the snow. That really makes it impossible. He can't change environments at this point. Back up the street is all he can handle.

[pennyaline]

Yeah, she can't accept that she can't leave the snow. That really makes it impossible. He can't change environments at this point. Back up the street is all he can handle.

Aw, that's too bad for both of them. Still, it doesn't mean he can't go home with services that will help out both of them, as in snow shoveling and winter maintenance stuff. And it doesn't adequately explain why they are medicating him through the roof. If they can afford to pick up with private pay, let him go home with housekeeping services. But when his Medicare time is up and she can't swing private pay, he'll have to go somewhere (God help them if they have go Medicaid). He might as well go home with services now.

[SuesquatchRN, BSN, RN]

He can't go home now because she'll take him to FL. She isn't accepting the new situation, Penny.

NY makes everyone Medicaid. That won't be a problem.