nursing homes for the cognitively intact?

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As an volunteer EMT I have a frequent flyer/caller for assists, a woman in her 50s with Parkinson's and some psychological issues. She and her husband are not coping and she really needs 24 hour care. Are there any nursing homes, or maybe floors on nursing homes, for younger people without cognitive problems?

Also, how do you protect someone who you think is falsely accused of abuse when you do mandatory reporting? Anything besides document, document, document ("Patient whispers 'My husband beats me.' No ecchymoses, abrasions, lacerations or other injuries noted on limbs, face, belly, buttocks...")

Social services has been called and hopefully they'll manage to set some things up for this couple, but we'll probably be back...

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Specializes in Government.

I can't answer the abuse question. However, your thread title reminded me of when I started working in nursing homes in the 1970's. People often retired to nursing homes, intact mentally and physically. We'd have whole wings for them.

However, those days are gone. Nursing home, 24/7 skilled care is extraordinarily expensive if you are paying for it yourself. Meeting the criteria is a bar higher than most ambulatory, functional people will achieve. Reimbursement requires a far higher level of disability than you are describing. I'm not in LTC now ....I'll be interested in the replies you get.

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Specializes in LTC,Hospice/palliative care,acute care.

Up until the early 90's nursing homes could segregate residents according to their needs.We had entire units of tube feeders,a unit of residents dependent for all adls and several units of more able bodied and oriented residents (which used to be such a rarity in LTC anyway.We had rooms of trachs,rooms of screamers...

We used to re-admit hospital returns to the appropriate unit depending on their condition.Then the Dept of Health decided that those residents had the right to remain in their room no matter what their condition and we are not permitted to segregate in any way.Now we have alert and oriented residents rooming with trachs.I work in a county run home and we have very few private rooms.We have alot of conflict between the residents.

I don't see anything changing until the baby boomers start entering LTC.We are seeing more and more younger and alert residents and they really fall through the cracks in LTC. It's sad.

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This woman can't walk - can't get up if she falls. We were getting calls for lift assists and assists to the bathroom.

On the other hand, there are psych issues going on - her husband claims she can walk if she wants to, and she's on a slew of psych meds. Intermittant conversion disorder? I don't think she's faking; she definitely has the Parkinson's diagnosis from a neurologist, but she didn't seem as Parkinson-y as all that - not rigid.

Even if her issues are more psych than neuro - what about patients who definitely have major motor impairments and can't care for themselves and don't have care at home either - say ALS, quadriplegia, advanced MS, Parkinson's, paralytic stroke - but their minds are still there? Even for old people - I remember one gentleman in my grandmother's nursing home who was perfectly cogent, surrounded by all these vacant women.

Patients who have their full wits should have company they talk to - there should be at least one floor in some nursing home in the region for them.

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I once had a young quadraplegic who lived in a nursing home. He was alert and talkative. I asked him if there were any other young people in the place with him. He replied that there were but they were unresponsive, brain-damaged young people. This guy said he would wheel past their rooms quickly and consider himself a lucky man.

It sounds like your patient would be a candidate for a social work consult. Social workers have lots of knowledge about her options.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

In my state, paramedics and EMT's have to report unsafe living conditions to the Adult and Family Services of the state and let them know why you feel it unsafe for a patient to return to the independant home environment. Also, if she is going to a hospital and returning her home to an unsafe enviroment, that needs to change and social services contacted to start up placement into a proper facility for her. Otherwise it is called neglect and dumping.

I am very lucky that my MD's and Discharge planning department is very big on not letting people return home unless they have met criteria for simple out of facility living (well, the hospital is getting screwed on costs though!!! Medicare is a evil beast when it comes to all this, but our discharge planners are top notch and know this stuff...whew!). If a person keep falling, then we have them do rehab (and we will even make them stay the three days...uhgggg...that medicare requires for them to go there or a home!!!! Don't get me started on that BS!)...or assisted living, or skilled nursing facility. They pool as many resources as possible for these folks including family (if they are even around or care) and place them after hospitalization in the proper place.

Now, it doesn't say a patient can't refuse this...and this is where it gets ugly! Then the hospital has to go through adult and family services and get a State Appointed Power of Medical Attourney to order it so if they are not able to make safe choices themselves. If the husband is not able to make these choices...he may need some help too because perhaps some dementia has set in or depression or what not and can't see the truth of the matter...that he is putting his wife at great risk, even death!

It is a sticky situation, but check out mandatory reporting to Adult and Family services in your protocols...it may be the first step in getting her help (also, if you have a nurse you know that is working there, you may put a buzz in their ear too...that may help get things started too!).

Good luck, and thanks for looking out for our elderly...they need that help!

The other question...depends on circumstance and typically a lawyer is best dependant...

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Specializes in ICU, CCU,Wound Care,LTC, Hospice, MDS.

What about Assisted Living? They are springing up all over the place just for this purpose.

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Specializes in subacute/ltc.
What about Assisted Living? They are springing up all over the place just for this purpose.

:yeahthat:

Pop onto the ltc forum here on AllNurses. There is a sticky re ALF. ALF(s) go from levels 0-9 translated: levels range from totally independent living to almost total care. Cost may be an issue billing is predicated upon services provided. Some may be covered by medicaid/ssdi or have to be paid by the resident privately. I never really got into the billing aspect of it, sounds like it is worth investigating.

Tres

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I'd recommend a care home search facility where you can search homes for specific requiements like this; each offer these

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husband may be in denial about what wife can no longer do

independent living and assisted living that are subsitized by medicare may require that person's assests be below a certain level and self pay may be prohibitive

sometimes yo can be between a rock and a hard place

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