goodadvocate

Although accountable care organizations have appeared I still feel there is little management of patients when they are discharged. The concept was to have this umbrella over coordinating care for patients at discharge to keep them from being readmitted but there just isn't enough. Enough of what? Enough nurses, enough information, enough collaboration, enough management, enough questions, enough accountability!! Enough nurses that are within the organization to educate and coordinate care among the patients who leave. We're still giving them a document that we're not sure they understand and telling them what to do. Enough information to know what home is. Do they have a safety net at home? Who lives with them? I once had a patient being discharged out of the hospital after a TIA. No one asked him what home was. The boxes were checked for him to be stable enough to go home. BUT now he couldn't drive. It turns out that he was the caregiver of his wife who had dementia, and he did the shopping and the cooking and the driving. He would be leaving without being able to drive for 6 weeks. Enough collaboration to know who can work with those being discharged and what appointments do they need. The hospitals tend to be the "fortress" wanting to manage everything under one roof thinking that makes it easier. Accountability is an issue and I find it kind of funny that we had developed "Accountable Care Organizations" in a system that should have been accountable all along. Enough Management, meaning to manage the needs of the patient and families. People are living longer, more family live apart and have their elderly parents living alone with an occasional phone call. If we don't manage those patients effectively they will return back to the hospital. Knowing what doctors they see, knowing what medication is they take, knowing they have monies for their medications and knowing they have transportation to their appointments. Managing patients is an important part of the accountability of the system. Physician offices that are seeing 28-30 patients a day don't have the staff or the time or the knowledge to know anything about managing their patients outside the 5-10 minute appointment they have with their patient. Enough Questions,we need to start asking the questions. We need to know the patient, their resources, their community, their support system, their culture, their anxiety, their problems. If we don't ask the question they will return to what they feel is their safe zone. We as a system need to support their discharge with all the ducks in a row for them and then!!! Enough Accountability, there is never enough accountability if there is any at all. When a problem occurs we used to go up the chain to lodge a complaint or tell the story. Hoping that those administrators, managers, executives, leaders would help make a change. What we found was the typical response from healthcare. They would listen, sometimes like they actually cared or get annoyed because how dare we bring them yet another problem that seems insurmountable to resolve and then we we returned to that same entity.....voila our challenges to get things done have become more difficult than it ever was before. So now we leave it alone and change the problem one client at a time as we are never going to be able to change the culture or the system alone. So as you go forward in your practice, whether a staff nurse, a case manager, a discharge planner a social worker please remember there is never enough and make sure you provide enough for your patient before they go home.

The truth is that many of those living in those communities can converse quite nicely. They aren't a threat they are a risk. The reason they are in those communities is because they have memory issues. They can't remember to dress or to cook or to manage their daily activities. Yes some have behavior components but NONE of them deserve to be restrained just "because". The answer is to educate staff. The following information from the CDC is important From 2000–2010, the number of persons in the United States aged 65 and over rose 15%, from 35.0 million to 40.3 million, and in 2010 this age group represented 13% of the population (1). It is estimated that by 2030, nearly one in five persons will be aged 65 and over (2). Given their growing proportion of the population, older individuals will comprise an increasing share of emergency department (ED) patients in the coming years. This is important because of the ED's role in treating acute illness and injury in older adults and providing a pathway to these patients for hospital admission (3,4). This report describes ED visits made by individuals aged 65 and over and compares age groups 65–74, 75–84, and 85 and over. With those statistics facing our society we have to look at educating those managing thee patients. Over-medicating and/or restraining is not the answer. It may be excused by staff that it is for the "safety" of the patient but the reality is it is easier for staff to restrain and forget or medicate and forget. 1. Provide mandatory education for every person in the hospital on how to manage patients with dementia. Including knowing what communities these patients come from. 2. Develop an emergency department for geriatrics. My client with a UTI that created some behavior changes in the memory care unit ended up in the locked unit with the alcoholics and drug addicts swearing and ranting while my clients rests in bed in an open area. 3. I don't know when we stopped caring but if you don't care then get out of healthcare. If there are 4 people in a room restraining someone who then becomes combative and has dementia someone needs to have the courage to say "stop", take a deep breath and re-evaluate your approach and your response. Aging is something we can all count on. How do YOU want to be treated???

That's my point you shouldn't think its ok to come in early to make your job easier and not get paid for it!!! The system should make our job easier and they don't. That culture comes from our environment and although you "think" you are not being treated poorly, I can tell you that you are nothing more than a number and if you rub them the wrong way you will be dismissed without guilt by anyone in administration. We have evolved into an environment that is driven by costs and nothing more. Its no longer about the patient or the employee its about the numbers, length of stay and outcomes, outcomes I might add that are generated and reported by the source. Truly toxic.

It is the culture and it is wrong. There is no other profession that you are an hourly employee and you don't get paid for your hours. DO NOT let the facility bully you into performing work hours for free. 30 minutes per day time 5 days per week is 2.5 hours a week "FREE" they are getting from each employee. I don't know why we think this is acceptable and don't all stand up and holler. I know you feel threatened for your job but they need us more than we need them. If we continue to challenge this behavior we will change it. What is wrong with this picture~~~ There is no way anyone else in any other culture would put up with this yet we think its fine to do. I get so angry at our nursing profession for putting up with being treated so poorly. sharon:D:nurse: