The PT said WHAT????

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I had a resident admitted to the hospital for pneumonia and a UTI. She is recovering from a stroke about 6 weeks ago and making great progress with HH PT. Her family called me yesterday and said the head PT at the hospital said that they are not going to give her anymore PT and that she is no longer appropriate for ALF. WHAT???? First of all, she is no worse than when she left us and is probably in a better state now that she has gotten treatment for the pneumonia and UTI. Second, can a PT make that kind of judgement call? I make the dedcisions at our facility as to who is appropriate and who is not. Not a PT that knows nothing about what we require. THe family is very upset and so am I. SHe is A&O, can propell herself in a w/c, uses contact guard for transfers, and is a min assist. Trust me, we have residents in far worse conditions that live in ALF. What's worse is I can't get in touch with anyone at the hospital to talk about this. What do you guys think? Have you ever heard of a PT making a dispo decision?

Specializes in acute care and geriatric.

Ok-based on everything you've written: if they keep her in a hosp or subacute setting- this lady will develop skin breakdown- if she hasn't already!! Her appetite will diminish, she will only get weaker, Putting her in subacute will expose her to more infections, she will lose motivation and become depressed. This is going to snowball on them. I've seen this so many times.

SHe is so much better off with option number 2 - her life might depend on it.

I'll bet others will agree with me. I've seen it too many times.

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yes it's very frustrating! It's one of the most frustrating aspects of the geriatric population in regards to their care..

I'd assume if someone can't afford therapy (PT/OT/ST and the like are well aware of someones financial situations) then they probably can't afford assisted living... Most of the ALF in my area are all private pay. Depending on someones situation, that could mean 5,000 a month or more.

I was told some time ago when I first became upset with this logic.. that everyone gets this way (meaning, everyone in the health care field) eventually... You no longer care about the patient and/or resident.. your world revolves around the bottom line.. I've been a nurse 6 years, in basically the same specialty (LTC) and it continues to aggravate me.. I thought everyone got into this field because they want to care for people.. But money talks.. funny part about it is, you have to carry out your duties, and pretend that money doesn't matter.. and when you have situations like yours, when it could possibly be all about the money, you have to dance in circles coming up with excuses as to why things are, because lord knows, you could never tell a family member or a patient things are the way they are because their Medicare days are all up

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Specializes in acute care and geriatric.
yes it's very frustrating! It's one of the most frustrating aspects of the geriatric population in regards to their care..

I'd assume if someone can't afford therapy (PT/OT/ST and the like are well aware of someones financial situations) then they probably can't afford assisted living... Most of the ALF in my area are all private pay. Depending on someones situation, that could mean 5,000 a month or more.

I was told some time ago when I first became upset with this logic.. that everyone gets this way (meaning, everyone in the health care field) eventually... You no longer care about the patient and/or resident.. your world revolves around the bottom line.. I've been a nurse 6 years, in basically the same specialty (LTC) and it continues to aggravate me.. I thought everyone got into this field because they want to care for people.. But money talks.. funny part about it is, you have to carry out your duties, and pretend that money doesn't matter.. and when you have situations like yours, when it could possibly be all about the money, you have to dance in circles coming up with excuses as to why things are, because lord knows, you could never tell a family member or a patient things are the way they are because their Medicare days are all up

I didn't know that money was an issue in this case,

But regarding your reply I need to answer- our world revolves around the patients- we are their advocates, we care, we want their lives to be better. Taking care of people costs money. Food, Laundry, medical, nursing, PT/OT/ST etc. I wish we could do what we do for nothing but it isn't how things are .

Yes I do tell a patient that Medicare wont pay and they are welcome to pay privately. Why is it we understand that first class passengers get special treatment over economy class but we hate to tell them why one patient who pays privately gets more PT days. Maybe they scrimped and saved for this and didn't go on vacations etc. Whatever- the reality is the reality. I don't know of a country where its different.

I know your gonna say that this is life and death.

It is. But these services don't come cheap and someone has to pay.

I'm sorry.

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Specializes in Gerontology, Med surg, Home Health.

It seems like there is a misconception of what subacute is all about. People don't go to subacute facilities to 'rest'....hello....they come for the SKILLED nursing or therapy they need. And certainly not everyone who goes to a subacute floor ends up with skin breakdown or depression. Many many people go home from the subacute floor in much better condition than even before they ended up in the hospital. If y'all don't get it, how can we expect other people to know what we do.

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Cape Cod, Achot Chavi is in Israel, where sub-acute might mean something quite different.

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Specializes in Gerontology, Med surg, Home Health.
Cape Cod, Achot Chavi is in Israel, where sub-acute might mean something quite different.

I think AC is from there but works in the states...at any rate there are lots of people who don't know what we do.

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Specializes in acute care and geriatric.
It seems like there is a misconception of what subacute is all about. People don't go to subacute facilities to 'rest'....hello....they come for the SKILLED nursing or therapy they need. And certainly not everyone who goes to a subacute floor ends up with skin breakdown or depression. Many many people go home from the subacute floor in much better condition than even before they ended up in the hospital. If y'all don't get it, how can we expect other people to know what we do.

You misunderstood me! I meant that she will get those complications in the hospital. I didn't mean from the subacute-even though most of my patients and families cry and don't want to go, I think its because they are just so attached to us, the fear of the unknown makes them appeal the decisions to go to subacute. While I'm sure the staff works well, its still a temporary place for treatment- not "home".

YES ITS TRUE- most patients come out of subacute in a better condition as they hopefully received what they needed and they healed. The purpose of subacute is healing. Ratios of nurses and CNA's are higher and there are available many treatments not available in regular LTC's .

However- my patients come back depressed and sometimes (twice) with MRSA's. Its not the same as home. Maybe your place is better.

Sorry you misunderstood me.

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Specializes in acute care and geriatric.
I think AC is from there but works in the states...at any rate there are lots of people who don't know what we do.

I am from NY and live, raise my family and work in Israel. We have subacute here too- its great and they work well. As I wrote- I didn't mean subacute- I meant Hospital. Sometimes I post when I'm a bit tired. Sorry for the misunderstanding

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Specializes in Gerontology, Med surg, Home Health.

Totally agree about sending people to the hospital. We had a man who had chronic Cdiff diarrhea for 2 years. His skin was perfect. He got sent out to the hospital...came back 3 days later with 2 stage twos and a stage 3! All the studies done recently show that unless a resident is extremely acute or needs something outside the scope of LTC/SNF, they are most often always better off staying at their facility and being treated there.

I love this forum....it's a great place to share ideas, but unfortunately it's all too easy to have misunderstandings and misinterpretations of what was posted.

Happy New Year to all.

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