Why would they release such as sick person to a Long Term Care Facility?

Long Term Care Columnist / Guide · Apr 17, 2005

Because that's where people who need extended care and complicated dressing changes go........almost nobody stays in the hospital for very long anymore. Of course, they then get sick at the nursing home because they were released too soon and end up back IN the hospital........it's just a big revolving door, thanks to the trifecta of managed care, insurance company profits and CEOs' big salaries :angryfire

live4today, RN · Apr 17, 2005

Marla, you hit the nail on the head with that answer. Can't per--fect it anymore than that! :chuckle It's now called "Skilled Nursing" in the nursing homes..........another term for "Step-down unit of Med/Surg". :uhoh3:

Long Term Care Columnist / Guide · Apr 17, 2005

Marla, you hit the nail on the head with that answer. Can't per--fect it anymore than that! :chuckle It's now called "Skilled Nursing" in the nursing homes..........another term for "Step-down unit of Med/Surg".

Yanno, Renee, I think they ought to call it what it really is---subacute care---and pay nurses appropriately for the skill level that's required to care for these very sick patients.

Roland · Apr 17, 2005

Yanno, Renee, I think they ought to call it what it really is---subacute care---and pay nurses appropriately for the skill level that's required to care for these very sick patients.

I see your points about paying nurses better and the whole revolving door syndrome. However, I'm concerned about something even more immediate the life of the woman. It almost seems like a death sentence to ship someone who hasn't even really been stablized, let alone cured. If I were her physician I would instead be looking to send her to a facility (If I were going to send her anywhere) that specialized in treating antibiotic resistent bacterial infections. If the lady is going to survive she will probably need more operations, and need them stat as soon as it appears the bacteria is spreading. Of course my proposed interventions of high dose garlic and maggot larva wouldn't be tried anyway.

PicklesRN, RN · Apr 17, 2005

I see your points about paying nurses better and the whole revolving door syndrome. However, I'm concerned about something even more immediate the life of the woman. It almost seems like a death sentence to ship someone who hasn't even really been stablized, let alone cured. If I were her physician I would instead be looking to send her to a facility (If I were going to send her anywhere) that specialized in treating antibiotic resistent bacterial infections. If the lady is going to survive she will probably need more operations, and need them stat as soon as it appears the bacteria is spreading. Of course my proposed interventions of high dose garlic and maggot larva wouldn't be tried anyway.

MRSA is verrry common in a SNF. She will probably be on their specialized floor where she can be given IV antibiotics and more 'hospital like' care vs. the other floors.

SNFs used to be expensive housing with expensive baby-sitters where people went to die. Not so anymore, now SNFs are similar to an extension of the hospital.

I will suggest one thing, however. Go to your local Department of Health Services or whoever the licensing authority is and do a little background check on the facility. Where I live you have two choices, you can either call and get a brief overview of what the inspectors have found in previous inspections or you can go down there yourself and read the entire file from beginning to end.

See if this facility has a good track record or if they seem to have chronic problems. EVERY facility will have complaints that DHS will have to follow up on but that doesn't mean they did anything wrong. You can bank on a complaint to DHS with each disgruntled employee. Sometimes DHS will find it to be a valid complaint and other times they find it is unsubstantiated. So keep an open mind when reading through the file. If there are substantiated complaints or issues they found in the care home, does it look serious?

Some inspectors are silly twits that need to get a life and others are very fair. I had one elderly patient once that loved olive oil. He put in on darn near anything. He always had a bottle of the stuff. Well, depending on the facility and specific patient, some patients are permitted to keep some 'as needed' meds at their bedside but they have to be in a locked drawer. The patient and the staff have a key to that drawer.

The inspector saw Charlie's room and spotted the olive oil. She asked him if he used it on his food or if he used it as a laxative. He asked her why she wanted to know. She explained that if he used it on his food it was fine on top of his dresser but if he used it as a laxative then she had to cite me for it because it wasn't locked in a drawer. He looked at her and called her a bad name in Italian and he told her that was the most stupid question anyone had asked him in his 92 years. He went on to say that it was none of her business and to please leave his room.

I was cited for a patient's meds not being in a locked drawer. I had to ask Charlie to write a letter to DHS explaining that he did not use it as a laxative but he enjoyed it on his food instead. The citation was removed from my file and everyone was happy.

The same inspector saw a jar of Sween Cream on a patient's dresser. It's cold cream, nothing more. You can buy it in the grocery store. Our pharmacy ordered an extra huge jar for this particular patient at her request. Since a few others were getting Sween Cream as well they threw on a label so we would know the larger jar was for her, the other jars were for the other patients. I was cited for that too, if it has a label it must surely be a prescription drug. The inspector was just positive that by law a pharmacy can only put labels on prescription drugs. That isn't true, btw. I had to get the pharmacy to write a letter to DHS explaining that this cold cream is over the counter, not an Rx. They removed that from my file as well.

I tell you this so that if/when you read the file, keep an open mind.

leslie :-D · Apr 17, 2005

My wife treated a 53 year old female with Type II diabetes and a serious case of Necrotizing fasciitis which had already "eaten away" half of her lady parts (she had attempted to drain a boil at home in her perineal area and it imploded internally, she then didn't go to the doctor for another week), before the area had to be surgically debrided/excised. The patient was on the acute care floor for about ten days, but the Group A strep was still going strong (in fact according to my wife's read of the notes ect it seemed to be tunneling towards the LLQ abdominal area. So why in God's name would they release such a sick, relatively young woman to a LTC facility?

because as other posters have stated, a ltc facility will manage her wounds and continue with the iv abx.....i hope they get a wound consultant as to what type of treatment. it sounds like the area is now clean since it has been debrided and theorhetically, the abx will prevent further spreading of the bacteria. but once it starts tunneling, if able, you can try to pack it w/1/8" or1/4" strip gauze....and i agree: check out the reputation of this ltc facility- all info is readily available on-line through the dept of public health.

keep us updated should you hear anything.

leslie

Long Term Care Columnist / Guide · Apr 17, 2005

I see your points about paying nurses better and the whole revolving door syndrome. However, I'm concerned about something even more immediate the life of the woman. It almost seems like a death sentence to ship someone who hasn't even really been stablized, let alone cured. If I were her physician I would instead be looking to send her to a facility (If I were going to send her anywhere) that specialized in treating antibiotic resistent bacterial infections. If the lady is going to survive she will probably need more operations, and need them stat as soon as it appears the bacteria is spreading. Of course my proposed interventions of high dose garlic and maggot larva wouldn't be tried anyway.

Roland, my remark was partially tongue-in-cheek........the woman's survival is of course the most important thing, which is why I personally would NOT want her to be sent to the average nursing home. My sarcasm comes from having worked LTC in several different capacities, and I know its shortcomings all too well. I agree with you on this issue and share your concerns about discharging desperately ill patients; but the reality is that many people in SNFs nowadays are the med/surg patients of yesteryear, just as today's med/surg patients are the critical care patients of a generation ago and today's ICU patients are yesterday's fatalities.

I don't know whether there are SNFs that specialize in certain areas of post-hospital care, maybe in the larger cities or back East somewhere, but I do know that the average patient with average insurance or Medicare isn't going to be sent to one........they get sent to the average nursing home. It sucks, but that's health "care" in America today. Get used to it.......it's only going to get worse as we Baby Boomers continue to age and need care ourselves. :stone

leslie :-D · Apr 17, 2005

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I don't know whether there are SNFs that specialize in certain areas of post-hospital care, maybe in the larger cities or back East somewhere, but I do know that the average patient with average insurance or Medicare isn't going to be sent to one........they get sent to the average nursing home. It sucks, but that's health "care" in America today. Get used to it.......it's only going to get worse as we Baby Boomers continue to age and need care ourselves. :stone

marla, quite often our ltc facility looked like an er for the elderly as there were many dnh's so the care was done at the facility, including central lines, transfusions, vents, etc. i don't know if all ltc facilities are licensed to do this care but ours was.

leslie

Long Term Care Columnist / Guide · Apr 17, 2005

Thanks, Les.........where I live, NONE of that happens. Portland, Eugene etc. probably has facilities like that, but no SNF within 40 miles will take vent patients, and they sure don't have in-house MDs who can throw in a central line or perform outpatient procedures when a resident needs one. That would be wonderful.......just goes to show you what a country bumpkin I am! :chuckle

Bibeau1 · Apr 17, 2005

Unfortunately hospitals are looking at lengths of stay instead of what is really going on with patients. As a case manager in an acute setting I am continually pressured to faciliate a dscharge on a patient that clearly is NOT ready. prime example is a patient who was recently discharged from a hospital on the drug Zyvox. As you know Zyvox is for the treatment of vre, The cost is >$1500. The care manager ( not me ) asumed that because the patient has a prescription benifit they could afford the copay. Unfortunately the copay was $300 ( which she did not have ) so she went w/o her med for 72 hours until the Doctor that I work with asked me to look int it. medicare would have paid for her to have her medication in a skilled facility ( like the one that your wife works in ) BUt she has used al her mediare days . The hospital case manager was aware of this but discharged her to home with inadequate home support.

The question is not why did that patient come to your wifes facility but was there an alternative plan OR was she beyond the DRG so the hospital was losing money by keeping her or him. Please do not think I justify this , I do NOT . Unnfortunely patient care is clearly based on how much money can be made . The hospitals are going under because of the large population of indigent patients ,( that still need care ) and the limited medicare system. I do not support federal medical care . Ithink that if the senate and the house of representatives where all placed on medicare with its lmitations then YOU would see improvements in the system :angryfire

My wife treated a 53 year old female with Type II diabetes and a serious case of Necrotizing fasciitis which had already "eaten away" half of her lady parts (she had attempted to drain a boil at home in her perineal area and it imploded internally, she then didn't go to the doctor for another week), before the area had to be surgically debrided/excised. The patient was on the acute care floor for about ten days, but the Group A strep was still going strong (in fact according to my wife's read of the notes ect it seemed to be tunneling towards the LLQ abdominal area. So why in God's name would they release such a sick, relatively young woman to a LTC facility?