This a great article about health care acquire infections such as C.diff. ( Clostridium difficile Infection) and how going to the hospital puts us at risk.
There is also great information regarding preventative measures.
Your loved one needs more care
Your loved one is hospitalized for what everyone thought was routine. A hip or knee replacement, or a recent bought of pneumonia. Yet, in comes the Case Manager or Discharge Planner who states that the patient needs “more “care but at a lower level. This person also states that the patient must be moved today and that you (the family) must find a place to go or if you are lucky they have found a facility that is willing to accept.
What does this mean? Most important, the patient and the family have the right to ask for more information. It is important for everyone involved to have correct information about the extended care being proposed because it could be as little 1 week or it could be a month or longer.
Next, be aware that the patient has every right to make his/her needs known and has the right to choose where they want to go. If the patient does not have the capacity to make their own decisions then the family will have to make these choices for them. In all cases, the family has the right to ask for a list of all the facilities in the area especially for the facility that has accepted the patient. The family should take the time to tour. Please do not leave this decision to the hospital personnel.The hospital personnel is not allowed to make recommendations, however,they are allowed to give the family facilities to choose from. The right facility will make a difference in the patients recovery.
What kind of care is needed?
Usually, when it comes to extended care the case manager or discharge planner is referring to a Long Term Care Facility that offers rehabilitation services. There are times where a lower level of care such as an Assisted Living is more appropriate.
An Assisted Living Facility does not normally offer extensive rehabilitation services nor do they offer 24 hours nursing care. This type of facility is great for the patient who needs minimal assistant with ADLS (Activities for Daily Living) such as dressing, eating, and taking their own medications. Most of these patients need only reminders and are able to make all their needs known. There are specialized Assisted Living Facilities that have memory units for Alzheimer patients. Even patients at this stage can make most of their needs known and still do most things for themselves like brushing their teeth and feeding themselves.
If the patient needs “more” care, which may require things such as I.V. antibiotics, physical therapy, occupational therapy, and/or speech therapy then a Long Term Care Facility that offers rehabilitation is appropriate. These facilities are often referred to as Nursing Homes, Long Term Care Facilities, or 24 hour nursing facilities. These types of facilities assist the patients with all medication needs including pain management as well as with their ADLS. They help the patient recover and regain their strength.
Who can reside in a LTC (Long-term Care)
Long Term Care Facilities are no longer just for the elderly. Patients of different ages may reside in the same facility as long as everyone’s nursing needs are met. Nursing Homes may only take patients that they can provide adequate care for. Adequate care refers to providing all necessary nursing care that are ordered by the attending physician. This would include their medications, therapy, and assisting the patient their ADLS (i.e. going to the bathroom/getting dressed). It does not refer to their age.
The age of the patient can be as young as 21, but the facility must make sure that the patient is compatible with the other patient(s). For example, a 21-year-old cannot share a room with a 76-year-old (unless both patients can make their needs known and have chosen to be in the same room). Typically younger patients share a room with other young patients or reside/ in a private room. Also, the facility must ensure that there is age appropriate activities for everyone. For example, providing video games or movies, such as Fast and the Furious, for the younger patient is great, but these same items would not be age appropriate for the elder patient. Activities for all age groups must be provided.
Long Term Care facilities in California must follow Title 22 regulations as well as Federal regulations.
Long Term Care Facility/Nursing Home patients/residents have rights. These rights have certain protections under the law. The long term care facility must list and give all new residents a copy of these rights upon admission. These rights should also be addressed with the patient(s) at least annually.
Resident(s) rights usually include:
- Respect: A patient/resident has the right to be treated with dignity and respect. Some examples are as follows:
- A patient/resident should never be treated like a child or talked “down” to.
- At no time should any staff member yell at the patient/resident or call them names.
- The patient/resident should always be called by their proper name.
- The patient’s/resident’s dignity must be protected while using the restroom or while dressing. The curtains should always be drawn and the door closed. Staff must not before entering.
- Services and Fees: Each resident/patient must be informed in writing about services provided and fees before they enter the nursing home. Some of the things that need to be discussed are:
- Their insurance coverage. Those that have Medicare, for example, have 100 days of coverage. The first 20 days are at 100% and on day 21 the co-insurance days begin. The fees will vary depending on the facility. If the patient/resident has Medicare/Medi-cal there may be no co-insurance. The Medi-cal patient/resident often times has a share of cost . The facility is required to give full disclosure of the amount.
- Covered services that are a part of your room and board.
- Barber/hair-dresser cost
- Medical services included such as podiatry and vision care.
- Money: Every patient/resident has the right to manage their own money or to choose someone else they trust to do this for them.
- Privacy: The patient/resident has the right to privacy, and to keep and use their personal belongings and property as long as it doesn’t interfere with the rights, health, or safety of others. Things to keep in mind are:
- Because of the HIPAA regulations facilities are not allowed to disclose private medical information to the families. Privacy of the patient/resident is critical even if the family believes they are entitled to the information. The only time medical information disclosure to someone other than the patient is allowed is when there is a POA(Power of Attorney) for health care appointed and it is in effect. The POA only takes over when the patient/resident no longer has capacity to make decisions, which is determined by the physician. The POA in this case would be the only one that would be able to obtain medical information. All other family members cannot gain access to the requested information.
- All mail must be given to the patient/resident unopened. If the patient needs help opening the mail or reading the mail the facility can have a staff member assist them.
- Items such as scissors, metal nail files, and pocket knives are a danger to others. These items should not be brought into a facility if possible. But if the resident feels they need these items ask for a locked drawer or lock-box to store them in.
- Medical Care: The patient has the right to be informed about his/her medical condition, medications, and to see their own doctor.
- The patient/resident can refuse medications and treatments. The patient must be informed by the appropriate medical staff (i.e. the doctor or charge nurse) of all the possible outcomes.
- The patient/resident may see their own physician. If their physician does not follow their care at the facility the patient can choose to make other arrangements to see their primary care physician.
- The patient/resident also has the right to change physicians. The facility staff must assist the patient in finding a more suitable physician at the request of the resident or person designated to make decisions.
Patients/residents are people too and they deserve respect. Just because they are in a Nursing Home does not mean that they cannot make decisions for themselves nor does it mean that they has less of a citizen. Cherish our elderly.