Insights:# 1 Dr Visits & Poor Hygiene in Long Term Care Facilities

Residents of Long Term Care Facilities are required to have a primary care physician affiliated with the facility. It's been our experience the list is short and often limited to not include a hospital of choice for additional services.


In the months preceding Mom's death, we became even more disappointed in the medical care from the physician "attending" Mom at her Skilled Nursing Center.


Rereading the "official" entry papers and "contract" just before her death we realized the facility Dr only had to see Mom (or any resident) once every two months. 


Elderly men and women who often develop infections and catch strains of Flu and other often life threatening illnesses relegated to every 60 day "visits" doesn't seem to be a very sound medical decision. But that was Mom's facilities' practice, except, of course, when we wanted our "own" Dr and then we were mandated to have Mom seen every thirty days.


In the interim, i's up to the "Nursing decision" of the LPN on the floor and her/his personal "fear" of the "wrath" of the Dr as to whether he/she contacts his/her office for advice or just sets aside any potential medical concerns expressed by the resident or the family.


And we wonder at the high cost of Medicare and Medicaid?  Why don't we realize as a society when we don't take action to ensure the safety and well being of these people, many of whom cannot express themselves and many who give up because no one wants to hear "another complaint" or "another problem" as it takes too much time and additional "person power" to resolve -- we're increasing the cost of Medicare and Medicaid.


I digress. We finally found what we thought was a Dr with whom we could communicate and who took the time to "counsel" when we did have interaction.


To get to that point, we endured being provided with lists that weren't current including Dr's who no longer were willing to come to Mom's facility; were no longer accepting new patients; were no longer adding Medicaid patients.


Doesn't it stand to reason if this list is obsolete many other records at the facility are questionable?  None among us believes this is an "oversight" but rather that it's typical of the failure of SNC's to maintain accurate records.


ON CALL.  My son, who was also a POA, in the last hours of his Grandmother's life, learned how this terminology at a Skilled Nursing Center simply means the Dr "may" be accepting phone calls. NO DR IS SCHEDULED TO BE AVAILABLE TO GO TO THE FACILITY.  In fact, we were advised, as we often were, to take Mom to the Emergency Room if we didn't like the level of care the facility was providing.


ANOTHER DRAIN ON FUNDS PROVIDED BY YOUR TAXES AND MINE. 


Common problems that should be prevented are escalating and causing those family members or in some cases the individuals to seek Emergency Room treatment to take care of Urinary Tract Infections that have gotten out of hand and gone into bladder or other infections and advanced to a point where they become Vanco or other medicines for treatment non receptive could easily be corrected through more demands by those of us "following" into these years to make legislative corrections today.


As a society, we should see how not only the over prescription of medications has caused a development of a new "strain" of resistant "bugs" to develop, but how the neglect to perform common, everyday functions of cleanliness have put our Elderly population in Nursing Facilities back about a hundred years or more into times before antibiotics and knowledge of how clean hands and a clean body prevents contracting some diseases and the spread of many.


Think about it. Long nails used to cleanse areas after urinating and defecating without ensuring the nails have been clipped or cleaned and then using the hands to eat, as is common with advancing Dementia.


Think about it. Giving a shower or two a week but neglecting to wash the hands or face or body of a person who's become incontinent or who cannot wash any part of their body without potentially misusing a piece of toilet paper they've used to wipe themselves with or even food placed in front of them -- thinking they have a washcloth in hand.


Think about it.  Allowing Dentures to remain in someone's mouth without using a toothbrush and never a denture soak. Developing sores and eventually Thrush and other infections in the mouth.


Think about it.  Failure to ensure toenails are clipped and clean causing potential loss of limbs due to set in of infections leading to gangrene.


Think about it.  Clothing fouled by sitting in excrement thrown into the closet without encasing in a plastic bag and closing it.  Resident is able to move around, resident has Dementia, resident pulls out clothing from bag and proceeds to dress themselves or use a pair of pants, complete with urine or fecal material to "wash" or "dry" themselves.


Attendants don't see this. Nursing staff doesn't check to see how personal hygiene is done by Attendants.


Who cares? Do you? Do you want to end your days this way?  And, please don't think if you pay enough you won't; it's happening behind closed doors in some of the most "fashionable" and "costly" facilities.


That old song ..... "Nobody knows what does on behind closed doors."