ReHab: Truth & Consequences

I heard it again the other day when visiting Mom's previous Long Term Care Facility about no Rehab being provided even though a resident had received a Dr's orders for this service.

A "new" resident had arrived about a month previous.  Her husband was distraught.  They specifically chose the LTC becasue it had "on site" Rehab care.

He'd expected his wife would begin receiving rehab care immediately because it was "on site".

The husband was given every reason you can think of including the paperwork hadn't been processed for her "total" admission, the paperwork from the prescribing Doctor wasn't complete or certain Insurance information wasn't forthcoming.

Now, they're not sure exactly when the facility Dr will order the Rehab due to so many delays. Meanwhile, his wife's capabilities are decreasing below what she arrived at the facility having from her medical challenges and, of course, that means her "ability" to "go home" is far lower than when she first arrived.

While rehab may be the best course of action, because it is a medical decision, there are other factors entering in to whether or not your loved one receives physical/occupational therapy.

Our experience was if Mom didn't go to the "rehab floor", she didn't get rehab services or if she did, they were long in coming, short in duration and often didn't involve using the Rehab Facility on the lower level.

Our experience with my husband wasn't any better.

I chose a particular Long Term Care facility specifically because they advertised they had "on site" Wound Care and was assured in an interview they knew about my husband's condition and needs. 

I'd discussed at length the challenges my husband faced with an open wound and the skin constantly rupturing on his abdomen opening a second and sometimes even a third area needing to be bagged and providing a constant "collection system". 

He needed round the clock care and someone who knew about infections and wound care due to the high risk for infection and complications.

We chose to enter the facility. We saw a couple of days of really good care. Then it was downhill all the way. 

ONE person was trained. ONE person did not work round the clock. ONE person did not stay with the facility and left during his rehab period. They ran out of bags. I had to run to get more because they couldn't order more -- for whatever reason. Infection became a constant challenge.

This is the reality of Rehab in Long Term Care Facilities. This is the everyday experience of thousands of people nationwide. This is a contributor to the "short" life span of living in a facility versus living with family.

What happens is there is usually someone, one person, trained in wound care or other more medical forms of care in a facility. If they have a day off, if they take a vacation or IF THEY LEAVE the facility, your trained and knowledgeable provider of specialized care is not there and severe complications can occur.

Going back to the man and his wife's situation not receiving Physical Therapy:

In this case, the man's wife left the hospital with Dr's orders for rehab requiring a Physical Therapist and possibly an Occupational Therapist. 

It's also very simple mathematically. Dr prescribes, Insurance doesn't pay or pays limited amount, facility doesn't provide or provides less than needed for adequate recovery.

Once you return to a facility, your Dr in charge at the LTC takes over.

The challenge is the on site Dr can change, reverse or even eliminate that order and once you're "back in your room" the chances are strong you will not get into the REAL Rehab unless you leave the facility and return via the "special services of the Rehab floor".

My advice: if your loved one needs PT/OT, get the "prescription" in writing and you keep a copy. It can be your leverage and your evidence. 

Keep a journal. Take pictures. Use the tools we now have in starting a blog or add to another blog like this one your personal experiences and challenges.

The husband doesn't know what to do.  I told him about the Ombudsman program. 

WHERE'S THE OMBUDSMAN?  A program that's grossly understaffed and overworked. 

A program relying on Volunteers and few paid workers because your State has earmarked funds that should go for this purpose to other "more necessary" programs.

Federal Law gives us this advocate. Why didn't this man know about this service? Probably the same reason so many don't know about it -- because it's not effective, is poorly funded and cannot possibly do the work for which Federal Law was passed to ensure it could.

Why are we all so very uninformed when the time comes to make decisions for our loved ones regarding "outside" care and services including Federally Mandated and supposedly State provided protections for our aging population?

Where's the posting in the facility stating if you have a concern this is the telephone number and name of the Ombudsman for the facility to contact.

Not in the elevator along with other promotional signs. Not in the main area where visitors arrive. 

Not in the dining room.

Not in the cafeteria.

Nowhere prominent, nowhere you and I can be reminded there are others responsible for our aging population.

It's not there because there isn't one "assigned" or permitted by the facility to make frequent visits to talk with residents.

SIGNAGE is limited to "acceptable" communications.

SIGNAGE is used as Public Relations and anything about the real "rights" of residents would be a negative message.

What is posted? Featured in the one elevator on the back wall are announcements of upcoming "special days"; reminders about the on site extra pay "massage therapy"; gentle reminders how "Mom" would love to visit the Beauty Salon. An occasional reminder of a Family Council meeting.

The Entry Area 

Announces an upcoming "event", a luncheon where "guests" can attend for a price. 

Provides a prominent area for a display honoring our Veterans and on a "pole" facing the dining room are pictures of residents who served.

A Common Room

A room used only by facility employees for "training" and occasionally used for "approved" small meetings contains one computer never used by a resident as it's "off limits".

The system of US Health Caregiving for our aging population is greatly in need of a thorough and effective "house cleaning".

Our elderly who do not have extensive medical care and who must rely on policy's that "change" or become "reduced" are suffering as much or more than we who are coping with losses and reductions in provisions of health care. 

You and I must be constant advocates. We must be informed. We must know the rights of our loved ones and we must ensure these rights. 

You and I, everyone who care gives or cares about our aging population, needs to frequently and continuously take action on behalf of those who cannot speak out or act on their own.

You and I cannot age without advocating for Seniors in Long Term Care Facilities. 

People think there are "systems" in place, there are "funds" for them when they reach this stage in life.

NOT TRUE!  Investigate. Research. Learn.