# Acute care at home



## Nevada (Sep 9, 2004)

I live with an elderly woman who has turned very ill. It looked like a bad bout with the flu (with sore throat) earlier this week, but I still took her in to see the practitioner on Tuesday. The practitioner said there were no signs of a bacterial infection so she concluded that it was mucus pooling. She prescribed Nasonex, advised her to take Mucinex, and drink plenty of fluids.

It got worse. This morning she had clearly deteriorated and was unable to speak her thoughts very well (brain disconnected from mouth, sort of like with stroke victims). I got her in to see the practitioner again today. They started respiratory therapy in the office, then sent us out for an x-ray (no sign of pneumonia). Back at the office again, they measured her blood oxygen, and she was down in the 80s. The practitioner recommended admitting her, but the patient refused.

The practitioner arranged for home oxygen, a nebulizer, and prescribed a strong antibiotic. The practitioner also wants to see her in the office Monday. To pull this off, I've got to give her nebulizer treatments every 4 hours, around the clock. I just did one. Of course, if she gets any worse I'm under orders to take her to the hospital.

This is tough work. She's seeing things, like pointing across the room and yelling, "Who's that?" when there's nobody there. I suspect it's the fever talking. Needless to say, she's confused about everything right now. She keeps taking her nasal canula off too. It's like I can't turn my back on her for 20 minutes at a time.

I don't know that the hospital can do any more good than I'm doing, but I don't mind telling you that the seriousness of the situation and her advanced age (early 80s) really bothers me. I guess I'm concerned that this might not turn out well and I'll blame myself for not insisting on the hospital.

Thanks for listening. I'm going to try to get some rest.


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## ann in tn (Nov 25, 2007)

The confusion and hallucinations could be that her oxygen level is worse even with the treatments - you may want to consider taking her to the hospital sooner rather than later. She probably needs more than the home treatments are able to provide.


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## Nevada (Sep 9, 2004)

ann in tn said:


> The confusion and hallucinations could be that her oxygen level is worse even with the treatments - you may want to consider taking her to the hospital sooner rather than later. She probably needs more than the home treatments are able to provide.


I got up do the respiratory treatment and discovered she removed her oxygen again. I don't see how this is going to work if she keeps taking it off. Maybe things will improve with daylight. Actually, her brain and her mouth seem to be working together now, so that's an improvement.

I'll consider what you said, but she wont like it. Thanks.


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## Nevada (Sep 9, 2004)

She seems to be more collected during the sunlight hours. Her speech is definitely improved, but her mind is still playing tricks on her.


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## motivated (Sep 6, 2004)

Do you have any urine dipsticks? My granny always became disoriented with her frequent UTI's. Of course trying to get her to drink was fun

Good luck hope she is doing better now.


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## Nevada (Sep 9, 2004)

motivated said:


> Do you have any urine dipsticks? My granny always became disoriented with her frequent UTI's. Of course trying to get her to drink was fun
> 
> Good luck hope she is doing better now.


I don't have any urine dipsticks on hand, but she's drinking plenty of water. That's the one thing working in our favor right now.

Her mental condition disturbs me more than it probably should. I suppose I should simply understand that her mind is playing tricks on her, but it becomes very personal. Last night we had an episode where she was accusing me of giving her belongings away to the people who she was imagining were in the room. As absurd as it sounds, it was still important to me that she knew that she could trust me. I know I shouldn't try to straighten-out a disoriented person, and it makes more sense to just leave it alone until it passes, but it's a knee-jerk reaction. I didn't argue with her, but I did expend a lot of emotional energy for nothing. Evidently she forgot all about it by morning.

In a lot of ways this is more difficult than responding to critical emergencies when I was a firefighter. Back then we would show-up, do our best, then the patient was usually on the way to the hospital within 20 minutes. This kind of 24/7 care is an entirely different game.


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## beccachow (Nov 8, 2008)

This is classic Sundowner's Syndrome, which hit me when you posted she is better during the daylight. I took the liberty of copying and pasting a quick article since you are probably so tired:

"Symptoms
People with Sundowner&#8217;s Syndrome can exhibit any number of symptoms. Of course, the key is that the symptoms occur in the late afternoon or evening, or in the case of someone with more severe dementia, the symptoms worsen at night. These symptoms, which are also symptoms of Alzheimer&#8217;s Disease and other types of dementia, include:


Rapid mood changes 
Anger 
Crying 
Agitation 
Pacing 
Fear 
Depression 
Stubbornness 
Restlessness 
Rocking 
The most difficult symptoms to deal with are:

Hallucinations 
Hiding Things 
Paranoia 
Violence 
Wandering 
These symptoms can be dangerous, both for the person with the Syndrome and for anyone around them.

You may find that your loved one is suddenly seeing angels in the room or believes you have stolen something. They may not recognize you or become terrified at the thought of your leaving even for a moment. The behavior is illogical and irrational, but bear in mind that someone with Sundowner&#8217;s cannot control these behaviors.

Wandering is especially dangerous because the person with Sundowner&#8217;s will suddenly be missing and may not know where he or she is going or why. Without identification, people with the Syndrome have become lost and unable to find their way back home.

People with Sundowner&#8217;s Syndrome may also &#8220;shadow&#8221; you, following you around and doing everything you do. They might ask you questions over and over or interrupt you when you&#8217;re speaking to someone else. They may lose their full language abilities, and abstract thoughts may become especially difficult for them to comprehend.

Keep in mind that if someone has a paranoid or hallucinatory episode, there&#8217;s no point in trying to convince them they&#8217;re wrong. It simply won&#8217;t work, and they will most likely not remember the episode in the morning."

Hope that helps.


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## Pearl B (Sep 27, 2008)

I personally would just take her to the hospital, till she's stable, whether she likes it or not.
I appreciate you're trying to help her yet, what happens when you try to get some well needed sleep, & she removes her oxygen mask, or worse harms herself, or just goes wondering around the neighborhood, maybe never to be seen again.
I think you're dealing with more than 1 person can handle, I could be really wrong.
I just wouldn't want that on my conscience.

I hope it works out

ETA:
If I could put a person in those conditions, where they could be watched over & cared for 24/7,
I would choose that option


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## beccachow (Nov 8, 2008)

Also wanted to add, that you can do what is called an Emergency Petition on her, meaning that she is a danger to herself or others (as in, refusing to go to the hospital for care when she is obviously sick). With her altered mental status, she could be what is considered "unable to make her own informed decisions". It is kind of a dirty trick, and she will not like you for it, but she CAN be forced to go to the hospital. Check into your state's laws, or call the sherrif's department for guidelines. As a medic, I run into this all the time, and it is a way to get someone to the hospital who NEEDS to be there. If you are dealing with Sundowners, there might be some meds they can put her on, not sure. If you are dealing with hypoxia, she NEEDS to get some where like the hospital where they can keep an eye on her, like Trinity said, 24/7.

I am deeply respectful in your desire to help this lady; be very careful you don't do it at the expense of your own health and sanity!


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## Nevada (Sep 9, 2004)

Trinity3 said:


> I appreciate you're trying to help her yet, what happens when you try to get some well needed sleep, & she removes her oxygen mask, or worse harms herself, or just goes wondering around the neighborhood, maybe never to be seen again.


I wake up to discover her nasal canula off all the time. I reason that if she was in the hospital she would do the same thing as soon as the nurse leaves her room.

There's no realistic chance of her wandering around though. She's an advanced RA & osteoporosis sufferer with multiple back fractures. She barely makes it to the toilet (I have a portable toilet in the bedroom).


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## Nevada (Sep 9, 2004)

beccachow said:


> If you are dealing with Sundowners, there might be some meds they can put her on, not sure. If you are dealing with hypoxia, she NEEDS to get some where like the hospital where they can keep an eye on her, like Trinity said, 24/7.


We had a pretty good day, at least until mid-afternoon. That's when she took her oxygen off. Her color was good and her brain & speech seemed to be coordinated so I left her alone about it. I was hoping that she wouldn't desaturate, but she deteriorated within a few hours. After a 1/2 hour discussion I just got her to put her oxygen back on. I just hope that the antibiotic kicks-in and she goes into an upswing soon.


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## Nevada (Sep 9, 2004)

Last night after the midnight nebulizer treatment she took her oxygen off and refused to put it back on. At 4:00 am she refused her nebulizer treatment and was seeing things again. She was looking bad, but refused to go to the hospital.

I called 911 and asked them if they could send a sheriff deputy to have a talk with her, but after hearing the circumstances they also sent the fire dept and an ambulance. She's in the hospital now. The new x-ray shows early signs of pneumonia. The ER doctor thinks we got it early enough that she'll be fine.


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## ann in tn (Nov 25, 2007)

I am glad that you were able to get her some help. Hopefully when she comes back, her mental state will be better and she will understand that you did what was best for her health.

Good luck.


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## beccachow (Nov 8, 2008)

Good deal, now get some rest knowing she is in the right place right now.


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## Nevada (Sep 9, 2004)

ann in tn said:


> I am glad that you were able to get her some help. Hopefully when she comes back, her mental state will be better and she will understand that you did what was best for her health.
> 
> Good luck.


I guess what bothers me is that this is the first time I've taken anyone in due to my inability to deal with the situation. It seems that I could have found a way to convince her to use oxygen and take neb treatments.

However, it also may be that her life was saved through her own stubbornness.


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## Nevada (Sep 9, 2004)

beccachow said:


> Good deal, now get some rest knowing she is in the right place right now.


Thanks, and good night!


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## marvella (Oct 12, 2003)

lack of oxygen could certainly make her confused and combative. but ask if they won't check her for a cerebral bleed while they have her.

get some rest! home care is tough under the best of circumstances.


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## Cliff (Jun 30, 2007)

Nevada said:


> I wake up to discover her nasal canula off all the time. I reason that if she was in the hospital she would do the same thing as soon as the nurse leaves her room.
> 
> There's no realistic chance of her wandering around though. She's an advanced RA & osteoporosis sufferer with multiple back fractures. She barely makes it to the toilet (I have a portable toilet in the bedroom).


no, they'd put mittens on her hands so she can't pull it off. she's not in her right mind and can't cooperate with her treatment so the niceties have to be put aside to get her better. she might even have to have her hands tied for a couple days, but think of it this way, if she gets so bad she has to be put on a ventilator bc she won't cooperate and gets worse, she'll then be tied down with a tube down her throat.


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## Nevada (Sep 9, 2004)

Cliff said:


> no, they'd put mittens on her hands so she can't pull it off. she's not in her right mind and can't cooperate with her treatment so the niceties have to be put aside to get her better. she might even have to have her hands tied for a couple days, but think of it this way, if she gets so bad she has to be put on a ventilator bc she won't cooperate and gets worse, she'll then be tied down with a tube down her throat.


No such luck. I left the hospital at about 3:00 this afternoon to do my eBay shipping and to get her favorite quilt from home, which she had made herself. I returned to the hospital at about 5:00 pm, but they stopped me at the nurses station. The nurses explained to me that there had been an accident.

Evidently she got out of bed and fell. She had already been to x-ray, which confirmed that she broke her hip. I went to her room to see to her well-being. She had a goose egg on her forehead and was in horrific pain from the hip. I asked what she had been given for pain, but they hadn't given her anything. All they had orders for was for pills, but they had already given her an ativan injection to relax her so she couldn't swallow for us. They were waiting for her dr to call back. (What, no ER Dr?) They finally got an order for a morphine injection. At around 8:00 pm they got around to putting the leg into traction so the bone ends wouldn't grind together.

Later tonight I spoke with the ortho Dr. He said the femur can't be pinned because the bone broke off too close to the ball to anchor a pin. He needs to do a partial hip replacement to repair it. He isn't sure she'll survive the procedure, and gives her a 20% chance of making it year if it's successful. He wants to do the surgery tomorrow evening, if her primary Dr thinks she's up to it. (Don't forget, she's 83 and still has pneumonia)

That's just swell... :flame:


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## ann in tn (Nov 25, 2007)

Oh Nevada I am so sorry - did they not have bed alarms available for her bed as she was a fall risk. I know that for high fall risks some units have bed alarms that go off if the pts weight is removed from the bed. 

I will be praying for her and for you.


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## marvella (Oct 12, 2003)

wish we could help. anything we can do?


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## BeaG (Aug 21, 2008)

Nevada, my heart is breaking for you. I know that many of our HT community (including me) will be praying for you as you make whatever decisions you must make.


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## Nevada (Sep 9, 2004)

ann in tn said:


> Oh Nevada I am so sorry - did they not have bed alarms available for her bed as she was a fall risk. I know that for high fall risks some units have bed alarms that go off if the pts weight is removed from the bed.
> 
> I will be praying for her and for you.


They had a bed alarm, but evidently they didn't get there in time. It was going off all the time. It was pretty sensitive, since it would sound just from rolling over in bed. The lower bed rails were down so she got out fairly easily.


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## ann in tn (Nov 25, 2007)

I am sorry they did not get there in time. About the bed rails at the feet - we are not allowed to put them up or it is illegally restraining a patient.


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## Nevada (Sep 9, 2004)

ann in tn said:


> I am sorry they did not get there in time. About the bed rails at the feet - we are not allowed to put them up or it is illegally restraining a patient.


Well, legally or illegally they're restraining her with soft restraints and lower bed rails now. I understand that she needs it, but they take them off when I'm with her. I let them know when I'm leaving so they know to secure her again.

At any rate, she survived the hip replacement procedure. That's the step I was concerned about. The problem was that she still had pneumonia, which was being aggravated by laying flat. They really couldn't raise her up while she was in traction without hurting the fractured hip. Now that the hip is repaired they are in a better position to treat the pneumonia.

I spoke the the health care coordinator today. He thinks she'll need a week in he hospital to recover from the surgical discomfort, then two more weeks staying at the rehab center before sending her home. He doesn't want her to go straight home and do the rehab as an outpatient because of my 2-story cabin. Sounds reasonable.

I want you people to know that I'm not angry about the broken hip -- but I am disgusted. It was their responsibility to keep her safe. After all, that's why I took her to the hospital in the first place. They either didn't evaluate the risk properly, or they didn't take appropriate precautions for the risk. Either way they screwed-up. Incompetence is my pet peeve. I particularly dislike having to bear the burden of the consequences of someone else's incompetence, which is what it looks like we're being set-up for.


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## Nevada (Sep 9, 2004)

marvella said:


> wish we could help. anything we can do?


Thanks. Interestingly, I've gotten pretty good help from the most unlikely places. I talked to a lawyer this morning about getting a power of attorney so I could help make decisions regarding her health. After discussing her mental condition he concluded that anything she signed would be of little value at this point, because she's not competent to make informed judgment decisions in her current frame of mind. His advice was for me to forget the legal issues for the time being and return to the hospital to see to her well-being. That's what I did.


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## marvella (Oct 12, 2003)

Nevada said:


> Thanks. Interestingly, I've gotten pretty good help from the most unlikely places. I talked to a lawyer this morning about getting a power of attorney so I could help make decisions regarding her health. After discussing her mental condition he concluded that anything she signed would be of little value at this point, because she's not competent to make informed judgment decisions in her current frame of mind. His advice was for me to forget the legal issues for the time being and return to the hospital to see to her well-being. That's what I did.


you will probably have to obtain an emergency POA at some point. she will need someone to look after all of her interests.

while you are talking to a lawyer, mention the fall. you may not be interested but it is grounds for a lawsuit.


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## Nevada (Sep 9, 2004)

marvella said:


> while you are talking to a lawyer, mention the fall. you may not be interested but it is grounds for a lawsuit.


Since the objective of the call was to discuss immediate practical issues we didn't go into the subject of liability too deeply. However I did mention that I thought the hospital has at least some shared liability regarding the fall. The lawyer replied, "I saw that one coming."

The possible lawsuit issues seem to be:


The cost of the hip procedure, recovery, and rehab.
Loss of quality of life.
Loss of length of life.
Pain & suffering.
Punitive action (punishment for wrongdoing).
Even overlooking all but the first, it seems to be in bad taste for the hospital to ultimately profit from their own negligence. While I'll be discussing her interests with the lawyer, I'm curious how the hospital is going to handle this. I would really like to wait and see what they do about the bill on their own.


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## frogmammy (Dec 8, 2004)

> it seems to be in bad taste for the hospital to ultimately profit from their own negligence


Spot on! They will mostlikely try to ignore it if they think they can...don't wait too long to do something.

Mon


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## ann in tn (Nov 25, 2007)

By illegally restraining I meant we must have a very strong reason and a written doctors order to do that.

The latest news about her recovery time sounds better than what you were first told. I will keep her in my prayers for a speedy recovery.


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## BeaG (Aug 21, 2008)

Thanks Nevada, for keeping us up to date on how things are going. We will continue to keep you in our thoughts and prayers.


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## Nevada (Sep 9, 2004)

BeaG said:


> Thanks Nevada, for keeping us up to date on how things are going. We will continue to keep you in our thoughts and prayers.


Thanks. For being the day after having a hip replacement, she had a pretty good day. I watched the news channels with her for a few hours, then came home early when she got her pain shot. It looks like she's on the road to recovery.


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## Nevada (Sep 9, 2004)

The lungs are about cleared out now, so they're talking about moving her to the rehab center as early as tomorrow to learn how to walk on the new hip.


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## BeaG (Aug 21, 2008)

Wonderful News, Nevada! The progress is quite remarkable, considering her age. You must now be feeling some relief about the situation. Don't forget to take care of yourself too; we are all thinking of you, and holding close the best wishes for you and for her.


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## Nevada (Sep 9, 2004)

BeaG said:


> You must now be feeling some relief about the situation.


I'm pleased with her progress, but I'm still not happy about the fracture. I suppose I never will be.


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## BeaG (Aug 21, 2008)

You are right about that. Perhaps, after all of this has settled down a bit, you should go ahead and follow up with your lawyer, especially if the hospital sends a bill for the hip replacement. There is no way you/she should have to pay for the hip replacement, or for the therapy in the rehab center. She should be able to collect for pain and suffering also.


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## Nevada (Sep 9, 2004)

BeaG said:


> There is no way you/she should have to pay for the hip replacement, or for the therapy in the rehab center. She should be able to collect for pain and suffering also.


Medical bill, rehab, pain & suffering, loss of quality of life, and since she now has a 20% probability of living a year I think we can add wrongful death to the list.

Yes, I'm disgusted. I'm not angry, but I'm definitely disappointed and disgusted.


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## Nevada (Sep 9, 2004)

She's not being transferred to the rehab center today after all. Her white cell count is up so they're keeping her for the time being. I left her alone to let her get some rest.


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## Nevada (Sep 9, 2004)

Her white count is still up, and she's eating like a bird. She was pretty much out of it all day yesterday. I'm heading in to be with her again in a little while and expect to stay all day.

Old man winter decided come back one more time for the year. I woke up to snow on the ground this morning, and it's still coming down. It's not deep so it won't interfere with me getting to town.


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## BeaG (Aug 21, 2008)

We are remembering you and her every day. I pray for strength and protection for you both, and I am sure that many others of our HT community are doing the same.


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## Shygal (May 26, 2003)

Nevada said:


> I want you people to know that I'm not angry about the broken hip -- but I am disgusted. It was their responsibility to keep her safe. After all, that's why I took her to the hospital in the first place. They either didn't evaluate the risk properly, or they didn't take appropriate precautions for the risk. Either way they screwed-up. Incompetence is my pet peeve. I particularly dislike having to bear the burden of the consequences of someone else's incompetence, which is what it looks like we're being set-up for.


This is not always accurate an assessment. A hospital can evaluate the risk properly, take ALL the precautions in the world, and a patient can still fall. You would not believe how fast someone you think could not move, can get out of a bed. Calling it incompetence is unfair. A hospital cannot have someone sit with every patient 24 hours a day. You can be standing in the room and a patient can still fall.

You yourself said that she was no risk to get up and wander when she was at your home. You would be surprised what people can do. A hospital can only do what they can do. People DO fall with 4 rails up. They fall with bed alarms on, restraints on, people in the room with them. There is only so much the staff can do, and she is not their only patient to watch for.


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## Nevada (Sep 9, 2004)

Shygal said:


> This is not always accurate an assessment. A hospital can evaluate the risk properly, take ALL the precautions in the world, and a patient can still fall. You would not believe how fast someone you think could not move, can get out of a bed. Calling it incompetence is unfair. A hospital cannot have someone sit with every patient 24 hours a day. You can be standing in the room and a patient can still fall.
> 
> You yourself said that she was no risk to get up and wander when she was at your home. You would be surprised what people can do. A hospital can only do what they can do. People DO fall with 4 rails up. They fall with bed alarms on, restraints on, people in the room with them. There is only so much the staff can do, and she is not their only patient to watch for.


She's not a risk to wander. With the number of back fractures she's suffered she can't be considered anything other than a cripple. It's just too much trouble for her to get around for her to wander. I strongly suspect that she had a specific mission in mind for getting up, such going to the toilet.

Maybe the term "incompetence" is a little strong. Cut me a little slack, they've cut short the life of a dear friend. Maybe saying that they are "responsible" is a better way to put it. They are totally responsible for this. It may be that I can't hold them legally responsible, but nobody is denying that her well-being was the hospital's complete responsibility. There is no way that she can be held responsible for her actions that day as ill and medicated as she was.

I had every reason to believe that the hospital would take whatever steps were necessary to keep her safe. Remember what Cliff said.



Cliff said:


> no, they'd put mittens on her hands so she can't pull it off. she's not in her right mind and can't cooperate with her treatment so the niceties have to be put aside to get her better. she might even have to have her hands tied for a couple days, but think of it this way, if she gets so bad she has to be put on a ventilator bc she won't cooperate and gets worse, she'll then be tied down with a tube down her throat.


None of that happened. My faith was misplaced, and she will almost certainly die of complications within the next year as a result. That sucks, and I'm stuck with that reality.

I brought her in because of her altered state of mind, and they shot her up with ativan within minutes of her arrival. It wasn't like her condition was a secret or anything.

Sorry I can't be more charitable about this; but as I said before, I'm not angry. This was an accident, and I know it. Nobody intended for this to happen. This is similar to someone dropping and breaking an expensive vase in an antique store. He didn't intend to drop it, but unfortunately he is still responsible for the vase. You can even have sympathy for the person who broke it, but that doesn't change the fact that he's responsible.

The hospital had complete charge of her well-being, yet they allowed a terrible thing to happen. I don't want to see anyone punished or fired, but I don't think that an innocent little old lady should get stuck with tens of thousands in medical bills as the result of someone else's mistake. She already has to pay for this mistake with her live. It's not too much to ask that the hospital at least step up to the plate and share the responsibly.

Just so you people know who we're dealing with here, this is a photo of her taken last month in Las Vegas. She was posing with $1 million (she didn't win it, it was just a promotion). We were in Las Vegas so she could get some dental work done (yep, still has her own teeth), but we had a great time while we were there. She even had a rum Collins that night. She saw a show at the Freemont Street Experience, and we had spaghetti at the 4 Queens earlier. I remember every detail of that night. Anyway, here she is barely 6 weeks ago.


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## BeaG (Aug 21, 2008)

What a lovely woman she is! Thank you for posting the picture.


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## marvella (Oct 12, 2003)

Shygal said:


> This is not always accurate an assessment. A hospital can evaluate the risk properly, take ALL the precautions in the world, and a patient can still fall. You would not believe how fast someone you think could not move, can get out of a bed. Calling it incompetence is unfair. A hospital cannot have someone sit with every patient 24 hours a day. You can be standing in the room and a patient can still fall.
> 
> You yourself said that she was no risk to get up and wander when she was at your home. You would be surprised what people can do. A hospital can only do what they can do. People DO fall with 4 rails up. They fall with bed alarms on, restraints on, people in the room with them. There is only so much the staff can do, and she is not their only patient to watch for.


i know from years of experience that most hospitals and almost all nursing homes are short staffed and frequently unable to care for the people they admit.

accidents happen all the time, even tho nurses, cna's, etc. are doing the best they can under the curcumstances.

i NEVER let a family member or loved one stay in the hospital for any reason unless someone is with them 24/7 and asking questions. it's simply not safe.


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## Nevada (Sep 9, 2004)

marvella said:


> i know from years of experience that most hospitals and almost all nursing homes are short staffed and frequently unable to care for the people they admit.


No question, this hospital has a short-staffing problem.


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## Nevada (Sep 9, 2004)

Okay, she's out of the hospital and into the rehab center/nursing home.

I asked the nurse of I could take her to the rehab center myself. He said he thought it would be okay but would need to clear it with the health care coordinator, just as the health care coordinator walked by. The nurse inquired and the health care coordinator asked, "Is that 'THE HIP?'", to which the nurse nodded yes. She replied, "No, she _has to_ go in an ambulance." I suppose we're stuck paying for a $500 ambulance ride.

I'm not sure exactly why, but I feel a lot better knowing she's in the rehab center instead of the hospital.


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## Nevada (Sep 9, 2004)

FOLLOW-UP

After a week of rehab she's using the hip fine, but she can't walk very far because she's still as weak as a kitten from being so ill from the pneumonia. But I suspect that she'll get out of the rehab center this week. She's not really ready to go, but she hates it there. I think she'll wear them down and they'll send her home with me in a few days.

I did find a lawyer for her and got him started. I had to request her medical records from the hospital and mail them to him (he's in Reno). Hopefully he can at least get the medical bills neutralized.

My plan is to get her out of here until the weather improves a little (it snowed again last night here). I'm thinking a few weeks in Las Vegas or Laughlin, to take advantage of $15/night hotel rates available from the economic downturn. Low hotel rates and 2for1 meal coupons should make for an economical vacation where it's warm.


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## BeaG (Aug 21, 2008)

Nevada: Thanks for posting the followup. It is a thrill to hear that she is doing so well. Your choice of getting a lawyer was probably the only choice you had to prevent overwhelming medical bills. I hope you both have a great time on your vacation!


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## Nevada (Sep 9, 2004)

BeaG said:


> Your choice of getting a lawyer was probably the only choice you had to prevent overwhelming medical bills. I hope you both have a great time on your vacation!


Change of plans. I got a call today from the lawyer. He has had a medical professional review the hospital records and wants to pursue the case. He would like to meet with her as soon as she's able to travel. We're headed to Reno as soon as she gets out.

Reno won't be as warm as Las Vegas, but she'll enjoy seeing the Comstock. We'll go to Virginia City, Lake Tahoe, and the State Capital for sure. After 2 or 3 nights in Reno we'll head for warmer weather.


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## Nevada (Sep 9, 2004)

Another change of plans. She's not going anywhere. She seemed to stop improving so they don't want her to go home for at least another week.

While reviewing her case in a meeting today with the nursing staff, I discovered that she hasn't taken her thyroid medicine or the medicine she takes for rheumatoid arthritis inflammation for about 2 weeks. They told me that the hospital didn't convey any information about her regular meds to them.

I'm convinced that I'm working with a bunch of clowns now. Acute medical care around here is unquestionably substandard. If you aren't hurt, you'll get hurt. If you get well, they'll make you sick again.

I just can't put into words how disappointed I am with the local medical system right now.


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## BeaG (Aug 21, 2008)

Back at the beginning of this thread, you discussed her symptoms of mental confusion. 

Your description reminded me of another case I had heard about. A lady who was taking multiple prescriptions had paranoia; she was convinced that people were "out to get her", and she did not remember her own son, who was her caregiver. Her son took all her prescriptions to a pharmacy, and discovered that there were serious side affects associated with the interactions of the mix. (She had received them from multiple doctors.) When her doctor changed the meds so that they did not conflict with each other, her mental confusion went away.

I did not mention this at the beginning of the discussion, because I (assumed! ha!) that with her in the hospital, this kind of error would not happen. Maybe this problem is something that you have already addressed, but considering the level of care she has been receiving, it might be something to be careful about, now that they are about to restart her previous meds.

I have sympathy for the sincere medical personnel who are trying their best, especially the overworked staff at the bedside level. They try hard, but they do not have the level of knowlege and the understanding that the family has. A hospital or nursing home can be a dangerous place...... Have you considered a nurse for home care?

We will keep you both in our thoughts.


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## marvella (Oct 12, 2003)

Nevada said:


> Another change of plans. She's not going anywhere. She seemed to stop improving so they don't want her to go home for at least another week.
> 
> While reviewing her case in a meeting today with the nursing staff, I discovered that she hasn't taken her thyroid medicine or the medicine she takes for rheumatoid arthritis inflammation for about 2 weeks. They told me that the hospital didn't convey any information about her regular meds to them.
> 
> ...


i can pretty much assure you they are not clowns and reasonably competant. it may not show but they really do care. 

what they are, is overworked, expected to do too many things for too many people.

this is a good example of why it is soooo important for there to be a competant person around when anyone is hospitalized. 

never, ever let a loved one stay in the hospital by themselves. ask questions and make sure you get answers you understand.

good luck and keep us posted.


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## ann in tn (Nov 25, 2007)

So now that they are aware of her need for thyroid meds and her arthritis meds - did you provide them what she was taking prior to going into the hospital. Also with her thyroid meds - was she taking them to stimulate an underactive thyroid or replace a removed thyroid. Not having meds for either of these could be a big part of why she was not hungry and any lack of energy to participate fully in rehab. Ask questions of the rehab and make sure they are taking blood tests to check her levels.

I am still praying for her. I hope she starts to improve again.


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## Nevada (Sep 9, 2004)

BeaG said:


> I have sympathy for the sincere medical personnel who are trying their best, especially the overworked staff at the bedside level. They try hard, but they do not have the level of knowlege and the understanding that the family has. A hospital or nursing home can be a dangerous place...... Have you considered a nurse for home care?


Taking her home was my purpose is calling that meeting yesterday. Since the health care coordinator had estimated 2 two week rehab stay I wanted to know is she was on-track to be released on Monday. I asked her RN and her eyes sort of rolled back in her head, asking, "What do you mean by 'go home'? She our patient, so she can't go home." Upon learning that there was no discharge plan I spoke with the hospital administrator, and the meeting was called.

I have to be honest here, in that I'm considering signing her out against medical advice. I'm still having difficulty believing that as much has gone wrong as really has. While I can give the nursing home a pass for the hospital not letting them know about her regular meds, the fact that they still hadn't sought a patient history for more than 10 days is clearly incompetent. I thought I saw the end of it when she broke her hip, but now I'm wondering what's going to go wrong next.


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## Nevada (Sep 9, 2004)

ann in tn said:


> So now that they are aware of her need for thyroid meds and her arthritis meds - did you provide them what she was taking prior to going into the hospital. Also with her thyroid meds - was she taking them to stimulate an underactive thyroid or replace a removed thyroid. Not having meds for either of these could be a big part of why she was not hungry and any lack of energy to participate fully in rehab.


They said that they would be calling her regular practitioner to obtain orders for the meds, and asked that I bring the meds in with me today. Presumably they'll resume the meds as soon as I get there today.

Yes, not having her thyroid med can cause a variety of symptoms, but I can't imagine the discomfort she's suffering by not taking her arthritis anti-inflammatory med, then being forced to go to physical therapy. It's no wonder her walking isn't improving, since she's basically an invalid without her anti-inflammatory med.


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## marvella (Oct 12, 2003)

please do not take her against medical avice. they can refuse to treat in the future and the insurance can refuse to pay.

just keep on the way you have. question everything. it's their job to give you good answers.


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## Nevada (Sep 9, 2004)

marvella said:


> please do not take her against medical avice. they can refuse to treat in the future and the insurance can refuse to pay.
> 
> just keep on the way you have. question everything. it's their job to give you good answers.


I know, and taking her out of the facility against medical advice would be a last resort. I'm not there yet. But if I think the incompetency could kill her, I'll have no choice.


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## Nevada (Sep 9, 2004)

I stopped by the nursing home late this afternoon to bring her a new 4-wheel "rollator" walker (the ones with a seat built-in) that I bought for her at eBay. There was a definite attitude change in the staff when I arrived.

Her long-standing diagnoses were confirmed by her regular practitioner, and the proper meds have been prescribed. She's already been started on the meds for thyroid & RA. The nurses now realize that she's ill because she wasn't getting the meds that she needs, and they are treating her much better now. They've canceled physical therapy until Monday, put her to bed, and are bringing her meals to her. I expect her to be on her feet again in a few days.


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