I’m back from Florida
Apologies in advance. This entry will have little to do with bass. I just want to get some things out of my head. I guess we can look at this as one of the few times I’ll use my blog as a device for a non bass- or music-related issue. Ignore this post if you’d like. I’ll resume bass-related articles shortly.
We got back from Florida on Sunday. I was down there for 3 days with my mother and sister to visit mom’s aunt, who is in an assisted living facility there. I was wrong about her age in my previous post (see bottom half). She’s 88, not in her 90’s. You’d never tell the difference though… or at least I can’t.
Anyway. She was in really bad condition. She didn’t recognize anyone very well, she was weak, she’s lost a lot of weight… I don’t think she’s been eating well and there were other issues that are too personal with regards to her for me to get into online. But, anyway, we found a lot wrong with the place, including the fact that her transfer data from the hospital was sitting, unopened, in her room. As I design clinical software and work with medical records, and my sister worked at a doctor’s office for a while and now is working in medical records for a hospital up in Albany, we decided to let anger cloud our judgment, forget HIPAA and go through the file.
She hadn’t received any of her meds in 2 days. The document says that she needs assistance in ADL’s (Activities of Daily Living – think bathing, toileting, eating, transferring from bed to a chair, etc.). She’s a vegeterian and the day-old meal at the foot of her bed had ham and eggs. There was a lot wrong. That’s just the tip of the iceberg.
So, I went downstairs, with my sister and a really vocal aunt who I’d just met, and we tracked down a nurse. To her credit, she was responsive and level-headed. She let us know that the staff had not seen the transfer data that we had. She thinks that the ambulance staff left it upstairs, which also means that my aunt wasn’t properly admitted to the facility. She complained to us several times that the hospital keeps discharging patients to assisted living that should really be in a nursing home or rehabilitation center. From our description, she already thought that mom’s aunt should not be in assisted living.
After explaining our personal determination that mom’s aunt was improperly-placed, she went upstairs with us and performed a quick cognitive assessment. Now, before she got up there, my mother had fed Aunt Stella. She had made food and brought it with her. Auntie also drank a lot of water. She kept asking for more. I had run out with some family from down in Florida to grab supplies to leave at the assisted living facility. After feeding her, my sister helped her to bed. My sister worked in a group home for about 4 years with developmentally disabled adults, most of them geriatric and behavioral. She’s not a large person (5’4″ and maybe 115 lbs. at the most). She later told me that she was surprised how little Auntie weighed. She compared it to lifting our twin nephews, who are 6 years old.
As soon as Auntie’s head touched the pillow, she passed right out. From what my mother was able to understand, she had been sleeping upright in a chair for the past 2 days. No one had come to help her to bed. We tried to help her stand before I had left for food and supplies. Her whole body shook when she tried to stand, and she simply wasn’t able to. In the end, we physically transferred her from chair to chair, and finally my sister put her to bed.
Ok, so the nurse gets upstairs and does a quick cognitive assessment. She wakes Auntie and asks her a few questions, like her name, what day it is, what time it is, if she knows where she is, and so on. Auntie wasn’t able to answer any of the questions correctly. I don’t know if this was nocturnal confusion (and being awakened after only an hour of rest) or if it was her prevailing mental state over the past few days. In any event, we explained that she is not generally like this and the nurse made the determination that she had a cognitive decline, which is reason enough to send her to the hospital.
A 3-day period of hospitalization is necessary for a patient to be transferred from one kind of facility to another, and to qualify for Medicaid. I rode in the ambulance with Auntie. She was largely unconscious. I stayed there with her for a few hours and spoke with the doctor on her behalf. I didn’t have much information about her medical history, but I explained to them that I felt that she was inappropriately placed in an assisted living facility and that I thought that she belonged in a nursing home or rehab center. She was not able to meet a minimum requirement for self performance with regards to transfer, bathing, toileting and eating. These alone meant that she needs assistance, which was not available at the assisted living facility.
The doctor understood this and told me that he felt that she would be transferred to a nursing home, not to a rehab facility. For those of you who are unfamiliar with all of this, its not a drug rehab facility I’m talking about. There are different kinds of rehab – physical therapy, occupational therapy and speech therapy are the 3 main ones. There are also disciplines like recreational therapy and psychological therapy. I think that maybe she will qualify for rehab if we can get her to recover enough of her strength.
Anyway. I want her placed in one of these. At a nursing home, she will have 3 meals provided to her by a dietician, specially-prepared to help her get strong again and fend off dehydration. Activities workers will help keep her socially stimulated with games, TV, radio, special events and normal social interaction with themselves and other residents. Social workers will be able to advocate for her and keep tabs on her general cognitive and socio-sensory status. Finally, nursing staff will help with her ADL’s, help feed her and keep her generally comfortable. They’ll also make sure that she gets her meds and takes them at the right time.
Overall, I’m much more comfortable with nursing homes that assisted living facilities. Assisted living assumes a certain level of independence that she does not possess. She might have been stronger when she first got to the facility where we found her, but she degenerated while there. I’m actually not completely sure how long she was at the facility. It might have been 3 months or even half-a-year. I’ll find out all of that information once I’m certain that she’s on the road to recovery though.
Right now, she’s still at the hospital. Its been 4 days, so she’ll qualify for coverage. I don’t have power of attorney for her in any parameter, but I’m going to deal with the person who does. She’s an aunt in Canada that I’ve never met, who did some very bad things to Auntie and got her into the situation that she’s in. Its not going to stay this way though.
Anyhow, there are a million details I’m leaving out of this, because I’m past the point of brevity but don’t want to go any further into the road of long-windedness. I’ve not practiced much bass in the past few days. A thread I started on TalkBass about the modes (to help clarify some things about a previous post) has moved in directions that I”m not necessarily ready for, and I have a lot of catching up to do.
If anyone reads this and wants advice about nursing home placement for someone that they know and care for, feel free to leave me a message. I’m more familiar with NY-based facilities, but I can offer some small advice about their general procedures and the federal systems by which they must all abide.