When an Arizona parent needs nursing home care, overseeing that care usually falls on whichever child happens to live in Arizona. This article is for that “responsible” child who just happens to live here.
The first question one must ask is whether any patient can receive quality care in a nursing home. We’ve all heard the horror stories about the warehousing of nursing home patients, who are just waiting to die.
Although nursing home care in Arizona is often less than adequate, I believe that it is possible for nursing home patients to receive quality care. However, in order to receive that level of care, patients must have a knowledgeable advocate.
Nursing Home Advocacy 101.
Nursing home advocacy doesn’t require a degree in nursing or medicine, just time, tenacity, and a little information.
Communication is the First Lesson.
One of the major problems in the nursing home is lack of communication between and among families, nursing staff, and physicians.
So how do you, as the patient’s advocate open channels of communication?
Become Aware of the Patient’s Needs.
Become aware of your loved one’s needs. Are they bed bound? Can they feed themselves? Are they taking a new medication?
Communication Just Doesn’t Happen by Itself.
Very few families understand that they have to become involved in facilitating communication within the nursing home.
Families are led to believe that the nursing staff will provide the physician with all the information about the patients. Families are also led to believe that the nursing staff will provide all the nursing care the patient requires. Unfortunately, both of these assumptions are not correct.
Nurses and nurses' aides are short staffed in nursing homes and are unable to provide all the necessary care the patients require. Physicians, who are responsible for the care of patients at nursing homes, rely too heavily on the nursing staff to follow physician orders or to perform adequate nursing care.
Meet with the Patient’s Nursing Home Physician.
Discuss your loved one’s needs, in person, with the nursing home's primary care physician. Find out when the physician plans to be at the facility for his regular visits with the patients, and meet him there.
Patient advocates must take steps to encourage physicians to personally take a close look at their loved one’s condition and ensure that the nursing staff is functioning as intended.
So, when meeting with physicians at the nursing home, ask them to check the condition of the patient. For example, if the patient appears to be losing weight, ask the physician to weigh the patient. If the patient has in fact lost weight, ask the physician to meet with you, the dietitian, and the nursing staff to discuss how to encourage weight gain.
The advocate may become a “pest”, but the physician won’t be able to say that he had no idea that his orders weren’t being followed or that he was unaware that the patient’s condition has changed.
It is the primary physician’s responsibility to know the care your loved one is receiving at the nursing home. If the patient is losing weight, the physician should determine why the patient is losing weight. The physician must ensure that his patient is eating his meals and if not, the reason why not. The physician must then take action to ensure adequate nutrition.
If the patient is bed bound, the physician needs to examine the patient’s skin in order to determine whether his patient is developing pressure ulcers (bed sores). And, if the patient has pressure ulcers, the physician must ensure that his patient is being turned and repositioned regularly and is also receiving adequate nutrition.
The advocate must be the vehicle by which the physician is encouraged to completely check the patient’s status, during each visit, and not merely rely on what he is being told or not being told by the nursing staff.
Make Regular Visits to the Nursing Home.
When you visit your loved one in the nursing home, visit during the morning, lunch, and evening meals which are the busiest times of the day. This will give you the opportunity to determine whether the nursing staff is able to attend to patient needs during stressful situations.
During your visits, check the following and report any changes you observe to the nursing staff and the patient’s physician:
1. Patient’s weight.
2. The percentage of breakfast, lunch and dinner the patient has eaten.
3. The patient’s skin condition (twice a week) for signs of red, blistered, or broken skin on hips, buttocks, shoulders, or any place that comes into contact with the mattress or wheel chair cushion.
4. The patient’s medication record documenting medications that were supposed to be given.
5. Look for any change in the patient’s condition including eating patterns, sleep patterns, falls, bowel movements, agitation, etc.
Meet the Director of Nursing.
The Director of Nursing (DON) is the highest level of nurse management in the nursing home. Introduce yourself to the DON and explain what you know about your loved one’s needs, likes, and dislikes. The DON is responsible for making sure there are enough nursing staff at the facility and is the “go to” person when nursing care isn’t up to par.
If, as a result of your observations, the patient is not receiving adequate care, speak with the DON and the patient’s physician.
If matters don’t improve, speak with the Administrator, who is the general manager of the nursing home.
If there still is no improvement, consider moving the resident to another facility. If matters are such that you decide to move the patient you should inform the Arizona Department of Health Services (ADHS) which is the regulatory agency in Arizona responsible for overseeing nursing homes.
The patient advocate is the additional oil that keeps the nursing home engine running well. When the oil is low and the engine spurts, the advocate is there to move things along.
It is unfortunate that nursing home patients need an outside observer and facilitator to get the care that Medicare and Arizona Long Term Care have paid for, and that patients are entitled to receive.
Our Next Article.
Our next article will discuss avoidable pressure ulcers (bed sores), a principal killer of nursing home patients.
The “Guardian Blog” will continue to provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.
