She is 88 and had surgery to replace the ball part of the bone that had broken off. The surgery was yesterday (the break occurred the evening before.) She still seems confused and out of sorts from the anesthesia. She had also broken her fibula three weeks ago. Left leg and right hip. Not a good situation! She will have to go to a SNF when she leaves the hospital. How do we find a good one? The ones I have researched online get HORRIBLE reviews! Anyone have any recommendations for facilities in the Dallas/Ft. Worth area? I am worried and concerned for her recovery.
Mom then has one hour of physical therapy one-on-one and an hour of occupational therapy also one-on-one. The sessions are spread out with a break for lunch between. No therapy on weekends unless you did not get 15 hours during the 5 previous days. She also has the same therapists every day which is great.
The facility is called a “Rehabilitation Hospital”. Nobody lives here. It is solely rehab.
All the rehab therapy I've seen has been one to one, therapist to patient.
Since your mother's not in a SNF, what kind of facility is she in? Is it solely dedicated to rehab, something like some of the Medilodge facilities?
I'm glad to read of the great report of your mother's progress though - that's wonderful!
I stay with Mom at night and once the Physical Therapist trained me to help Mom with transfer to the toilet, my life got easier since I did not have to wait for a tech to show up to take Mom. Most times it took so long that Mom could not wait. Mom does all the work with the transfer and I am there just in case something were to happen. So far so good! I am so glad I fought to get her into this facility and not a SNF. This facility is in the top 1% in the nation for their success rate in returning patients to the community. We want Mom to be able to bathe, dress and toilet herself again just like she was before the broken fibula and broken hip. She is getting there!
I am getting proper grab bars installed in preparation for her to come home. They have a tentative discharge date of 5/19 (coincidentally the exact number of days Medicare/insurance covers!)
After 3 different nurses stuck her far too many times, I insisted they get a PICC Nurse to put in the IV using sonogram guidance. It took an additional 15 hours for the PICC nurse to show up because someone did the order wrong. On top of that, the order for blood was cancelled because some staff member wrote in the notes that “the family does not want a transfusion”!!! What??? So screwed up.
We will hear the decision of the insurance company today regarding my appeal of the denial of acute rehab. Mom is running a fever today and that, coupled with the low hemoglobin is causing her to be even more lethargic. We may be here a while longer. Rehab will have to wait.
PS: Not sure why they give Mom a menu to order her meals. It is day 9 and on only one occasion has she received anything remotely close to what she ordered! And we are in a big city major hospital.
http://theconsumervoice.org/uploads/files/issues/Harrington-state-staffing-table-2010.pdf
I thought there was a state minimum standard for ratios of patients to staff. There is in Michigan.
I also found that the best care was initially at a well run chain, but that deteriorated to the point that it didn't even meet basic standards. However, I found that a SNF founded by the Dominican Sisters of Peace was the best so far (other than one in Ann Arbor, but AA is a teaching hospital area and standards are higher all around.)
Sorry to learn you've had some bad experiences as well. I asked one SNF I interviewed 3 times before someone finally told me what the ratio was. When two people said that they "meet the minimum state requirements", red flags went up. And I was right - that was the place with the 1:14 ratio.
Rusbar, good idea to get information from someone who visits a lot of different SNFs and knows the good from the bad!
Texas, one thing concerns me, right now. That's that the IV was pulled out and apparently not put back in again. If she's dehydrated, she's not even going to feel up to thinking about recovering.
I would address, first the nurse, then the charge nurse, then the administrator, if that IV isn't put back in ASAP.
Even if she's taking fluids by mouth, she may have been getting antibiotics through the IV line.
My understanding is that if a floor nurse can't restart the IV, someone from Anesthesiology should be called to get one restarted. Make sure the staff knows you're on top of this; they really "dropped the ball" when my father was in last time.
As I think about all the issues with SNFs, I'm beginning to think a continuing ed course on selecting SNFs might be a good idea.
So I’d love to know where better ratios can be found, so I can plan ahead for myself!
Her BP is tanking and her hemoglobin is 7.3 as of yesterday. Apparently, new guidelines are to not transfuse unless 7 or below. She pulled out her IV and incision drainage tube during her delirium and they never put them back. I think she is dehydrated and anemic. And with a broken left leg and operated-on right hip, you can imagine how much fun getting to the commode chair is! It is so painful for her that she decided not to pee or poop anymore. This is a disaster! And don’t get me started on the quality of care in this hospital (because there is none). @GardenArtist, thanks for the list. Your wisdom and experience are always appreciated.
Visit during mealtime; do residents eat together in a central room or alone in their own room? Look for menus; see what's available and try to get a look at some of the meals. The best I've seen had a chef from a former high profile restaurant. The food was literally to die for. At a another facility, the brownie was stale and the fish looked like drywall. Blah.
Does the facility extend comfort to visitors and family with hot coffee and water? Does it offer a free meal for the family? (this was a surprise, but a pleasant one)
Wander by the physical therapy room and see what's available. For someone recovering from leg fractures, a parallel bar setup is helpful. Are there "beds" that can be lowered and raised? These provide a wider range of PT that can be done. Or does the PT room just have a few exercise bikes and variations thereof? Steps with side rails are also a good form of leg therapy.
There should also be a variety of OT devices, beyond just putting round or square pieces in appropriate holes. Some have kitchens so people can practice preparing meals. Some have laundry facilities so the resident can learn how to use top or front feed machines.
Activities - how often, what are they? Are there pet visits and live music? Any pianos at which visitors can play?
Most importantly, what is the staff to patient ratio? The last one to which I took my father had 8 aides available during the day for about the same number of patients. One I didn't take him to had a 1:14 ratio (1 aide for 14 people on the wing - yikes!) The less aides, the longer it could take for patients to get help with ADLs.
Observe the faces of the residents/patients. This is an individual issue, but when I've seen too many people staring vacantly and left alone, I would be concerned. Some places have puzzles, tv rooms, movies, etc. Getting someone out of the room and interacting, or just being with others, can make a big difference than being alone in a room.
Good ones also have common areas; that best one was configured so that visitors could see out into the courtyard, or forest for that particular side of the building. Staff and visitors both told me that deer came up from the forest in the evening to feed along the perimeter of the small facility.
Are the rooms private? This seems to be the trend, at least in my area. Check for cleanliness, and especially a bathing area in the room. Older homes used to use communal bathing facilities, causing embarrassment and anxiety when my parent would have to be cleaned.
The ones I've used in the last several years had private bathing facilities, in the resident's private room. And they were immaculate.
Are there any unpleasant smells?
What is the resolution process? I.e., if issues arise, how are they addressed and resolved? Watch for mouths beginning to open to address the question (good sign) , or, alternately, blank faces (bad sign).
What security is there? Since there are people coming and going, this is always an issue of concern. The last facility had a private security force as well as a bank of cameras at the front doors, of which there were 2. The outer door could be opened by visitors, with the handicapped buttons to push. The second, inner door could only be opened from the lobby. It's the first time I've seen cameras monitoring the grounds and access available only when the receptionist or staff pushed the right access buttons.
Don't judge the place by how it looks outside. My Dad was in a rehab/nursing home that was building back in the 1950's, not a very cheery looking place.... but Dad had excellent care, the rehab was great, and food was very good. Dad didn't mind being there.
On the other side of the coin, my Mom went into long-term-care. The place was less than a year old, looked very nice inside. Even thought Mom had good care, it was nothing like the old Rehab my Dad was in.
Hopefully a caregiver from the Dallas/Fort Worth area will see your post and give you a recommendation.
As for your Mom's recovery. For every hour she was under with anesthesia, it will take one month to recover.... so if surgery was 2 hours long, then 2 months to recover from the anesthesia fog. The older a person is, the longer it takes to heal. So give Mom plenty of time. Broken bones are very painful so the pain meds will also make her zoned out.