My friend and fellow writer, Beth (aka Betty) Barnett posted a piece to her blog, Beth’s Everything Blog, entitled, Patient Control, which talks about current hospital processes as taking control away from the patient and making them feel helpless. She ends her piece with the conclusion that “caregivers must be facilitators, not dictators.” To read her piece, click on the link above.
When I finished reading her post, my neck muscles had tensed at the memories of my own experiences in the hospital and nursing home with my mother. So much so, I had a headache.
At eighty-four when Mom entered the hospital for her second major surgery, a hip replacement, she lived independently in her own house, maintained the yard, paid her bills and managed her own money. She prided herself on her independence. she retained her capacity for making sound decisions if people took the time to explain her choices to her.
Many caregivers from doctors to nurses to hospital personnel had little or no time for explanations something I didn’t know prior to Mom’s surgery. My friends had told me horror stories, but I hadn’t really listened.
After my mother’s surgery and week-long, in-patient recovery, she could walk okay. Being in the hospital, she had run around in her hospital gown never having to put on her clothes. People brought her her meals, took her to the bathroom and bathed her. They’d babied her.
I spoke with her one day and she said, “I get out of the hospital tomorrow about noon.”
I assumed (thus making an ass out of myself) that she would go to a rehabilitation facility to learn how to walk up stairs, climb in and out of a car, bathe on a shower stool and learn what equipment we would need to buy so she could go back to a house not equipped for a person with a hip replacement. I arrived early enough to hear the nurse tell my mother that the doctor would discharge her home as soon as he arrived.
“What? Home? As in her house with the twenty-five stairs from the street to her front door?” I asked, not believing what I’d heard.
The nurse looked at me with that “oh-you’re-the-troublemaking-son” look. “There are no orders to discharge her to the rehabilitation facility downtown. She’s going home.”
My mother sat in bed listening to our conversation as though we were talking about the weather and not her.
“Don’t leave this bed, Mom. I’m going to have a conversation with the social worker.”
When I found the social worker’s cubbyhole, I took her only paper-free chair. “I just learned that my mother, Mrs. Chrisman, is being discharged to her home.”
The social worker smiled. “Yes, today is the day she leaves us. She’s ready to go back to her house. That’s all she’s been talking about since I told her. You’re probably here to get the list of things she’ll need to make a safe transition to her own home. Let’s see…here it is…a toilet seat elevator, a shower chair, a cane…”
“Are you people nuts?” I asked, a little perturbed. “My mother is 84 years old and has been flat on her back most of the time she’s been in this place. When she goes home today, which she isn’t doing by the way, she had 25 stairs to climb to even reach the front door of her house. Who’s brilliant idea was it to send her home?”
“Well, her hospitalist said she was well enough to live by herself.”
“That may be, but she needs to build up her strength again before she goes back home.”
At this point the social worker had developed an attitude. “Your mother is competent, isn’t she?”
“Yes, what does…”
“She never said anything about wanting to go to rehabilitation.”
I slapped my forehead with the palm of my hand. “Did anyone explain to her she had a choicer?”
“Not that I know.”
“Lady, with all due respect to you and this poorly run hospital, why do you expect elderly people to know these things? My mother depends on people like you to do your job, which includes explaining her options to her.”
“There isn’t any reason to get mad, Mr….”
“Huh? This hospital is about to send my mother home to live totally unprepared and I’m not to get mad. You better rethink that statement.” I paused for effect and also to keep from swearing. “My mother is going nowhere but the rehab facility. Do you understand?”
“Is that what she wants?”
“It will be in about ten minutes so get the paperwork started so I can take her downtown.”
“Oh, if she goes to rehab, we’ll do a transfer by ambulance.”
And, that’s what happened. An ambulance took my mother to rehab where she spent a little over two weeks before she had enough strength to walk any distance at all, before she could even climb stairs and before she learned how to use various assistive devices to make dressing and self-care much easier. Two weeks to learn necessary skills in rehab that she would have missed because she didn’t know they existed and the people who did weren’t telling her.
As I said in my comment to Betty’s post, everyone who goes to the doctor or hospital for life-threatening conditions or surgery should have at least one patient advocate who accompanies them and protects them from the blissful ignorance of some caregivers. We owe that to our family and friends, especially those who are elderly.
swqm60 
I dealt with similar situations with my mother, and now it’s happening with my dad. My brother has had to explain my dad’s situation to a different social worker at the same hospital on least four separate occasions in the last year (my dad keeps falling, but refuses to leave his house with stairs). And my sister’s mother-in-law had heart surgery last month and they sent her home (alone) with a catheter. She had to return the next day when she got an infection and had to stay in rehab another two weeks. They want to be rid of people as soon as possible, but I suspect most end up coming right back if they don’t rehab properly. Great, now I have a headache.
After Mom’s hospitalization for her hip surgery, I learned a lot about the medical care system in this country and it isn’t pretty at times. Despite the number of truly wonderful people who work in the health care system, the rotten ones leave the lasting impressions.
I had doctors question my mother’s decisions. They had to do it with me because I held her medical power of attorney. A couple of doctors tried to bully me into changing my mother’s directives. Fortunately I’d dealt with ignorant doctors in my job and felt really good about taking them down out of Heaven on occasion.
Okay, so now I have a headache too. Better go take some aspirin. Hope your headache goes away.
Yes yes and yes again. I had a similar experience with my mom’s stroke.
Tomorrow I go with Chris to be his advocate for shoulder surgery and then aftercare, at home. This hospital, an orthopedic specialty hospital, actually was very thorough with my own aftercare following my spinal fusion. So perhaps they are an exception. They made sure, before my surgery, that I had the right equipment at home. They confirmed this with both of us when Chris came to take me home. They made sure I could walk with my walker, could go up and down stairs, and could go in and out of a car, before releasing me. (They had a wooden model of a car, life size, in the PT room.) They called me at home a few days later to check on me. Nice. It should always be like this, especially for elderly people.
Jude, perhaps the fact that it is an orthopedic specialty hospital is the key. With a limited specialty they know all about their area of expertise. They know what happens in aftercare. I don’t think the same is true for big hospitals who treat all kinds of patients and never have the staff necessary to do a good job. That’s my bias.
My mother was treated at the ONLY hospital in her small city. They have the market cornered in that area and have no competition to worry about. What care you get is what care you get and they rarely respond to complaints…as I know from another experience I had with them concering my mother’s care.
I think elderly people in particular need advocates to go with them and deal with the bureaucracy of the hospital. People with experience doing that should be the advocates, not other people who trust doctors, nurses and hospitals to do right by their patients.
Yup. Once again, I agree with you on all counts. The elderly, in particular, receive subpar information and guidance. I think the Ortho Hospital I went to is more responsive because its owned and run by the doctors who use it, not by some big corporation. And it’s in a relatively large city.
From what I’ve heard from patients and medical personnel, elderly people become victims of a system that is no longer friendly to the patient, especially ones that require a little more time and patience. That does not bode well for our generation. Time for reactivation of the Gray Panthers.