Friday, January 2, 2009

Visit to the Nursing Home

I was invited to visit an elderly gentlemen in a nursing home. I was invited not by his elderly wife, but by their home aide. The woman who cares for the husband and wife daily was worried about the way the husband was being treated in the nursing home. The wife, she told me won’t ask questions and is too timid. The aide also said that when the husband calls for help at night, now that he is immobile following a stroke and then a fall, no one comes. She went on to tell me that the nurses were rude and wouldn’t answer questions. They feared for the safety of this elderly gentlemen, in his 90’s unable to care for himself.

When I visited, the elderly man was sleeping at 11:00 in the morning. He was more than just sleeping, it was pretty obvious to me that he was medicated. When he awoke for a moment, he said they did give him medication to make him sleep after he dirtied himself after breakfast.

I was waiting for the family to come and some friends stopped by to visit. They said he was never as bad as he was today. They feared something was dreadfully wrong. I didn’t mention my thought that he might be medicated but they came to the same conclusion.

When the wife came with their home care helper, a nurses aide came in. He was young and said he just stopped by to see if the patient needed anything. I asked him about bedsores and would he please remove the patients (I am not using names) socks so we can see if there are any bedsores, and, I asked him if he wouldn’t mind showing the patients wife and aide how the skin should look. He was happy to comply, removed the socks and gave the patient a foot and leg massage.

The family seemed surprised at how simple it was to ask. And, how graciously the aide explained bedsores and how they develop. We spoke about how he cares for the patient and stayed available to answer additional questions.

When I consulted with the family later, they said they have meetings with the social workers and dietician. Everyone involved in his care will be having a meeting next week. I suggested they write down their questions and keep notes that can be looked at later.

There were some areas of concern too, such as I couldn’t find any antibacterial hand cleaner and had to go find some at the nurses station. The patient had no water though he is supposed to have water at all times and the television from the neighbors bed was blasting loud, all things that families, of a younger generation may be more likely to speak up about or just take care of.

Patient advocacy is, in many cases generational and the culture needs to be addressed. It really is OK to show an interest in the patient by asking questions, learning from the medical staff and sharing what your expectations are.

Safety must start with conversation.

No comments: