Mom's still in the rehab facility, nurses aren't understanding a couple of key issues. How do I address this?
She's got diabetic retinopathy with major scarring, so she's limited on seeing colors, has a large blank spot in the very center of her vision and a lot of blurriness in the rest of it. Eyeglasses don't really help the main issues, they only help for seeing in the very far distance.
The problem is that the nurses seem to be assuming that mom can see/find her things by herself, and aren't very helpful if she asks where something is, or asks them if they can hand her a specific item. She *can not see it*, this was an issue before the stroke that landed her in the facility. How do I stress to them that she isn't trying to be difficult about this, she literally can't see things like a normal person?
The second issue, she has some pretty bad bowel issues, including repeated fecal impactions. She is on a medication for this (Linzess) that helps her be able to "go" on a regular basis, however the local hospital was never "able to verify" the rx she had (nevermind that I actually brought the bottle, from our local pharmacy, with her name on it, to them so they could see that YES she needs it). As a result, this new hospital keeps saying they need to "wait and see what the doctor says". In the meantime, she's not had a bowel movement since Friday, and taking the Linzess at this point will *not* help. She has been given Colace and Ducolax in the meantime, but they don't address the main issue, which the Linzess does. They won't allow us to bring her medication to her in the facility, and seem to be under the impression that she doesn't actually need it.
They (admissions, charge nurse, and "patient liaison") were all made aware of this issue. I know my mother is a very *very* difficult patient, but this isn't just idle complaints or resistance to care. I live too far away to be there daily (the facility is a 2 hour drive, one way, from my house, and I'm also caring for my dad, who is still at home and can't be left alone overnight). I'm extremely concerned, most of her resistance to being there is linked directly to these two issues, and I feel like these are not just minor things. I'll be at the facility tomorrow, I just don't know who I should speak with about these things. The charge nurse again? Her doctor at the facility? (the liaison doesn't actually work in the facility, she's the person that visited at our local hospital before mom was admitted.)
I hate to keep posting questions like this, but I've never been in a situation like this, every other time either of them has been hospitalized (even for strokes), they were released back home with homecare visits from local nursing agencies.
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You may need to sit with the director of social work to get the whole staff to understand what your mom's visual issues are. Telling staff members one by one is not efficient. The information needs to get put in the notes. Ask social worker how best to get this done.
With regard to medication, was this med noted in your mom's medical records when she was transferred? If not, can you have her previous doc talk to nh doc?
The medication was prescribed about a month before her last hospitalization, by a doctor in the hospital's "Care Network" (it's a group of doctors that actually work within one of the hospital towers, and are supposedly linked through the hospitals own system), however when she was hospitalized (this past Monday), they claimed to have no records of it. Called the doctor and they were going to send the info over, but then she was transferred to the rehabilitation facility. The facility has no record of the medication (despite me having actually shown her bottle from our local pharmacy to the care director AND several nurses both at the local hospital and the rehab facility) and they seem to either not believe the severity of her issue, or they are just dragging their feet with getting this medication ok'd.
I've given the rehab place the doctor's name and number (along with her GP's name and number). I'm just extremely worried, about several issues. Some of which are over very minor issues... like not being able to find her cookies, others are slightly more worrying, such as the fact that no one has bothered to even rinse out her water bottle since she's been there... which means she's not had fresh water in 3 days. And I've called the nurse about that, they were going to check it and see if she'll let them wash it out and refill it for her. She didn't bother to say anything to me about it earlier and didn't bother to ask my brother to do it... which is a whole different problem. She is there for a stroke, she is not capable of remembering all this stuff yet, and no one's bothering to check on her.
At this point I'm honestly seriously considering calling the local facility (which isn't as intensive but IS just a 20 min drive for me) and having her transferred back there instead (if that's even possible). It might mean she's got to stay in the facility a week longer, but at the same time I'd be able to know for sure if some of this is absolute bullshit because she doesn't really know what's going on, or if there are actual problems with some of it.
Don't chase down the facility Dr. That would be like trying to chase smoke. I would go to the Director of Nursing....again....and explain, again, that your mom needs this medication and what can you, her daughter, do to make sure she's getting it everyday?
The facility won't give it to her on your say so, they'll need to contact the prescribing Dr. Have that information available when you speak to the DON. Get the DON's contact information and let her know that you'll be calling her back to follow up and to make sure that your mom is getting the medication.
I don't know how long your mom has been in the rehab but I would give the DON 24 hours to straighten out this medication issue. And what I would personally do myself if it were me, I would call the office of the prescribing Dr. and explain the situation to them (be brief, the Dr.'s office doesn't care about the history and the facility's inability to see this through) and see if there's anything they can do on their end. I used to do that kind of thing when I was caring for my dad and things would fall through the cracks.
As I said in the last comment, the cookies were a minor issue, however, imo at least, not having any water or other liquids to drink for nearly 2 full days is more than a minor issue as well.
I did go to the facility today to visit with mom and talk to her "care team". They have noted that she is low vision at this point, including placing a rather large sign on her 'nurses board" in her room (it's where they pin her schedule for each day, there's also a sheet where the nurse checks on her hourly and signs off on it, and where they note how much she eats/drinks during the day.). They were not aware that she wasn't able to see the lids to the cup they brought (or really see that it WAS a cup in the first place), so they have changed several things to make it easier for her to see and reach things like water, dinner trays and the call button for the nurses themselves.
As for her medication, they are concerned that it may raise her blood pressure at this point (which no one bothered explaining at any point), however she's still not gone to the bathroom since Friday. She was transferred to another floor today, from the "traumatic brain injury" floor to the actual "stroke recovery" floor, and the nurses there seem to understand the issue much better. While they won't allow the specific medication that she had previously, they now have orders for several other things that should help with it, as well as a consult with the Gastroenterologist to see if there is something else that will work.
Hopefully this will be the last issue. She's got 3 hours of therapy daily, as well as "recreational therapy" whenever she requests to join it (sort of like arts-and-crafts at a summer camp). She seems to accept that it is the best place for her, and seems to actually like most of the new nurses.
However, they do intend to release mom in 2-3 weeks, and if at *that* point she's still in need of pt/ot/st, she will be transferred to the local rehab facility instead (which is very *very* nearby. Less than a 15 min drive from my home!).
She's improving at this point, has been able to feed herself (even if she complains about how much they feed her. 3 full meals and 3 full snacks daily, when she's used to 2 full meals and 2 snacks because she sleeps late and doesn't like to eat breakfast), and is walking with a rollator, so hopefully she can be released closer to 2 weeks, instead of 3 or 4.