finding plan B

Jo C.

Went back and re-read some of your prior Posts and it dawned on me.  After you were informed of the medication errors, did you at any time speak to  the Psychiatrist?  That would have been the primary MD for her care as required because it is a Psych Unit.

Any meds dispensed by pharmacy and given by the nurses would  be done only if ordered by the Psychiatrist.  Did any other MD get called in on her inpatient care?  AND . . . if the meds she is taking were listed in the ER, did they get them all listed properly and was that list the one the Psychiatrist followed to order initial meds on the unit?  At any time, did the Psychatrist speak to you about the medication history and what your Partner routinely takes?

Did the Psychiatrist know what meds your Partner was on is a question, and did he/she state that they would be ordered and continued OR did he/she want to remove some of the meds to see if any medication side effects were contributing to the behavioral changes . . .  that would have been documented in the medical record and should have been addressed with you.

The Psychiatrist and any other MD treating your Partner when an inpatient are the ones at the helm; wonder if the meds you mention actually were ordered by the Psychiatrist . . . . if so, then that is that. If not, then that would be the genesis for much or all of what is happening.

Gues my brain is now whirling on your behalf.  Just disregard if this is putting more stress on you.  

J.

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Iris L.

Do not let any of them know that you are on this message board.

Iris

M1

Thanks Victoria, you can be my long-distance legal eagle until I get one locally.  Given no phone calls all day, I am trying now just to reach her nurse for a checkin.  Nada so far.  They say they are having "phone issues" but I even wonder now if they are blocking my calls.

M1

And I won't, Iris.  Not a bit.  Nothing discoverable.

Late update:  final email from the SW tonight, so sorry no one has called me, they are reviewing and someone should call Monday.

They want me to come in for a "family meeting" with my partner.  The treating MD was "so sorry to hear about the medication errors."  Pardon me?

I didn't agree to anything.  I told them I thought my partner's seeing me would be a huge negative trigger, and that I wanted to wait until Monday and their phone calls before agreeing to anything.

I am going to ask for a different MD to take over.  Trust is nil.

Lills

M1, I have nothing more to add but still wishing you and your partner all the best.  You are an amazing advocate for your LO!

Jo C.

Phone issues?  Talk about timing.  Do you have a different phone with different ID on it?  If so, try using that one just to check things out.  I would be tempted to have my close friend call and see if they get through.  If they do get through and you still cannot reach the hospital unit, but can reach other numbers with the phone, well; flashing, red light call to the attorney with siren on if you are being gamed.  Probably are not, but still raises questions.

I know you are documenting your phone attempts.  Just hope this is not a ploy to get you to go in person and have your Partner pleading and acting out to go home and you relenting.

Can't imagine that, but yes; I guess somehow, in a way, I can.   PM shift now on duty; night shift will commence - wonder if the nurses are on twelve hour shifts.  May want to try calling late night or in the wee hours "to check on her," to see what happens if you continue not to be able to get through at this point in time.  Later may help and the night nurses will not have been as involved in the current dynamics.

And it is now the weekend . . . .

J.

dayn2nite2

Now that complaints have been filed and there are attorneys being contacted, I wouldn't expect to hear a whole lot from the hospital.  You will get a meeting that will be heavily documented and recorded, but they will protect themselves.

Are you also using this time to identify other placements for her, even just exploring?

Jo C.

Just saw your last Post.  I do not know what state you are in.  Each state has different mandates for how many days pass when a person must be re-certified with cause to extend the Psych stay.  We had 72 hours, and then I think it was again, nine days later.

Your Partner was a voluntary admission if I am remembering correctly; this would be a bit different from an involuntary admission.  Would this make a difference in mandating her to attend a recert conference in your state?  I am thinking this is a re-certification meeting to extend or not extend her inpatient stay. 

Do you know any Psychiatrists through work or other way that could discuss this with you on the weekend?  When it was time to re-certify my LO to extend the Psych stay, they wanted my LO to be in the meeting with the Psychiatrist, nursing staff rep, and someone to represent the legal system.  I agreed to attend the meeting, but not with my LO there; she had a behavioral variant of FTD and it was pretty severe. She was an involuntary admission.  We did have the meetingwithout her, but some places are not so apt to do that as the Psych patient has "rights," and off that goes .  Again; being a voluntary admission may make a difference in how things go. 

Best to know what the laws are if you have not currently worked with them so you know what sort of dynamics are driving the train.   If you do not have a contact you can reach over the weekend, you can do a lot of online research as best can..

I truly feel so bad about this.

J.

jfkoc

". if the meds she is taking were listed in the ER, did they get them all listed properly and was that list the one the Psychiatrist followed to order initial meds on the unit?"

You would think.

Dick took a fall..head hit so lots of blood. Called EMSA. They arrived and I gave them an accutate list of meds/OTC. They asked for the bottles. Fine. They doyble checked the list and off we went.

Arrived at ER where I was asked what were the current meds. I told them the EMSA person had them. They were recovered and entered.

Next stop was ICU where they asked me for the current meds. They located them on the computer. When we went over them the list was inaccurate.

True story and since then I have had occasion to have the list of my meds incurrate. I now take all of them in a bag and hand them to the person recording, one by one. Like socks in the dryer...seems like one is always missing.

M1....you have gotten some wonderful advise from people with professional as well as non-professional experience....from friends you will never meet but are here trek with you through this mess.

I wonder how often **** like this happens and is just not picked up on. Frightening, very frightening.

Now when looking for a Plan C facility,x  you can do some preliminary work from  home. You can find out about training, look at the contract, find about violations and read their license and read personal reviews. 

How far from a "city" are you?  I am from Chicago where it is common to travel an hour one way to work so please look farther than you might  have thought to.

loveskitties

Jo C, you wondered if in this electronic era the records regarding hospitalization could be changed.

The answer is a resounding yes!  My father's records on his last hospital were on the patient portal which my daughter and I religiously monitored.  We know for a fact that changes were made with no "notation" of correction or addendum.  I would advise anyone with a serious issue who has access to the patient portal to print off any information which supports their concerns.

You would have to delve into the guts of the system files in order to find out that a change was made.

For those on Medicare, the system is even more complex since the hospital and Medicare get together to determine when discharge should be, regardless of it being a safe discharge or not.  I had to file 2 complaints with Medicare just to keep dad safe in hospital until we could get suitable placement ( in less than 3 days).  We lost both complaints...not surprising...so will wait to get hospital bills to see if Medicare paid after initial discharge date.  If not, I guess it will be lawyer time for us too.

M1

Well here's my late-night epiphany, after chewing on this all day.

You know, not to toot my own horn, but I'm known as pretty good at what I do.  I have high standards, and I am used to handling extremely complex medical cases.  My partner is one of those; I've always called her the healthiest chronically ill person I've ever known.  Tough as a darn* boot.  I've been so close to her care for so long, it no longer seems complex or unmanageable to me:  and she's been medically remarkably stable, as long as there is close attention to detail.  She's really had no unstable medical issues since her last spinal surgery in 2018.  She's on a carefully constructed regimen of medications (about ten altogether with a few additional as needed/prn ones) that to me, is not that big a deal.  I don't prescribe for her, but all her docs are good friends of mine.  I know well what she tolerates and what she doesn't, and I did my damndest to communicate that carefully, over and over again.

But I'm so close to it, I lose sight of the fact that it is complex to other people.  This hospitalization has proved that, in spades:  they messed it up, in a heartbeat, to her short- and long-term detriment, by not being careful enough.  And jfkoc, to answer your question, we're about 45 minutes west of Nashville:  she's in HCA's premier, supposedly tertiary care psych hospital.  Makes me tremble.  We routinely go to town for our medical care.  Not always HCA, but there's plenty of excellent care available in Nashville, it's a sophisticated medical community.

But this brings me back around to why I have such a strong, single preference for this one MCF:  I know, for a fact, that they are the only ones around that have the sophistication to potentially handle the complexity of her medical and psychiatric needs and maybe give her a decent quality of life for a while yet.  Most run of the mill places are going to kill her in a heartbeat, just as this hospitalization almost has, by not paying close enough attention.  I know it in my gut.  So I either try again to get her in there, or resign myself to the fact that she is likely to get only substandard care that is going to kill her in short order.  Which is again why she always says to just take her home and shoot her.  She has a point.  I don't want to guilt trip this good facility if they really can't take her, but I honestly think it's her only shot.  And we are fortunate that she can afford it.

Day2nite, I just haven't had the energy to go look at what I know are lesser facilities.  Maybe I'll be surprised, but I doubt it.  I'll try to keep an open mind and not to make it a self-fulfulling prophecy.  I guess I'll have to do it next week.  But again, I feel like I have known all along that this MC route would kill her one way or the other.  I still think that.  I just want her time left to be as good as possible.

Beachfan

M1,

I am sorry you are having such a difficult time trying to ensure placement and care for your LO, especially given the care she has received with you up to this point.  You both deserve attention and respect.  I am puzzled by the MCF’s rejection of her due to aggressive behaviors.  None of your past posts mention behavior that is out of the ordinary for Alz  patients, when compared to what others have dealt with and reported.  Given your expertise and staunch advocacy, I can’t help but wonder if the uppity ups are circling the wagons, just waiting to wear you down until you go away.  I’m sorry I have no advice to offer, just empathy for you and admiration for your tenacity.  Your LO is fortunate to have you.  Stay strong!

Regarding ER and hospital mess ups: I am still a little shaken from my one and only ER visit where the nurse admired my “pretty bracelet”- - a Medical Alert bracelet, and yes, it’s pretty, but no one took a close look at it.  

jfkoc

Thanks for the additional information. I am relieved that you are not light years away from care as some of posters are/havebeen.

I have told my children that should I need memory care they            should send me to Nashville. My thought is that I would rather be cared for 24/7 by trained people than stuck someplace nearby that looks good and has decent food. If Nashville doesn't have a bed send me on to The Hearth.

Hopefully you can have some moments to refuel in the garden this weekend in preparation for Monday. In the meantime we are here to listen...always.

Ed1937

M1, I'm sorry things haven't been straightened out by now. A man should not have to go through what you are just to get decent care for a loved one. It is just mind boggling. I hope you are able to get the needed rest while this thing unwinds for you.

M1

Thanks Ed. I got the non-Covid haircut today and am aching my way through my fourth booster shot. Saw my granddaughters briefly, which was a lift. Love of a two year old and a six year old is a good thing.

I am one to rehearse conversations ad nauseam so that’s what I’m doing now, trying to plan what to say in various settings on Monday, depending what unfolds. I made an appointment to tour another facility. Reviews online are not great. 

jfkoc

OT and BTW...interesting about Buddy Ebsen.

Jo C.

NOTE:  It appears that Medicare criteria requires a psych patient be screened at 12 day after admission for recertification for continued psych care services need.  The 12th day for your Partner is on, April 3 - on a weekend, so the Unit needs a meeting at the first few days of the week to meet compliance.  **************************************************************************

 Good morning, M.   While preparing yourself for the meeting that will be held at the GeroPsych Unit, I was not sure whether or not you had read the Medicare Psychiatric Regulations . . . here is a link:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c02.pdf

While the initial part of the link discusses the unit formation itself, do keep on scrolling down - lots of information beginning from the day of admission AND addresses "delays" in services.

Medicare criteria will be driving much of the train for the staff re re-certification of stay as criteria is fairly strict which gives them a tool for manipulation if that is the way they have decided to proceed.  Hopefully not . . . however, discharge could rightfully be delayed due to treatment - this is addressed in the link. The Unit staff themselves are responsible for the "delay" in your LOs treatment through their errors and she will need more time to ensure stabilization under the circumstances.  Wonder how they will document this in the record and it may be helpful for you to ask such a question.

Anyway; reviewing the Medicare information may be helpful so you do not get blindsided should such a conversation come up at the meeting.

Good to hear you are only 45 minutes outside of Nashville.  That will give more options for care facilities.  It is also good that you are beginning to actively look for new places to screen.  Truly sad the other center did not work out.

The idea that you can change course for long term care needs at any time is always an option.  This behavioral "stage" your LO is caught up in will eventually pass in time, and it does take time.  When the current behavioral issues are no longer a driver for your Partner and things become more calm, you can assess everything and make a determination whether or not continuing with care at the new setting serves her best, or whether you would rather have her at home with 24 hour care. 

You can also, as her POA, make the decision to have your LO placed on a Palliative level of care if that is what you determine serves your Partner best - I say this as you have mentioned your feelings a bit earlier and we here completely understand.

All of our best wishes are with you in the coming days and especially with the pending meeting.

J.

abc123

Dear M1, just wanted to check in with you. I am thinking of you both, you are in my prayers. Hoping for the best outcome with the meeting tomorrow!

M1

Thank you Jo, that's very helpful.  No wonder they want me to come in.  I have told the SW that as much as I appreciate her help and forthrightness, I feel my conversations with her should be on hold until I have spoken with medical, nursing, and administrative leadership.

Had lunch with our best friends today, also a physician who is her backup medical POA.  I am going to take him with for any meetings.

As far as I'm concerned, her complete inpatient treatment started on Friday April 1 when she was put back on her regular medical regimen.