If you had a chance to live your life over what would you change? Knowing that our medical community is tapped to the max for Dementia Care I would have pursued a career as a Geriatric Physician that specialized in Dementia Care......why.....because we have a failure of our health care system in NH.
Let's go back to a few weeks ago. An elderly gentleman falls at home and is taken to our local hospital. Admitted for a few weeks and then discharged home to his elderly wife. The next day enters the Emergency Room again because the VNA nurse stated he needed to be admitted because he was not safe at home. He has Dementia and did not sleep at all and was disoriented etc....the list goes on.
At 3pm our agency receives a call from the Emergency Room social worker....we are given the above story with some slight variations and she was seeking round the clock care for this elderly gentleman until a the family could place him in a nursing facility. The hospital had medical checked him out but could not admit him because he did not have a medical condition. So Visiting Angels enters the picture and we begin services at 5pm. Shortly after we arrive the wife sends the aid home believing she can care for her husband. At 8pm she calls us and stated she made a mistake so we arrange care again and provide services.
To keep this story short I will leave out all the details of what happened for the next several days but let's just say this gentlemen never slept and was in grave danger of hurting himself, his wife and our aids assigned to this case.
What went wrong????? Let's start with the family. The gentleman was never evaluated for dementia. The primary care provider or family never saw the signs or ignored the signs of dementia. Second, he was in the hospital for about 10 days due to his fall etc. Yup, the hospital never did an evaluation to determine is cognitive ability or diagnose what type of dementia he has. The hospital never attempted to admit him for further evaluation due to cognitive deficits.....the family was told there were no beds available and tried to push him into a nursing facility. The nursing homes were completey full or refused to care for him because he needed a one on one aid at all time due to his fall risk and safety judgments.
Once we were able to find a hospital to admit him for a geriatric psychiatric care....guess what? The family could not locate their DPOA (durable power of attorney). The wife could only find the will. So he needed to be sent home again to our care. Once the DPOA was found it then needed to be activated. Another huge hurdle for the family. The primary care provider needed to have this activated. Guess what....he never had to do this before and didn't know what to do. So we needed to explain this to the staff at the physician's office on what to write for the hospital. Can I say HELP!
So this family was going around and around the rotary for approximately 7 days with a discharge from our local hospital to home, ER visit, to home, ER visit , to home and finally ER visit and then transferred to second hospital for proper evaluation and treatment of his dementia. Why did this family have to waste all this time and torture. The wife was beside herself with grief, pain and a huge amount of lack of sleep and anxiety. Our system is killing them both.
To top it off I called several professionals to help guide me on my journey with this family and find that this occurs often. I don't understand how a hospital can discharge someone home that has dementia and is not safe only because they do not have any beds available on their floor for the Geriatric Psychiatric Unit. Who is responsible to protect this dementia patient when they cannot advocate for themselves and his family is being guided by a system failure. How do we advise families to get help when they are turned away back home without solving the problem or being treated? I recall calling for an appointment for my grandmother to get an appointment with a specialist and had to wait months for an appointment. What if it was a crisis like this family.....you don't have months to wait.....most would die before you make it to the appointment. Our system desperately needs help and our medical communities need to find solutions for these families.
What is going to happen in a few years? Our system is going to break and lives will be lost.
