body, health, mind

nursing homes and hospitals

My dad has been moving between the hospital and the nursing home, sometimes several times in a week, for the past six weeks. As a diabetic, he runs the risk of poor circulation to his feet, and that has resulted in two surgeries, one to remove two toes and the second to remove the remaining three toes on that foot. Those surgeries, the drugs that have followed them, and the movement from hospital to nursing home and back again are the context for my thoughts below.

I don’t know how our family would get through this without my sister-in-law, a nurse, serving as patient advocate for my dad. And the situation makes me wonder whether a patient who doesn’t happen to have a daughter-in-law who is a nurse can get an advocate to listen to the string of instructions and explanations the doctors and nurses provide to tired, confused, and often, if only temporarily, cognitively impaired patients. For example, my dad cannot tolerate a certain class of medications. Yet every time he returns from the hospital to the nursing home, my sister-in-law finds that the most recent physician has added one of the drugs in that class to the list of his medications. So the discussion occurs again. A phone call from the nurse on duty to the physician must happen to explain that my dad won’t take that medication. The result is that it is once again removed from the list of medicines.

My dad grew up during a time when there was only one way of doing most things. And he grew up in a small town where everyone knew everyone else and everyone knew what the only one way of doing things was. So he expects that he doesn’t have to repeat his wish not to be given drugs in that class to every new doctor. He thinks that information should be in his chart and that new doctors will review his chart before determining what is best for him.

Instead, it appears that doctors are treating his symptoms instead of treating him. And since his symptoms are treated with a number of drugs, including those in that dreaded class, the medicines are added to the list without reference to his history.

Thankfully, my family has a patient advocate in my sister-in-law. What do others in our situation do?