As a Patient Advocate, I am always asked… what do you do? My response is usually “I help people navigate the health care bureaucratic maze.” or “I oversee someone’s care to make sure they’re getting the care they need from nursing homes, hospitals, personal care homes and even in their own home.”
These all sound good, but it doesn’t give anyone a clear picture of what I actually do. So when my mother-in-law, who is 94 year old, fell for about the seventh time in approximately three years, I put the many things I do as a patient advocate to work.
My mother-in-law is alert and oriented, very healthy and can balance her check book to the penny! She lives in a independent living setting, which provides a dinner meal and a very good activity program. Her biggest problem is her balance, and subsequently she walks with a walker. We have an aide that comes three times a week to assist with bathing, cleaning and shopping.
When she fell, the paramedics took her to the emergency room for x-rays, etc. Following this, she was admitted to the med-surge unit in the hospital – she had severe tendon tears in her ankle and couldn’t walk without pain.
The first three days she was there, she was never bathed or washed. I noticed a new basin sitting on the counter, never opened, still in the wrapping. She hadn’t gotten out of bed this entire time and was still in considerable pain! She didn’t like using a bed pan and couldn’t get to the bathroom because the nurses wouldn’t answer call bells in a timely manner.
Needless to say, this treatment is unacceptable… yet not uncommon.
As both her son-in-law and patient advocate, I requested someone immediately get her washed and out of bed sitting in a chair. I asked for a bedside commode to be placed next to the bed so she could use the bathroom when she needed. I requested ice to be put on her ankle twice a day.
While I was there, the RN case manager told me my mother-in-law’s status had been changed by her insurance company from in-patient status to observation status. This means even though she’s in the hospital, the consumer now shares in the cost of care; instead of the insurance company paying for her care in its entirety. In addition, if you’re on Medicare, the current requirement is a three night hospital stay to get into a nursing home under skilled nursing care.
I immediately called my mother-in-law’s health insurance company to see if they would still pay for her care, and if she could be admitted to a skilled nursing facility for rehab. Fortunately, because she was admitted to the hospital through the emergency room, her stay would be covered. I suggest everyone check their health insurance policy to determine what their company will pay for under observation status.
They wanted to discharge her to a skilled nursing facility, because all of her tests were negative, and they believed her only need was therapy and pain management. I knew something was causing her to fall beyond her balance issues, and I asked the RN case manager not to discharge her until we found what was causing her to fall so frequently.
I asked for them to take an orthostatic blood pressure – a blood pressure reading while laying in bed, followed by a blood pressure reading from bed to standing after 1 minute, followed by a blood pressure reading standing after 5 minutes. They discovered her blood pressure DID drop considerably when she went from laying to standing!
She was placed on medication for this.
Finally, a wonderful neurologist came up and examined her as well. We discovered she also had neuropathy, and had very little feeling in her feet. They also placed her on medication for neuropathy.
After a day or two of monitoring, they discharged her to a facility for rehabilitation.
During the one week stay in the hospital, I ensured my mother-in-law was getting basic care – getting out of bed, bathing and dressing, and pain management. I dealt with her health insurance company, ensuring she was getting the maximum amount of care her plan would allow. I pushed for additional medical testing – obtaining a cardiac and neurological assessments to make sure they got to the root cause of the problem – which in the end could lead to fewer problems down the road.
While small, this is a comprehensive example of what Patient Advocates do through Caregiver Champion, LLC. For more information, contact us at www.caregiverchampionadvocate.com.