A few years ago, when my mother's charcot foot first began, Medicare chucked her out of the facility she was staying in connected with the hospital. Her time was up, but because she had a wound vac hooked to her foot and a PICC line in for treatment of MRSA the doctors would not release her to go home. The next stop would need to be a "skilled nursing facility" with a rehabilitation unit to get her up and moving. The social worker gave my brother and I a list of facilities in the county and told us to come back with our top three. With the help of a physical therapist friend of mine and my mother's primary doctor, I got the names of three facilities to tour, and my brother and I set out one morning to do just that. The experience was demanding, depressing, and very emotional. I wrote about it on my blog, but then decided not to publish it because I couldn't find an ending to the piece. Because there is no ending.
Aging parents with health issues is not like it was seventy years ago when they moved in with their children. Today we live in houses built practically on top of one another with smaller rooms and ridiculous layouts. We don't own land to expand and many houses have two working adults. My brother and I always said we would take care of our parents, but now that reality has hit us we find we are not capable, physically, emotionally, and practically to do what we once promised. Instead we must find alternatives so that our mother is comfortable and well taken care of, and that is where things get dicey. There is no magical place.
The facility that my mother stayed in a few years ago was adequate. She had a private room due to her MRSA diagnosis and because the only private room they had was one that they transferred patients about to be sent home into it simulated a "real" home and came equipped with a refrigerator and microwave. In skilled facilities a doctor is only obligated to see patients once a week so if a patient is ill the facility has to access and then contact the doctor and follow his instructions. My mother went through a couple bouts of pneumonia while there and some other mysterious illness that no one really could diagnosis. The therapy was good, but the caring part was iffy and she lasted almost three weeks before checking herself out and going home.
She has stayed out of a skilled nursing facility since then, instead going from the hospital to acute rehab centers which keep patients for two weeks for intense physical and occupational therapy and where a doctor sees the patients daily. These places ready you to go home and then send therapists to come into your home to continue the work that you did in their facility. While these places are the best scenario they aren't always perfect and they aren't always the answer for everyone.
This past month, due to a medication change, my mother was admitted into the hospital for observation for four days. From there she went into an acute facility where she worked well for almost two weeks, but when the facility opted to keep her another week, she contracted bronchitis, which the doctor did not pick up on. That facility released her, and because she did not feel ready to go home, she was transferred the skilled nursing facility. I was once again told to pick three places. My mother and I discussed places and ended up putting down the one she had been in before, which back then she hated, but which now she calls "adequate", one that my brother and I had visited previously, but had rejected because they were doing loud construction, and one that I then went to visit to make sure.
This facility is three minutes by car from my house. My friend, Kim, worked there when she was studying to be a nurse over twenty years ago. I drive by this place daily, but because I remember her stories from there I have never thought to explore it. Recently a couple of people told me that "friends of theirs" thought it a fine place for their own parents so my mother sent me off to check it out. And therein lies the difficulty.
Checking out these facilities means meeting with someone in admissions, going over Medicare rules, giving out your parent's situation, and taking a tour. While you can tell whether they know their stuff and you can see other patients as you walk down hallways and view the rehabilitation center it doesn't tell you what you really want to know. Will your parent receive good care? Will they get the rehab they need? The Internet is, of course, a starting place. My brother and I armed ourselves with a list of questions to ask from various websites that help the elderly and family members. But these places and their employees have accessed the Internet too and they answer these questions almost before you can ask them for yourself. I can see for myself as I take the tour whether the patients are well groomed (90% of them are dressed and sitting up), whether the facility is clean (never have toured one that wasn't), whether it smells of urine or disinfectant (most carry an undefined odor), and whether the residents appear happy (90% of them stare at you like an animal in the zoo). I've based the majority of my judgement on the rehab portion of the facilities because that has always been the main reason why my mother was coming in the first place. In the rehab center you see whether patients are being worked with or just sitting in a corner. You can count the number of therapists and gauge the ratio to patients. You can view the equipment, the size of the room, and the mood of the staff. Unfortunately, judging that doesn't mean the care outside of the center is what you need. The only way to know anything for sure is to stay there.
When I visited this place near my house I entered the assisted living portion of the place first and since this might just be an option soon I went ahead and spoke with the director there. I loved her. She was a Pittsburgh Steelers fan and gave me some some Steelers cups to take home with me. "You're easy," my brother said when I texted him. She gave me loads of information and sent me off with a folder stuffed with papers. I felt good as I drove around the complex to the other end where the skilled facility was located. The admissions girl (she looked about 19) was knowledgeable, the tour the same as always, the staff courteous and friendly, the residents a mixture of ages, the rehab hopping, and the facility had just passed their state certification and had received a 5 our of 5 rating. I left feeling this place would be fine for the five days or so my mother felt she needed to recover. I put it number one on our list for the social worker and felt we were good to go, forgetting what I already had learned from our first skilled nursing experience; there is no magical place.
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