The Second trip to the ER

My mother settled in the nursing home as well as can be expected and started both chemo and radiation for the cancer. Also, since being in the nursing home, she's required to attend PT and she is actually standing and walking a few steps.

Since my sister came in, she basically took over, first because of my trip, but since I've been back, I'm Ms. Assistant. I discussed with her setting up important information in an online doc(i.e., doctor names and numbers, chemo/radiation names, numbers, appointment dates) so that if for some reason she couldn't be reached, it'd be easily accessed. She disagreed, saying that she has all the information on her notebook/calendar and its easy to access...for her...not so much for me. This is not a big problem usually, but my sister went back to Texas last Thursday; mom got sick on Friday.

I got to the nursing home on Friday to find mom still in bed, looking a bit gray and not being very alert. She had only eaten a bit yesterday because her throat was hurting(which was expected with the radiology)and refused to eat today, not even yogurt, in fact she wasn't even drinking and when I looked at her skin, I could tell she was dehydrated. Her nurse told me that she had a temp and that she was going to call her doctor to see if s/he would approve her to be moved to the hospital. Mom's chemo doctor said no, watch for a day, but her nurse was not deterred...and called the next doctor which approved her to be moved. Here we go on another adventure....

The ambulance picked up my mother and I went in my car. I decided to park my car in the parking garage instead of having the ER valet because of how far I would be walking after my mother was placed in a room. I get to the ER, I go to her room...and wait. Before I made it to the room, the staff had set up the tubes, the BP, pulse and heart rate machine, you know, the normal stuff. Tests are ordered – blood and urine cultures, chest and neck x-rays. The diagnoses? A very serious bladder infection, thrush and possible inflammation of the esophagus(one of the side effects of neck radiation). So, we had gotten to the ER at 1:30 or so and by 4, the ER doc gives us the diagnoses and tells us that she will be admitted. I heard the doc tell the desk staff that she will be admitted, but he had to talk to her primary doctor. About an hour later, I heard him on the phone talking about my mom(he had to spell her last name and we were situated directly across from the nurses' station) and then he said something to one of the nurses. At this time he came back in and told us that mom's doctor agreed. It was about 5p.m. So, I text my husband, tell him I'll pick up pizza and I should be home around 7...hahahaha. Her BP had dropped for the second time and I went out to speak to a nurse about it(it had dropped from 160/65 to 150/48, now 116/41). I was told that's probably because she's been laying down. I tell them that my mother is getting a bit stressed and considering she suffers from hypertension, that should make the BP go up, not down and that it was abnormally low. She said she'd be in to check. At this time I noticed mom's file on the desk. She never did show up to check on mom, but her BP didn't go any lower.

At 6:30 p.m., 90 minutes later, I ask what's taking so long? I had heard the doc tell them to admit 2 other people after my mother and at least one of them had been moved(the doc says, “(room) 12 is to be admitted” and then the process begins). The nurse tells me that she doesn't know, she never received the file...I said, “Its sitting in the same place it was when I was up here before—just to your right!” Now, to be fair, it was busy, but it wasn't crazy. There were open rooms, no traumas. The charge nurse came over and then “took care” of me and my mom. Then the transport....

This small woman, probably older than me, was our transport—very loud and brassy. I made a remark about now we could get something to eat and she went off on a tangent on how she never gets time for lunch because she's sooner busy at work, but she loves her job. All of this was said in a very snarky tone and all I wanted to do was to trip and fall on her, squishing her skinny ass under all of my fat, overfed body. But, I didn't, I told her that, by federal law, she is to receive a 30 minute break after 6 hours and if she doesn't take it, she is putting herself as well as her transports at a health/safety risk and her employer should be reported for not allowing it. She shut up after that.

We get to the 5^th floor and its only 8 p.m., 6 1/2 hours after we got to the ER, 3 hours after being admitted and now...the questions...again. I don't understand why I have to answer the same questions that I've(or we have) answered during mom's first stay in this hospital just 5 weeks ago or some of the same questions we answered in ER! The nurse has to spend at least 20 minutes per admit asking redundant questions—that is such a waste of time, both hers and the patient's. It seems pretty stupid that since she was in the hospital, the staff should be able to bring up her old records(which has the information on medical history) and just have to deal with the last 5 weeks! But, no St. Joe's computer system doesn't have that capability.

So, now...we wait...again. See, until all this information is actually input and then the floor doctor(or on call doc) approves these orders, care is at a standstill. The nurse can't request any of the prescriptions to be filled and my mom was in pain and thirsty(no liquids per ER doc) and hadn't had anything to eat in 24 hours or so, not that she could swallow, but these were the problems I saw. Doc calls back after 9, nurse gets scripts to pharmacy and gives mom some ice chips. She still can't swallow, but at least the ice can numb some of the pain. The drugs finally get there at about 10:30p.m. And I stay until mom calms down...and I get to leave at midnight...11 hours after we arrived at the hospital. Nope, no pizza tonight!

Cancer, Senior Care and Nursing Homes

On July 4, I left on my trip to California and left my sister in charge of mom and her health issues. When I left, we knew she would be going to a nursing home, but we didn't know when or which one. So as I'm winding through the mountains in Arizona and California, my sister is winding hr way through the paperwork needed to get my mother placed in a nursing home.

My mom has nothing but her Social Security check, so the paperwork does simplify when “poor”. But that wasn't the hardest part. That was finding a nursing home.

Senior living, assisted living and nursing homes have all sorts of acronyms on who they will take. The best ones are “private pay”--they don't take Medicare or Medicaid patients so they pick and choose who they take and how much work there will be. They are usually better staffed(but not necessarily so) because they charge the insurance companies and patients. This is the type of situations that Long Term Insurance pay and also any and all finances that the senior may have. We didn't bother looking into these nursing homes.

I even knew the nursing homes on the NFW! list(No F*&%!ng Way), there are many of them in Joliet as well as other towns. These are the ones that normally are largely state subsidized and have a minimal level of care. They are usually underfunded and under staffed, we've probably all heard the horror stories of these.

And then there are the ones in the middle, like the nursing home attached to St. Joe's Hospital which my mother was at. Now, this one requires you to make an appointment, 24 hours in advance to check it out, will only allow you at certain hours without an appointment—not when you want to come, not something you want to hear when trying to place your mother! Before my sister actually made an appointment, she found out some other information from people who had family at this nursing home and said not interested.

So....there's Lakewood in Plainfield. Our great uncle had been placed there in the 90's and it seemed to be a decent place. Sister went and interviewed, toured the place, submitted request through there and Medicare/Medicaid and mom was no longer homeless. Due to the constraints on Medicare, she could not keep her apartment and get placed in a nursing home. Also, the nursing home receives all but $30 of her Social Security check to pay for the nursing home which doesn't leave much for her living expenses so if she is released from nursing care, we have to find her another place to live.

Lakewood, is ok. Just ok. Although the staff is good, and attentive, there aren't enough of them. This means that patients might have to wait. It also means that sometimes the midnight staff wake my mom up at 5 or 5:30 a.m. to take a bath cuz they have to get 6 rooms cleaned before the day shift comes in. What do the patients then do? Sit around until breakfast gets there at 7:30 or 8...in other words, not much! This is the nature of the “beast”. That and because my mother is on the “medicare” ward, that means they are only receiving about $1100 a month to care for her(that's about what she received from Social Security—I don't know what type of reimbursement they receive from the state and federal gov't.), there are limited beds and she gets moved around a lot...what's a lot? She was placed there the second week in July and has been moved 4 times.

Because of some of these shortcomings, we try to make sure that one of us is with her during the day, we can make sure she's cared for, she gets her meds on time(which can sometimes be a problem due to the nurses are also responsible for the intake interviews of new patients instead of having other staff handle the paperwork) and that if she's uncomfortable, we can hurry things along.

Then there is also transportation to her chemo and radiation appointments. That is done by an ambulance company in the area and usually she gets the medvan—this can be used with her wheel chair rather than the full blown ambulance. But this costs her about $65 per ride...and she has one appointment for chemo weekly and 5 for radiation...$30 a month for expenses just doesn't go too far, does it? We think we've got it covered now under the Medi-plans, but not certain.

“Growing old ain't for sissies”...or those that have no family or friends to fight the health care system.