Being a patient advocate can be a daunting task, even when you are a health care professional like me. Shortly after Dad’s birthday, he was taken to the hospital after hitting his head when he fell at the Home. Although he seemed alright, they transported him to the hospital as a precaution. Diagnostic tests revealed he had a small subarachnoid hemorrhage (a bleed) in his brain, so he was admitted for observation.
Within 36-hours of his admission, I noticed a significant decline in Dad’s mental status. Understanding that a hospital stay is often confusing for the elderly, I decided to reach out to the Hospitalist for her perspective. She provided a well-constructed synopsis of his medical progress and plan of care. However when I inquired about his change in mental status she quickly added; “…we noticed he was a bit agitated, so we increased the dose of X medication, but I just reduced it today because it made him too sleepy” Upon further investigation, I also found out that the dose of his memory medication had been reduced because the hospital didn’t carry the strength that Dad was taking. Bingo! Despite checking and rechecking Dad’s medication list with the hospital staff, changes had been made without my knowledge. As I said in an earlier post, small medication adjustments can have dramatic effects on LBD patients – especially Dad. I told the Hospitalist that she wasn’t to change any of his dementia medications and that I would bring in his memory medication from the Home. We had worked so closely with the neurologist to successfully titrate his doses to just the right affect, I wasn’t willing to backtrack. I then continued to tell her that any medication changes and adjustments from that point forward were not to be made without my consent. I think the exact words I used went something like; “I don’t care if the man needs to fart, nobody is to order even a Mylicon without my approval.” That certainly brought the message home and I was pleased to see that afterward she started calling me with even the most minute details about Dad – perfect.
Now I’m not suggesting that everyone has to be this bold or challenging with medical staff. Just know that in order to be an effective patient advocate you need to be knowledgeable about their current regimens, willing to step in, ask questions (lots of questions) and say no when it is appropriate. Stay informed, use common sense and remember, you can Google just about anything these days.
After 10-days in the Hospital, it was time to get Dad discharged. We are blessed to have such wonderful health care services here in the United States, however the fact remains that hospitals are one of the most dangerous places for an elderly person to be in. With the potential for adverse medication events and opportunistic infections that are becoming resistant to standard antibiotic therapies, once your loved one is medically cleared to leave, make every effort to get them out. Since Dad had been bedridden for so long, we thought it would be best to discharge him to a rehabilitation center for some physical therapy before he went back to the Home. After a few phone calls from the social worker, we got Dad a bed at a local rehab center. When he arrived I spoke with the admitting nurse to reconcile his medications. Wouldn’t you know, they had been changed again (what a surprise, welcome to health care!). Nothing earth shattering this time, however I took the paperwork from the kind nurse’s hands, wrote down what needed to be corrected and gave him the same speech I gave the Hospitalist just days prior, while acknowledging I knew that I was a pain in the ass. Well I guess that message was positively received because when I passed the nurses desk on my way out that afternoon, the unit secretary gleefully held up a sign she had just printed that said; “No Medication Changes Without Approval from Jennifer” – exactly.
It’s been just a couple of days at the rehab facility and things are looking up. Showered, shaven and drinking a strawberry ice cream shake from his favorite convenience shop, Dad seems stronger and is starting to improve. Our goal is to get him back to the Home, but it will depend upon his progress. For now, he is wheelchair bound until he begins to start ambulating more steadily and regularly during his physical therapy sessions. My hope is that we can make that happen within the next several weeks.