Nursing home short term care

[Terry_1234]

My wife is having a serious episode of depression. She is 64 yrs old. She is currently in hospital and this is the second hospitalization in a month's time. They are recommending a nursing home for short term care. Their social worker claims that they will find possible facilities but have not responded to my calls when I ask for progress in the search. I have decided to do my own search to get her out of the hospital asap. The problem is that I'm not certain what to look for in a facility for her condition. I want her to get suitable treatment and get home, and not be warehoused. Can anyone give me guidance or point me towards a resource in what to look for in a facility?

Thanks,
Terry

[Terry_1234]

My wife is doing slightly better, sometimes we can redirect her from her pain for a while. She is coming home on Monday. It’s not that she is really ready to come home yet, it seems to be our only viable option. Though there are some positive aspects to this.

As, you know she was going to a nursing home for temporary rehabilitation (this was the hospital’s recommendation), but she failed a pre-admission review at the hospital called a PASSR, this caused her case to be kicked up to Columbus for review by the state mental health board. Friday, the state responded and denied ANY transfer to a nursing home. I find this decision astounding, since the whole reason for the state review (at least as far as I’ve been told) was because she possibly was at risk for suicide (she is not, her doctor has stated as much). If this is the reason then why does the state and hospital feel it is OK then to send her home? This is crazy! Besides where does the state have the right to mandate what care my wife does or does not get, as long as it is not detrimental to her, and we can pay for it! I’m shocked that Ohio holds that much power over its citizens. Things are even worse in this country than I thought.

So anyway she is coming home on Monday. The hospital social worker is looking for home nursing care to help out. Of course, they also said they would look for nursing homes earlier but didn’t. I don’t care whether they do or don’t, this time I’m doing the detailed research so I can tell  them come Monday.

Anyway, as I said there ARE a lot of positives here:
1. She will no longer be in XXXXX Hospital. It was a mistake to take her there in the first place. They are good for other types of care, but are horrible at behavioral health.
2. And with that she will be home and not in some facility. My only worry is that things may not work out here and she will end having to go back to a hospital (but not the same damned place). I just hope the home nursing care helps.
3. I will finally be able to get her to a psychiatrist other than the one at the hospital, whom I have no faith in (His HealthGrade rating backs my opinion up).
4. I can finally get her in for an evaluation by a pain management specialist to see what can be done to relieve her suffering (somatic pain is real, its source is just different from pain caused by trauma or physical disease).

Thanks for putting up with my venting.
Terry

[4Maddie44]

I am so very sorry the way things have turned out.  I have read all the previous posts, and I am thinking of you and your dear wife, and hope so much that things turn out right for you both.

Bless you.  

[Terry_1234]

Thanks all for your advice and support.
Things got even more complex and frustrating today. The nursing home administrator called and informed that she and the chief nurse for the facility where going to see my wife. When they received the paperwork from the hospital they learned that she told the staff in the ER that she had thoughts of suicide (this was 2 weeks ago), but would not act on it because of her faith.
During the review she, the nursing home staff, the hospital social worker, and myself discussed this. The social worker report that floor psychiatrist does not think she is a risk for suicide. The nursing home staff asked if the doctor would sign a document stating that position. The social worker stated that he probably would. That ended the meeting.
Later today I got a call from the nursing home administrator telling me that at the pressor(? - I guess its some acronym) the hospital decided not to release her and that another review would occur on Friday. This is extremely frustrating and I'm beginning to wonder what I need to do to get her out of there? I'm certain the nursing home won't take her unless she passes this "pressor" review. I want her to be safe but she has talked about thinking of suicide during her other episodes. She has also stated that she would not act on these thoughts because of her faith. I suspect the Dr.,the hospital, or both is in CYA mode.
I'm going wait until Friday and see what happens. Does anybody have any advise this they further fail to release her other than "lawyer up" which I end up doing?

[MYoungAtHeart]

Nursegirl6572, that is an excellent reply to the posters question.  My brother is mentally ill and very very depressed, he has always said no to help, but in January he fell and was taken to a hospital where cancer was found.  He had no choice of nursing home coming off the street, but the first facility that had a bed open was given to him and he has been there since.  They have done an excellent job with him, giving him tasks and keeping the family informed of his health and prognosis.  I do wish the very best to Terry_1234 and his wife.  And yes Terry_1234, please let us know how you and your wife are doing....

M

[nursegirl6572]

I'm so sorry to hear of your predicament.  No doubt that's an impossible situation.

I have a slightly different take than the other poster who replied above.  While I agree that a nursing home setting isn't the most optimal choice for ANYONE, not ALL nursing homes are crummy, and sometimes it's just necessary, for the safety of all involved.  

I've actually worked in a few very very nice facilities where the residents were VERY well cared for and loved by the staff.  Staffing is a common issue of course, but there ARE regulations that protect the patients from dangerously inadequate staffing, and long term care facilities (especially those that accept Medicare) must by compliant with those regulations, in addition to a lot of other rigid rules.  I would not hesitate to put any of my loved ones in those facilities if a need arised.  

It sounds as though you've done your homework, which is exactly what I'd recommend.  The other advice I would give you is to remain vigilant while your wife is a resident.  Keep in close contact with the staff, especially the nursing staff and social workers, who will be working to set goals for your wife for discharge.  

Make sure that the nursing staff knows to keep in contact with you, about anything, not just urgent situations.  Let them know that you want to be kept updated if there are any new doctor's orders, if an ancillary staff member has seen your wife for the first time, and if any changes are made to her regimen.  Typically, most nursing homes automatically do this anyway (the ones I worked in did), but it doesn't hurt to mention it.  

Make sure that the staff is aware of your wife's preferences, from anything like food/diet, to bathing, clothing preferences.  The more she feels at home, the better she will do.  Make sure she has things like glasses, dentures, hearing aids (and batteries).  

Make sure the staff has a quick and easy way to reach you, and make sure that there is an alternate contact person on file also.  Lean on the staff for emotional support and for guidance in planning for the next step for your wife.  Never be afraid to ask questions, or bring anything of concern to the attention of the staff.  There is a very clear hierarchy of command that is easy to follow in the event you have a significant complaint.  You will be provided with that information, and in addition, it will be posted in several places in the building.  

MOST times, unless it's unreasonable, EVERYONE'S goal is to get the resident back home.  So, your wife's care should be centered around care plans that will facilitate that, even though it may take a little time.

The only other suggestion I would have for you is to maybe consider transferring her to a different psych hospital, with a new psychiatrist?  Would that be an option perhaps?  A fresh perspective, with different professionals?  I would suggest looking into that option if possible, before you proceed with the move to the nursing home.  That way at least, maybe her psych issues could be better addressed before she would need to go to a long term care facility for conditioning, strengthening.

I wish you the very best, and I will be keeping you and your wife in my prayers.  I'm sure this is a terribly difficult situation for you to be in.  Please keep us updated, okay?  And post whenever you need something, even if it's just to vent.

Hang in there!

[Terry_1234]

Thanks I appreciate your advice, but I'm going to have to go the nursing home route for the short term.

This has been a tough situation, it is her fourth major episode and we've always been able to get though the past episodes. It been 25 years since the last episode and I thought maybe she was past these, other than minor blue periods.

I have to get out of this hospital. Other than the nurses, the unit she is in *****, I have no faith in the floor psychiatrist he has essentially given up on her. I told him I am not! I've spoken with someone who had the same experience with this character. His wife got home and is doing well.

I need to get her to another psychiatrist. Her old psychiatrist, who was excellent, has retired, and it has been hell trying to find a new one. The soonest any one of the 3 her insurance takes is in mid-July. I had to go outside the insurance network to find one that will see her as soon as she gets out of the hospital.

Unfortunately, I just can't handle her in her current state so I am going to transfer to her a nursing home where she can get some PT and OT and I can get her to the psychiatrist, psychologist, and others.  I've found a nursing home that is rated high by Social Security and I've visited the facility and talked with the staff and I think she will do well there or at least better than the hospital.

If this doesn't work in the short term then I'll find another solution.

[caregiver222]

All of the nursing homes are crummy and I don't agree with a nursing home stay as a cure or treatment for depression. Nursing homes are necessary and fulful a definite need, but psychiatric treatment is not one of those needs.  In the best nursing homes there is a shortage of staff. They treat "depression" with a chemical straightjacket. Furthermore, the diet in most homes is lacking and good nutrition is part and parcel of treatment for depression. Depression is best treated by tender loving care, holding, touching, caressing and by paying attention to a person. It is difficult to find a nursing home when you are only looking for a "short stay". A far better solution is home care with daily assistance from an aide(s) who is caring and thoughtful. They exist, but are hard to find. In the absence of debilitation, incontience and senility, I would advise against a nursing home solution. That being said there are many "missing pieces" regarding the "medical condition" of your wife. There are, however specialized psychiatric facilities that will care for the elderly for short periods of time, which may be more appropriate.