Well I finally got his medical records from the hospital he was in before he went to AL. How can anyone keep such secrets with dementia? I found out he has COPD, CHF, Afib, Kidney disease, and a leaky valve! He also had a heart attack in the ER. Said he has had mini strokes which most likely caused all of the falls. Took a look at the discharge papers and he was supposed to be on oxygen, metoprolol, lasix, nitroglycerine, biped support, and two types of insulin!
Do homes have to follows these directions? Because they never did anything but give him an insulin shot and metoprolol. Since being home he has declined immensely. He looks very bad and can just about walk. I thought it was weakness.
Talking these new records to his primary to try and understand how all this could have happened for so long. I'm shocked the AL didn't do much of anything for all of his conditions. Seems like they were only interested in his cognitive skills.
If anything the AL could have said that with the current medical conditions he can not return to AL he needs a SNF (Skilled Nursing Facility).
The Social worker and or you would have had to locate a SNF that would accept him on discharge.
Are you the POA? It is up to you then to get the patient to the MD and to discuss with the MD what medications the patient should be on. These medications are then written orders to the Assisted Living for the medication nurse. The medications are provided through the facility or through you yourself. Assisted living isn't the same as SNF (skilled nursing facility, where there is a doctor on call. There is no medical personnel at your average ALF unless patient is in Memory care, and even there there is no ordering MD.
How long have you been POA? Who is the MPOA? Who has been discussing your Dad's condition with the medical personnel on his hospitalization? Your Father's doctor is the one to discuss his condition with, and find out what medications should be given to him. The same would pertain were he in ALF. His own doctor prescribes his medication. If he is not capable of taking them himself he is put on the care plan for a med nurse who will deliver medications as ordered by his own MD.
If your father isn't doing well he needs to see his own MD unless he is in a skilled Nursing home where he is being followed by THEIR MD, who should have all the records from his former doctor.
It's complicated for certain.
Your Father is 98 and he is diagnosed with severe illness of his major systems including his heart, which is failing. It is time for you to discuss palliative or hospice care with the doctors now. Medications can help to treat these illnesses, but there is no answer to aging body and failing major systems. I wish you the very best.
He ‘s 98 and has pretty intense health care needs and medications. He is not going to get back to the Dad of 95 or 85. Try to be accepting of his being in his final stages. Hospice can be a total godsend for this period.
Need to say that ALs are just that for assisting. They are not skilled care facilities. They are primarily for people who can still do for themselves with a little help in certain areas. They are limited and eventually residents need to go to Memory Care or Skilled Nursing.
If Dad had transferred to Skilled Nursing, they would have requested Hospital paperwork and taken it from there. Skilled nursing is who you would expect to do the things that you thought the AL should have done.
When a person is Hospitalized, yes there are a certain number of days that they have to be in (3 or 4) before "Rehabc can be suggested. Medicare only pays for Rehab. First 20 days 100%, 21 to 100 only 50%. The balance has to be paid out of pocket or the secondary may pay full or part of it. Medicare determines how long a person is in Rehab. It has to do with how they progress in therapy. If they plateau or do not progress Medicare has Rehab discharge the patient. Rehabs are not skilled nursing. If skilled nursing is needed, then the patient is transferred. Since Medicare does not pay for skilled nursing, it becomes out of pocket. If the person does not have the money, Medicaid is applied for. If approved, the persons SS and any pension are used to offset the cost of the patients care with Medicaid paying their share.
One of the blessings - and they're not so many you shouldn't count what they do have - of a socialised universal healthcare system is an established, predictable communications pathway. Discharge letters are sent by the hospital consultant to the patient's GP with a copy being (metaphorically) stapled to the patient's ear for the attention of whoever is in charge where he's bound for, whether that's home, rehab, residential care or family care. So at least in theory they are available to whoever will next be leading his medical care.
Whether or not anyone reads them, let alone reads them with understanding, is a different question.
But, so, I'm wondering - were the notes sent to the ALF, to your father's GP, or seen by anyone supporting or responsible for his care? Why did you have to go and dig them up?
And to address the original question: the ALF couldn't comply with directions they didn't have, nor even monitor whether your father was able to himself. Did they have them? Could they have known about them?
Who picked Dad up from the hospital and took him to the AL? (This was a new AL, correct?) First, the person picking him up should have gotten discharge papers then. Those discharge papers should have been given to the RN at the AL. My Moms RN handled anything needing to be done concerning meds. If there was a new medication, she called Moms PCP and got a prescription that was sent to the pharmacy the AL used. All of the meds could have been ordered by the RN unless this kind of thing is left up to family in Dads AL. Oxygen maybe the only thing that could not be ordered. That may have to be done by you or RN by calling his PCP and getting him to order it.
Did the doctors not talk to you? Is Dad competent so they talked to him? The AL is probably not entitled to know about Dads health issues. Thats up to him to disclose or you if he is not competent to do so. But they should have gotten the discharge papers and followed thru IF that is part of their responsibility. If considered yours, then you should have made his PCP aware that prescriptions were needed as per the discharge papers. If you received no discharge papers at the time Dad was released, thats on the hospital.
His primary could have requested those records. I finally learned after a couple of times of hospital stays for Mom and DH, get them to their PCPs ASAP after discharge not wait the one or two weeks the discharge papers suggest. You may find out Dads PCP does not agree with the Meds prescribed. He/she knows Dad not a doctor in the hospital that has no idea about his prior health.
I would discuss Hospice with the doctor. Your Dad has a lot wrong with him and Hospice will keep him comfortable.
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