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May/1/2011

Elder Issue

The Injured and Vulnerable Elderly Need a Strong Advocate      
Donna B. Heinrichs, Esq.
Schrade & Heinrichs

(From the May 2011 Newlsetter)

It has been some time since I wrote an article for this Newsletter.  Recent events have compelled me to take the time to share my experiences and to enlighten practitioners as to the necessity of being a strong advocate for an elderly client or an elderly relative, particularly when dealing with a hospital and hospital staff.    

The facts:

  Elderly female patient/client and/or relative is 90 years old.  She lived fairly independently and in good general health with the help of family members, part-time aides who bathed her, fed her meals, and assisted her in various tasks.  She was able to feed herself, dress herself, ambulate, go out occasionally with family members, watch television, read, etc. This continued with the help of family members and limited privately-paid part-time health-care assistants for over three years.  She had a telephone and she had a personal response system, a button she could push in the event she was unattended at a time she needed assistance.  She had excellent insurance coverage:  Medicare and also Blue Cross/Blue Shield (PPO).

One evening, after the aide left, she lost her balance and fell.  She pushed the button.  Responders called and nearby family members responded instantly.  Lo and behold, she had broken her collarbone and also her hip in four places.  An ambulance took her to the *hospital (*which will remain anonymous).

After a cardiologist cleared her for surgery, rods were placed vertically in her femur and horizontally in her hip joint.  The collarbone was left untouched and was believed to be able to heal without intervention in 4-6 weeks.  However, this broken collarbone would obviously significantly interfere with subsequent physical therapy since no weight could be placed upon the upper right extremity (collarbone/shoulder) while trying to rehabilitate the lower right extremity (hip).

Operated on a Friday, they expected to discharge this 90-year-old patient on Tuesday.  Why the bum’s rush?  I am not sure, except that they complained of a shortage of beds.  As a matter of fact, she went right from the ER into the OR with no room in between.  Time to make a fuss over premature discharge? You bet.  (Insurance was more than ample.) 

In my travels to and from this hospital, I encountered an older man who overheard me telling a relative that I would not let them push her out that soon.  He interrupted my conversation and told me this story:

“My 88-year-old mother was just in here last week with two broken bones in her back.  They operated on her, pushed her out of the hospital way too soon and into rehab after only three days.  She fell during the second day of rehab and broke her hip and is now back in here with a broken hip!  Don’t let them get away with it!”

Make your presence known:

Do not hesitate to tell the powers that be that you are an attorney, especially if you are an elder law attorney.  The eyebrows raise when you say that.  Give them your business card, and also the health care proxy if you are the agent. Express serious concern over the patient’s plight.  If you are also the patient’s health care proxy, come on even stronger at the nurse’s station.  Let them know that you will be ever-vigilant and watching over this patient, client or (perhaps) relative, whatever the case may be. If you are not their health care proxy, advise their health care proxy that “the squeaky wheel gets the grease.”  If you don’t do this, be prepared to observe substandard care and neglect.

Disturbing things that can occur:

(1)  The elderly patient has no appetite and doesn’t want to eat.  Regardless, the meal tray must be put within the patient’s easy reach, so that the patient can drink fluids and eat whatever they can tolerate.  You enter the room and find the patient’s untouched tray in the far corner of the room out of reach of the patient.  You question it.  The staff explains that the patient stated they were not hungry.  This is unacceptable.  The rules are that, regardless of what the patient says, the food and drink must be within arm’s reach of the patient until the trays are picked up by dietary staff.  The untouched trays that go back to the kitchen could feed an army.  Many times this is because the trays are placed out of reach of the patient.  Often, the result is dehydration and electrolyte imbalance which the hospital eventually recognizes and tries to remedy by IV.  Call them on it.  I assure you, it will get their attention. 

 (2)  The nurse call button is buried under the pillow or hanging out of reach of the patient.  The patient has no way to call for assistance because they can’t find the call button.  When you visit, make sure the call button is within easy access to the patient and instruct the patient that the red button is for the nurse and they need to push it for help. Push the call button and check out the response time. 

 (3)  The patient complains to you that they are uncomfortable and don’t know what “this hard thing is” that is pressing on their bottom and aggravating their sore hip.  You investigate and learn that it is a bedpan that was placed there two hours ago and forgotten by the nurse and the patient is trying to sleep on it.

 (4)  What are these things wrapped around my legs that are so uncomfortable? Alternating pressure pads? They are placed there to help promote circulation and prevent blood clots, but they are not plugged in and, thus, are not functional.  Why did they leave them on the patient even though disconnected?  Probably because the next time the staff feels like plugging it in, they don’t want to take the time to re-wrap them around the legs of the patient so they leave them on the patient for days in a non-functional state regardless of any discomfort.  Eventually the legs perspire and a skin condition may develop.

 (5)  The patient is confused and complains to you of burning upon urination.  You inform the hospital that the patient should be checked for a urinary tract infection (“UTI”).  They assume you are “making this up” to keep the patient there longer, since the infection would need to be medically treated.  You insist that they check the urine.  They reluctantly check the urine.  A different hospital doctor calls you the day before discharge and informs you that the patient has a significant urinary tract infection and they have prescribed not one, but two antibiotics prior to discharge to clear the infection. 

Oh, yes, I could go on and on.  My next article will discuss Medicare and your rights to appeal what you believe to be a premature discharge.  These are important rights; don’t hesitate to assert them on behalf of your elderly client or relative.  Without your intervention, the ill elderly are the most powerless and vulnerable people in society today.






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