A topic of increasing concern during the COVID-19 public health emergency (PHE) is the treatment and care of elderly and often incapacitated patients. Teri Dreher, RN and owner and CEO of NShore Patient Advocates in Chicago, reported to us on March 26 on some patients for whom she is serving as an advocate, then followed up with us this week.
Mach 26:
The pandemic is causing a lot of confusion and difficulty transitioning people to rehabilitation facilities as many are on lockdown; nobody in and nobody out.
I got a call this morning from a frantic husband whose wife is having posted complications from a back surgery. She developed a fever today and has not been tested for COVID-19. Communication is poor because she has been moved around the hospital multiple times and is becoming so weak she really cannot advocate for herself.
Her husband has not been allowed to come visit her and is frantic. He hired us as RN patient advocates to manage/oversee her care and normally we would be going to the hospital daily to look at labs, see her ourselves and ask questions that lay people do not know how to ask -- but they will not allow us into the hospital.
We are doing our best by phone to get the information we need, but the hospital is understaffed and there is a lack of continuity of care. We cannot even get in to make sure she has a POA (power of attorney) in place and the hospital knows we are the family’s proxy…
Another client of mine needs to be admitted to a SMHRF (specialized mental health rehabilitation facility) due to his disabilities and inability to care for and protect himself. I will have to do the second screening interview via video conference and they are requiring a temperature log of no fever for two weeks – plus, if they admit him, he will be quarantined for five days…
I think we are going to see an increase in medical error rates due to increased fragmentation of care and poor communication. Many people are not able to advocate for themselves and when the family advocate is denied access, miscommunication and delayed/incorrect treatment is going to happen.
April 9:
It is now much worse. Last week it took me eight days to get an 85-year-old patient released from a hospital into a safe environment. He had advanced dementia and was falling frequently, went to the hospital for a urinary tract infection and fall. The hospital was told they should send everyone home, but his wife was frail and overstressed from caring from him for years. Hospital care managers were under pressure and took several days to agree to send him to memory care; by then, all the quality memory care facilities were refusing to take patients from hospitals or nursing homes. We had to send him home with 24-hour home care support, which is very expensive…
[My specialized mental health rehab patient] has since refused to make a second video interview and the SMHRF is now refusing to take new clients. He is unstable at home and relapsed on drugs and alcohol, which caused problems with his anxiety and decision making overall. We are having him meet with a new psychiatrist today virtually, as the last psychiatrist refused to care for him any longer due to noncompliance. One of my nurse advocates is a psychiatric nurse specialist and they are talking by phone and video and we are staying in contact with our client daily for emotional support and close monitoring of new medication adjustments.
[Do you stand by your March 26 statement about "increased fragmentation of care and poor communication”?] Yes. I think most hospital-based nurses will agree as well. It’s becoming a real war zone working in hospitals right now: Everyone is working so hard and with families not allowed in hospitals, so many miscommunications are happening, which often lead to medical error. Family members are the primary patient advocates and not being able to see and advocate for their loved ones is really hard.
Bottom line: the best quality and safest facilities are refusing to take patients and the ones who are all have COVID. There is even one hospital that is becoming a COVID only hospital.