Caution: Moving into a Nursing Home Can Mean a New Doctor
There's a caution that goes with moving a loved one into a Nursing Home. It has to do with doctors. Often, you have to pick someone new to provide care.
This is because the caring individual who has been there for years and really knows the ins and outs of a patient's problems doesn't visit nursing homes. At the same time, the patient may have become too frail to visit the doctor; of course, that's one of the reasons the patient needs the level of care provided by a good facility.
Where do you look? You can start with the home. They have lists of doctors who visit there. But that's not the place to stop. Check out the choices so you don't decide without some independent information. You might start by talking with the families of other patients the doctor visits. And talk to the doctor.
This process is especially delicate since, when your loved one needs a home, it's likely that the medical situation is complex. Make sure the doctor understands what's going on.
Nursing homes supply families with a list of physicians who visit their facilities. Families might choose from the list knowing little about the doctors. Likewise, the doctors often take on medically complex patients they have never met.
Examples from the Chicago Tribune's recent articles about misuse of anti-psychotic drugs in nursing homes illustrate the problem.
One describes a 74-year-old woman who was not psychotic but was placed on an antipsychotic drug. It happened early this year at the Fondulac Rehabilitation and Health Care Center in East Peoria. A family member told state investigators that when she was admitted, she was assigned a doctor who had never taken care of her before. She had no history of mental illness, but on her second day in the home the doctor put her on medicine for "agitation." Three weeks later, she was dead.
The inspection report says a family member complained to the nursing staff about her reaction to the medication: that she was difficult to awaken, couldn't hold her head up and was slobbering. The family member added that the doctor canceled a meeting to discuss the matter. On the woman's 20th day in the home, a nurse wrote in her notes that the woman was "lethargic, extremely limp, eyes rolled back in head." The family called the next morning to complain again about the drug, and the director of nursing pulled the woman's file. But 25 minutes later, the director called the family back to tell her the woman had just died.
Said the nursing home, we were following the doctor's orders. The state cited the nursing facility for failing to "medically justify" the administration of the drug, but nothing happened to the doctor.
Several owners told the Tribune they struggle with doctors who rarely visit patients, and the fact that doctors can also cause problems for the nursing homes adds some credibility to their recommendations.
There is, by the way, another safeguard to consider: Nursing homes are required to have pharmacists visit regularly and review prescriptions. If they discover a problem, such as a patient placed on a drug without cause, they notify the nursing staff and doctor. They can't guarantee, however, that the doctor will act.
Indeed, doctors have disagreed with the inspectors, who often are nurses. The Tribune said many argue that their patients do better on psychotropic drugs than off. Others said families demanded the medications. Some said they were puzzled that inspectors would urge patients be taken off drugs that have eliminated unwanted symptoms.
Says the Tribune, "When inspectors at a facility in central Illinois in March reported finding a woman on an antidepressant who showed no signs of depression, they cited the home for not trying to reduce her medicine. Contacted by the inspectors, the doctor pointed to his medical expertise: 'How do you assess her for depression? She doesn't talk. She has lots of things wrong with her and lots of reasons for being depressed. It is my clinical judgment, all of that would make anyone depressed. I will not go by pharmacist recommendations."
Michael Kosner, President
The Kosner Firm Chtd.
