Need [nurse?] opinions (long)

So my Dad has been moved to the full time "Skilled Nursing" section of the Assisted Living Community where my parents have lived for a little over four years now.

He has Type 1 diabetes. His body produces no insulin. He moved there directly from the hospital. He had pneumonia, and his blood sugar levels were all over the map, tending to the high side. They removed the pump. His endocrinologist was away on Spring Break.

The staff in Skilled Nursing are working out his new insulin regimen. They are not going to use the pump. That's fine. But despite my mom's repeated requests, the doctor(s?) there have NOT consulted with his endocrinologist.

My mom is spending most of her time over there, because they keep letting his blood sugar levels drop too low. He was starting to shake, so she alerted someone. (His short term memory is so bad he can't remember how to work the call button - or that it is a call button). They took their time about getting over there - by the time someone came, his teeth were chattering.

Then the nurse wiped his finger with the alcohol pad. But she didn't wait for it to dry. You get inaccurate readings this way. The reading was 60. My mom thought it was much lower.

They gave him crackers and orange juice. They've been trained to give them milk and peanut butter crackers. The milk can get into your system pretty quickly, but peanut butter crackers can't. This works for Type II diabetics, but not Type I. Dad's protocol is orange juice, because it gets in your system right away. They often forget this and don't bring him orange juice.

Anyway, after he'd eaten a couple crackers and had some juice, the nurse that knows what she's doing came and took his blood sugar. It was 40.

Obviously some of the LPNs (?) and CNAs (?) need further (or reminder?) training. And I think she should insist his staff doctor consult with his endocrinologist. The way my mom puts it is that they treat her like "we can deal with this," and she requests they take his blood sugar and they roll their eyes at her.

I said there is NO excuse for this, and they're obviously not remembering the difference between Type 1 and Type 2 diabetics.

I said she should do four things:

1) Write a note to the head of Skilled Nursing (she's already tried talking to her). Get it in writing that some of the staff needs proper training on doing the blood sugar testing. And they need to give him HIS protocol, not their standard protocol (juice vs mild and peanut butter crackers).

2) Talk to his staff doctor, NOT the head of Skilled Nursing, and found out WHY they aren't having Dad's endocrinologist involved in his treatment!

3) Put up a big white board on his wall and write on it: "Hi! I'm Dr. Chuck XXXXX. I am a Type 1 diabetic. My body produces no insulin at all, so I am completely dependent upon you. Thank you for taking proper care of me!

4) Talk to the head of Skilled Nursing and find out what she can do for the entire staff - whether it's pizza at lunch for the day shift and pizza at dinner for the night shift, or several deliveries of baked goods - or SOMETHING, and send it along with a note that says she knows she's being a PIA, but she's cared for him for 59 years, this is a transition for everyone, and she really appreciates all their hard work.

I mean - she SHOULD insist on things like proper blood sugar testing, and getting his own doctor involved (they seem to think that "bringing in a specialist" means there's something deficient with them), shouldn't she? I mean, he does keep running very low blood sugar levels!

(And no, he's not sick any more).

I mean - he's going to turn 80 this year!!!!!!!!!!! I think my mom has done a fabulous job of taking care of him and knows what needs to be done. She's trying not to be bossy or pushy, but seriously! They think her asking for something is a hassle? Is this OK?

I'm sorry that your dad is ill and that your Mom is feeling as though his care isn't up to par. Due to the shortage of nurses, under staffing and too many patients, it's likely that his care isn't as optimal as it could and should be.

His diabetes sounds like it's brittle and difficult to control. So he definitely needs Endocrine's involvement. It could be that he needs to be on insulin or a combination of oral medication and insulin, with a dietary change to incorporate proper morning, afternoon and evening snacks.

What I recommend that you do is call the hospital and ask for the name of the Patient Representative, and their phone number. Then call this person and explain to them exactly what you posted here.

The patient representative is there to advocate for the patient, ask the hard questions, find out the answers and get the ball rolling if there is a ball to roll.

Every hospital and/or health care centre has a Patient Representative.

Thanks Linda.

Even in what is technically a nursing home?

Originally Posted by LDG

Thanks Linda.

Even in what is technically a nursing home?

Click to expand...

They should have one. And just because he is in a nursing home doesn't mean he deserves less than responsible health care. Diabetes is a very very serious disease. It can lead to blindness, loss of limbs, kidney failure and a host of other problems. So he needs to have his blood sugar controlled, at the very least. And by the sounds of things, it isn't being controlled.

It's been my experience that staff in nursing homes tend to be more blahze about things than they should. And many nurses have lost their skills because they typically don't do much more than blood pressures, blood sugars and the occasional dressing change.

In the off chance that they don't have a patient representative, speak directly to the Director of Nursing. Don't speak to a supervisor...speak directly to the top person, the Director of Nursing.

Not much help with most questions; but my Grandpa was just in a nursing home and they had signs all around his bed (put there by the nurses) reminding them of everything from that he is heard of hearing to specific care needs. My Dad wasn't thrilled with his care still; but at least this helped. I would say the way they are treating your father is unacceptable. Someone (even if it's you) has to stand up for him! Can your mother call his endo doc and let them know what is going on herself?

Also; my Grandmother is in another nursing home and she has a social worker assigned to her. Not sure if they would be someone to help; but there should be some sort of patient advocate. I'm not even sure it's standard procedure for them to have one or if Gram has one because she is getting medicaid services with her medicare. (Grandparents on different sides of my family)

Document everything see you when your father is being cared for by the staff,time,date staff name everything. Document,document,document. Call the nursing director directly if you have to leave a voicemail but follow up right away with the nursing director.
There really is no excuse for that kind of behavior from the nursing staff.

Laurie, I agree with Linda that YOU are the one to deal with this. You're so articulate -- I'm sure you could do a great job of communicating with these people. Maybe you could even arrange for your dad's endocrinologist to come visit him with you, so he could meet with their staff and define for them exactly how he wants your dad cared for.

I know it's terrifying to entrust a loved one to other people's care, especially when they've been failing him so badly. All your ideas for handling it sound wonderful -- but it's all carrot, y'know? Maybe you need to add a little bit of stick to the plan. If the endocrinologist will come with you, he could provide considerable "stick" just by making them aware that their care of this patient is being closely observed.

And Laurie, you don't need to apologize to them -- you're not being a PIA, you're being a loving daughter who wants the best possible care for her dad. If they don't respect that, they're in the wrong profession. (Grrrr!)

Many vibes for your dad, and for you in coping with this on top of everything else.

If I could add my two cents, I agree that you should be in charge of this. When my aunt was in the nursing home, my sister and I basically took over her care...my parents were in no shape to do much of anything. So we were the ones to make the phone calls and who did the visits to the supervisors and doctors, who went to her care and progress meetings. The nurses in nursing homes simply do not have the time to deal with patients' needs. I'm sorry, but that's just the way it is. They are overworked. Being with my aunt and watching how things worked in the nursing home, I honestly don't know how they manage to get done what they do.

And when it was time for Hospice to come to my father, my sister and I dealt with the issues. It had to be done and somebody had to take control.

I'm sorry that you're going through this. Diabetes is such a nasty disease.

Thanks, everybody. I really appreciate the suggestions, experiences, and input.

I'll coordinate with my sister, who has been trying to figure out how best to handle this. She lives a few miles away, I live 900 miles away.

Carol, I suggested exactly that to my mom (about scheduling an appointment for Dad with his endocrinologist AT the facility). She already looked into this, and it's not a possibility UNLESS the staff doctor requests it.

And just as a kind of post-scrip, my dad's blood sugar has been usually pretty easy to control (one of the reasons he's made it to 79! ). This is a change in regimen, but any time THAT happens, it does take some time to figure it out. But the process is labor and time intensive. The staff there is used to dealing with Type II diabetics, not Type I (they usually don't live to be this old, at least with this generation), and there is a world of difference. I think that's something being overlooked by them, as his body produces no insulin whatsoever. They're just not used to managing that.

Laurie, I'm so sorry you have to be going through this. My mom was in a nursing home for "extended care" for 3 months before she passed away and while I can understand being short staffed and everything, some things were not acceptable.

One thing one of the nurse aids told me flat out was the nurses HATE when doctors come because their mistakes are pointed out and they look bad. "Doctor's orders" are apparently only a suggestion. Basically, they aren't going to consult with the doctor. You (or someone in your family) are going to have to have the doctor's office call them, and then follow up on it. I was a PITA when it came to my mom and it made her life more bearable, but that was just her comfort. This is a life or death situation here.

I am a nurses aide and have worked in several nursing homes in the past 10 years...out of 5 only 1 i truly enjoyed.
Your situation sounds very typical of why i chose to leave nursing in general,There is only so much we are trained to do but that's why their are trained LPNs and RNs,who normally do not listen.
The only 1 nursing home i enjoyed was a small town and we had lots of residents in our care but we always made time for them and families,Doctors were always a welcome site on their rounds and we always welcomed family to visit.
I won't really say why i left the other ones but the safety standards that the other staff was doing were well below everything i believed and was trained.
My thoughts every day i went to work was what if this was one of my family members,how would i want them cared for.
I do understand their are shortage of nurses but still i will sacrifice maybe washing a face for other care needed that is more important(yes i do eventually do it).

Laurie I do sympathise - as you know, my father and one of my oldest friends are currently in high-attention nursing homes, both with end-stage dementia, and I have experienced vastly differing standards of care. As far as my father is concerned, although my mother tried to change a number of things about his care, in the first home he was in, she was largely ignored and she didn't like to complain. It was my sister who took things into her own hands and sorted things out, though we still had some reservations. I think that often the staff bully elderly relatives and patronise them, and it needs someone younger and more authoritative to get changes made. I do hope that your Dad gets all the attention and medical care he needs.

Laurie, I don't have much advice here as I have no experience with these types of nursing centers, yet..... But just want to say that your dad is very lucky to have your mom, you and your sister all managing and over-seeing to make sure he is getting proper medical care. And, at least your mom can spend tons of time there since she is so close although I am sure this is very emotional for her (and you girls too ). I am very sorry that your dad is not doing so well and am just sending off many prayers.

Well, my sister got in touch with the head of nursing. She explained that she thinks the basic problem is that my Dad is Type 1, not Type 2, and they've never had to deal with a Type 1 patient before. She pointed out that at 79, he is an anomaly, and managing his diabetes is quite different than managing type 2 as his body produces no insulin. Susan explained that she's sure they have very competent doctors on staff, but if they are not independently going to consult with his endocrinologist, then simply put, the family insists. She reviewed the issues with taking his blood sugar and his treatment protocols, and the head of nursing agreed, some "refresher" training may be needed, and it will be seen to that his care protocols are followed.

I had suggested to her that she call first, and THEN send a letter reviewing their discussion: that way it's not just documenting the list of issues, it's documenting the responses she got as well.

In the meantime, she says she's going to take my advice to put a few signs up around my dad's room.

We discussed my mom not wanting to "reward" the staff for "bad" behavior. I told her that in doing something nice for them, she's not rewarding poor performance, she's incentivizing them for better care for dad. I suggested they do something once a month, but start, and see what happens.

There are only 30 patients in Skilled Nursing at any given time. There are 10 staff during the day and 3 at night. That sounds like a pretty good Staffatient ratio to me, and dad should not have trouble getting the care he needs.

Laurie I'm so sorry I'm only just seeing this I can't offer any good advice but I can add and and