I have never worked in acute care, and I have never worked in an inpatient 
setting,
so maybe I am way off base in my feelings about a recent incident...

My 85 year old father fell and broke his ankle last month.  He was on the 
floor for
probably about 12-20 hours before he was able to drag himself to the phone 
(he lives
alone, and won't have it any other way) and call 911.  The paramedics had 
to go
through a window to get to him.  He spent four days in the hospital before 
being
transferred to an acute rehab hospital.

I have to confess that I already had it in for the PTA that worked with him 
before I
even met her.  I have friends who work in outpatient in that facility and 
they told
me she wasn't known for her ethics (she apparently documents more time than 
she
actually works with patients and discharges them as fast as possible to 
lighten her
workload)...   and I was livid when she wanted to discharge him after only 
five days
of minimal therapy.  (He was there 10 days, but got no therapy on weekends 
or the
days he was admitted and discharged)

I was warned that the Dr always took the advice of the therapists and that 
the treatment
team (in this case the PTA and an OTR) always stuck together and backed 
each other up,
but I thought I could fight it and get them to keep him at least a few more 
days.  There was
NO way my father could have gone home at that point and been able to care 
for himself.  He
couldn't shower or dress by himself, and he couldn't stand to prepare a 
meal.  (he is fiercely
independent and wouldn't hear of staying at my house or having someone stay 
at his house
with him).

We had a family meeting in which the PTA proudly announced to me that my 
father could feed
himself.  I was furious.  Imagine that... being able to get a fork from a 
plate to his mouth with a
broken ankle.. as if that was some great thing she accomplished.  I told 
her that my idea of
being able to feed himself was to be able to stand at the stove or 
microwave and prepare a meal,
and then clean up after himself.  She also told me that he only needed min 
assist to shower.  Well,
he couldn't get the boot off and on by himself, so that translates to NO 
shower when he is alone.

I could go on, but the bottom line was the Dr said that as an OT I should 
know better than to think
he could keep my father there when he had such glowing reports from the 
therapists, and he was
discharged in spite of my protests.

He ended up going to a SNF for three weeks, where he worked with a 
wonderful OT and PT and is
now back home on his own (and still driving!)  In retrospect, it turned out 
to be a blessing that he
was forced out and had to go to another facility, because the new treatment 
team worked with him
on things he could actually use and they seemed to care more about him.

The OTR told a friend of mine that I was "unrealistic" in wanting them to 
work with him a few more
days (I only asked for three).  I guess my question is... was I?  Do acute 
care facilities only keep
patients until they meet bare minimum requirements?  They knew he lived alone.

Pat




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