Janice’s mother, Esther, is in a moderate stage of Alzheimer’s dementia. She had been relatively content at a local memory care facility over the past year, but this was unfortunately not to last. Janice called ConciergeCare for help after Esther had fallen, fractured her tailbone, and landed in the hospital closest to her facility. Janice felt like her mother was in too much pain and it wasn’t being addressed by the hospital staff. Janice couldn’t be at the hospital around the clock due to her own family and work obligations, and was exhausted from spending every spare hour she could at Esther’s bedside.
When the ConciergeCare RN arrived at the hospital to assess the situation, she found Esther’s room was on a general medical-surgical unit. Esther was lying flat on her back unattended and calling out “Help!” repetitively. Her covers were off, leaving her fairly exposed, and she had removed her ill-fitting incontinence brief. The charge nurse on duty said the unit did not have enough staff to provide a “1:1” sitter for Esther, but they were checking on her as often as they could. When the ConciergeCare RN assisted a nurse’s aide to put Esther’s incontinence brief back in place, she noted a pink area on Esther’s tailbone.
Despite Esther’s significant disorientation, the ConciergeCare RN could tell Esther was in a lot of pain and confused about why she couldn’t move without hurting. Esther’s nurse said night staff reported Esther didn’t seem to be hurting “as long as they didn’t move her or raise the head of her bed,” so he was continuing that plan. He mentioned not wanting to give pain medication other than ibuprofen to such an elderly person.
The nurse also reported that Esther wasn’t eating anything from her meal trays, so the physician was talking about a feeding tube for nutrition. (Indeed, a full meal tray was delivered to Esther’s room while ConciergeCare was present, but no staff arrived to help her eat.) Finally, while physical therapy had been consulted, Esther had refused to participate in therapy because it hurt. So far, she had been flat in bed for three days.
ConciergeCare Services Provided:
It was clear there were multiple problems with the care Esther was receiving. ConciergeCare developed a Plan of Care for Esther that was implemented during her hospital stay after requesting a family conference with the attending physician, case manager, physical therapy manager, and charge nurse. The Plan included the following interventions:
- Esther was transferred to the hospital’s orthopedic unit, where nursing staff was more current in best practices for fracture management.
- Undertreating pain in the elderly can lead to states of delirium. Ibuprofen was discontinued, as that class of medication may disrupt bone healing. A set schedule was ordered for IV pain relief to be given, with extra-strength Tylenol given between the IV doses.
- With Janice’s consent, ConciergeCare arranged for a companion-level caregiver to stay at Esther’s bedside during the hours Janice was unavailable. The caregiver was directed to provide frequent mouth care, assist Esther to eat, engage her in conversation to help with her disorientation, and ensure staff was repositioning Esther in bed, to avoid bed sores.
- Early mobilization is crucial to elderly fracture patients, to avoid other life-threatening complications. The physical therapy manager agreed to coordinate with nursing staff so that Esther’s therapies would take place ~30 minutes after receiving IV pain medication.
- Once Esther was receiving adequate pain relief, she could stand to have the head of the bed high enough to eat. Nutritional shakes were also ordered to supplement her low meal intake.
ConciergeCare assisted Esther and Janice throughout Esther’s hospitalization and rehabilitation. Esther is back to her memory care facility, using a walker well, and participating in a daily exercise program run by the facility’s staff.