When mother arrived at SOS Skilled Nursing (remember a fictitious name), she was turned over to a nurse and nurses’ manager for check-in. They started off with checking her vitals and a brief assessment of her condition. They did not allow catheters, so hers was removed. She was still bed-ridden and using a newly placed feeding tube located just below her left ribs. She had not eaten or had anything to drink through her mouth for a week. The reason for this was due to the fact that she had failed a swallow test in the hospital. The hospital had sent detailed documents about her stroke and diagnosis, as well as, care instructions.
She was aware of where she was and recognized me, but her ability to communicate was limited. She was diagnosed with aphasia which is a condition of the brain that commonly occurs after a stroke. In layman’s terms, she had problems translating her speech to match her thoughts or intentions. I would only hear words that did not make sense to me. At first, she was unaware that she was not using the right words. It was like learning to understand a toddler’s baby talk. After a while, moms can understand their child’s vocabulary and I slowly began to figure out what Mom was trying to tell me.
The therapists began working with Mom within the first couple of days of her arrival. The goals were small in the beginning.
- Sitting up and awake for a few hours a day
- Sitting in a wheelchair and adjusting to staying in the chair for as long as possible.
- Practicing using pictures and cards to communicate what she needed.
- Swallowing exercises and speech exercises to wake up areas of her brain.
The milestones in the first month of mother’s stay were really baby steps. I would get excited just to see her out of bed. The communication was improving somewhat and her swallowing exercises were helping. She passed her second swallow test which graduated her to food by mouth that was pureed and liquids that were thickened. The biggest issue with all of this was that the pureed food looked very unappetizing and Mother would often refuse to eat it. She also did not adjust to staying in a wheelchair for more than an hour to two. She would get upset if she could not get back into bed when she wanted.
This is where the issue with the large number of patients per caregivers came to the surface. I would come in and Mother would be eating her meals in bed. She would often need assistance in getting cleaned up or her teeth brushed, but there were no caregivers available to help her for long periods of time. She had been diagnosed and treated for a bladder infection and hemorrhoids, which were obviously caused by her adult garments not being changed often enough. There were days when her breakfast tray was still in her room at 5PM. If she was in her wheelchair and wanted to go back to bed, she could be waiting for 45 minutes or longer for someone to come help. One day, she got impatient waiting and tried to get out of her chair herself and fell. She hit her head on the floor and had a cut and a black eye for a couple of weeks! I must have complained to the staff and nurses’ manager a dozen times, but I was always told that they were just short-handed and doing the best they could.
After about 2 months in this facility, the therapists had Mother standing and learning to use her left hand. Her speech was getting better and her accuracy with words was about 50%. I was beginning to get excited about her progress and had great hope that she was on the road to recovery. She had passed a third swallow test and they put her on a regular diet. She just needed her food cut up for her, but it no longer had to be modified.
After a couple of weeks, I started noticing Mother was wheezing and asked the nurse to check her out. They told me that they didn’t hear anything that unusual and it was probably just congestion from allergies. Over the next several days, it only got worse and a terrible cough developed. I insisted that they have a doctor examine her, so they got the nurse practitioner to okay an x-ray of her chest. I was told that the results did not show any fluids in her lungs and that they were giving her something for allergies. I was also told that she was given antibiotics for yet another bladder infection. Another several days goes by, with Mother’s condition only getting worse. She was not eating and refusing to get out of bed. Her therapy appointments were being missed. She was getting very weak. I kept insisting that I was concerned she was getting pneumonia, but they showed no concern.
4 more weeks go by. Around midnight, I received a late night call from the nurse who said that Mom was running a very high fever and they were ordering another x-ray. The next morning I came in to see her and was stopped as I walked down the hall by the nurse. She tells me that Mother was diagnosed with pneumonia, because the x-ray did show fluid in her lungs! I asked if they were sending her to the hospital and was told, “No.” The nurse said she was being given a stronger antibiotic, but that was all. In disbelief, I went straight to see Mom and found her looking and sounding terrible. My intuition was telling me that she needed to be hospitalized. One of the therapists came in to check on Mom and I told her my concern. She just said to me, “I understand. If you feel she needs to go to the hospital, you have every right to ask she be sent there.” I asked her, if she were her mom, would she send her to the hospital? She just repeated to me what she said earlier. I read between the lines and went straight to the nurse’s station to demand an ambulance be called to transport Mom to the emergency room. They told me it could take up to 2 hours for a “non-emergency”. I insisted they call. Thirty minutes later, Mom was being transported to St. David’s Medical Center.
Tomorrow, I will tell you what happened next ……….
