Choosing the Right Facility

The care landscape is changing rapidly. For years, policymakers have been pointing out that we don’t have nearly adequate resources to care for our growing number of elderly. There aren’t enough geriatricians. There aren’t enough geriatric psychiatrists. There aren’t enough physical therapists and social workers with expertise in geriatrics. There aren’t enough skilled nursing facilities and assisted living facilities. Don’t take my word for it, you can find all the alarming numbers here, in a recent Eldercare Workforce Alliance report.

So what does this mean for my patients and their families? Increasingly, it means that families need to be aware that sometimes patients may be assigned to certain kinds of facilities simply because that’s all that’s available. Many hospitals are now treating “assisted living” venues as if they were “skilled nursing facilities.” These are not the same at all. Assisted living assumes that elders can take responsibility for part of their care, and it’s not set up for complicated medical issues. Skilled nursing means just that: skilled nurses and medical professionals who are qualified to provide medical care. Families need to be vigilant, to fight to make sure that their elder is in an appropriate facility.

Here’s a recent horror story that may make the point: I had a patient with complicated medical issues who had a hip replacement operation. To my dismay, the hospital discharged this man to “assisted living.”

Without the proper care necessary after such a major operation, the surgery wound opened up within a week. I sent the patient to the ER, and the hospital sent him back to assisted living with instructions that each day, he have “wet to dry” dressings changed. This is a delicate procedure in which a wet gauze bandage is placed on a wound, and allowed to dry. When it dries, the bandage can be removed, along with wound drainage and dead tissue. Trained medical staff should do these changes.

Alas, my patient’s bandages don’t appear to have been done properly in assisted living. He became septic, infected, within a few days. He had to go back to the hospital, where they had to remove his new hip. Then, finally, the hospital discharged him to a skilled nursing facility—where I think he should have been sent in the first place. There, the poor gentleman had to endure a much more difficult and expensive recovery.

In many cases, it may be possible for an assisted living facility to provide follow-up after a hospital stay. But it’s not appropriate after a complicated, major operation like a hip replacement.

If your elder is about to discharged from the hospital, make sure to ask questions:

• What sort of care will my loved one require after being discharged? Exactly what kind of wound care or rehabilitative therapy or tests will be required?

• Is this kind of care normally provided by a nurse or a doctor?

If the answer to this last question is “yes,” make sure your elder goes to a skilled nursing facility!

What do you think?

Elizabeth A. Landsverk, MD                                                                                           Specialist in Geriatric Medicine