Medical Care- A Consumer’s perspective- Brookdale Pt 2

Part One– https://thatwoman.wordpress.com/2019/03/22/the-ratings-of-medical-facilities-series-it-begins/

Part Two- https://thatwoman.wordpress.com/2019/04/09/medical-care-from-a-consumers-perspective-ohio/

Part Three- https://thatwoman.wordpress.com/2019/04/22/medical-care-a-consumers-prospective-mercy-health-lorain/

Part Four – https://thatwoman.wordpress.com/2019/04/29/medical-care-a-consumers-perspective-mercy-health-lorain-2/

Part Five – https://thatwoman.wordpress.com/2019/05/27/medical-care-a-consumers-perspective-cleveland-clinic-rehab-hospital/

Part Six – https://thatwoman.wordpress.com/2019/06/15/medical-care-a-consumers-perspective-brookdale-skilled-nursing/

This will, hopefully,  be the last in the series of medical care received in various  medical facilities , three different types of medical care, and three different providers. Ideally  this post should be in two  parts but I want to  leave Brookdale behind  so  it will be lengthy.

The common denominator was the insurance coverage Medicare and Medical Mutual. Although  I  am fighting one bill ( will be explored in this post)   and the Medicare evaluation of Brookdale as mentioned in Part SIX is an issue for us, on the whole Medicare and Medical Mutual – so far – has been less than the nightmare I  thought it would be.

I believed we were spoiled by  the nursing staff/ aides and housekeeping staff  at Mercy  Health  Lorain, upon reflection they  set the bar very  high– a  few of their  physicians I  found decidedly  lacking ( see Part One).

 

Also , the Cleveland Clinic Rehabilitation was beautifully  clean and the food was very  good , rehab staff were excellent, you  knew what time  therapy  was every  day and who what and where so  families could adjust schedules to  participate with  the patient. You  knew who  the nurses were that day  and your aides. Unfortunately,  it was down to  a small percentage of aides  that spoiled the experience and also  caused a health issue ( in my  opinion) by  spreading C’Diff from one room to  another and then sending  contaminated material with  the patient to another facility. Brookdale

 

Ah! Brookdale, Westlake Ohio…..the 5 star Skilled nursing and rehabilitation facility  which is in the middle of a very  large Assisted Living and Senior Living

Brookdale Senior Living owns and operates over 1,000 senior living communities and retirement communities in the United States. Brookdale was established in 1978 and is based out of Brentwood, Tennessee. https://en.wikipedia.org/wiki/Brookdale_Senior_Living

The typical Brookdale Senior Living CNA salary is $12. CNA salaries at Brookdale Senior Living can range from $10 – $15. This estimate is based upon 66 Brookdale Senior Living CNA salary report(s) provided by employees or estimated based upon statistical methodshttps://www.glassdoor.com/Hourly-Pay/Brookdale-Senior-Living-CNA-Hourly-Pay-E6433_D_KO24,27.htm

Independent living prices average $2,900 monthly. The majority of locations will cost between $2,300 and $3,500. Skilled nursing communities are available as a Basic Monthly Service Rate of between $6,000 and $8,500.

I have not received the cost of our one  month stay at Brookdale Westlake “skilled nursing and rehab ” in Westlake as of today’s date but I do  know one charge was $400 per day.

After the poor experience of “transfer” from Cleveland Clinic Rehab Hosp. Avon  (which was paid for by  self -pay) I wasn’t in the best of moods . I understood from literature that I  had read  this was a “newer facilty”. I understood it to be around 10  years old. In my  opinion it was becoming a little “shabby” without the chic.

 

 

I should point out this is a very  large complex and the “skilled nursing” ( bit of an oxymoron in my  opinion) section had quite a large turnover of people coming in and out of rehab. However, my  first impression after leaving the gleaming white , bright Cleveland Clinic Rehabilitation Hospital(CCRH) was one of “OH!” and not in   a pleasant way.  The parking for the visitors for the skilled nursing/ rehab   section was awful, you  had to  hope the parking gods were on your side as you  drove round and round hoping for someone to  leave.

Please note this a critique of the Skilled Nursing and Rehabilitation Section of the complex, I  have no  thoughts or opinions as to  the rest of their complex and assisted living sections.

 

The facility  allows pet visits to  the patients rooms, all well and good but unlike The CCRH where there was a designated area  tile floor) for those  pet visits,   animals in all shapes and sizes routinely  walked the “carpeted corridors” , one little fella dragged his bottom along the carpet which  made me go  eeeewwwwwww. Had they  been bathed, de-fleaed , some looked as if they   weren’t exactly a pampered pet? I did take my  dog to  see her master at the CCRH after going through the paperwork and a shampoo. I  did not bring her to  Brookdale!

 

The room was  supposed to  be “homey” and an effort was made in the design and décor.  However too many  bumps and bruises on the paintwork, furniture  left an impression of needing a redecorating. The “homey”  bedspread  with  its little bag of goodies, had decidedly  seen better days , faded (hopefully)  through a lot of washing?  Again, being spoiled by  the open airiness of the CCRH with  large windows this was a bit of a disappointment , his room was dark and yes in my  opinion a bit dingy. The photo  from their website  is really not a great representation as to the “light” in  the room  we had.   After the pristine cleanliness of CCRH it was a bit of a disappointment Oh well thought I different facility  not a hospital .

 

The bed was actually  quite small, and no  sides. Apparently  “nursing homes” cannot restrict the occupants ( such  as  the side up  in a hospital)  neither can they  belt you  in  a wheel chair. This  was  all well and good but for a patient that has very  little trunk strength and one who  was a fall risk  this was not ideal. I  was told we could request the sides if we went through the paperwork and the Dr. must write out a prescription  to  have the sides installed. I said this is what I  wanted done. That was the last I heard, and actually  he fell out of the bed twice, a chair once  and the wheelchair once. Not so  good when it comes to  the fact he had just had major brain surgery after a fall.

 

After 4 days of being a resident  the bathroom became   the holding room for dirty  sheets, linens, towels  used diapers and pads ( remember that C’Diff) I  was ready  to  remove the patient from the 5 star facility and interaction with  some very  off putting aides  . I  called the head nurse and one of the administrators , after my  daughter was given the pads etc to  clean up the leaking Foley  bag. Since she was gowned and wiping down the room with cleaning cloths due to  the C’diff   maybe they  did think  she was a staff member, as we were told. Obviously  no-one else up  to  that point – knowing there was an issue with  C’diff wore those items. ( Benefit of the doubt)

Some aides did make a half hearted effort to “gown up” after the complaint, however,  latex gloves routinely  ended up  being  taken off and thrown into  the “general purpose waste basket”, well those that made it in as they  were thrown – I  was forever  picking these up and emptying the  room trash!

 

As for “housekeeping” I can’t remember that happening to  any  degree maybe weekly and only  once was there what I  call a thorough cleaning ( the Sunday  after I complained )  whereas in the previous two  facility  it was daily and sometimes twice a day.

 

 

The ‘weekend administrator” did get the bags of laundry and garbage out of the bathroom , did send in a cleaner  and apologized. The “head” nurse did get the Foley  bag removed, changed the mattress to  an air mattress,  as he was starting to  get a bed sore due to  being stationary and unable to  move on his own ( eg. roll over)  and was also very  uncomfortable due to  a pre-existing back condition. And so  it began…………

 

The rehab staff were very  good, he could not have intensive rehab at this facility , again only  so  often  due to  Medicare restrictions. But on the whole we were pleased. My  goal was to  have him ambulatory , able to  get into  a bed at home and to  be able to  get to  the bathroom. This was going to  mean  on a walker at least because this “Old House” was not wheelchair friendly.

Since there was definitely  an issue with  85% of the aides ( remember the staff that was above average according to  the Medicare evaluation  ) my  daughter would spend every  morning going with  him to  rehab, not the organized times etc of the CCRH we were expecting, she would stay  until after lunch  and I  would come later in the afternoon through the evening.  Night times were very bad for him, but he was on digoxin and although  he had adverse reactions  to  this drug we could not get  Doctors to  take him  off of it ( prescribed by  the ghost cardiologist from Mercy)

https://www.nhqualitycampaign.org/…/Drugs_that_may_cause_psychiatric_symptoms…visual hallucinations, fear, paranoia, agitation, anxiety. Sudden … Hallucinations, paranoia, delusions, confusion, mania, anxiety … Digoxin (Lanoxin*).

Note: the moment he was home and our cardiologist saw him digoxin was “nixed” and so  were many  of the other medications.

I am sure the administrative staff as well as a number of the aides were not at all happy  with  my  advocacy for my  husband. A “difficult patient” due to  medications, pain and confusion and a difficult wife 😉 . I  would ask you  to  remember this man went to  bed at Mercy  woke up eight days later after being intubated  and having respiratory  arrest unable to  move , unable to  speak ( due to  his vocal chords being stretched, ) not knowing where he was and what happened and having an 8 inch  slice taken out of his scalp. He remembers nothing at all from Mercy  , very  little from CCRH and too much  from Brookdale, Westlake.

 Patients were told they  could eat in the dining room  and for the most part the food was fine, the aides in the dining area were very  helpful  and the view of the duck pond a nice outlook. Mealtimes became a highlight to  one trapped in a wheelchair.

The call light response times were awful, in our case, of course being a “demanding patient” who  wanted to  use the bathroom or get out of the bed  and wheelchair due to  his discomfort didn’t help. The notice on the board in his room “call don’t fall” didn’t count for much.

The  Administrator did print out a  record of the response times to  the call light. Amazingly  they  had response times of 30  seconds  up  to  5 minutes.

What they  hadn’t realized with  the amount of time my  daughter and I  were putting in and the fact that as a blogger and ex- columnist I  have this penchant for documentation we also  kept a record of those call times and for the “most” part they  didn’t concur with  the print out. With  that printed out response time for his room number   I  received a bill for another patient, which  I  duly  returned, that had had that room previously.

March  17th  he fell again , this is an excerpt to  Medicare  appeals as they denied the cost of the emergency  room Dr.  after I  insisted Brookdale transport him to  St. John’s after yet another fall.

“On March 17^th I received a call from the night nursing staff at Brookdale that my husband had fallen trying to get out of his chair. The nurse informed me he had bruising to his abdomen and an abrasion to his left leg.They could not tell me if he had hit his head. Considering they stated he had only fallen 10 minutes previously to calling me   I was concerned they could not tell me whether he had hit his head and that bruising to the abdomen was already in place. I deemed it important considering the history of previous weeks of major brain bleed and surgery he should be checked out by someone other than an LPN. Hence the trip to St. John’s Westshore Emergency Dept. He was monitored in the ER and after a few hours sent back to Brookdale .

It is my contention that due to the recent history of falling and two brain bleeds the ER was the appropriate facility at 1 a.m in the morning. Brookdale, in my opinion did not have a qualified individual on duty or equipment to ascertain a diagnosis. The ER was the best place”

As time wore on and actually  his discharge times got put back , I  realized that, in our case , although the rehab therapy was very  good, it wasn’t enough. He was spending too much  time “waiting” and sitting in a wheelchair for the  two  to three hours of rehab and at least two  days a week where there was no  rehab at all. ( Again due to  Medicare restrictions). So  as his Dr. concurred and my  husband was unhappy  at the facility  and was at least able to  use the walker (with  help) and we felt we could manage his  care  we discharged him from Brookdale Westlake  on March 29th.

I am pleased to  say  that in April he went into out patient  physical therapy  at NeuroSpine Care, Sheffield Village, three times a week. He has progressed amazingly  well and they  have him transitioning to  a cane , able to  stand  and do  the things that make life normal. http://www.neurospinecare.com/

I do not agree with  Medicare ratings that this is a 5 star facility, but then again I  do  not know how low they  set the bar!

The best I  can give this facility  in rating , remembering it was supposed to  be, according to  Medicare, a 5 star facility  is a C minus. Although there were highlights such  as the rehab staff, the “aides” were another let down  and remember these are the individual that are dealing with  your loved one.  ( I  would say  my  general impression was that the aides were dealing with  quite a few patients each  shift and if their stated wages were anything to  go  by  they  need a raise in order the attract  better qualified individuals !

Remember this is a FOR PROFIT facility  and you  are the consumer not a charity  case and Medicare  and yourself will be paying for the “business”

of care and rehabilitation!!!!!!!

https://www.ibisworld.com/industry-trends/market-research-reports/healthcare-social-assistance/nursing-residential-care-facilities/nursing-care-facilities.html

 

July 3rd- continuing – Chris Ritchey

I have written about you  every month  on the 3rd of the month as my  memorial to  you – your life and your art work. A few months ago  I  wrote these lines in the post https://thatwoman.wordpress.com/2019/04/03/april-3rd-forgotten-chris-ritchey/

““They  say  you  die three times – once when your body  fails you – again when you  are buried ( funeral) and again when you  are forgotten”.

Death  of the body  and death  of memory. When you  are buried and that headstone in place is a remembrance of sorts but there’s the rub how long will that headstone last?

 

Most of us believe that record of our being in the places designed for such – as cemeteries and crematoriums  will last forever, not so especially  with  the way  things happen with  cemeteries in recent years.  This Blog https://lisanneharris.com/2013/05/12/sadly-utterly-abandoned-churches-cemeteries/ Ms. Harris has a plethora of photos from around the world of these sad places. The forlorn graves sinking into  oblivion once held the tears and heartbreak of mourners  who  grieved over their loved ones. Even in this old neighborhood the citizens of Lorain in the past plowed under and buried  the little Charleston Village Cemetery

https://thatwoman.wordpress.com/tag/pioneer-cemetery-lorain/

 

 

I read once , here you  can’t reclaim or take out graves until 100 years after the last burial. But that is another law that is circumvented. I  know it happened to  your Great Grandmother and Great Grandfather and Great- Great Grandmother, the site was moved (although other family members wouldn’t have it) but I  remember visiting those graves in a totally  different area of the cemetery and one was missing altogether.

 

You  are not dead because our love of you  is alive and you  are in our thoughts and dreams daily.

 

Your Nana was not afraid to  die, she was actually  welcoming her demise -99 years is longer than most get on this earth.

 

She had out- lived her brothers , sisters, friends of her youth. She was ready  but as she sipped her tea one day  near the ending  she look at me over the rim of the cup and said

“you  won’t forget me will you, Nikki  and the children will remember they  had their Nana”.

There is no  headstone in a “family  plot” because that is not what she wanted. Her ashes will hopefully  one day  make it back to  “her England” , time and life permitting.

Today,  I  received a notification from the Crematorium in England

St Marylebone Crematorium – Memorials

about your  Grandfather. What a mess that was when he passed , he had gone off with  someone else – had a new family  – although  he clung still to  his old one. Due to  the fact he never remarried, I  was still his next of kin, the arrangements were left to  me  although  his “woman” did orchestrate some aspects.

Then a few years on, since Nana and I were home, we went to  the crematorium and I  asked the office where my  fathers ashes were interred. Imagine my  guilt when I  found out no-one had ever claimed them! I  had thought his fancy bit would have,  she obviously  was done with  him after he died.  I  was told his ashes were scattered in a part of the crematorium  I was shown the spot where his ashes had been scattered and  was told

 

“I  could have  a “tablet” positioned on the walls surrounding the Willow Garden, and are ideal for those who wish to mark the position of a loved one whose ashes have been scattered below.”

It was decided, only  Nana would have nothing to  do  with  it  , didn’t want her name mentioned  and went and sat in the rose garden. This is truly  a beautiful place.  I realized, although  his work of a cross ( commissioned by  the Governor of Gibraltar) hopefully  still adorns the altar in the Naval Chapel there ,

 

there  was not a permanent dedication ( well as permanent as can be in this life) but one day  even that small reminder will be taken from the wall

 

Anyway  I purchased a “tablet: and every  10  years I receive an invoice to  renew the dedication, a few hundred pounds.  No-one goes to  the crematorium anymore to  pay  their respects, I  am not sure anyone other than I  ever did but I paid this invoice today because his name is there , the fact he lived and died on those dates is still  there and he is not forgotten and he did live and he loved me and I , him

My Dad and I happier times

Oh his great grandson has the look of him  but only  I and a photograph of old realize that :

 

 

 

 

 

 

 

 

 

And that is why  I  write about you  month  after month for as long as I  can  so  you  know you  aren’t forgotten and that you  lived…….. and are still loved with  every  breath  in my  body………..

Breath of Life – Celtic Knot – Chris Ritchey