After a couple of days, his physical state seemed better but his mental state continued to deteriorate. He asked repeatedly what was going on, who was in charge, why he was here, and why we thought he was sick. On the day he was to be discharged from the hospital to a rehabilitation facility (next door), his nurse removed the PICC line and the catheter, to my dismay. How, I wondered, was he going to receive his antibiotics, and did they really think that his appetite had magically returned? Four hours later, after failing to pass urine (duh!), the catheter was reinstalled and he was transported to the rehab facility.
The first thing you see when entering this rehab facility is a large poster proclaiming their commitment to compassionate care for elderly clients. My father-in-law saw very little of this compassion from the nursing staff. We waited for hours before his nurse deigned to come into his room and meet him. After we got him settled in for the night, or so we thought, my husband, mother-in-law, and I went home for some much needed sleep. I arrived at ten the next morning to make sure he was OK and here's what I found: a confused, depressed, distressed, lost soul who had been parked at the nurses' station so they "could keep an eye on him". There wasn't a nurse in sight except for the occasional CNA who buzzed by on her way to do something other than acknowledge the existence of a clearly distressed and suffering gentleman. The problem, they explained to me, was that he kept trying to get out of bed and walk around and they were afraid he was going to fall, so they had to put him in what amounts to a traffic island so that if he fell, someone might see him and put him back in the chair before any harm was done (i.e., a family member showed up and raised holy hell). It took me two hours to calm him down but I failed to convince him that he was not being held prisoner.
Five hours later, the facility manager - intuiting that we were not happy with Dad's care - came and made nice with us. Finally, we thought, he will get the attention he needs. Nope. The next morning I arrived and found him in a guest chair with his head banging into the glove dispenser and sharps disposal. All someone had to do was move the chair five inches so his head wouldn't bang into those objects, but apparently this did not occur to anyone. Again, it took me two hours to calm him down but he continued to insist that a nefarious plot was afoot and that I needed to be extremely careful lest I get caught in the web of deception.
I noticed that someone had left a stapled stack of papers on his table with a pencil. It turned out to be a list of menus for the next two weeks which my distressed, depressed, demented father-in-law was expected to select from in order to plan his meals. I did it for him because he was completely unable to do it for himself. Again, I asked myself, has anyone here noticed that he is losing his mind? Do they really think that he will be able to make food choices? Have they not noticed that he eats nothing? Moreover, we told everyone who would listen (and it seems we were talking to ourselves) that he was in extremely fragile shape and needed help with everything. Their policy, we discovered, is to "get to know the patient" before intervening. Excuse me?
Once I finished selecting his meals from the fourteen page menu I noticed that he was sliding off the chair and tried to lift him back up. He told me that his testicles ("balls") were hurting and he was trying to find a position which was less uncomfortable. I asked if he needed someone to help him adjust the position of his catheter and he said that he was in pain and that no one was paying attention. To indicate how bad, he insisted that I, his daughter-in-law, look at his male parts! Having no experience being a man, I could see that all parts were swollen and inflamed. I called a nursing assistant in to look at the catheter. She concluded that all he needed was a change of depends. After an hour during which nothing happened, I sought out his nurse (who had not shown her face in the two hours I had been with him) and explained that he was in significant pain and that his penis and scrotum were inflamed. A little while later, a nurse practitioner entered the room and examined my poor father-in-law's private parts. She concluded that the catheter was "leaking" and someone needed to address that. I explained that he was in increasing pain and needed to see a doctor. She explained that she could make him an appointment but he wouldn't be seen for two or three days. "Your other option," she said, "is to send him to the emergency room."
I have to say that I was incredulous. Here we have a frail, infirm, very elderly man who has a history of infection and whose penis is looking severely infected and the nurse practitioner is acting like it was OK for him to wait until a doctor had an opening in his schedule instead of saying "get him to the emergency room, STAT!". If I were passive or stupid, my father-in-law would probably still be sitting in that room, dying from pain or infection.
This facility, "The Pavilion at Jupiter Medical Center" is considered one of the best. One of my good friends who suffered severe head and body trauma from a car accident spent several months there and has almost completely recovered. So why was my frail, demented, very ill, father-in-law neglected to the point that we had to have him readmitted to the hospital? [Sidebar: he is not on the dole, so no one could claim he was a charity case.] The answers point to a shocking attitude toward frail elderly people in America, that because they are at the end of their lives they do not need the same attention as a younger patient with a longer life expectancy. It upset me tremendously because we are not trying to keep a dying man alive at any cost; all we wanted was for him to be cared for with compassion and to have his discomforts addressed immediately, because he is old and fragile and he matters to us.
Long ago and far away, I worked for AARP when the headquarters building was on K Street in northwest Washington, DC. In the 23 years since I worked there, in spite of tons of rhetoric and lobbying on the part of this mammoth organization, care for the elderly is still grossly inadequate. My father-in-law has a wife, son, and daughter-in-law nearby who can advocate for him and still he received lousy treatment at a so-called rehabilitation facility. All he needed was for someone in that facility to sit with him and hold his hand until a family member arrived. Instead, he was left isolated in a strange place being "cared for" by people who couldn't have cared less.
AARP should get its priorities in order: instead of selling insurance, they should be developing care standards for people who move from hospital to rehabilitation so that no one gets parked in the nurses' station or left with his head banging into the sharp's disposal container. There is no excuse for the shabby treatment this World War II veteran, entrepreneur, job-creator, philanthropist, husband and father received when he was at his most vulnerable.
