First, I want to thank the many readers who have been following along with my mother's adventure with the knee replacement. I've received a number of nice comments and i can see that documenting our experience with the operation is helping others. That's what I was hoping for.
Today's topic is the Care Plan Meeting. I'm sure different facilities will use different names but it is a way for the patient and family to meet with the care team to determine how the patient is doing, where there are any problems to be addressed and when it will be time to go home.
QUICK SUGGESTION: If possible, schedule a planning meeting within a few days of the patient's arrival. Get an idea of what the facility plans for your patient, what goals the patient will be working towards, get to know the people involved in the patient's care, and set a tentative date for the update meeting. This makes it easier for everyone to be on the same page. We had no guidance at the beginning to know what was going to happen or what the goals were for her progress, so we didn't know if she was meeting them or not. When I got a letter from the facility inviting me to this Care Plan Meeting it was a date nearly 3 weeks after mom started there. At that time, I thought she would be home before that date, so I clearly had no idea about what we were facing.
At our rehab, the meeting consisted of the nursing supervisor, the head nurse, the primary physical therapist, the occupational therapist, the nutritionist, the activity director, and the social services director.
The nursing supervisor started by introducing each person. Then she talked about mom's progress to date.
This is the time to ask your questions. For us, two main concerns were mom's sleeping problems and her weight loss.
The physical therapist talked about how hard momwas working and the degrees of bending and straightening in her knee. Mom can now manage stairs (although slowly) and can walk 1500 feet twice a day, much more than she could 6 months before the surgery. But the therapist also voiced one of my main concerns, the fact that mom has some kind of allergy or other problem that is keeping her up all night coughing and sometimes vomiting. When she doesn't sleep at night, she doesn't have the endurance to do 3 or more hours of physical therapy each day. It could be an allergy of some kind or something "going around." But she has been in so much distress that her vocal cords are affected and she doesn't even sound like herself.
After a brief discussion, we determined that the cough suppressant ordered by the doctor wasn't being given until she had been awake for several hours at night. The head nurse made a notation to have the suppressant brought in a bedtime. (Mom got it a bedtime last night and was able to get a full night's sleep. I wish we'd thought to ask about this sooner.)
The second concern was her weight loss and its effect on her endurance. It is typical not to want to eat much for the first week to 10 days, but this lasted much longer. After a discussion with the nutritionist, and the fact that she has lost 6 lbs in less than 3 weeks, her diet is being changed to get her more calories and nutrition. A 4-oz portion of an Ensure-like supplement will be given to her instead of mile to take her pills. This has vitamins and 240 calories. I explained that she normally has three small meals, not the jumbo portions they bring her, and small snacks like a pop tart at 10 and 3, then a dish or ice cream or peanut butter toast at 9 before bed. (When she had a leg injury in June 2007, she was in the hospital 3 times, 4 of the first 6 weeks and was down to 81 lbs. The multiple small meals and snacks brought her up to 107 in a year, even with another major injury in between.)
The nutritionist will add Ensure like drinks to her meals, add ice cream for lunch and dinner, and provide other items, like individually wrapped muffins and graham crackers that mom can keep in her room and eat as she wants them.
As you can see, they did work with us and came up with solutions to get around the problems we were seeing. If your facility is not being helpful, or flexible in the needs of each specific patient, you may have to suggest that if they can not accommodate your needs, you will have to consider discussing the option to move to a different facility. Usually, a subtly worded suggestion is enough to get them to work with you rather than lose your business. One lady I know lives in a retirement community and said that if they couldn't help a specific problem for her father, she would have to talk to others in her community to see where a more appropriate place would be for him. They didn't need an outright threat to understand that she would let a lot of people know they weren't happy with the facility and encourages others to avoid it. Fortunately, we took a lot of care selecting this facility and it worked out well for mom.
This is also the time to discuss other concerns. Perhaps your patient has a roommate that keeps them awake by snoring. Or a roommate is allergic to tobacco smoke and, even though the roommate is taken outside to smoke, it clings to their body, hair and clothing, enough to cause breathing difficulties. Or the person across the hall is hard of hearing and falls asleep with the TV up very loud.
You can also talk about visitors. Maybe you have someone coming in from out of town and they need to be allowed in after normal hours. Or you want to schedule a visit with a pet.
Mom used this ploy when faced with all the staff wanting her to give up her desire to go home today and stay for another week or more. They gave her reasons, her need to be stronger, more independent, and build up her endurance. She finally, reluctantly, said she would give them one more week (although not the full two weeks to the initial goal date) but only if she could see her dog. LOL Since I knew that the facility did allow small well-behaved dogs, I was ready for that possibility. On the way to the meeting, I had dropped off her 5-lb long haired Chihuahua at the groomers. They gave her a bath, cut her toenails, and even filed them smooth to reduce any risk of scratching mom's fragile, paper thin skin. I was able to go pick the dog after the meeting and bring her in for a visit before mom went to her afternoon therapy. It was a joking bribe but it made mom happy, so it was well worth the effort.
For those of you who might not have the same title at your rehab facility, the social services person at the meeting has the same type of responsibilities as a case manager in the hospital and does the actual release of the patient. They also help coordinate in-home as well as extended PT after discharge as needed. If appropriate, it is the social service director that does an in-home review before release. This in-home review determines if the patient needs any medical equipment or services before they can be released, like a wheelchair or walker, a chairr for the bath or wall mounted handles in the tub or toilet area, a commode chair, home nursing services, or even oxygen. Once these needs are determined, the director makes sure all the items or services are ordered and in place, before the patient leaves the facility.
I hope this gives you some idea of what a planning meeting is for and how you can use it to your advantage. As I suggested above, if you can schedule a brief meeting as soon as you arrive, even if it is only the social services person and the nursing supervisor, that would really help you get a handle of what is going to happen while you are there and what to expect. It will also let you know who to go to when you have a concern, something we just didn't understand.
I wish you all well. Take care.....
Kathy
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