The hospital calls. Your mother will be discharged to a nursing home in two days. Now what do you do?
If you are responsible for a parent or spouse’s move from the hospital to rehab, a nursing home or even back to their home or yours, you have to make a critical decision, without all the facts. You can collect stories from friends, but their situations may be too different to help you. You can research online, but do you know the right questions to ask?
Mike Tropper had friends coming to him for advice in this situation all the time. With his 22-year background in nursing home management, he was the go-to person for questions about how to choose a nursing home or what to do when a patient wasn’t getting proper care. That led him to create HarmonyCare, a company to help families when they have a loved one who has to transition to this new phase of life.
“HarmonyCare is like having a nurse in the family who can be your advocate,” said Tropper, “Someone who has the expertise to talk to the staff and the know-how to acclimate patients to their surroundings. We have people who can be there on site, who can tell you what’s going on and make sure the right things are being done.” HarmonyCare is involved in the entire process, from helping families choose a facility, through developing and monitoring the care plan and overseeing the patient’s day-to-day well-being.
If you haven’t been in this situation before, you might be tempted to assume that all nursing homes are similar and that care managers and their staff know what they’re doing so you don’t have to be involved. That would be a mistake. “Nursing homes differ in their staffing levels and approaches to care,” cautioned Tropper.
A HarmonyCare nurse will tour prospective facilities with family members; HarmonyCare has no financial interest or incentive to choose a particular one. “I always tell clients to make a list of things they see that they like, or don’t like, and I’ll do the same; then we’ll compare notes,” said Tropper. “Our lists are always different.” Tropper said the family may focus on externals like the wallpaper and furniture. He looks at the way residents are being treated. Are meals unsealed for patients who would have trouble opening the packages? Or are patients being fed when they are capable of feeding themselves, leading to unnecessary dependency? Are the aides pleasant and responsive?
One of the most important functions of HarmonyCare nurses is to be with patients when they are admitted to the new setting. The level of support at a rehab or nursing home is much less than at a hospital. Newly arrived patients may be distressed and in pain. They may be admitted at a time when staff is very busy and the directions from the hospital do not get relayed properly. Nursing homes get medications delivered from their pharmacies at set times. The HarmonyCare nurse will make sure the newly admitted patient gets his prescribed medications called in before shipments end for the night. The nurse can also provide comfort to a patient whose adult children can’t be there because they are at work, home caring for a baby or live hundreds of miles away.
HarmonyCare nurses know how to get patients settled and communicate with the staff to make sure they understand treatment instructions. They also make sure that the patient’s personal needs are taken care of. Later, they get involved in the care plan and let the staff know what the patient is capable of doing. “It’s important for the patient to do what he can for himself to maintain whatever level of independence is possible,” said Tropper.
If the patient is returning to his own home, or yours, the HarmonyCare nurse will help with arrangements including setting up new equipment. If the patient has a home health aide, the nurse will observe if the aide is properly taking care of the patient, his food and his environment. When the patient doesn’t have outside help, the nurse will step in to make sure he has what he needs.
The nurse will also review prescriptions to prevent dangerous errors. Tropper relayed a story about a patient who was released from the hospital but didn’t return to his previous good health. The source of his problem was a mistake in the drugs he was taking. He had been given prescriptions for 10 medications—but he should have been taking only five. His doctor discovered that the others were generic duplicates under different names.
Everyone has their own specialty in the medical world. Abe Weinberger, HarmonyCare’s chief operating officer, was running a nursing home medical group when he met Tropper. They got to chatting about Tropper’s idea for HarmonyCare. “Families are trying to look out for loved ones but may not understand complex terms and conditions,” Weinberger said. “A nurse advocate can provide a clear explanation.” Weinberger said he immediately realized the value of what Tropper wanted to do. “I was happy to take on the front end of the business.”
Tropper helped Rachel Simon* when she was plunged into the world of medical facilities after her husband had a stroke and four weeks later went into cardiac arrest. “When the hospital told me they were ready to discharge my husband, who was in a coma and on a respirator, and I had to pick a nursing home, I was absolutely clueless,” she said. “I had no idea why I had to be involved and thought, ‘why can’t the hospital just pick one for us? I have zero knowledge!’”
Tropper was a family friend and guided her through all the decisions she had to make. He took his checklist and went on tours of nursing homes with her. “My eyes opened up,” she said. “There were so many differences. I walked in completely blind, but Mike was so knowledgeable.”
Tropper accompanied Simon when her husband entered the nursing home. He knew the specifics to ask for, such as a special air mattress for patients in a coma that helps prevent bed sores, and he made sure the feeding tube was connected. He established a rapport with the nursing staff so they would be motivated to take good care of the patient. Tropper met with Simon before care-plan meetings to review her concerns and spoke at the meetings on her behalf. He also called for emergency meetings when he became aware of errors, which Simon said happened a few times. With Tropper’s support, Simon had the confidence to ask for information she was entitled to but had to insist on getting, like blood test results. When her husband had to go back to the hospital, Tropper came to the nursing home to ensure safe transport.
Simon had to change nursing homes after the return to the hospital, but Tropper had taught her what to look for. “I wanted to know the nurse to patient ratio; if the vent rings, how long until someone comes; how clean the place is; are there x-ray and labs on site; how often the patient is positioned and cleaned; how often the doctor comes in.” Simon said Tropper advised her to notice if there were family members visiting patients. It’s a sad reality that patients in a residential medical facility get better care when someone is watching.
Tropper showed by example an extremely important factor in getting good care: gratitude. “Mike told me to be very thankful to everyone, especially the staff responsible for hands-on care. He would smile and thank them and bring them treats. I brought muffins and cookies with a note that expressed our appreciation.”
Tropper was there for Simon as long as she needed him, which turned out to be three years from the beginning of her husband’s illness until he passed away. “He never stopped helping,” she said. And that’s what Tropper is training nurses to do for all HarmonyCare clients. Clients can choose different packages of services including initial tours of facilities, meetings with staff, attendance at appointments, phone calls and outings.
HarmonyCare is available in the New York/New Jersey metropolitan area and Rockland County. For details, visit www.HarmonyCareAdvocate.com.� For more information, email [email protected] or call: 1.855.HARMONY.
*Name changed to protect privacy.
By Bracha Schwartz