Generations, signing off.

I’ve been busy! That sounds like an excuse, and it kind of is one, but things at a Skilled Nursing Facility (SNF) happen at a much quicker pace than any facility I’ve worked at before (Independent Living ILF or Assisted Living ALF). I think Generations is going to continue to take a back seat for a while, so while I have enjoyed this ride, I wouldn’t expect too many alerts in your email notifying you of a new blog post. I appreciate every single person who has taken the time to read my thoughts, and especially those of you who have reached out and responded. It means more than you know.

I thought maybe I’d give you a little taste of my job, and why it’s keeping me so busy. I have a resident in house who we’ll call Mary, and she lives in the long-term wing of my SNF. This means she has one or more conditions that require 24-hour nursing care, or needs assistance from more care givers than an ILF, ALF, or Adult Foster Home (AFH) can staff. ICF is the highest level of medical care in the senior care industry. Mary is wheel-chair bound, and spends some of her day in her bed, but most of the day sitting up in her wheel chair. Because of this, she’s worn in her wheelchair (which insurance purchased for her when she first moved in a year ago) and has been expressing concern about getting bottom sores due to sitting all day. This is a valid concern – one of the most common health issues for long-term care residents are bottom sores which can develop into pressure wounds or ulcers. Due to this, one of our nurses evaluated her and decided she needed a new wheelchair to better fit her large body and help prevent sores. Enter Tracy.

I called Mary’s insurance, who stated that she received a pricey new wheelchair paid for by insurance less than a year ago, and since her height/weight measurements had not dramatically changed, it was very unlikely that she was going to qualify for a new chair. However, the insurance company authorized an evaluation through their therapy department to more accurately assess her needs. Their therapy department outsourced the evaluation to our in-house therapy staff, who did the evaluation of Mary…in the wrong wheelchair.

I recalled that evaluation, and the therapist went back in and evaluated her in the right chair. The therapist recommended a pressure relieving gel cushion for her positioning comfort. Now, this didn’t all happen in one day; I would estimate by this point in time it had been a week since Mary’s original complaint of discomfort/concern.

I faxed the recommended cushion information to the insurance office, and the next week, I called back to follow up on the status of our request. Insurance stated that they need a doctor’s order for them to fill the request, so I then sent a fax to of the recommended cushion information to the doctor’s office, who faxed back “sure, go ahead.” Really impressive medical communication, I know.

I took this documentation and faxed it to the insurance office. I would guess that this was about the end of the second week, so at the beginning of the third week, I again called the insurance office to follow up. Keep in mind, every time I call insurance companies, I get to go through the fun song-and-dance of waiting on hold, being transferred to the wrong department, etc. I don’t have some secret phone number I call to be assisted immediately (on a related note – if you do have this number, please share; I spend far too much of my day on hold).

The insurance company stated that they’d approved the request, and had faxed the cushion information to a third party medical supplier to fill the order. I called the third party to follow up on the order, and they stated they needed a therapy evaluation to fill the order. I thought my eyes would roll out of my head when I replied that a therapy evaluation was what had determined the patient needed this cushion in the first place! I told them I could fax them the notes from our therapist who conducted the evaluation, and they replied that their team needed to do their own evaluation, and when could they schedule a time for their evaluator to come out? “Yesterday,” was my response.

By the time the medical supplier came out to look at this resident’s wheelchair/cushion/no cushion/positioning situation, it was well into the fourth week of this whole process. This meant that the fairly cognizant resident had been harping at me for four weeks, asking why she didn’t have the recommended cushion yet, which I concede was a very valid question. The evaluator determined that yes, Mary needed this cushion, and stated they would place the order. Add in another week of me being badgered by the resident, and, in turn, badgering the delivery team of this medical supplier, and voila, we had ourselves a brand new gel pressure relieving cushion. It only took five weeks of the resident being uncomfortable, dozens of faxes and phone calls, and about four eye rolls from me to get the job done.

Besides extensive patience, this job has also quickly taught me medical jargon. If I want to keep up on what’s happening with our patients, I need to be familiar with diagnoses, medications, and doctor-speak. I have spent a fair amount of time googling diagnoses, medications, and medical terminology to try and understand what’s happening with our residents. I’m proud to say that now, after a few months, a doctor can send a message reading, “add quetiapine 25 mg po q 6 hrs prn agitation,” and I know immediately that this resident has just been prescribed quetiapine (or Seroquel, as it’s commonly known) in a quantity of 25 mg to take by mouth every six hours as needed for when they experience agitation.

What impresses me even more than being able to understand this lingo is the fact that our staff wants my opinion on medications. I get to know our residents really well, and I read through notes on their behaviors, eating habits, bowel movements (yes, you read that right), etc. on a daily basis. So when the nurses are considering changing a medication, or are trying to think of how to get a resident to be a little peppier and more engaged, they often ask my opinion. I can’t prescribe medications, but I do make suggestions, and I feel like my knowledge of the residents and of available medications plays an important role.

The rest of my day is filled with documenting in our system for insurance/state guideline purposes, checking in on residents, and completing all the miscellaneous tasks that don’t fall to someone else. Some examples include scheduling a dentist appointment, finding so-and-so’s favorite blue sweater that went missing, following up on a complaint, helping residents move rooms, and completing admission paperwork with families.

While I stay busy (and happy) with all that, I wish you the best and want to genuinely thank you for following along with Generations, and I hope you will continue to reach out to me with your questions, thoughts, and comments on senior care. Find me on Facebook to connect or read more long-term care stories. In the mean time, I'll still be here, ready to care for every senior who comes my way.