Monday, November 4, 2013
The Patient's Advocate
Hospitals are a difficult and maddening maze to traverse.Add an elderly patient to the mix, and often, you are left spinning from trying to manage their fears as they try to adapt to an unknown environment, doctors and nurses that may not be familiar with your parent's other health issues (thanks to the lack of electronic health records in Ontario), an often hurried and incomplete assessment, and a rush to send the sick home sooner rather than safer.If an elderly patient has the good fortune of having family members that can speak up for them, then you just may have a chance at getting respectable health care in a hospital, or any health care setting for that matter. This post is the first of several that will focus on our family's learning from having experienced often the darkest corners and niches of Ontario's healthcare system.Through Dad's several hospital stays, we have learned through trial and error when, how, whom and how often to push the buttons necessary for Dad to get the necessary health care he required. It was and isn't easy, requires intestinal fortitude and sheer will and determination that you just will not accept what doesn't and often isn't right.With different members of our family playing good cop/bad/cop, we have had to stay on top of nurses who, due to sheer lack of numbers, rush from room to room trying their best to assist their charges, but will ultimately be unable to respond to most patient's needs; doctors who don't always take the time to fully understand the patient's previous history, rushing to conclusions and assessments that may miss the mark entirely or only just so; the overuse of prescription drugs in trying to manage difficult patients (those that may require extra resources) so that those resources are freed up elsewhere; the consequences and hazards of the end of shift to new shift of nurses, whereby things get missed, forgotten or simply ignored; and the hospital administration that directs its staff to free up all beds as soon as possible, often far too early, thus placing your aging parent at risk.You see, the elderly have it particularly difficult in a hospital environment. Confusion will set in for most elderly patients: confusion as to what ails them, unfamiliar hospital staff, new environments, foods that may not agree with them, new drugs that may have problematic side effects, and even language barriers.Woo to be an elderly all alone, without family to speak for them, in this day and age, in any health care setting. They will be forgotten, ignored and missed. We have seen it time and again, for elderly patients in joining rooms to Dad's, when they either did not have families in town, or none in general. Our hearts often broke at the treatment they received, or short cuts that were taken by hospital doctors and staff. A couple of times we stepped in, but with no real ability affect any changes.For Dad, we battled doctors, nurses, and administrators, sometimes making headway, and other times, just banging our collective heads against the wall. Until we learned about the Patient's Advocate role.Every Ontario Hospital has a Patient's Advocate, a resource for any and every patient that can be called in to mediate or facilitate concerns or issues that a patient or family member has.We have used such an individual twice, each time successfully to ensure that Dad's best interests and safety were protected, because with today's budget woes, we can no longer say that a patient's best interests and health is the overriding concern for all healthcare workers. It can't be, not in the manner in which emergency rooms are crowded, health issues missed, programs cancelled, diagnostic tests short-shifted, life-altering physiotherapy short-circuited or cancelled altogether, and nurses overworked beyond exhaustion.The first time, we fought with Toronto Western Hospital for a sitter to stay with Dad overnight, as he had clearly become a danger to himself. We had spent the first three weeks rotating shifts ourselves, watching over Dad day and night. But we couldn't keep that pace up forever. He remained there for 11 weeks.For a patient that was supposed to be on strict bed rest due to a spine infection, and one that had Parkinson's and dementia, they stood by as he repeatedly put himself in danger by forcing his way out of bed, standing and falling by the bed side, and roaming the halls at night. Clearly, we needed a sitter to watch over him, until the drugs took effect, the infection cleared, and he could once again place pressure on his spine. We were willing to do our part, but needed obvious help from them.It was the Patient's Advocate that stepped in, arranged for this sitter, brought in a more helpful and supportive tone to our discussions and also suggested weekly meetings between the hospital staff on Dad's care, and our family.We used the Patient's Advocate again, when two years later, Dad was hospitalized again, this time at Trillium Hospital, for a broken hip. The short term care facility there is abysmal, indescribable and to be avoided at all costs. We know of several families in the community that have had a family member end up there, that will not leave that member alone for any length of time. Often you would find husbands, wives, daughter, sons, nieces and the like camped out overnight and during the day, unwilling to trust the staff there with their ailing family.The Patient's Advocate was used to communicate with a difficult and belligerent staff and nurses, who were more passengers than actual drivers of the healthcare that you expect in a short term care facility.So, if you are concerned, upset or just scared when you find yourself in a hospital, contact the Patient's Advocate in the Patient Relations Department. They're there to help ease your situation, and bring some semblance of humanity back into hospital care.Perhaps at some point, our healthcare workers, staff, management and leaders, will recognize that families energies are better expended dealing with serious health issues and concerns, and not in unnecessary and unhelpful battles with them. Until then, a Patient's Advocate can prove to be an important resource when hospital care becomes a reality.