~ written by Jan Judge used with permission ~
This is an article I wish I didn’t have to write. It is about protecting yourself from the medical institutions in which you put your trust. I am a physical therapist who has been physically disabled for the past 3 years. I feel that this gives me a unique perspective on the health care field.
As a working therapist, my last employment was in a sub-acute nursing facility. The clients that came to us were living at home prior to their hospitalization and hoped to return home when able to be independent or require minimal care from relatives at home. Some of the clients were post-operative; total knee or hip replacements, strokes, general reconditioning from being in the hospital or status post some type of trauma. Sub-acute nursing facilities are rehabilitation centers for those who cannot take the vigorous regime of an acute rehab facility. Most of the clients were 60 years or older.
I had a total hip replacement on July 9th, 2003 at the age of 48. After surgery, I was admitted to an acute rehab facility. Prior to my surgery, the insurance company approved a 7-day rehab stay. In addition to needing the hip replacement, I have a myraid of other medical conditions such as pituitary adrenal gland insufficiency, severe asthma and sleep apnea. These conditions presented a higher surgical risk with a chance of prolonging the rehab process.
As it worked out, the surgery went well without complications. The pitituitary adrenal insufficiency required me to have high doses of intravenous steroids. After surgery, the steroids need to be weaned as quickly as possible yet leaving me enough to have the strength and energy to participate in the rehab process. There are no guidelines for this. It was a day-to-day decision of the endocrinologist and myself based on my response to therapy and my clinical presentation.
When you are in a rehab facility, a family conference is scheduled to discuss discharge planning. In the sub-acute facility I worked for, the patient and their family were invited to attend. In the acute rehab facility where I was, the conference was mentioned but there was not a concerted effort to make sure you or your family attended. I told my therapist, that I would like to attend the meeting.
The rehab conference was attended by my nurse, the social worker and my assigned psychiatrist (he is a doctor of physical medicine). Physical and Occupational Therapy were also to be present at the meeting. In my case, PT and OT sent written reports of my progress, as they were both out of the building doing a home assessment on another client. At the meeting, I was told my stay was up on Saturday, which would constitute the 7 days allotted by the insurance company. I spoke up and said I had not yet met my goals, which were to use crutches, to be able to ascend and descend steps, and to be able to prepare an easy meal in the kitchen since I would be alone all day once I got home. I live in a split level house where there are steps to get to each level.
I was told that these goals didn’t need to be met. This made me inquire as to why were goals even set if it did not matter if I achieved them or not. No one had an answer for this. I was told the insurance company would give me a hospital bed to use until the home physical therapist came to teach me to go up and down the stairs. I said that I wanted the social worker to appeal to the insurance company for an additional 3-day stay. She did not want to do this. I insisted. The psychiatrist too didn’t think it was necessary that I stay. I, again, insisted. The endocrinologists who were treating me also felt I needed a longer stay due to my decreased endurance from the pitituitary adrenal gland insufficiency.
The social worker did make the call and the insurance company approved coverage until Monday. This entitled me to an additional 5 hours of therapy which helped me to become independent with the crutches, independent going up and down the stairs, and I could prepare a simple meal in the kitchen. I did not need to go home with a hospital bed.
I was appalled that I had to be my own advocate to insure that I stayed until I was safe with my adaptive equipment and met my goals. I have empathy for the clients that do not know that they are entitled to appeal decisions made by social workers and doctors. It should not have to be this way. When I was practicing, the therapists were supposed to have the final say to determine if the client was safe enough to go home and to be able to work at their highest functional potential. What will happen to the senior citizens who do not know their rights and are sent home before they are safe? Would the insurance company rather pay for another hospital visit for a broken hip sustained at home while another week of therapy would have made them safer? With all the stories of medical malpractice and errors made, is it safe to go into the hospital without an advocate? And if so, is this the way we really want it to be?
Some major changes need to be instituted in the lengths of hospital stays and letting the professionals, i.e. the therapists, decide when the client is safe to return home. The important issue is the client’s safety. Is it cost effective to send someone home too soon only to have him or her back in the hospital after a fall? Some drastic re-thinking needs to be done if we are going to ensure the best possible health care for our loved ones and ourselves. Perhaps hospitals, rehabilitation centers, and nursing homes should provide a client with an advocate should they chose to have one. It is a scary proposition going into a hospital without someone to make sure the right decisions get made in your best interests.
Jan Judge, who has been diagnosed with Secondary Addison’s Disease, began another taper from prednisone on January 7th, 2005. She gave up her position as a physiotherapist due to ill health. Jan is the coordinator of the NJ/PA Support Group and has written a number articles including this one that have been published in the “Physical Therapy Magazine”. Jan graduated with a Bachelor of Science Degree in Physical Therapy in 1978 from Temple University, Philadelphia, PA.
For additional information:
Please feel free to contact Jan at: JanPT@aol.com
Or the NADF at: The National Adrenal Diseases Foundation
505 Northern Blvd.
Great Neck, NY 11021