One of the areas I find the most resistance to a patient advocate is skilled nursing facilities and nursing homes. I have become accustomed to the initial chill and suspicion of the staff. My early on nursing home visits or phone calls had me befuddled. It was very difficult to get information or access to the chart even with a HIPAA form.
It doesn’t change from one facility to another. Each new facility I visit, it is the initial same response. I have learned to be patient, friendly and cognizant of the institutional protocol and pecking orders. Staff gets used to seeing me and slowly the chill thaws. It doesn’t necessarily mean I am going to get any quicker results when I make a request.
I do everything I can to engage the staff and communicate the family’s wishes. I do my best to get the necessary care changes acted upon. I am not always successful. When I don’t get results, I talk to administrators who seem always to want to support my requests. I’d like to say after these meetings my requests are put into action. Not always the case.
Nursing home doctors are often the most resistant. I had one doctor tell me he didn’t believe in patient advocates. I asked him why. He said that was his job to advocate for the patient. He went on to say, the staff calls him with any changes and he then takes care of any issues. I’d like to think, in general he was right, but my experience visiting many institutions, tells me otherwise.
It is predictable that at some point, the family will be approached by an administrator and told how they always have their loved one’s best interest in mind. They go on to say how they are constantly reassessing care plans and providing the best possible quality care.
Then comes the classic line (and I have heard it multiple times repeated to me) Why do you need an advocate when we are doing everything for your loved one?
I used to get irritated when my clients would tell me about the conversation. Now, I chuckle and realize I am doing my job.
So much of the problem is communication. It seems to be inherent in all institutions that information is not communicated in a timely fashion, if at all. Most of my clients engaged my services because of repeated interaction and communication failures with staff and administrators. The families become frustrated and angry at the lack of timely response to any requested changes.
Here is my sage advise to families with loved one’s in nursing homes: be vigilant with requests and don’t back down. When all seems lost, call the local ombudsman or the state Department of Elder Services. And if need be, hire a patient advocate. It will help to relieve the stress and pressure.