You or a caregiver want to come across as someone who can make it easier for the doctor to do his or her job -- versus someone who's a nuisance. You want to build trust, not annoyance.
Q: What about skilled nursing facilities?
A: These are settings that people go to after the hospital, to get rehabilitation. Typically, the contact with doctors is minimal after an initial evaluation, though there's a spectrum as to how much medical care there is.
A subset of older adults go to rehab just to get physical therapy after they've had a joint replacement or a hip fracture. They are really pretty stable, medically. If they get good physical therapy and nursing care, it's probably OK that the doctor isn't around much.
But there are also older patients who come to skilled nursing facilities, or SNFs, after having had one complication after another in the hospital. These patients can be very fragile, with many medical problems. They're at risk of getting some new problem in the SNF -- perhaps an infection -- or an exacerbation of one of the problems they already have that hasn't resolved.
Q: What do you recommend?
A: When you arrive at an SNF, it's a new cast of characters. A physician whom you'll see fleetingly. Nurses. Physical therapists. Aides. If you're a caregiver, make sure you have face-to-face time with these staffers.
SNFs are required within the first week or so to have a care planning meeting with the team. They're supposed to invite patients and their representatives to the meeting. This is a good place to say something along the lines of "My mother has been through a lot, and now that we've met you and seen what you can do, we'd like you to do your best to treat her here and not send her back to the hospital."
You have to have trust to make that happen. The family has to trust the medical team. And the team has to trust that the family isn't going to get upset and sue them. A meeting of this kind has the potential to allow everyone to figure out what's important and what the plan will be going forward.
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