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My mom went on hospice in October. She has dementia and lot's of respiratory issues. She had been wincing when she swallowed and we asked the nurse to check it out. They did a swab (like 3-4 weeks ago) and results came in as MRSA. The AL called the hospice staff and told them to get her out of the place. (My words, but AL's meaning). Hospice took her in their in-patient unit. But they don't want her (no symptoms to treat) so I've been told they will be speaking with me tomorrow about a discharge plan. AL won't take her back til labs are negative. That will be 3 weeks. (AND yes we have to pay in the meantime!) They are suggesting SNF, which can do isolation but nothing else. My spouse has a compromised immune system, so I don't feel comfortable bringing her to my home. My Mom is 95+ but seems to have many days of surprising strength, so while anything can happen, she is not down for the count right now. Sibs are useless. Looking for everyone on this site who can share their wisdom and experience here. I want to be prepared for 'discharge discussions." Thanks

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Vonette, thanks for your input!

I'm pointing out that this thread is three years old, just so people don't start offering advice to the original poster.
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ALF's cannot do isolation the way SNF's and acute hospitals can. Unless the MRSA can be contained with a dressing, catheter or mask; then ALF policy is to move patient to these other levels of care for protection of the other residents. Dressings get soiled and come off, patient's take their masks off to eat and don't stay in their rooms.(Usually dementia), and catheters leak. Patient gets a private room in SNF or Acute Care Hospital and gowns, gloves and masks are used, even booties on the feet. Sometimes goggles if it's respiratory. It protects everyone. I would say 3 weeks in the minimum amount of time to resolved MRSA it can be longer and can become colonized even. Then every time she gets a cough, she will be tested and moved.
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..my apologies: I mis-used the term "sitting shiva".
That refers to a period of mourning after death.
We went thru sitting there watching Gma die, due to the facilities' mishandling of her case/care.
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ALSO, in that particular sort of mayhem Systems can create:
Be prepared to strongly advocate for your elder--and know that all the best advocacy still may fail.
We were unable to advocate strongly enough for ours, years ago:
their game of "hot-potato" literally killed Grandma.
She fell, went to the ER w/ mid-back pain;
the ER Doc refused to order Xrays of her mid-back, so I pleaded w/ the Xray Tech to overlap the upper and lower Xrays, to show the mid-back
--of course, that was where the break was, but the Doc was not listening--he was only cursorily reading her chart, discussing upper back and lower back issues, discussing other non-related issues...
[[plus, I think he was one who graduated far below the 50%]]
She was admitted, bedridden, then almost immediately shipped to a SNF.
the Hospital sent orders for meds by mouth--only Gma couldn't swallow properly by then, and, the orders stated she could get up and about unassisted, sit up, etc....all lies. I had to advocate again to the director of nursing at that SNF
The SNF director was furious to learn how the hospital had so flagrrantly lied--and indicated it happened all the time.
The SNF, of course, shipped her back to the hospital.
We ended up sitting shiva until she died several hours later, but at least, she had an on-demand morphine drip by then, and a Hospice nurse.
She'd been left in fierce pain, until that.
That entire charade took about 3 days.
It was absolutely malpractice, but, the hospital and SNF covered their tracks so well, lying on record, there was little we could to.
Hospitals DO lie on records.
Staff can & are coerced to re-write charting if the nursing supervisor thinks the charting might cause any hint of problem for the facility. Charting has been reduced to the bare basics, trying to avoid any mention of any bit that might indict a facility.
Charts can and are changed to reflect better on a facility, if any hint of legal action is in the wind--even if they have to fake it.
Increasingly, large corporations have gotten legislation passed protecting them from litigation /malpractice /restitution.
[[speaking from experience]]
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NH=nursing home, DH=darling husband, sil=sister in law,bil=brother in law, btw=by the way, AL=assisted living, IL=independent living, DS=darling son, DD=darling daughter, SNL=skilled nursing facility.
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Naturally when some is in nursing we get use to using abbrev..its something we pick up
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Our managers at the hospital used to get yearly bonus's for coming in "under budget." If they have one patient that is draining resources they are going to try really hard to dump that person. Passed around like a hot potato is a good description. That is why we have to advocate for our loved ones, it is only a numbers game with the medical field, there is no real compassion. (((HUGS)))
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Totally true and they will not let you know that little gem. I was an RN for over 30 years and know all the tricks. Stand your ground, do not be intimidated. As they say the s--- runs downhill and the administration goons are only interested in $$$. When you are talking to a social worker they are pressured from administration to get rid of your loved one! They want you to take her home because of the above statement - you will be stuck.
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DO check her contract, to see if there is a removal clause if person is sick with communicable illness....but...

1. The facility that currently has patient in their custody/care, is ultimately legally obligated to keep them, OR find her another facility
--otherwise, they can face "patient abandonment" charges. Tha family is not the cause of her MRSA, and cannot be forced to take her in, especially if it endangers others in the home [other elders including yourself, children, any with decreased immune function]

2. It is irresponsible for any facility to demand a family take their elder into their home, especially when others in the house are immune compromised, and the elder in question has MRSA, or any other communicable ill.

IF a facility forces a family with immune compromised members, to take the sick elder into their home [they really cannot force it, but can make you feel that way], they can also be charged with endangering other patients [at your house].

This kind of case is why those laws were made.
[[ask them: what does the facility do if a patient has no family? put them in the street?]]
Put your foot down to the discharge planners/social workers, and
==make them put note on your elder's chart that:
"Discharge to family's home is impossible"

UNFORTUNATELY, it may mean your elder gets passed from facility to facility, like a hot potato.
Facilities DO have responsibility to other paitents, sure.
BUt they also are responsible for your sick elder, no matter what the contract says.

If it means quarantine in a private room, or moving them to a different facility to handle it, that might need done.
UNfortunately, there is no good way to handle it, given how our systems are set up these days.
There are usually consequences of moving elders around--even rooom to room, as they get more confused, and sicker, often.

ADVICE: if you buckle and take her back into your home, under pressure from the Discharge Planner, NO facility will take her back, and you truely WILL be stuck. [[that's what I was told, and observed, over the last 25 years]]
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This makes me so mad. A hospital killed my brother in 2007 with MRSA (pacemaker implant). And they never even were required to put it on the death certificate! He had to leave the hospital and be in isolation for six weeks before he was sent home. Then he had a massive seizure at home, was readmitted to hospital (in isolation again), and later died of sepsis and multiple organ failure (official "cause of death"). More recently, my mother was hospitalized for a head fall in 2010 (minor, could have been sent home from ER), kept for IV hydration and UTI antibiotic administration for 5 days. Little did I know she could get C. diff easily thanks to the Levaquin. So when she was discharged to a nursing home for rehab the following day, they caught it (diarrhea and the smell was unmistakable), and she was immediately sent back to the hospital for five days to clear it up. Well, she has had it twice since then, both times after getting IV antibiotics for UTIs. The second time was this past December when she was hospitalized for a stroke. She had a minor UTI but they still thought they should put her on Cipro IV for three days, and when discharged to nursing home for rehab? You guessed it, they found C. difficile! I took her home and treated her at home with Flagyl and probiotics and got her cleared. This third time was last month when she was again admitted for another UTI. I had had her checked prior to admission to the hospital by her primary physician, primarily because she was scheduled to enter an assisted living facility, although the staff at the facility did not require her to be "negative" and said they would instead take precautions. Her test did come out negative for C. diff and that was just a week prior to admission to the assisted living facility. She ended up leaving the assisted living facility after only two days because the staff dehydrated her and it turned out she had a raging bladder infection that her primary had not bothered to treat (and had not even bothered to obtain a sample via cath), although I had had her in his office just the week before and had mentioned I thought she had a UTI. She again wound up on IV antibiotics (this time it was Levaquin again) for five days. The real kicker was I told the hospital to collect stool while she was there, and keep her on Florastor and check her for C. diff due to the previous infections BEFORE she was discharged so we could put her on Flagyl or Vanco right away. The attending physician ignored my request, never tried to collect a sample and as we put mom into the car to go home upon discharge she let go. I collected the diaper after getting her home and cleaned up and took it back to the hospital. It was within an hour of discharge and still they said they didn't know what to do with it because she had already been discharged! So the suggestion was to bring her back to the ER! I did, and after being there for four hours, no diarrhea, no sample collected, just a cath urine sample to be sure the UTI was gone, we were sent home with a specimen kit. A few days later I returned with a sample and sure enough, C. difficile was reported two days after that. Now she is not only on Vanco but the adult day care center she was scheduled to enter tomorrow had to train staff how to handle her if she has an "accident", AND I had the ER doctor call me at home today to talk about "fecal transplantation"! I had filed a complaint with the BBB and talked to a law firm in the interim. I let them know this through the ER staff and the Patient Relations Advocate and so they are trying to fix this problem, which they started, and which has led to a revolving door between my mother's UTIs, leading to C. Diff and back and forth until I am worn out and so is she. Now we are on a preventative dose of Macrobid for the UTIs AND the vanco for the C. diff. And it's all the hospital's fault, but they won't admit it because of Medicare's "never event" policy, which denies payment to any hospital for a readmission for treatment for anything they have caused. As it is we had to shell out over $450 for the Vanco prescription that the hospital SHOULD have given her upon discharge so insurance could have at least covered that. Now the ER doctor assures me the hospital can perform the "fecal transplant" free of charge if we use an "approved donor" ($2000 extra if I donate the material). Of course, there are risks of perforation, aspiration, etc. with that procedure not to mention I do not want my mother to have any form of anesthesia that is not necessary! And it may or may not work, in any case. The hospitals are spreading disease and have so many ways around their own liability it's disgusting. We need to approach this as the UK has been doing -- their incidence is far lower than ours. Incidentally, this hospital was recently featured on local news as having gotten their C. diff "problem" under control with bleach wipes. I called the news station to tell them my experience AND I called the hospital to tell them I had done so. END THIS SUPERBUG EPIDEMIC. MAKE A LOT OF NOISE!
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Thanks everyone. I will check the contract but I suspect they covered themselves fairly well with respect to this.

Sorry about all of the acronyms, I guess I have been at this so long and on this site for so long that it's become my 'shorthand'. BTW, I did mean 'by the way' for BTW. : - ) and 'because' for b/c.
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When looking for assisted living for my mom years ago, I questioned staff as to what would happen if she developed C-diff or MRSA or any other type of contagious disease. Many said that she would need to go to the hospital or nursing home until tests came back negative. A few said she would be able to stay in the AL however; she would be confined to her room and no visitors from the AL facility residents. Check the contract that she/or you signed when she began living at the AL, it should state what would happen in that event. Also, since so many of the AL put on an extra fee for bringing meals to the room, etc. I found that some of the AL said that would have to be added on the bill during the time of confinement, while others stated that because she would be in mandatory confinement to her room that extra fee would be waived for that period. Check her contract - may give you guidance there. Also this is good advice for anyone on this site to consider BEFORE they go into an AL. The AL I used also had a provision that should she need to go to the hospital and stay (for whatever reason) in order to reserve her room at the AL the bill had to be paid for ONLY the rent - not adding on any charges that she normally had for bath assistance, dressing, meals, etc. since she would not be using those things while away from the facility. Just some things to consider when choosing an assisted living facility - they all have different rules and conditions, unfortunately.
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PLEASE.... I'm new to all this - so por favor, stop using abreviations in the post until you have spelled out the first usage? In other words, make the first useage something like this:
New Hampshire (NH)
Senior Living (SL)
etcetera (etc)
(the obvious, like MRI or HEP B or TB, is of course, well known. The other terms may be familiar to the writer (sorry that you actually ARE familiar with horrible abbreviations like MRSA...I always just HEARD the term, and thought it was spelled Mursa or something, never knew it was an abbreviation...dumb I guess. Thanks)
THANK YOU SO MUCH! Hugsies (HUGS)
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Stand your ground with the administration. They can talk about "discharge plans" all they want - you still have to agree to take her to your home. If she is admitted to the hospital it is THEIR responsibility to find placement if you are unable to take her home. Do not let them bully you. Tell them until she is negative they need to find her a safe placement. They are just trying to get you to take her out of there and once you do there are multiple problems with readmission. Good luck to you and your loved one and a pox on the medical profession.
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rural - well about the NH, they just didn't know what to do. Your mom's place seemed to approach it as they would for other respiratory infections, like influenza. They probably got a notice from the state health department with a series of things to do in case of respiratory outbreaks. So it's a case of "hey lets's do this...".

CRE is carbapenem-resistent Eneterobacteriaceae bacteria. Very scary.

The whole "superbug" situation has facilities all in a dither as how to approach; for MRSA and C Diff at least there are tests routinely done. Personally, I'd like to see Katherine Sebilous do an emergency mandate for CRE testing for all patients over 50 who enter a hospital. At least this would create the start of a data base and then you can follow the outbreak patterns and the effectiveness of what was done. Back in my old life, I was in health planning and worked on a study involving Colistin. Scary drug as far as your kidneys go, so got out of favor. Colistin seems to be only antibiotic that's effective with CRE. Effective doesn't mean cure but rather allows it to be manageable.
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GeeWhiz - well that is good news and I bet you've let out a BIG sigh of relief. It's interesting about the MRSA and how they handled it. My mom is in a NH and they have a new MRSA protocol. I don;t know if this is for all patients, my mom has extremely low WBC and she has always been this way, so I think this is why I was told about it. Because of her WBC she is viewed as immuno-compromised. Long story short, she is still in her room but has a new roommate and she too is immuno-compromised (according to her son). I've noticed alot of the other names have changed on her wing. I bet the NH is regrouping residents because of future MRSA concerns. I do know that the residents who get really sick are moved to the first floor which is shared with the "new" in for rehab residents and there is more nursing staff there.

If your family needs to go into a facility, you really should look to NH rather than an AL. You know AL has a totally different playbook than a NH does. AL (like an IL) can just do a "30 Day" notice and well, it's just too bad for family. AL since it is usually private pay, can set whatever terms. (Now if the AL takes Medicaid or is in some sort of state voucher system in which Medicaid is involved they can't do this as easily as a 30 Day). BUT a NH has totally different regulations and if they take Medicaid and Medicare, then they can't do a 30 day. NH has to find a comparable facility with the ability for complete care and work all this out with agreements between the next facility, the residents personal MD, family etc. And no NH is going to take a new resident who has MRSA. OK maybe a leper colony (LOL) and the last one was closed ages ago (I live in Louisiana and have been there - just gorgeous site and adjacent to white-collar prison and a Catholic retreat)

MRSA is scary and then there is the whole clusterF with CRE and how that doesn't get reported (there is NO Medicare billing code for CRE so it doesn't get reported so therefore no epidemiology followup and so no info to look at to see if it is increasing and what co-mobidities are involved). Personally I bet 30-40% of the C Diff infections are CRE.
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AL - assisted living
SNF - skilled nursing facility
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I don't understand your nmemonics - what is AL and SNF. BTW means by the way to me.... My Mom was in the hosp and the NH/Rehab for stroke, developed MRSA. All of a sudden, we had to wear yellow smocks and gloves to cover ourselves when we went in the room. Had to remove them and throw them away if we left the room for a moment. Told we should not eat there with her. Unfortunately that was the least of her problems. But I found that while these things are extreme, they were so loosely enforced as to make me wonder why they bothered. The aide who took her to an MRI had no yellow smock, and I wonder how they could prevent the infection from being transferred via the MRI machine. Sounds like a windfall for the people who sell yellow smocks.
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When I first posted, the current location was already talking discharge. With some new developments, they have backed off. Time will tell, thanks for taking the time to respond.
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Can you just keep her where she is for another three weeks, doesn't seem too much to ask for and then perhaps the labs will be negative?
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