Trach collar, Parkinson's disease, hearing-aid, feed tube, first month was alright. Stopped OT/PT by end of February 2021, cause she is not responsive, (not replacing batteries in her device). Has had pneumonia twice, had a wound infection that they can't stage because it keeps getting worse. How can we get her transferred to a better facility? I'm informed that she can't get transferred unless she has a doctor at the facility we want her transferred to. How is that possible if she doesn't have a doctor there? The administration at the facility she's in told us this, we are so confused on this process and don't know what to do. Any help please.
I see the trach and the feeding tube being a problem in transferring her to another facility. YOU need to find a better facility. Its really not up to the facility where she is to do that for you. Most facilities have a doctor associated with them. Its if the facility can do the care she needs. Also, that bedsore. They are very hard to heal especially if at the base of the spine. There should be a qualified woundcare nurse. She should be on an air mattress and turned frequently. If that sore started at the facility, they are responsible for seeing that it gets healed.
Nursing facilities are not prisons. If you find a better place, then you will be responsible for the cost of transporting her. There is no law that says you can't.
When I had to locate a facility that could handle a trach and tube, I found literally less than a dozen within driving distance of the major metropolitan area in SE Michigan. Most admitted they were not prepared to treat or care for someone with a trach and tube.
That could be the primary obstacle you face in attempting to find a different facility.
I don't have any insight on a wound that can't be staged; but there should be some means of treating it to at least keep it from worsening.
If she is in a step down facility, (and based on recollections of about 18 years ago), it has be determined that she's capable of improving for the primary reason she's there, which again, would be the weaning off the trach and tube.
Reasonably, and safely, I doubt that the staff and decision makers in that kind of facility would agree to transfer someone who needs that high level of attention, although I'm not sure how many facilities like Select Specialty exist.
As to the confusion you're experiencing, I can certainly understand that. There is a stepdown procedure, which existed at the time we were involved: acute care hospital to long term care hospital, to rehab facility, to home, with home care nursing and rehab.
Perhaps some background would help: how old is your mother, what was her condition before the events that required a trach and feeding tube, was she hospitalized for those conditions, and were any of them cured?
I ask b/c my father underwent a similar kind of situation, beginning with multiple co-morbidities shortly after my sister died of cancer. He was hospitalized, intubated, put in an induced coma, and eventually about 3 weeks later came out of the coma, despite the advice of a pulmonary doctor and ICU nurse that I should make terminal arrangements. I knew my father better than they did though.
Some rehab and care was provided by the acute care hospital before moving him to a long term care hospital. MRSA and VRSA entered the complex mix and caused more complications.
Long story made short, this was a 7 month hospital journey, then to home with rehab support, eventual decannulation, and gradually back to normal, including eating. It was a long and emotional journey for both of us, but Dad survived, walked again, and by the end of the following year was back working on the shed he built.
A lot depends on the strength, perseveration and stability of the patient, as well as family and friends support.
I don't know the specifics at all here, as you do not give them, but you are dealing with a person who clearly is very loved, and who is not getting better. Artificial means are already being used to keep life going. I hope that family is speaking with the MDs, social workers, and possibly with counselors to help adjust to the fact that they may be unable, no matter what is done, to save this loved one from the finality that comes to us all.
I think that the rules of transfer may be a simple matter of coverage. I am uncertain. If you are able to self pay it may be easier. Few people are wealthy enough to do this, and I think that you do need to consider that this may not be a matter of WHERE, but a matter of the overall condition of your loved one.
I am so sorry.
I am uncertain what you mean by "they are not replacing batteries in her device". Hope you can enlighten us on that one, and on whether social services has helped you in exploring options for end of life care. It sounds as though the person you so love may not make it, and it is important to decide what would be easiest for the loved one and what they would have wanted. My heart goes out to you. This is difficult to see.
If the lady has a trach collar and a feeding tube (is that a PEG, one that goes through the skin on her tummy?) and she has Parkinson's then it sounds as if there might be other difficulties in supporting her with PT besides faillure to replace her hearing aid batteries. I agree and sympathise that stopping the PT, especially, may have made her more vulnerable to pneumonia and pressure sores simply because it will have reduced her opportunities to keep mobile.
The standard of care you describe does sound pretty poor, actually. There are formal channels for making complaints, or are you just focused on getting the lady out of there?!
PS On second thought, that may be very unfair to her current facility. Why the trach and why the feeding tube - what happened in the first place?