Last week or so, my uncle had an assisted fall at home. As he was picked up, he got a nasty cut because he wouldn't hold still and he scraped against something.

It was actually a good thing this happened because the ER did blood work which showed low sodium. This required a two night hospital stay. We don't know why the sodium was low, could've been from a UTI that was being treated with antibiotics.

About a week later we went to the doctor as instructed for follow up blood tests. They expedited the results and the sodium was low again - 122. The doctor sent us to the ER across the road.

Uncle spent two nights at the hospital. On the day he was to be discharged, an occupational therapist came in and was rather nasty to us. She said that we needed to show her that we could care for uncle at home or he would be sent to a rehab facility. We were dumbfounded because they never made us do this after he broke his ankle. We asked why this was and the OT got even more of an attitude. She said it was because this was the second ER visit in a week. We said that it wasn't our fault, the doctor sent us here because of low sodium - something beyond our control.

I could understand this rule if it was another wound or broken bone, but it was because of blood work. In fact, both times he was admitted was because of blood work.

We were required to do transfers to and from the bed without putting his weight on his ankle. I explained that the set up at home was different but we would do the best we could. Thankfully we passed even though the chair moved when we transferred to the bed. The equipment we have at home does not move.

I later found out that in the 24 hrs prior, they had moved my uncle out of bed and he fell to the floor. He has a bruise on his hip. It took four nurses to move him back into a chair. They were shocked when I ( a small female) was able to do transfers by myself without problems. He weighs around 94 lbs. and is about 5 feet tall.

Anyway, has anyone encountered a rule like this? I asked the nurse about it and told her what happened, but her answer made no sense. She's actually the one who let it slip out about the fall, though she didn't actually use the word "fall."

As a side note, he also came home with a bed sore on his butt because they neglected to turn him every two hours. They left him laying on his butt for three days and two nights. We also had to explain to the OT that at home he sleeps on his side for 8 hrs a night so bed sores have never been a problem.

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I'm not totally clear as to whether or not it was the same hospital for both stays and if not this might have contributed to any lack of communication or detailed info about the first stay. Still it sounds like you agree that a system that flags a senior making back to back trips is a good thing in general. If he was only there 2 days they likely didn't have a chance to get to know you well enough to be sure a higher level of concern wasn't necessary and I don't mean concern that you are neglecting or hurting him but concern perhaps that the family is in over their heads or not properly aware of the proper way to make transfers or keep him from tying to get up on his own (if he does that and shouldn't) so covering that base very thoroughly is in the hospitals best interest as well as the patients of course. "Fall" or Fall Risk are glaring words hospitals tend to be very focused on and those labels stick with a patient.

Now that doesn't mean it's OK for the OT or anyone else to be nasty or accusing about it. To start with while the OT is sent to do an assessment and his or her recommendations are important, in my experience they don't have the last say or any power to order a patient to rehab a doctor needs to write that order. But it's also been my experience that OT's and PT's are very helpful and try to pull any strings they can to be helpful as well as fill in info when you ask and treat them well. Your unfortunate experience may have been a combo of things, the perfect storm if you will,maybe you got this OT on a bad day or time, maybe she took your confusion and questions about why this was all necessary as you being uncooperative or nasty to her and maybe it's as simple as your personalities just didn't jive. Don't get me wrong it is not your job to make her comfortable it is hers to take the best care possible of her patient and that includes his family and keeping her bedside manner in check. In the end though it doesn't sound like there was any real issue other than the frustration of having to prove you are able to do the things needed to care for him at home unless I'm missing something. If upon reflection you still feel in your gut that this OT has a horrible bedside manner and wasn't just having a bad day it should be addressed for the benefit of other patients and families with the hospital. I know our hospital always gives us an evaluation for or on-line access to give feedback about the stay and this is where I would clearly voice my experience and concern.
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Your stories aren’t consistent in your questions or your posts. One minute it’s not a fall, then it is a fall. First story was he had broken fingers, now it’s just a nasty cut. You ask the internet how to transfer him due to a broken leg. Anemia? Low sodium levels? Pee pads instead of diapers for your grandmother? And it’s really curious that your cousin didn’t want anyone to document the fall for “insurance reasons.” To be honest, I’m surprised the hospital didn’t start asking questions sooner.
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Careful documentation with names, dates and full details in a diary and I hope you already have that. This isn't good. This is one person, but one person can cause a world of woe. You need to document ALL of this in a diary DAILY. Trust me, this may be needed.
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I would send a letter to the administrator with only the facts and word it in a way that you want to bring to their attention the poor care patients are receiving in their hospital. If people don't speak up they don't know that people are developing bed sores, falling and staff has an attitude problem. We all have bad days, but being harsh when people are in the hospital dealing with a loved ones illness is unacceptable and there really is no justification for it, neither is letting someone develop bed sores. Falls happen, so that one is a little tough, could have happened to him with anyone, but not telling you is problematic.

I always appreciated when a customer told me what was taking place on a job site.

See something, say something.

These people are dealing with others lives. They should be held accountable for their actions.

I have found that hospitalist work in the hospital because they can't deal with a practice. They shouldn't be practicing medicine in my opinion.
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Under ACA provisions, the hospital is paid less for care when a patient is readmitted a second time, regardless of reason, and even less if there is a 2nd re-admission within 30 days. So if your uncle is released from a hospital and injured in a car accident the next week and ends up re-admitted to the same hospital, the hospital reimbursement rate for both stays is reduced. Sending your uncle to rehab, even if the total cost of care is greater, could benefit the hospital because it reduces the chance of a hospital readmit. Some hospitals even go so far as to push for rehab in a facility where there's another hospital closer to the rehab so any re-admit would be to a different hospital.
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JoAnn29 Dec 2019
I have heard something like this. Good to know.
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I agree with CountryMouse that a flag was created by the second fall.  I suspect that hospital records are programmed to flag something like a return event so close to a prior one.

Then the staff have to address the issue, and I suspect that's part of hospital protocol.

There was no reason for the OT to threaten you, however.    Something like that occurred when my father was hospitalized, and one of the baby doctors (my insulting nomenclature for a resident who isn't up to par) was trying to encourage my father to agree to hospice, raising religious issues and completely going off script).   She was a resident with a rounding doctor who also was offensive.

So I told her that I thought she was making observations and determinations that were not w/I her scope, that she didn't know enough about my father's history to make those determinations, and that I thought it was appropriate that she leave before REALLY offending me.    Then I reported her to the charge nurse, and also advised that I didn't want either her or the doctor involved in my father's treatment.   So Dad got a different doctor.

The issue wasn't necessary what she was advising; it was her arrogance in the obnoxious presentation of her baby doctor issues.     She wasn't an experienced practitioner; she was still learning, and had  a long way to go, especially in patient relations.  

In your case, I would contact either the charge nurse, or go directly to the hospital administrator and take a similar approach.   I.e., that the OT may or may not have been right, but her hostility created an unpleasant environment and mitigated against any advice she might offer.  In  addition, it was unfortunate that the staff wasn't more attentive to prevent a pressure ulcer from developing.

You might also ask why no treatment for that issue was suggested, instead of just focusing on the AL issue.   And what changes they'll make to ensure that other patients don't fall out of bed.   

I would even be so brazen as to infer that an OT's recommendation held little significance when a patient had not been moved for 3 days.  There's no excuse for that.

That hints at your dissatisfaction and potential action.   That should result in some action, but if you have a preferred hospital, consider that option.
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KateH2 Dec 2019
Thanks, but there was not a second fall and the first fall was an assisted fall. The only reason he was admitted to the hospital twice in a week (11/26 and 12/3) was purely because of low sodium. The second time we were told to go there by the family physician. Oddly, a hospital doctor said it was not low enough to be a concern - it was 121.

Our issue with OT was primarily her attitude and tone of voice. She came at us like we were criminals charged with some heinous crime. We were upset and scared, but not angry. We wanted to know why we were required to demonstrate a transfer now and not after the assisted fall. She kept saying the same thing - because we were at the hospital twice in a week's time. I tried rephrasing the question and was met with even more hostility. I do not believe there was anger in my voice, emotion yes, but we did not display anger.

She did not have to come at us like that, there was no reason. It makes me wonder what will happen this coming week when/if my uncle gets his sodium tested again. The hospital doctor wants us to put my uncle under hospice care. Since he's been home from the hospital this second time, he's been drinking beautifully.

The concern with sending my uncle to rehab is with his Alzheimer's and not drinking enough fluids. We are certain that he will deteriorate in a place like that, especially if he gets the same care he got in the hospital. The hospital did not provide adequate beverages. They gave him 4 oz. of beverage three times a day. This was both before and after he had been off IV fluids for more than 12 hrs. They ask him what he likes to drink and he answers with water, even though he will not drink it. The family always tries to encourage him to drink. We offer him many beverages a day. Now that his UTI is cleared up he drinks more beverages, but still needs encouragement.

He also has no idea how to operate the TV or use the call or page button. At home he knows how to do this, but not in a hospital. He needs care that a rehab place or nursing home don't provide. They like for people to think they provide such care, but they don't. I've seen firsthand how these places treat residents who have memory issues and it's deplorable. Even my uncle's doctors said they would not stick their own parents in these places. That speaks volumes.
I understand your puzzlement, but is there a reason you didn't take up the occupational therapists "threat" of sending him to a rehab facility? I would have loved to have had that offer of more help. Family member gets skilled treatment and caregiver gets a break. why didn't he go to rehab?
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Your uncle attended the ER twice in one week. The system flags this up as something that wants checking out. The system does not say anything about "whose fault it is." The OT explained that because of the alert, she was required to make sure your uncle would be safe to be discharged home.

What's "nasty" about any of this? What's the problem with the health care system's making sure that your uncle can be looked after at home?

If your uncle develops a pressure sore and needs turning every two hours when he is on a hospital mattress, he is very frail. Setting aside your own input for a minute, is your cousin confident about handing his care?
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