Hi, it’s Patrik Hutzel from intensivecarehotliine.com where we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, get peace of mind, control, power, and influence fast.
So today, I’ve got an email from one of my clients, Joy and Joy has a question and a situation that she needs help with. So let me read out Joy’s email and then I’ll answer her questions.
So Joy writes: Hi Patrik, my 83-year old aunt was in fantastic shape but suffered a major stroke in the first week of September. She was on a ventilator through her mouth. The stroke happened behind her right eye and left her unable to move her left arm and leg, but she can still see out of both eyes and turn her head.
Weeks later, they discovered the source of the blood clot, a massive benign tumor in her left aortic ventricle. She underwent heart surgery. They stopped her heart and removed it and blocked off that section. She began to recover and they graduated her to a tracheostomy but was never properly inserted, so her vitals were always through the roof.
Then one day she flat-lined and they realized she’d not been getting enough air the entire time because the tracheostomy malfunction due to improper installation. They did CPR and brought her back. After another stint in ICU, breathing is finally normal. She’s been on the ventilator since September the seventh and it’s now November the fourth and she finally was well enough to be moved to a physical therapy facility as of yesterday.
The tracheostomy is still in, but we are hoping now that the pneumonia and fever are gone and now that her breathing is really good and they will try and wean her off again. She is responsive and can squeeze my hand when I ask her to. We’d like to see her backup and independent enough to where her daughter can hire a nurse to care for her at home. What should we do next?
Well, thank you, Joy, for your question and describing your aunt’s situation. Well, where do we start? Well, I’m very glad that they finally discovered the source of the blood clot and the stroke and that she underwent heart surgery. You made a comment that they stopped her heart.
They, most of the time do always stop the heart during cardiac or open heart surgery by putting people on a bypass machine. So yeah, they can bypass the heart and still keep people alive by doing that.
I can imagine that this would have been a long recovery, and I’m not surprised that your auntie had a tracheostomy eventually. It’s disappointing to hear that they didn’t properly insert the tracheostomy and that there were complications. Most likely from what you are sharing, got your aunt to have a cardiac arrest because she probably, went into respiratory failure because of the tracheostomy not being inserted properly, that’s a major event.
And potentially being paused by medical negligence, something you may want to, you and your family may want to investigate down the line. We can help you with that. For example, by reviewing medical records and we can find out very quickly if there has been medical negligence or not.
So, you are then saying that your auntie after the CPR and after having the tracheostomy inserted properly, that she’s been on the ventilator since September the seventh, and it’s now November the fourth, so you’re talking about two months of ventilation. Finally, she was well enough to be moved to a physical therapy facility but she’s still not off the ventilator.
So, and now that her breathing is better, they will try and wean her again. Now you’re telling me that she’s responsive and she can squeeze your hands when you ask her to and that’s all good. So, and you asking that you’d like to see her backup and independent enough to where her daughter can hire a nurse to care for her at home.
So, there are two things that I can see, Joy that I believe are incredibly important. Number one, your aunt has gone to what’s probably an LTAC facility, long term acute care, and they’re trying to wean her off the ventilator there. Now, the reality is most LTAC’s are not designed to wean patients off ventilation. They are often a better version of a nursing home.
So what that means is patients go from ICU or intensive care to LTAC’s. They’re going from an environment where there’s critical care doctors, critical care nurses that are really well trained to look after ventilation, tracheostomy. They’re trained to wean patients off ventilation. They’re going to an LTAC, which is again a better version of a nursing home.
And they’re going there often for financial reasons and not for clinical reasons, because, the health funds don’t want to pay for the ICU bed any longer. And the other thing that needs to happen in your aunt’s case if she had a stroke, she also needs to have some neuro rehab, some neurology rehab especially, after the stroke.
So, and often weaning off the ventilator stands in the way of having neurology rehab, right? Both is important of course, but it’s sort of the chicken and egg question. Which one is more important? Which one is first? Is weaning off the ventilator more important? Is the neurology rehabilitation more important, right?
Both are important, but you know, we can often only do one instead of the other. And again, most LTAC’s are not designed to provide neurology rehabilitation. So one of the steps for your family should be to ask the neurologist of what their plan is from a neurology point of view to get your aunt into neurology rehabilitation for the stroke.
In terms of weaning off the ventilator, again, from my experience, LTAC’s are not designed to successfully wean patients off ventilation. Again, there are better version of a nursing home. They often don’t have an ICU attached to it, and furthermore, LTAC’s are often far away from people’s and their family’s homes because you know, there’s not that many LTAC’s close to your home.
It’s just the reality again, with dealing with that on a day by day basis where people ask us, you know, or should we be agreeing for my mom, for my dad to go to LTAC after their stint in ICU after they had a tracheostomy. And my answer to that is simply no, because again, we hear horror stories from LTAC’s all the time. And the outcomes are not good. So what’s the solution to that? Well, the solution Joy really is to look at options like intensive care at home.
So you’re talking that your aunt’s daughter is already thinking about hiring a nurse to care for her at home. And again, that can be done even now while your aunt is on a ventilator with a tracheostomy, right? So, have the ICU nurse come to your home. Have ICU nurses coming to your aunt 24 hours a day, get your aunt out of ICU and wean your aunt off the ventilator at home and again, and potentially have rehab services coming to your home as well, to focus on the neurology rehabilitation side of things. So, that’s really the solution to your problem.
You know, from a cost perspective, the health insurances are paying $5,000 – $6,000 per bed day for an ICU bed. Home care is about half of the cost of an ICU bed. It might be a little bit more expensive than LTAC, but nevertheless, your aunt will be in the right environment, and she’d be surrounded by the skills that she needs, which is ICU nurses, and she can have a respiratory therapist coming to your home and all of that.
So it can all be done at home in a much nicer environment and that’s the answer to that, right? So the next step for you really is to have a look at intensivecareathome.com, that’s intensivecareathome.com and get more information there and how the service is set up.
Again, intensive care at home provides home care nursing with intensive care nurses, 24 hours a day to provide an intensive care substitution service and a genuine alternative to a long-term stay in intensive care to long-term stay in LTAC. And it gives you incredible peace of mind by having your aunt at home and not in a facility.
So that’s your questions answered for today. If you have a question, give us a call on one of the numbers on the top of the website, or if you have a question, just email me to [email protected] and I’ll talk to you then.
Take care and have a great day.
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