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Quick Tip for Families in Intensive Care: Is the Only Option for My Dad on Ventilator, Tracheostomy & PEG in ICU to Go to LTAC After MBA (motorbike accident)? 

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s tip is about the question from one of our readers who says, “I have concerns about the hospital wanting to send my dad to an LTAC facility. He is currently in ICU for a TBI, traumatic brain injury, from a motorbike accident and he’s still on the ventilator at night. I just want to make sure I know what grounds I have to stand on for our rights for best care and treatment.”

Then our reader, Jessica continues and says, “My dad is in ICU for a traumatic brain injury from a motorcycle accident. The caseworker states he is ready to be discharged for the doctor’s orders. However, I have yet to receive this news from the doctor himself. He has a TBI and is currently in pneumonia and he’s still on the ventilator at night and they put a tracheostomy in a couple of weeks ago. I’m concerned with what our rights are here, and they have not provided the plan for his health care.

When they sent over a list of LTAC (Long Term Acute Care) facilities, the only search requirement they had was ‘needs a bed’. I feel they’re just trying to push him out to a facility as his health insurance is not good. It is basic Medicaid. The local LTAC facility has lower than a three rating. I want to make sure he’s getting the proper care needed, not just being pushed off into another facility which will cause him to stop making progress.” So, and this is from Jessica.

So, Jessica, as I spoke to you on the phone, you’re well aware of your rights now. There is a document that we share with clients that no hospital can send anyone to LTAC without your approval, without your consent, assuming you are the power of attorney, which I know you are. Obviously, this is for our U.S. audience when it comes to LTAC. LTACs really only exist in the United States.

So, for anyone who’s new to my blog and to anyone who doesn’t know what an LTAC is, LTAC stands for long term acute care. A lot of patients in ICU in the U.S. end up with a tracheostomy at some point if they can’t be weaned off the ventilator and then the ICUs are often trying to send them into LTAC.

Now, there’s a few things you need to know. Number one is the hospital can’t send your loved one to LTAC without your consent or approval. LTACs are not even the better version of a nursing home. So, picture this, your loved one is critically ill and is going to LTAC, to a nursing home basically, instead of staying in ICU, that is dangerous.

Now, what we’ve seen over the years is many patients go to LTAC from ICU prematurely. They often bounce back into ICU within 24 to 48 hours. Furthermore, often the beds in the ICU then have gone, they’re blocked and then they end up in another ICU. That is sheer madness because then your loved one might end up in three different facilities within sort of 24, 48, 72 hours. Three different teams, sheer madness.

When someone is critically ill and is vulnerable, they need a constant team around them that gets to know them, that can work with them one on one, that can help them on their path to recovery.

Now, once again, have a look online at LTAC reviews and let me know what you think. Have a look at some LTAC reviews online and let me know what you think. They’re pretty average at best. Most LTAC facilities have no ICU nurses to look after ventilation, tracheostomy.

But here’s probably my biggest takeaway. When I spoke to Jessica yesterday, I said, “Has your dad got a tracheostomy and a PEG tube?” She said yes. I said to her, “Look, if you had come to me by the time they were talking about a PEG (Percutaneous Endoscopic Gastrostomy Tube) and a tracheostomy, I would have said to you do not give consent to a PEG tube. Give consent to a tracheostomy, but do not give consent to a PEG tube.”

Here’s the reason why. (A) a nasogastric tube is perfectly suitable for nutrition. You don’t need a PEG tube. (B) an LTAC won’t take a patient without a PEG tube. A PEG tube is a percutaneous endoscopic gastrostomy. It’s like a feeding tube through the abdominal wall, going into the stomach. There’s no need for that.

The whole idea of a PEG and a tracheostomy is to hospitalize patients. The aim should be to get someone off a ventilator as quickly as possible. By leaving a nasogastric tube and then by working on rehabilitation, on physical therapy, mobilizing patients, by putting a PEG tube in, it almost says, “Well, we don’t expect any quick recovery here and we’re not working on it anyway.”

It’s really, really important that mobilization starts as soon as it’s possible, breathing exercises, physical therapy, and so forth so that a PEG tube is not even necessary in the first place and sometimes that’s difficult to achieve, but you got to give it a go anyway.

Again, by not giving consent to a PEG tube, LTAC won’t be on the cards. I have looked after patients in ICU with the nasogastric tube for 6, to 8 months. There’s no issue with that. Absolutely no issue with that. Also, a PEG tube is a surgical procedure that can be avoided.

So, you absolutely have rights here, and just by you looking at the online reviews of LTAC, you know what to expect, you know that your dad won’t be in good hands.

Also, what you told me yesterday was your dad seems to be in pretty good hands at the moment, and the criteria from what you’re writing here ‘needs a bed in LTAC’. Well, that’s not clinical criteria.

They need to be accountable towards their decision making, and they need to be accountable. Why does that need to be in LTAC with? What are the goals of care? Weaning off the ventilator would be one goal of care and that isn’t going to happen in an LTAC from experience.

What often happens in an LTAC? They give patients 30 days to wean and if they can’t wean within 30 days, they want to send them off to a skilled nursing facility, goes from bad to worse.

So, you need to keep your loved one in ICU for as long as possible, and that’s what we can help you with here at intensivecarehotline.com.  We have proven strategies to keep patients where they should be and where they need to be. So, we can help you with that.

Now, if you have a loved one in intensive care and you need help, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org or you can go to intensivecarehotline.com and click on the membership section in our membership area. You have access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions, intensive care related.

I also offer one one-on-one consulting and advocacy over the phone, via Skype, via email, via WhatsApp. I talk to intensive care teams directly. I ask all the questions you haven’t even considered asking what you must ask so that you can make informed decisions, get peace of mind, control, power, and influence. Critically important for you.

Also, I represent you in family meetings with intensive care teams. As a matter of fact, I wouldn’t go into a family meeting with an intensive care team without two things. Number one, without a written agenda, and number two, without a clinical representative like myself to be there that can ask all the questions that must be asked, but you don’t even know need to be asked so that you can make informed decisions, get peace of mind, control, power, and influence.

We also offer medical record reviews in real time so that you can make informed decisions, get peace of mind, control, power, and influence in real time. We also offer medical record reviews after intensive care.  If you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Now, if you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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