Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Eric, as part of my 1:1 consulting and advocacy. Eric’s mother-in-law is in ICU and he is asking if it’s safe for his mother-in-law to transfer from ICU to LTAC.
Will It Be Safe for my Mother-In-Law to Transfer from ICU to LTAC?
Patrik: Hi Eric! This is Patrik from Intensive Care Hotline.
Eric: Hi Patrik! I have gone across your videos and your website and I know a lot of what you teach about. And I believe you’re an expert on patients’ rights and helping them heal and stuff like that. And I want to ask for your advice regarding my mom.
Patrik: Yes, sure.
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Eric: So, my mom got the tracheostomy, and the PEG (percutaneous endoscopic gastrostomy). They are transferring her to another facility that would not have been our choice, but that was a decision that was made. What I’m hearing from this facility is that their focus is on helping her get better. So, I know we talked last night about the importance of moving her and sitting her up. I was told today that they do that there, that they have that special chair and that they’re going to try to get her up and move her around more. So, I’m complimenting this, that this is a good facility and they’re going to push her and they’re going to have a good attitude with her recovery. But I wanted to know any insight that you may have, anything that we should look out for, and stuff like that.
Patrik: Yep. So a few questions there, what facility will she be going to?
Eric: It’s an LTAC.
Patrik: Right. Okay. I know a lot about the LTAC facility. I’ll talk about LTAC in a minute, I just very quickly need to look at their website. And I found their website, I’ll just quickly go on there
Patrik: Can you share with me why did they want her out? What was the reason for it?
Eric: Well, first of all, it was a decision made by next of kin. So, there’s nothing we can do about it legally.
Patrik: Sure.
Eric: But the reason why they wanted her out of the hospital is because… I mean, I’ve been reading a lot of your content and my assumption is lack of resources, COVID cases are rising, they probably need the bed. But their reasoning was, there’s nothing else we can do here. But you can tell that it was pretty clear that they’d been wanting her out for a while, they’ve really been pushing for that PEG. But it is what it is because whether they wanted her out or not, this decision is already made.
Patrik: Okay then and they pretty much informed the next of kin as soon as they did the PEG?
Eric: No, they’ve been saying for a while like, “Hey, this is where she’s going to go, go take a look at it.”
Patrik: Right.
Eric: And we’ve been trying to prolong that as much as possible, but today they said that they were going to dismiss her, and they did the PEG today. So they seemed to be in a rush to transfer her there.
Patrik: Right, yeah. Okay.
Eric: If we had legal choice, we could have been able to dispute it, but we don’t, right? So we could have killed it with Medicare and done a few things, but that’s just not the decision that was made with family. So we’re trying to deal with what we have at hand and do the best that we can.
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Patrik: Right. Okay. Look, my concern is that whenever someone leaves ICU and is still ventilator-dependent, that’s a risk in and of itself.
Eric: Yeah, we know that.
Patrik: Yeah. So, it’s always a risk. The next risk is someone in a vulnerable condition like your mother-in-law, I just think it borders on insanity changing location, changing teams. There wouldn’t be many more people in this world right now that are in a more vulnerable situation than your mother-in-law.
Eric: I know. There’s nothing to do about that. It was finalized.
Patrik: It’s a done deal, I get that. I’ll tell you what the next risk here is. The next risk is, a lot of these patients bounce back into ICU, okay? So, the question is, how far away is that from the ICU where she is at the moment?
Eric: It’s relatively far but what we have been told is that this new facility is an ICU in itself. It has nephrologist, it has specialists, pulmonary stuff, so…
Patrik: Okay. Not that I can see that on their website, there is not talk about ICU as far as I can see. But if I look at their services, there is no talk about an ICU.
Eric: Yeah. But given the fact that there’s really nothing we can so about the fact that she’s getting transferred, how do we take care of her? Or how do we fight for her? How do we advocate for her?
Patrik: Yeah, okay, great. So how can you advocate for her? So the most important thing is mobilization and a weaning regime.
Eric: Okay.
Patrik: Right? And also, with the hypoxic brain injury, it’s also a neurological rehab program that needs to happen.
Eric: When you say neurological stuff, is that like they give her activities to activate her brain?
Patrik: Yes, absolutely. Talking to her, mobilizing her, stimulating her. The biggest challenge in those facilities is, when I look their website, they’re advertising ventilation liberation. Now the reality is that the level of care she will most likely be getting in that facility is lower compared to what she’s getting now, with some variances. The nurse-to-patient ration usually goes from a 1:1 or 1:2 to down to a 1:5, potentially to 1:8, or 1:10 overnight.
Eric: Okay. I get that. So, what I’m trying to say is, with what we have in front of her, how can we take care of her? Say for example they’re giving her too many sedatives or something that we don’t agree with. How much agency do we have on those choices? Things like that.
Patrik: Great question. It depends on (A), what questions you ask; and (B), how transparent are they going to be. I mean, you can force them to transparency by getting access to the medical records as quickly as possible. You will probably figure out whether she’s on too many sedatives or not pretty quickly. Do you know if she’s on sedatives at the moment?
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Eric: No, not at the moment. And I do believe that we were told we were going to have constant access to her medical records, so we’ll be able to see what they’re doing. But for example, are those things we can fight as family members if we feel like they’re giving her too much and stuff like that?
Patrik: Oh, absolutely. You need to fight… As soon as you think it’s not heading in the right direction, you need to ask questions, you need to put pressure on them, and you need to hold them accountable to what they’re promising you. And I guess what was the promises that have been made there?
Eric: I mean, the neurologist, the head nurse, a lot of people in the hospitals talked really good about this place. They say it’s one of the best facilities, they say they’re going to focus a lot in mobilization.
Patrik: Good.
Eric: … in stimulation. They talked about that special chair that you talked about, they’re going to try sitting her up more. So that’s a good sign. They do have good reviews; they are talking about the things that you were recommending for her moving forward to get her to wake up more. So yeah, I asked today, “What’s the mindset?” I know you talk a lot about doctor mindset, stuff like that, and I was told that the mindset there is not a mindset of comfort and giving up, it’s a mindset of, we’re trying to get her to recover-
Patrik: Good.
Eric: … and get better and do what she can.
Patrik: Good, that’s really good. Have you seen the place?
Eric: Not yet. My brother and his wife are going to go tomorrow, and they’re going to take a look at it.
Patrik: Right.
Eric: So when we see tomorrow, what should we look for?
Patrik: Yep. I’ll tell you what you should be looking for. I would strongly recommend to talk to other families if you can. Rather than talking to the team there, and that’s all part of your research of course, talking to the team. But I would actually get it from the horse’s mouth, which is other families.
Eric: Okay.
Patrik: Because if they’re telling you, “Oh yeah, we’re really very happy here.” That’s what I believe is the best recommendation, from someone actually using it, that’s what I would be looking for. Because the doctors, the nurses, the physios, they can tell you stuff all day long.
Eric: Yeah, that’s true.
Patrik: Listen to other people’s success stories if there are any.
Eric: Right, maybe pull them aside and be like “Can I ask you a question?” Okay.
Patrik: That’s right. And your mother-in-law’s situation is not unique. Unfortunately there are many people out there with a similar condition, right? And you would think that somebody at this place would’ve arrived there in a similar situation than your mother-in-law and… Or ask, if you can’t find a family that’s been in a similar situation, ask them, “Hey, can you tell me about the time when someone like my mother-in-law arrived there, what was the outcome?”
Eric: Okay. Those are good questions.
Patrik: I think that’s… You got to hold their feet to the fire in terms of, okay, what have you done with someone in a similar situation and what was the outcome?
Eric: Right, like, what’s your treatment? What is the outcome?
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Patrik: What’s the length of time they stayed there? But more importantly, it’s really important that they… We all follow routines every day. All of us. And it’s very important that they get her in a routine every day with physical therapy, mobilization, weaning off the ventilator, stimulation. It’s not rocket science, but it takes work.
Eric: Okay. Yeah.
Patrik: It takes work.
Eric: It takes time and work, yes.
Patrik: Takes time and work. Your mother-in-law is very helpless at the moment, I would think she probably can’t do anything for herself.
Eric: No, obviously we’re getting her to wake up.
Patrik: Right, right.
Eric: Yeah.
Patrik: So, it really takes a lot of work, effort. It gets a team that’s willing to get to know her.
Eric: Okay.
The 1:1 consulting session will continue in next week’s episode.
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
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- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
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- How you need to manage doctors and nurses in Intensive Care (it’s not what you think)
Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
Make sure you also check out our “blog” section for more tips and strategies or send me an email to [email protected] with your questions!
Also, have a look at our membership site INTENSIVECARESUPPORT.ORG for families of critically ill Patients in Intensive Care here.
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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