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yourlittlebirdie
03-24-2018, 11:49 PM
My character's mother lives in a nursing home and suffers from late stage Alzheimer's. She is otherwise in good physical health. The phone rings and it is his mother's nursing home calling, and they leave him a message. He is her next of kin and only living family member. Why would they be calling? Is there specific paperwork that needs to be renewed or resubmitted each year? Could she have suffered a minor injury or a fall inside the home?

What would be a realistic reason for them to call? A little more information: this would be in New York State and the patient is on Medicare and Medicaid.

Thank you!

mccardey
03-25-2018, 12:24 AM
I'm not sure what it's like in NY, but down here the home will call if there's been a fall however slight, if there's any need for medication tweaks, if there is any paperwork that needs updating or if an appointment with anyone needs to be made or altered, if there's a question about allergies, if she's been hard to rouse, or has not eaten well for more than a day - oh all sorts of things. We visit my m-i-l every second day at least, and we get calls about once a fortnight.

You might make it about outside appointments that need to be made - for dental check-ups or something. They call to let us know they're making them, or have made them - just so we know that a bill will be coming in. Feet is another thing. If she's ambulatory and suddenly stops walking around, they might call to find out if she has ever had foot or leg problems - if she might need to see someone about orthotics or something.

frimble3
03-25-2018, 12:29 AM
I would think the paperwork, even in these 'e' days, would be sent as paper copies to fill in and sign - not everyone has a computer (despite what my employers think).
I would think a good nursing home would certainly call for an injury or fall, just to keep the next of kin informed. They might also call if she's talking about something unusual, to see if it's just the Alzheimer's talking, or she did have another husband/child/life. Or, if she's been wanting some specific thing that isn't 'standard issue' that the relative could bring her?

AW Admin
03-25-2018, 12:33 AM
They wouldn't leave a specific message because of HIPPA guidelines.

They might call to check that a prescription is filled or to request additional clothing or to suggest that the child needs to visit or see the social worker.

They would call regarding a fall, or a change in her cognitive functions, or to suggest that she needs to have a medical appointment or physical therapy.

mccardey
03-25-2018, 12:50 AM
They wouldn't leave a specific message because of HIPPA guidelines.
This, because of privacy. But they would leave a message to say they called.

Maryn
03-25-2018, 01:05 AM
One of the more interesting calls we got (in New York state) was when there'd been a shooting outside the facility where Mr. Maryn's mom lived. In its parking lot, a jealous ex shot and killed "his" woman as she left work. Apparently the administration was either required to call in person or felt they should, assuring the family members of every resident that their resident was not in danger at any time, that the ex would not have been able to enter the facility if he'd tried, and so on. As I recall it, the shooter was arrested within a day or two.

bombergirl69
03-25-2018, 01:39 AM
They could call for any number of reasons--what does your story need? HIPAA would not be relevant if this adult child is already cleared to speak with the home and is on the list of people who can talk about the resident. That is usually done on admission. One reason they would call is if the resident needed some kind of capacity assessment and they wanted permission to schedule. They might call if the resident had a particularly bad outburst/reaction to medication. there might be a team meeting to discuss the resident's treatment plan and they were calling to invite the adult child.

dawinsor
03-25-2018, 01:44 AM
My mother's place called to say she'd fallen. They thought she was ok but wanted her family to know.

MaeZe
03-25-2018, 04:31 AM
This, because of privacy. But they would leave a message to say they called.
I've called on a number of occasions. I take care of employees that have been exposed to patients' blood. I don't leave a detailed message because explaining such an incident is best done in person. But I always tell them, "it's nothing bad, [patient name or reference like, 'your mother'] is fine."

Were I calling for something else I might say something like, "call us at your convenience", which is another way of letting them know it's not urgent. Or, I'd say, "It's urgent. Ask for Mary Smith the charge nurse or Mrs B the nursing supervisor and they can explain things." That says call right away and it's best practices to give them a person to ask for.

I would have no issue leaving a more detailed message but that's because I personally get clearance from patients or the NOK, "Can I leave a confidential message about [you, your loved one, whomever] at this number?" If it is a next of kin they would have already established the legal standing to get confidential medical information (MPA or medical power of attorney) about the patient.The staff may know the family well enough they feel they have permission to leave confidential medical information.

[TMI, skip if not of interest.]
Sometimes people are only DPA or durable power of attorney and they can only make financial decisions. Once in a while there is a DPA but no MPA. In those cases there are a number of procedures you would do. Someone has to give consent. When there is no one, a guardian is assigned. I would be able to leave confidential information on voice mail on a guardian's phone. It's the same if I am calling the doctor or clinic about something.

In reality though, things are a bit less formal in a nursing home, especially with a patient with dementia. The staff often get to know the family situation and most of the time, we'll call whomever the family designates between siblings, spouses, and children. The chart will designate who to call. If daughter Jane is feuding with son John, then everyone knows the details like Jane has MPA and John is not allowed to visit. Or the chart will have a number of people to call: Call the daughter first but if you can't reach her, call the brother.

If the chart says call the wife, for example, I call the wife. I don't look for the legal assignment of MPA because I don't expect any problems. I need to get consent to draw blood and order labs that are not part of the patient's medical care. If the NOK gives me permission, I proceed.


Reasons to call (mentioned by others):

an incident— could be an injury or a potential injury. In my case, a staff member had an exposure and I need to get permission for labs. I want them to know what's going on and for a confused patient, I call the lab results to the NOK

a change in the patient's status

the heath care provider asked staff to call the family about something

the patient in a lucid moment wants staff to call a family member
Some people are confused intermittently, or they are confused to things like time and place, but not confused about other things. They may be perfectly clear headed about me drawing their blood, and then they say something very confusing to me while I am drawing the blood.

talktidy
03-25-2018, 04:38 AM
Why would they be calling?

They would be calling to advise that SHE had fallen on one, and on two, occasions.

Quentin Nokov
03-26-2018, 10:34 PM
My character's mother lives in a nursing home and suffers from late stage Alzheimer's. She is otherwise in good physical health. The phone rings and it is his mother's nursing home calling, and they leave him a message. He is her next of kin and only living family member. Why would they be calling? Is there specific paperwork that needs to be renewed or resubmitted each year? Could she have suffered a minor injury or a fall inside the home?

What would be a realistic reason for them to call? A little more information: this would be in New York State and the patient is on Medicare and Medicaid.

Thank you!

My sister works at a Assisted Living Facility with Memory Care and we're in NY. I asked her and this is her response:

In NY there are yearly case meetings to go over how the resident is doing. Also if she is on Medicaid, the Medcaid paperwork needs to be renewed yearly. They could call for many different reasons, such as the resident needing more underwear. Any fall, trip, or scratch requires notifying the next of kin even if the resident is fine. If they have a personal account the home might call to have more money deposited. If any of their belongings went missing such as a hearing aid. If the payment check was written wrong or not signed.

Is the next of kin the power of attorney or health care proxy? If the character isn't, then the only reason why the home would call them is if the POA and HCP isn't available and they're the emergency contact.

If the character is able to walk around, is dependent, can feed herself, dress herself, relatively bathe herself, she would be in an Assisted Living Facility with a Memory Care unit rather than a nursing home unless there are no facilities with memory care available. Nursing homes are for people who can't get up/ wheel-chair bound. Are dependent on oxygen and can't function without help.

Being forgetful and wandering around isn't enough to warrant a nursing home. Only if the resident is completely unmanageable / aggressive would they be placed in a nursing home facility.

WeaselFire
03-26-2018, 11:28 PM
Why would they be calling?

She died. She fell and injured herself. She needs medical care that the nursing home can't perform. She had to be transferred to the hospital for heart, lung, kidney, pneumonia, critical care, etc. She left and they can't find her. She is hallucinating and demanding her son. She attempted suicide. She hit another patient. Medicare will no longer pay because she was reported dead. She says she has a message about a lost inheritance for him

These are all true events from nursing/assisted living homes here in Florida and there are probably thousands more. The real key is what your story needs, then write it for that effect.

Jeff

Tazlima
03-26-2018, 11:38 PM
My grandmother is in assisted living with extremely advanced Alzheimer's and they call for all kinds of things. Certainly changes in meds and any kind of injury, no matter how slight.

They call about more mundane things as well, though, i.e. being low on her favorite snack food or other household items that we provide for her.

At one point she kept forgetting she had more than one outfit, so she wore the same thing day after day (they were alerted to the issue by the oddly small amount of laundry she was producing). I know my mother got a call about that one.

Seems like they call for pretty much anything out of the ordinary and anything counter to a peaceful living situation (i.e. fighting with other residents).