Western Kentucky lacks resources for patients with most
severe cases
Part
one of a two-part series
By
Nick Tabor, New Era Senior Staff Writer
Roughly
eight years ago, Stephanie Gamblin was driving her father to the coal mine
where he had worked for 20 years. She asked him to navigate.
It
unsettled her when Hunt said he didn’t know the route.
The
family had noticed other signs of his memory decaying. Though he’d always been
a handyman, for instance, it seemed to take him forever to finish tiling a
cabinet for Brenda Hunt, his wife and Gamblin’s mother.
A
doctor’s visit confirmed their fear: He had Alzheimer’s disease.
He
stayed at home until 2010, when the family decided he needed full-time nursing
care and sent him to Tradewater Health and Rehabilitation Center.
Its location was ideal — a short drive for Brenda Hunt — but it soon seemed
Tradewater was ill-equipped for dealing with his illness.
Hunt
wandered the halls, searching for his father. It didn’t benefit anyone when
staff members told him his father had died many years before, Gamblin said. She
gave him a picture of his dad to keep in his room.
Another
day they tried to make him understand he wasn’t back in the coal mines. His
family had to come calm him down.
She
learned her father was starting conflicts with other residents, based on
misunderstandings. He might have shoved someone, she said.
But
the staff caught Gamblin off guard when they insisted on taking him to Trover Regional
Medical Center
in Madisonville.
At the emergency room, someone from the nursing home’s corporate office served
the family with discharge papers.
Brenda
Hunt said she refused to sign, but the nursing home wouldn’t take Hunt back.
“So
there we were, stuck in the hospital, with no place to go,” Gamblin said.
Trover’s
ethics coordinator agreed to get Hunt a bed, though he didn’t have a medical
problem. There his condition worsened.
“It
was just absolutely traumatic to him,” Gamblin said.
Brenda
Hunt said he hit her on the lip — something he’d never done in their 50-year
marriage. Hospital staff had to keep him in restraints.
Eventually
they sent him to a facility in Prestonsburg that specialized in helping
dementia patients. But separated from his family by more than five hours, in an
unfamiliar place, he stopped eating and lost his ability to talk. After only 14
days, the family moved him to a hospice in Henderson.
He
died in August at the age of 70.
The
family’s experience underscores a dire problem in Western
Kentucky’s social services: The region lacks a facility designed
for the most severe dementia patients, particularly those with violent
histories.
And
because the population is aging, the need becomes greater every year.
Feeling
trapped
Imagine
that you’re 80 years old and living in a nursing home. You’ve received Social
Security checks for 15 years, but now your family is using the money to pay
your nursing home bills.
Imagine
that you have dementia and don’t know where the money is going. You decide the
nursing home staff are stealing from you.
Or
imagine that you think you’re a child in your parents’ house. You wander the
halls of your nursing home and take a book from your neighbor’s room. When he
tries to take it back, you think he’s your brother and swing at him.
Even
worse, imagine you can no longer control your bowels. Nursing home workers need
to change your clothes immediately, to make sure your fragile skin doesn’t
develop sores.
Two
nurses — strangers — try to pull you out of your chair and take off your pants.
You attack them in self-defense, but more strangers come and pin you down.
Dr.
Susan Vaught, director of psychology at Western State
Hospital, provided these
examples from her experience with dementia patients. They’re disastrous for
nursing staff as well as patients, and local nursing home directors can tell
similar stories.
Anita
Gilbert, social services director at Christian
Health Center,
said her facility knows a dementia case is severe when the patient starts
hitting staff, cursing or refusing medication. Patients have the right to
refuse drugs, but they often become too hard to control after their drugs wear
off, she said.
At
another nursing home where she worked years ago, she suffered a broken arm and
a black eye from dementia patients, and once someone tried to choke her.
Dementia-related
outbreaks have caused no injuries in her five years at Christian
Health Center,
but it’s partially because there are now facilities in Tennessee that can usually accept the worst
patients until they get stabilized.
Last
resorts
Jennie Stuart
Medical Center
and Trover don’t have geriatric psychiatric wards. But as with Hunt, Vaught has
seen families or nursing homes bring patients to the emergency rooms at these
hospitals, then refuse to take the patients back afterward.
Keeping
them in hospital beds ends up costing huge amounts of tax money, and it’s often
uncomfortable for both the hospital staff and the patient, Vaught said.
Western
State occasionally treats dementia patients, but only when they meet four
criteria: They must pose a threat to themselves or others; it must result from
mental illness; there must be a reasonable chance Western State can
successfully treat the illness; and Western State must be the least restrictive
place they could go.
Usually
nursing home patients who get combative fall short on two or three of these
criteria, Vaught said.
Further,
Western State isn’t a long-term care facility —
the average stay there lasts 19 days — and it’s not uniquely outfitted for
patients with dementia.
When
dementia patients do end up at Western
State, the hospital
sometimes confronts the same problem as Jennie Stuart and Trover: After a
patients’ treatment, the original nursing home won’t take them back. Nursing
homes have no legal obligation to do so, Vaught said.
Most
often these patients end up at Western
State’s nursing home.
The
New Era reported in June that in 2010, Western State Nursing Home gave
sedatives to 60.4 percent of its residents who didn’t have psychosis or a
related disease. This was the highest rate in the area — compared to a national
median of 16.7 percent.
Vaught
said its saturation of dementia patients helps explain this. The data didn’t
count most dementia patients as psychotic, even if they had schizophrenia or a
similar disease, because their dementia diagnoses usually eclipsed other
categories, Vaught said.
Some
critics claim nursing homes drug their patients up to make them sleepy and
docile — to make their jobs easier, or to employ fewer nurses and increase
their profit margins.
But
sometimes it would be inhumane not to give patients medications, Vaught said.
The drugs also help keep facilities safe and secure.
And
even Western State Nursing Facility limits whom it accepts. For instance, it
turns away many patients with violent histories, Vaught said.
In
a way, this leaves the patients who need help most severely with no place to
go.
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