Unseen Perils at a Rehab Facility: Safeguarding Your Loved Ones

Introduction

After a hospital stay, patients are often recommended to regain their strength and mobility at a sub-acute rehabilitation facility, also known as 'short-term rehab' at a skilled-nursing facility (SNF), or nursing home. The services at these facilities are typically fully covered by insurance for up to 20 days when the patient’s hospital stay as an inpatient lasts three nights or more.

Patients and their families are often glad to receive this service and simply accept the facility suggested by the hospital’s case manager or social worker, understandably assuming they are heading in the right direction...

However, recent trends reveal that private equity firms are increasingly acquiring these facilities, often prioritizing profit over patient care. “A growing body of research shows that health outcomes in private equity-owned facilities are worse than in those under other ownership.”

This is the true story of my client, Greg (names are altered to protect privacy), and his harrowing experience at one such facility, highlighting the urgent need for vigilance and advocacy.

The Beginning: A Hopeful Transition

Greg, an 80-year-old retired Army officer, was relishing his life at an assisted living facility (ALF) with his wife, Cindy. Known for his good nature and gregarious personality, Greg managed several medical conditions and minor cognitive issues with the help of his doctors.

However, after falling and injuring his ankle, he underwent surgery in the hospital and was discharged to a rehab facility for recovery. This facility, part of a chain recently acquired by Oxford Finance LLC, looked like a nice place on the surface. It was even named as one of the 'best nursing homes' by the US News & Report. However, it wasn’t long before the reality of its care came to light...

First Signs of Trouble and Family Discussion

I became involved when Greg's family called me after he fell twice in the rehab facility, both times resulting in ER visits. Given Greg’s anticoagulant medication, he was extremely fortunate not to have sustained serious injuries. Meeting Greg and Cindy at the facility, I immediately noticed that his environment wouldn’t be safe for him. To my dismay, Greg's bed did not even have adequate rails or a bed alarm. It’s a well-known fact that these facilities do not have enough staff to watch over every resident. No wonder he had been falling!

During my assessment, Greg’s overall status seemed fine with a functioning Foley catheter. However, he occasionally exhibited serious cognitive issues, which seemed to have worsened post-surgery, possibly related to his medications. As we discussed ways to prevent his future falls, the family (via phone) and I agreed that hiring a private sitter to watch him during the night (when he had previously fallen) would be the best option, as the staff could not possibly provide adequate oversight.

Inadequate Care and Broken Promises

Next, I introduced myself at the nursing station and was provided a copy of his care plan. I informed them of the family’s plan to engage a private sitter during the night, which they agreed to. We had a pleasant conversation, and they admitted, "Things can be wild around here."

I knew medication questions must be addressed by the physician, but I asked if nurses could take any additional measures to prevent his falls. They offered to move his bed next to the nursing station during the day to watch him more closely. When I mentioned the lack of a clear plan to discontinue his catheter, risking infection, the charge nurse responded that they were monitoring his condition via regular labs and planned to do a void trial in a few days.

Unfortunately, I later found out these promised measures were not implemented.

A Preventable Crisis

The hired sitter helped prevent further falls, but a few days later, as I was about to follow up, Greg’s condition took another turn for the worse. He was rushed to the ER with vomiting coffee ground emesis, indicating a potential emergency. At the hospital, Greg was found to have a severe UTI, with records showing he arrived with a dark, bloody foley bag—a stark contrast to a few days earlier, pointing to gross negligence.

A Heartbreaking yet the Best Decision

Greg’s hospital visit also revealed a throat obstruction related to his chronic condition, making him highly susceptible to choking and pneumonia. Given the rehab facility’s track record and his mental status, the likelihood of safely maintaining a feeding tube was slim to none. Additionally, his ALF could not administer tube feeding either. After thoughtful discussions, Greg’s family and the ALF nurse concluded that the best course was for Greg to enjoy his remaining life at home with Cindy, opting for hospice care that can provide additional support and comfort.

Lessons Learned

Greg and his family were hoping for his full recovery from the ankle injury and that he would return to his joyous retirement life at the ALF. Instead, he never regained his strength; his condition worsened during his stay at the rehab facility, and he is now in hospice. Greg’s story underscores the harsh realities many face in rehab facilities, particularly those owned by private equity firms. These facilities often fail to provide adequate care, putting residents at risk, despite their pleasing facades and positive ratings (lower-rated facilities could be even worse!).

The unfortunate reality of US healthcare is that the recipients of these services often must work hard to receive the care they deserve and are (indirectly) paying for. If you or your loved one has an ongoing medical condition or is experiencing cognitive decline (even temporarily), the next section will guide you on how to safeguard yourself or them.

Key Takeaways and Actionable Tips:

1. Do Your Homework Before Deciding on a Rehab Facility

• Consider an 'Acute Rehab' facility if you’re willing to work hard for full recovery: It generally offers much better care than the 'sub-acute rehab' (skilled-nursing facilities) which this blog post focused on.

• Engage with Case Manager Early: Communicate your preferences as soon as possible.

• Avoid Private Equity-Owned Facilities if possible: Generally worse health outcomes.

• Research Facilities: Check ownership and amenities on the provided list. Don’t rely on the ratings and reviews. Visit the sites and observe how residents are cared for.

2. Be Proactive

The following steps may seem like a lot (because they are!), but they are necessary to keep the staff accountable. It’s important to be pleasant yet firm and persistent with them (these are important characteristics of an advocate :) to ensure your loved one receives the best care.

• Frequent Visits:

  • Regularly visit the facility and spend time with your loved one.

  • Build rapport with the staff.

  • Consider hiring a private aide if prone to falling (discuss with the staff first).

• Care Plan Review:

  • Obtain and review the care plan to ensure it aligns with your doctor's recommendations.

  • Request a care plan conference, and prepare for it.

• Verify Actions:

  • Do not assume nurses will follow through on promises.

  • Verify actions through the care plan and follow up regularly.

• Obtain Medical Records:

  • Regularly request and review medical records. Stay informed and ensure accountability.

  • The 21st Century Cures Act guarantees access to electronic medical records.

• Monitor Condition (for those with ongoing medical conditions):

  • Pay attention to any signs of the condition worsening and inform your nurse immediately.

  • Ensure timely visits by a proper physician. Insist on seeing an outside specialist if appropriate. The facility must provide transportation for reasonable care.
    

• Consider skipping a rehab facility:

  • Access home health services instead (PT, OT, nursing, and nursing aide, up to 3 times a week). Insurance will cover these.

  • Likely to want to hire private home care aides to oversee your loved one (similar to what Greg’s family did).

  • It may be a better and much safer option because of the familiar environment and much closer attention.

• Consider engaging with a Professional Patient Advocate Early On: Don’t wait until a bad thing happens!
  

Conclusion

With the family’s effort and diligence, Greg was able to transition to hospice care, allowing him to spend his remaining time in safety, with quality of life, and peace of mind without additional expenses. His story is a poignant reminder of the critical need for vigilance and advocacy in ensuring the well-being of our loved ones.

Here are some reflective questions for you:

1. Have you or a loved one ever experienced subpar care at a rehabilitation or nursing facility?

2. How did you monitor and advocate for the well-being of a loved one in a rehab or nursing facility?

3. Would you feel comfortable asking for the care plan and other documents? If they resist, can you confidently state that it’s your right as the resident’s surrogate and cite the Cures Act?

4. How would you influence the nurses and staff at the rehab facility to prioritize patient care over profit?

5. In what ways can engaging a patient advocate improve the quality of care and support for you or your loved one in a rehab facility?