A Navy veteran gets dumped for not cooperation in the Medicaid application process. You would have done it differently I bet.
The story in the Des Moines Register goes like this:
- In July of 2013 the police and social services determined that John Chedester, 65 a Navy veteran was unable to live in his own home. He was removed from his home and admitted to Elmwood Care Centre.
- At the time of admission he was diagnosed with “post-traumatic stress disorder, diabetes, elevated blood pressure, congestive heart failure, sleep apnea and other ailments”.
- “He had little or no family support, and he required supervision and assistance with walking and hygiene, according to state reports.”
- Because he was a veteran he asked to be moved to the Iowa veterans’ home. This did not happen and there is no indication as to why it didn’t happen.
- Sixty days after he was admitted to Elmwood Care Centre he was given a letter telling him he was going to be involuntarily discharged for non-payment (October 23).
- Further, staff reported that he was uncooperative with staff when they tried to sign him up for Medicaid, which would have paid for his care.
- It was also reported that Chedester displayed signs of disorganized thinking and incoherent and illogical rambling speech.
- Elmwood made arrangements for him to be moved into a nearby apartment building and even offered to have the furniture in his house moved to the apartment. He refused that help and all help accessing home health services. He refused to take his medications or use his prescribed oxygen.
- The move took place on November 1, into an empty apartment. That same day a neighbor watched what was going on and tried to intervene. The next morning this same neighbor called police and Chedester was taken to the hospital.
- He spent 11 days in two different hospitals and, curiously, was ultimately transferred back to Elmwood Care Centre, where he remains today.
Slicing and Dicing
This facility is operated by Trillium Health Care Group out of Florida and they have strongly condemned what the local facility staff did and the Administrator is no longer working for the company.
- I find myself wondering why the State of Iowa’s social service department was not deeply involved in this situation.
- I wonder why the Iowa Department of Veterans Affairs was not involved.
- This seems like the perfect time to get the ombudsman involved in the situation.
- It seems as if somehow this guy who seemingly has serious mental health issues got sideways with the facility administrator and that, rather than dealing with it in a professional fashion, she reacted in a punitive manner.
The Culture Question
For me the bottom line is that, at least at this facility, there was a critically toxic cultural environment where a resident being impossibly difficult was sufficient reason to treat him inhumanely. I find myself wondering how it was that the director of nurses, the social services designee and, for that matter, staff nurses and care givers could watch this all unfold without calling anyone. I can only assume that there was such a culture of fear or apathy that all of these people were frozen in place to the point of allowing a resident, albeit a difficult one, to come close to dying. Because responsibility flows up-hill, one has to ask if this was a rouge administrator (which is possible) or if this is reflective of a corporate cultural problem that allowed an administrator to behave this callously. What Would You Do? While this story is a huge balled up mess where a whole bunch of people did the wrong thing, the question I would like to toss out to the community is this: If you have a frail resident (which is most residents) who refuses to pay their bills or help in the process of getting government assistance what do you do? In this particular instance before it devolved, what would you have done? Steve Moran
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Morning Steve! This took place in my home state of Iowa so I of course had to comment.
My AL and Memory Care (Ridgeview & Meadowview) are located just an hour and one half SE of Des Moines. I agree 110% that this situation is unacceptable!!
In my opinion, this happened for three reasons which all come back to poor Administration.
1) the gentleman did not have a family/friend to advocate on his behalf. Although sad, it’s a fact that whether in the hospital, nursing home, AL or simply going to the doctor, it’s important to have someone there to ask questions and advocate for you. Often LTC facilities have 1-2 social workers for 100+ patients. NOT EXCUSABLE
2) staff of the care centre were afraid they would be fired for going over the Administrators head. I have witnessed staff anonymously sending a letter to the state expressing concerns. Unfortunately, in Iowa staffing has been reduced for State surveyors so response to allegations have not been timely.
We are being told Iowa state surveys themselves are behind several months due to this cut.
3) Many Health care facilities are being purchased by/built by investors who are not well versed in direct care, regs, patient rights. Therefore, hire “professionals” to run the facility trusting them. Like in every business, investors track numbers unless they hear there’s an issue. Of course by then the damage is done.
In summary, I believe the responsibility needs to fall on the Administrator and Director of Nursing. They ultimately decide who comes in and out of the facility and therefore could have stopped this sad incident from happening.
Now to answer your question about what I would do had this been my patient 🙂 (sorry it took so long to get here)
I first would have had the DON schedule an appointment for the patient to see a psychiatrist at the VA for his PTSD. Next I would have contacted our local VA admin (which btw is based in Des Moines where this happened). To inquire about assistance in getting the patient transitioned to the VA home in Marshalltown, IA. If unsuccessful, I would get DHS involved.
Lastly, I would never kick the patient to the curb! What this facility did is unspeakable and not representative of Iowa’s health care system!
Steve, et al,
Definitely some calls needed to be made to outside sources… and I must remember our vision is 20/20 when looking in the rear-view mirror. 😉
The assistance to veterans is overwhelming at this time… The VA, Ombudsman, Senior Protective Services, VFW, even the local hospice* may have helped. Local VA Offices are truly dedicated to assisting… be persistant.
With this individual’s refusal to cooperate in all areas of care… the local court could/would have appointed a guardian. Even if the person is of sound mind… ring the bell and get assistance from others.
Don’t just leave them to their own devices… you don’t leave a kid on his own to cross the freeway because they’re stubborn…
*BTW: Many hospices are involved with the national collaborative between VA & National Hospice and Palliative Care Organization’s (NHPCO) program: WE HONOR VETERANS.
Check it out… Our “Vet to Vet” program may have worked for this individual; and no-one knows until we try.
I’d like to add: Acacia Hospice is the first Non-Profit in NJ to reach the 4 Star Rank of this program. Veterans are this country’s National Treasure! HONOR THEM!
Be Well ALL.
The VA should have been immediately contacted particularly with the PTSD besides the numerous other issues. They have the right support systems and the patients share a common bond and socialization is encouraged which really helps emotionally. May I suggest that the facility wanted the income, any income, which was the top priority.
The facility actions as mentioned are unspeakable. The institutional culture is a culture of fear. The fact that no one anonymously contacted anyone is the most disturbing of all -he was “disposable”.
We’ve had several situations like this in the past and we’ve learned through trial and error the following. If there is little or no support and the individual has questionable decision making potential, we contact the local guardian authority and let them sort that out. Guardian at Litem status is a temporary advocate that can help establish a legal and financial base for the resident. While that process is evolving, you can expect that there will be some charity care involved. Additionally, we have developed a network of social service contacts, including the Veterans Administration, and those relationships help us navigate the necessary services for the resident. Our responsibility is to see that the resident receives the best care possible, regardless. We have found that once some medical and social stability is introduced into our relationship with the resident, things proceed well. Some of these individuals have continued a longterm resident status with us and others returned to the community.