The Pill Trolley

Three months ago we had to move my mother into an assisted living facility. She’s still pretty sharp mentally, but she needs around-the-clock care. I shopped around and found what seemed to be the best place. It’s clean, the staff is energetic, and it’s only six blocks from my house, so I can drop in every day if need be and make sure Mom is doing okay.

Unfortunately, it now appears that there may be some serious problems lurking under the surface. Short of hiring a private detective to install 24-hour video surveillance, which would be prohibitively expensive, it’s hard to know for certain. But I’m seeing a pattern.

There have been persistent issues with the care-givers not understanding how to operate Mom’s oxygen equipment. On two occasions within the past month, I’ve spotted these incidents myself … and I’m not there all the time, so how many other incidents might I have missed? Last Saturday I stood there and watched a care-giver (not medically licensed personnel, but supposedly trained) switch Mom from the in-room stationary oxygen system to a portable oxygen tank — and fail to turn the valve that started the tank’s oxygen flowing. She tugged at the valve with the wrench, it didn’t move, so she decided it was already open and put the wrench away. But the valve wasn’t open.

On another occasion I arrived shortly after Mom had returned from the dining room after lunch. The care-giver had switched her from the portable oxygen tank back to the in-room oxygen system, but had failed to press the button that turned on the in-room oxygen machine. Again, no oxygen. With someone who is on oxygen 24 hours a day because of her weak heart, these are potentially life-threatening mistakes.

Then there was the lost hearing aid. Replacing it is costing us $2,000, but that was probably an honest mistake. It probably fell into a waste basket. I mean, why would anybody bother to steal a hearing aid?

The missing ATM card and $80 in cash from Mom’s wallet were not an honest mistake. The cops were called. The ATM card was used several times, so we know it was stolen. That isn’t costing us anything, because Bank of America is refunding the charges, but it’s doubtful the police are going to catch the thief. A few days ago there was a double murder here in Livermore, and I’m betting the police have more important things to do right now than try to track down a small-time crook.

Yesterday, Mom told me the medical technicians have been forgetting to give her her eye drops. She thinks they may have been forgetting for as much as two weeks. It’s hard to evaluate this; Mom is pretty sharp, as I said, but she’s not always at 100%. Still, the story she told was that the day before (that would be Wednesday) she had brought the matter to their attention, and then Thursday morning the med tech again failed to bring the eye drops.

Mom reports that the med tech offered some silly excuse about how the eye drops were on a high shelf that she couldn’t reach. That’s the kind of detail that Mom absolutely does get right. If she says she was given a fish story, she was given a fish story.

The question I’m asking myself is, is this the only slip-up in medication that the staff has ever made? Given the pattern I’ve just described, would you believe the staff is 100% on the ball except for this one problem with the eye drops (a problem that may have gone on unnoticed for a number of days)?

This morning I’m going to have to ask the head of the medical staff to tell me what’s going on. I’ve gotten to know the people who run this place a bit, and I’d like to give them the benefit of the doubt … but my intuition is telling me to be wary. They all seem just a little too sincere, if you see what I mean.

My impressions of these people are not evidence of anything; I want to be clear about that. But when dealing with such people, it’s difficult to know how to evaluate what they’re telling you. I think they’re probably trying to do a good job, but I also think they’re not doing as good a job as they’d like to be doing, and I think they’re not above misleading people who raise awkward questions.

I know for a fact that the care-givers were given additional training in how to use the oxygen equipment, because of issues that I had spotted earlier — weeks before the two incidents described above. But somehow, the training ended up being incomplete. Maybe some of the care-givers were out sick that day. Or maybe some of the care-givers … well, I try not to be racist, but it’s clear that English is not, in all cases, their native language. It’s entirely possible that some of these women (and they’re all women) were raised in households where the safe course was to smile, remain silent, and pretend you understood, and then try to work it out for yourself later on. They may have trouble admitting that they didn’t understand the training, because, for whatever cultural or economic reason, admitting they didn’t understand what the trainer was saying might pose a real or imagined threat.

But that’s purely speculation on my part, based on my rather spotty knowledge of human nature. All I know for certain is that the management of the place is persistently, over and over, assigning people to operate the oxygen equipment who then screw it up.

That being the case, how likely is it that they are hiring med techs who are 100% competent and responsible, apart from this one inexplicable slip-up?

Okay, that’s the preamble. The topic for today is, what am I to do about it? I could yank Mom out of the place and move her to another place across the street — but do I have any guarantee that the next place would be better? It might just as easily be worse. Do I yell at the management? Raise my voice, swear a blue streak, make threats? Up to now I’ve been very careful to remain positive and understanding, because I want to cultivate a good relationship with them. Is it time to turn into a raging maniac? Would that help, or would it only make matters worse?

Or should I hire a lawyer? How will a lawyer help if the med tech gives Mom the wrong pill next week, and it kills her?

I used to know a guy down in Cupertino. His name was Bill — I never did know his last name. Bill was a nice old guy, friendly and optimistic. At some point, due to some medical issue that he had, his doctor prescribed medication, and the pharmacist misread the prescription. Bill took ten times as much as he was supposed to. His lungs filled with fluid, and that precipitated a heart attack.

Bill didn’t die immediately. He lasted for a couple more months, gamely towing the oxygen bottle around with him, an oxygen bottle he hadn’t needed until the pharmacist screwed up. Bill remained friendly and optimistic right up to the end, but before long he died. I hope his children sued the pharmacist and put the bastard out of business. But the point of the story is, people who are trained in the administration of medications do screw up, and they do sometimes kill people.

So should I blandly accept the assurances of the management at the assisted living place that this was a one-off occurrence, that they’ll make sure it doesn’t happen again? What would you do if it was your mom?

Footnote: Having talked to the supervisor, I now have a better picture of how easily the medication delivery system can get screwed up. The med tech initials a form, each day, when the dosage of that medication for that day is removed from the dispensary. If the medication is not then administered — if the patient refuses to take it, for instance — the tech is supposed to come back afterward and circle their initials on the form to indicate the problem. But if the tech simply forgets, while going down the hall and visiting a dozen residents, to deliver some particular medication, no circle will appear on the chart, and the supervisor will have no way of knowing that the medication wasn’t administered.

Add to that the fact that the facility has been short-staffed lately because one of the med techs has been out sick, forcing the others to work 12-hour shifts, and you have a situation. I won’t call it a disaster waiting to happen, but I will say that if there’s a disaster, going back afterward and figuring out what happened will be difficult.

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One Response to The Pill Trolley

  1. David Jones says:

    Keep a diary. Document everything.

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