Emergency Department and remained hospitalized for two days. This was his second admission within…read morethe past year, and my 87-year-old mother has also been hospitalized at Beebe during that time. All three experiences raised serious concerns about the care of elderly patients. My father's most recent hospitalization, however, was catastrophic.
My concerns involve both the ED and his subsequent hospitalization. My father was seriously ill and medically complex, yet his care lacked the careful assessment, coordination, communication, and planning his condition required.
My father has an extreme hearing deficit, and his overall condition further impaired his ability to communicate effectively, provide a reliable history, understand complex medical information, and meaningfully participate in decisions about his care. I am his Medical Power of Attorney and an experienced Nurse Practitioner. More importantly, my father explicitly told his providers to speak with me about his treatment. Despite this, I was rarely consulted about his condition, history, treatment decisions, or overall plan of care.
The problems began in the ED. The physician appeared dismissive and made little effort to clarify my father's actual complaint or listen to my concerns. My father described difficulty catching his breath associated with "burping," which the physician characterized as shortness of breath and "indigestion." He had stable vital signs, an oxygen saturation of 98%, and no labored breathing. Given his cirrhosis, severe ascites, and history, I was concerned that his symptoms could reflect esophageal or upper gastrointestinal bleeding. I attempted to communicate these concerns, but they did not receive appropriate consideration.
There was a lack of coordination throughout his hospitalization. It was unclear who, if anyone, was directing his care, whether providers were communicating with one another, or what the treatment plan was. For a seriously ill, medically complex 89-year-old patient, there was remarkably little coordinated, team-based planning or management.
Equally troubling was the near absence of communication with family. There was no effective process to ensure that my father's designated spokesperson and MPOA was involved in his care--even after he explicitly instructed his providers to communicate with me.
Severe hearing impairment is not an incidental issue in a hospitalized elderly patient. It directly affects the patient's ability to provide an accurate history, understand information, and participate meaningfully in treatment decisions. His communication limitations should have resulted in greater attention to family involvement and coordinated decision-making.
After three hospitalizations involving my elderly parents, I am deeply concerned about the care Beebe provides to vulnerable elderly patients. In our experience, communication among providers has been poor, communication with family has been minimal, responsibility for the overall plan has often been unclear, and important information from family has not been adequately incorporated into care.
My father deserved a careful, coordinated evaluation that accounted for his serious medical conditions, age, communication limitations, and the information available from the person he specifically designated to speak with his providers. That did not happen.
These were not minor communication or customer-service problems. They were serious deficiencies in the assessment, coordination, communication, and management of a vulnerable, seriously ill elderly patient. In my father's case, the outcome was catastrophic.
