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        Declining Strength is a Call-to-Action

        150 150 Clifford Horwitz

        Question:

        My mother’s physical strength has changed, but it doesn’t seem that the routine of care is keeping up. Can I request more?

        Answer:

        Yes… and you should.

        Changes to a patient’s overall physical strength, which is often associated with a decrease in activity after entering a skilled nursing facility, can be responsible for a vast array of preventable medical issues and contributing factors in declining health.

        Sudden weakness (typically relating to one side of the face and/or body) can suggest a more emergent problem, such as a stroke, and requires immediate intervention and evaluation by a physician.

        Progressive weakness however, while not life-threatening, can lead to bed sores, pneumonia, bowel obstructions, urinary infections and other conditions that pose a threat of infection; often severe and indeed, life-threatening. In most cases, these infections can be easily prevented.

        A physically-regressive individual will often experience an increased level of depression and loss of appetite, contributing further to an overall decline in physical and mental health.

        Family members should begin a “diary” if you will, when a loved one first enters any level of skilled nursing or long-term care environment. They should ask for an opportunity to view and discuss the Minimum Data Set of functional measurements, which must be (by law) evaluated within 14 days after admission. The MDS should also state the level of care and supportive measures to be applied at that time.

        Skilled nursing and long-term care facilities are required to review MDS assessments every three months, and completely re-assess patients every 12 months …or, promptly after a significant change in their physical or mental condition. You can, and should request a reassessment now.

        • Questions that you need to ask include, but are not limited to:
        • What type of scheduled daily physical activity does your mother receive?
        • Who provides that care?
        • What extra steps are taken to ensure her physical safety during exercise?
        • What extra steps are taken to ensure her safety during trips to the bathroom, the dining hall (if available), and getting in and out of bed while in a weakened state?
        • How often is she assisted with re-positioning while in bed, a chair, a wheelchair …to prevent the risk of pressure sores (bed sores)?
        • Has her fluid intake been increased to prevent dehydration, or measured, and if so, ask to view such documentation to record in your diary.
        • What changes are being made to her diet to promote muscle strength?
        • And most importantly… what medications are being administered; how much and how often? WRITE IT DOWN!

        When patients show signs of depression (physical or mental), ongoing research and investigations are revealing that many are being over-medicated, either by design to keep patients quiet and still (requiring less hands-on care for reduced staffing levels), or simply because the administering and documentation policies of the facility are weak, resulting in double (sometimes triple) dosing by different staff members.

        Know what medications your mother is taking and request (in writing) to be notified when any changes occur… either to the dose of a current medication, or the addition of a new medication. If you have questions regarding medications, discuss them immediately with the physician in charge of her care. It is also important to request to see verification of the record for written orders; documentation that a physician ordered the change/addition of a new medication. What date was it ordered and why?

        Decreased physical strength and changes in mental alertness should never be dismissed as a normal and expected part of the aging process without a complete evaluation of cause.

        Residents of facilities that make physical activity (at various levels, even for bed-ridden patients) a priority with support systems and staffing levels in place, experience better overall health, strength, and mental agility with greatly reduced risk factors associated with unnecessary and dangerous infections.

        Unfortunately, our system of care today demands that family members stay active, aware and informed with detailed records of their own to support increased levels of care if needed.

        Clifford Horwitz
        AUTHOR

        Clifford Horwitz

        As Principal Partner and lead trial lawyer of Horwitz, Horwitz & Associates, Cliff has devoted his entire career to achieving justice for those who have been victimized by corporate negligence. He has won numerous record-setting jury verdicts and settlements, as well as what was the largest personal injury verdict in Illinois for an individual.

        All stories by: Clifford Horwitz