In some medical situations a geriatric care manager is the best option for families who don’t know where to turn when a loved one is in medical distress.
When Barbara Millstein fell in her Sun City Center home last July 21, she injured her pelvis. She was assured that with proper treatment, including physical therapy, her condition would improve without surgery. Little did Barbara know that her fall was only the beginning of a monthslong medical crisis that took her entire family and a senior’s advocate to solve.
Barbara’s case is an example of how an older patient became a “vulnerable person” at the mercy of those persons and facilities who would exploit her and her situation without regard for her personal wellbeing.
And that is why legislation passed this year by state lawmakers to protect the rights of elderly and disabled residents is so important.
House Bill 409, the “vulnerable persons” bill, was passed to protect the elderly and disabled by redefining the statutory definition of exploitation of vulnerable adults. It also increases penalties for those who steal seniors’ identities and holds caregivers accountable for negligence. The bill awaits Gov. Rick Scott’s signature.
After Barbara fell, her husband Jerry said that on one occasion after the physical therapy, something went wrong and the pain in her hip worsened. She also became less mobile as the weeks went by.
“In late September, she was in the bedroom and collapsed,” Jerry said. He said that emergency services took Barbara to a local hospital. In the emergency room, her temperature was recorded at 104 degrees when she was admitted, he said.
“Meanwhile, her mind was going south,” Jerry said.
When surgery to fuse her vertebrae was suggested, Jerry called their son Mitchell, who flew to Florida. Jerry and Mitchell decided to cancel Barbara’s operation. “None of them were talking to me,” Jerry said. “No one was explaining why her mind was going bonkers.”
Jerry said Barbara ended up in a nursing home, where her condition was not improving, mentally or physically. By then, Jerry and Mitchell were joined by the Millsteins’ daughter, Cheryl Schaier of Virginia Beach.
Jerry said they all had advanced degrees yet did not know how to deal with Barbara’s medical emergency. It was when the attending physician at the nursing home gave his prognosis to the family that they knew they needed help.
“He said to me, ‘You have to face facts. She may not come out of it,’” Jerry said.
They did not know where to turn. Then a random meeting with an attorney gave them the answer they needed. The attorney mentioned to the family that a geriatric care manager might be of help, and he recommended Deena Balogh. Balogh has a long line of credentials, including acting as a medical guardian, and is certified by the National Certification of Geriatric Care Managers.
“Talk about an angel,” Jerry said, referring to Balogh after she saw Barbara in the nursing home. “She said to us, ‘I think there’s hope. We have to get her out of here.’”
The kind of confidence needed to question top medical managers at hospitals and nursing homes about their clients, Balogh said, comes from knowing what they are talking about and knowing what they need to do to help the people entrusted to their care. Such geriatric care managers make the tough call.
On Oct. 21, 2013, Barbara was taken to Tampa General Hospital, where she was admitted to geriatric intensive care. They found she had Mercer Disease, or MRSA, and began treating her with antibiotics. The disease had infected Barbara’s lungs.
MRSA is an infection caused by the bacteria Staphylococcus aureus.
Within days, Barbara began recovering her mental and physical faculties. The Millsteins feel that a miracle happened. Without a third-party opinion, though, her family is sure Barbara would never have come out of the nursing home.
“When you come to a crossroad like this and you don’t know what to do,” Jerry said, “you get an independent analysis. She would have been in the nursing home the rest of her life.”
Barbara is still wobbly over her experience. “I’m not an overly afraid person, but I was so nervous, my body would shake,” Barbara said about her experience.
According to Balogh, the Millsteins’ story is a classic example of what’s wrong with the “system.” Balogh says she sees that same scenario a lot, where the patient is not receiving the care they need to make a recovery.
“It’s more than advocating. It’s a battle,” Balogh said. “We are trained and credentialed at the highest levels. I spend a third of my time in courts.”
Generally what happens, she says, is that people have a fall, are in the hospital for their maximum three days for which Medicare will pay, and then they are released to their home, or a short-term care facility like a nursing home.
That is when the trouble can happen, Balogh said.
Florida lawmakers are passing legislation to guarantee the safety of the elderly and the disabled. Unfortunately, Balogh said, the right kinds of lobbyists are not demanding that action be taken. Change is slow.
It is important to protect these people as they age and increasingly need help in making decisions about the quality of their life and health care. Many are finishing their lives in assisted living, or nursing homes, so regulations of these facilities must be enforced.
Failing to pass this legislative session were House Bill 573 and Senate Bill 248. Key provisions would have assured that there would be oversight over assisted living facilities similar to that over nursing homes. A rating system would have been implemented to establish fines if those ratings became delinquent. Also, a special license would be required if one or more residents at an assisted living facility were facing mental health issues.
Some 83,000 Florida residents who are elderly or disabled live in assisted living facilities. Since 2003, the number of facilities has increased by 32 percent.
According to the Florida Health Care Association, by 2025 “Florida’s population older than 65 years of age is expected to be 26 percent of the population.”
It is important to note the difference between assisted living and nursing care facilities. While assisted living facilities offer a housing alternative to older adults, who may need help with daily needs, only a nursing care facility can help with nursing and medical care.
Assisted living facilities are now overseen by consumer or lawyer groups.
Kay Coburn Dyer is an advocate for her clients on a different level than Balogh. She tends to work “inside the system” as a watchdog, placing her clients in the appropriate health-care facility, or making sure they are safe and healthy in their own homes.
Families and doctors make referrals to her when they see a problem with an elderly person who needs a helping hand.
“I go right to the hospital with my client,” Dyer, a CMC-certified care manager says. “I am on their first-responder list. I spend half my time in the ER (emergency room).”
As a cancer survivor, Dyer has seen the inside reality of medical facilities. She is working with South Bay Hospital now to bring in an arts and music program to help healing that she experienced when she was at Moffitt Cancer Center in Tampa fighting cancer.
What Dyer worries about is the lack of Medicaid availability in Florida.
“First and foremost, we should be getting Medicaid back,” Dyer said. “It is free, federal money. The legislature in Florida seems to have different priorities.”
