After Eloise had surgery to replace her broken hip, she was discharged from the hospital and sent to a skilled nursing facility (SNF) that was part of the retirement community where she lived. Like many patients, she had experienced a significant loss of mental acuity while in the hospital.
The Institute of Medicine found that even people living independently before going into the hospital experienced a rate of mental decline afterwards that was 2.4 times as great as it was before they went into the hospital, even if they hadn’t developed delirium in the hospital. People who also develop delirium, as Eloise did, fare much, much worse.
The SNF Eloise was in provided great physical rehabilitation, and Eloise was soon walking without even a cane or walker. Her daughter Rochelle tried to get the skilled nursing facility to help her mother regain some of her cognitive ability, and ran into a brick wall.
For example, while the retirement community offered regular computer-based brain training sessions open to all residents, somehow Eloise wasn’t able to participate. First, Rochelle was told that the eight-week course had just started and had no seats available. After that, she was told that someone would have had to take her mother to the computer room and sit with her, but there wasn’t room for the extra chair.
With each week that went by, Rochelle got more and more upset, because she could see the mental decline becoming more and more entrenched. It seemed to her that the SNF simply assumed that her mother’s current mental state was a given, and that there was no point trying to do anything about it.
When Rochelle talked with the nurse manager about the possibility of moving her mother to assisted living, the nurse scoffed: “She doesn’t even use the call button. You can’t be in assisted living unless you can use the call button.”
Rochelle looked for the call button in her mother’s room. She couldn’t find it. She called (on the phone) for help, and an aide came in and spent five minutes crawling under the bed untangling the call button and its cord from the cables that controlled the bed’s electronics (allowing it to be raised and lowered).
How was Eloise supposed to use the call button? Had anyone made any consistent effort to make sure the call button was visible and reachable and to teach her to use it, reinforcing the training over and over? Clearly, no.
This fatalism about patients’ sudden decline in cognitive abilities resulting from hospitalization does not serve them well, because cognitive rehabilitation, like physical rehabilitation, works best if it is started immediately and if it is done intensively and consistently. Next week’s column offers some suggestions.
