Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if
you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
My Mom Has a Tracheostomy and is Currently Admitted in LTAC. Should My Mom Have Stayed in ICU Rather Than Going to LTAC?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Tara, as part of my 1:1 consulting and advocacy
service! Tara’s mother has a ventilator attached to a tracheostomy and Tara is asking if LTAC’s are capable of weaning her mom off the ventilator.
My Mom has a Ventilator Attached to a Tracheostomy. Are LTAC’s Capable of Weaning My Mom Off the Ventilator?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Tara here.”
Part 1
Part 2
Patrik: I see. So you would have already noticed the difference in staff. In the skills, probably from the staff. Would you have noticed?
Tara: Yeah. They tried the same in the beginning but that’s what they specialise in, with weaning and that all their staff was skilled. And I actually don’t doubt the doctor. He did train at Acute Care Clinic. But everybody under him and it’s like a different set of people, every couple of days, so it’s hard to keep up.
Patrik: Right.
Tara: I can’t say that they’re bad at care, but I don’t really know if they’re doing fully what they need to be doing. But they’re doing it under the doctor’s supervision.
Patrik: Right, right. I feel like we need to get on the phone to them. I strongly feel that way. Sorry, I really thought, in the beginning she was still in ICU. That was my understanding.
Tara: No.
Patrik: Okay.
Tara: We thought it was a good choice to go to this, because that’s what they do. They are specialised in getting people off the ventilator.
Patrik: Right. Look, that’s what they say otherwise you wouldn’t agree to let your mom go from ICU.
Tara: No.
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Patrik: You wouldn’t have agreed to… If they were telling you, “Oh, we can’t wean her off the ventilator,” you wouldn’t have agreed to that.
Tara: Yes. Correct. Nobody at the ICU ever said she could not be weaned.
Patrik: That’s right.
Tara: It was a little bit of trouble because she was not coming out of sedation. When they put her under the surgery and she does have a history of not coming out of sedation. So, they were having trouble getting her off sedation so they couldn’t even start the weaning process.
Patrik: I see, I see. Okay, I think if that’s the case, it’s even more important that we get on the phone to them. I would like to see what’s their care plan. There must be a care plan. Right?
Tara: Well like I said, the respiratory doctor has given up.
Patrik: I feel positive that we can do something there and that we can change their approach. The other thing you always have to keep in mind Tara, is that if they can’t wean her off the ventilator, she will be there for, I don’t know how long. But that’s basically money for them in the bank.
Tara: Well, that’s what I was saying. Both doctors have to agree that there’s nothing more can be done. I think that’s when they’ll tell us that we have to go to the next step down which is more like what you’re… I think that you call the-
Patrik: Yeah, yeah. Intensive care at home.
Tara: More of a nursing home, yeah.
Patrik: Yeah, yeah or a home.
Tara: Skilled nursing.
Patrik: Yeah, sure, sure.
Tara: No. We do not want to do that under any… If we have to take her out of there, we’ll take her home. She will not go to one of those nursing homes.
Patrik: Okay. Tara, what I’ll do next is I will email you the options that we just talked about.
Tara: Okay.
Patrik: If you have any questions regarding those options, let me know. We could start as early as tonight if you wanted to. It’s up to you but as I said I do work on a first come, first serve basis.
Tara: Okay. Well, go ahead and send me the information.
Patrik: Yes, I will send you the information.
Tara: I’ll try to make a decision. I’m trying to finish up my work here and then I’m going to the hospital and that’s probably what I’ll… When I get there I can sit down, relax and look it over and I’ll make a decision.
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Patrik: Yeah, absolutely. Absolutely. So I will email you that in the next ten minutes and then you can get back to me.
Tara: Okay.
Patrik: Okay. All the best.
Tara: Definitely some sort of consulting at some level. I think is probably what we want to do with it. I need to talk it over with my brother and we will make decision.
Patrik: Of course, of course. Absolutely.
Tara: So, yeah.
Patrik: I’ll email that to you now. If you look at www.intensivecarehotline.com, this is a consulting advocacy service option. There are many case studies on our website, where we help families in similar situations. You can read some case studies there, you can listen to
some interviews.
Tara: Yeah, I did read it.
Patrik: Right.
Tara: A few. Yeah.
Patrik: Right, okay. Sounds like you’ve been there already then.
Tara: Yeah.
Patrik: You can read there as well. The shortcut is always to talk to me and get me involved there with the doctors. Because as I said to you, at the moment, your biggest challenge is you don’t know what you don’t know and they need to be asked clinical questions. At the moment, you can’t ask them clinical questions.
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Tara: Right.
Patrik: And you will need ammunition to ask them some questions and to a degree challenge them. Because if they’re telling you they’re giving up, that’s not good enough.
Tara: Okay.
Patrik: That’s not good enough.
Tara: Yeah, I understand about not being able to ask what you don’t know because I’m at the hospital.
Patrik: Yeah
Tara: And my brother lives ten hours away but he does a lot of research. So, he’s better at it than I am. I talk to the doctors and get as much information as I can, then I talk to him and try to translate it. And then he gets on the computer, starts looking things up so he can get back to me to tell me what to ask the doctors.
Patrik: Right, right. That’s good.
Tara: That’s how he came across the Alung thing.
Patrik: Right, right, right, okay.
Tara: So, unusual. And you.
Patrik: Right. So he found me. Okay, okay. Fair enough, fair enough. So I’ll give you an example, if you were to send me pictures of the ventilator, depending on the ventilator, there’s about ten, fifteen numbers on there. It would be very difficult for you to make sense out of what’s displayed on a ventilator. And again, that’s where things like my expertise comes in. And after having worked in the intensive care for twenty years… And also the
things like you’re telling me, she hasn’t been mobilised and I just go like, that’s ventilator weaning 101.
Tara: Okay.
Patrik: I have not seen patients coming off the ventilator without mobilisation. I just haven’t.
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Tara: Okay. Yeah, all they said was, she wasn’t tolerating it well but I don’t know what they meant by that.
Patrik: I can tell you, it might sound ridiculous for some people what I’m saying now. If you start with five minutes a day, and she can’t tolerate it, fair enough. Go back to bed, maybe the next day it’s ten minutes and maybe the next day it’s twenty minutes.
Tara: Right.
Patrik: You need to start somewhere.
Tara: Right. Okay.
Patrik: Am I right?
Tara: Yeah. That’s the problem. They don’t really have time to deal with patients. They just whisk on through and bing, bang and get them out the door.
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Patrik: Exactly, exactly. And if you had come to me by the time she’d had the tracheostomy, that’s exactly what I would have told you. I would have told you the minute she’s going into a facility like she’s now, she will be going from great care to low level care.
Tara: Yeah.
Patrik: This is what is happening now.
Tara: Okay. What’s our time on right now? I don’t have a watch on.
Patrik: Sorry, what’s the time? It’s just before five o’clock.
Tara: No, I meant… Oh, is it?
Patrik: Yeah.
Tara: We ran past our fifteen minutes?
Patrik: Sorry. What did you say?
Tara: I don’t have a watch to keep track if we only had fifteen minutes.
Patrik: We’ve gone way beyond but I wanted to have a good understanding.
Tara: Right and I appreciate that but I just… I want to make sure I’m paying you or whatever. Do you want me to. .
Patrik: Look, I’ll tell you what we could do… I can send you the link where you can pay for an hour and then, you wanted to take that up for… If you wanted to take that further to the four day option, or the seven day option, or the fourteen day option, you can. Right. I hope that was helpful to begin with.
Tara: Okay.
Patrik: That would be appreciated. I know I can help you with this and it’s just a matter of once we start talking to the doctors. I know the dynamic will change. Because at the moment, you can’t challenge them on the clinical level.
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Tara: Right, right. You know and I don’t and that’s it.
Patrik: Yeah, okay. So what I’ll do next Tara is I will email you those options that we talked about.
Tara: Okay.
Patrik: And then you can get back to me.
Tara: Okay.
Patrik: Okay?
Tara: Yeah.
Patrik: I hope that was helpful for now.
Tara: Yeah. Very helpful, hope is helpful.
Patrik: Yeah.
Tara: That’s all we were asking at this point is a little hope.
Patrik: Hope is not a strategy. Hope is important but not a strategy. You will need tangible things like… We will need to start asking some clinical questions.
Tara: Okay.
Patrik: All right. I’ll let you go for now and I’ll email you the options in the next ten minutes.
Tara: Okay.
Patrik: All right.
Tara: When I get to the hospital tonight.
Patrik: Have a look.
Tara: I’ll sit down and make a decision.
Patrik: Okay. Thanks for now, Tara.
Tara: Okay. Well, thank you very much. Thank you for your time.
Patrik: You’re very welcome. All the best for now.
Tara: I’ll be back talking to you later.
Patrik: Okay. Thanks Tara. Bye, bye.
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Tara: Hello?
Patrik: Hi, is that Tara?
Tara: Yes, Hi, Patrik, how are you?
Patrik: Very good, thank you. How are you?
Tara: Well, not very good at the moment. So, a lot has happened.
Patrik: Right.
Tara: Thursday they started the weaning process again, I don’t remember where we left off on our last email was.
Patrik: Right.
Tara: But she had a full day wean, 12 hours.
Patrik: Yes.
Tara: But her O2 level came back. CO2, I’m sorry. The CO2 came back and I haven’t been back up to get all the reports and stuff. I saw the doctor in the morning on Friday when I left, and what he was saying that he doesn’t think she’s weanable again. So we’re back to where we were a month ago. So today, the caseworker called and they said the doctor is ready to discharge her. I told him I did not want to go back to the place I was before, so now
they’re saying they want to shift her to this facility out in New York. And I said, you know, I hadn’t had time to look into it or anything.
In the meanwhile, I was trying to find, there’s a nursing home right in our home town, but they obviously don’t have a respiratory unit. I was looking into the possibility, they call them the suites, where it’s like having your own apartment. But they also have access to some nursing home facility type stuff. You know, there’s like a nurse on site and all that kind of thing. So I was hoping maybe if we purchased the equipment or rented the equipment, we could
maybe set this up at a nursing home type facility to get my mom at least into the same hometown that I am in. Then it would make life a lot easier.
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Patrik: I can imagine. I can imagine.
Tara: That’s where I’m at. But they are ready to discharge her today and I think that’s impossible.
Patrik: Yeah.
Tara: So luckily they said this facility in New York doesn’t have a bed open until Monday. So on Monday they’re going to discharge her.
Patrik: No, no, no. You’ll need to put a stop to that, but we’ll come to that.
Tara: Yes.
Patrik: We’ll come to that.
Tara: Yes.
Patrik: We’ll come to that. Let’s just look at the facts, right? What are the facts, okay? The facts are that before she went back into ICU, she was on a controlled ventilation mode, which means she wasn’t doing any of the work. Okay, that the work was done by the ventilator. Now, the first pictures you sent me from ICU showed that she was in a ventilation mode where she as doing most of the work.
Tara: Right.
Patrik: Something has changed considerably between the LTAC and then going back to ICU. Something has changed and something has improved. No matter what they tell you, it has improved.
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Tara: Well, I don’t think they ever thought of doing it that way. I think they just assumed that they had to be in the other mode.
Patrik: Yeah.
Tara: It wasn’t until the ICU doctor, he just like walked over, and changed the settings. And everyone else that was around, their jaws just kind of dropped. They saw, she was breathing on her own and the volume control.
Patrik: Yeah.
Tara: Yeah. So I don’t know if anything’s actually changed with my mom. I think just nobody at Criticare ever bothered to put her into a different mode.
Patrik: Correct and that’s why I can’t stress enough, those LTACs, they’re just a disaster. They don’t know what they’re doing. Literally your mom within a heartbeat improved because simply somebody had a look at this and realised, hang on a sec. This is just not right. Let’s try and breathe her by herself, which is what she did. Right? That’s why I keep saying, those LTACs are a better version of a nursing home, if at all.
Tara: Right.
Patrik: We have people coming to us, begging to us to help us get their loved ones out of LTAC. They have no idea what they’re signing up for. They have absolutely, you know, they realise when it’s too late.
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Tara: Right.
Patrik: Now, in this instance, you’re probably lucky that she’s in ICU for now, because that’s where she should be.
Tara: Right, well, she’s not really in ICU now, she’s in a step down, but I feel confident that they’re working with the settings that were started in the ICU, so at least we know that.
Patrik: Okay, but she’s still in a hospital, and she’s probably in ICU. Now last time you mentioned that she’s… Isn’t she in a respiratory ICU at the moment, or something like that?
Tara: A respiratory?
Patrik: No-
Tara: What was that?
Patrik: Isn’t it an ICU that’s specifically designed for respiratory diseases?
Tara: Oh, respiratory division? Well, I kind of thought that because it says MRIU, but it’s medical respiratory intermediate. .
Patrik: Unit or something.
Tara: Unit.
Patrik: Okay.
Tara: But it’s not intensive unit.
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Patrik: Okay.
Tara: So I was actually wrong when I said that.
Patrik: Okay, fair enough, fair enough.
Tara: But it is still a respiratory unit, so that’s better than…
Patrik: Absolutely. What’s the nurse to patient ratio there? Is there a one-to-one nurse to patient ratio?
Tara: No, no, but I’m not quite sure what it is. Probably, one, two, three. I don’t know if it’s three patients to a nurse or six because there’s like three rooms on one side and three on another. I’m not sure if a nurse covers, how that works. I mean, I can find out for you.
Patrik: I think you should. Who’s overseeing the medical care? Who is that? Is that a respiratory physician? Is it a pulmonologist? Who’s overseeing your mother?
Tara: Yes, there’s a pulmonologist. There’s a regular house specialist doctor, whatever, that comes through, and then there’s also a pulmonologist.
Patrik: Who’s the driver behind getting her back to where she was before? Who’s driving that? Is it the pulmonologist?
Tara: You mean moving her out of the facility?
Patrik: Yes.
The 1:1 consulting session will continue in next week’s episode.
