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Tim’s Last Years and His Daughter’s Formal Complaint Memo

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TO: Ms. Foster, Chairperson of the Autumn Gold Board of Trustees

FROM: Ms. Finnegan, Executive Director of Autumn Gold

DATE: June 14, 2020

SUBJECT: Tim’s last years and his daughter’s formal complaint

Findings

Tim had many health issues- chronic obstructive pulmonary disease (COPD), mild congestive

heart failure, a partially blocked carotid artery, urinary incontinence, high cholesterol, a reset hip,

and difficulty swallowing. In addition to health complications, behavioral issues became evident

while residing at Autumn Gold. Tim often ate alone, when he was still eating, in his apartment

and preferred little to none social interaction. Tim worked with a Speech Therapist to help

improve his swallowing reflux. Tim was intolerant of those with few intellectual

accomplishments, especially women who were superficial and unaccomplished. He often yelled

at staff to leave his apartment or became upset when they entered suddenly and did not explain

the reasoning for the visit. Care conferences took place to assess residents. Tim’s conferences

were one-sided and a condemnation of his behavior and threats of termination, rather than

consulting with family and friends on how to achieve highest quality of life. Despite health and

behavioral issues, medication did not affect Tim until after his second care conference, where

Ativan was prescribed. This caused his friends to worry that Autumn Gold was having Ativan

described so Tim was less work and challenging.

Transpiring Events

• Staff not encouraging him to eat or aiding him

• Staff not completing daily hygiene tasks (shaving, bath, combing hair)

• Staff not completing the minimally required comfort care (moving from bed to chair)

• Staff being afraid of him

• Plateaued progress in swallowing proceeding termination of Speech Therapist due to

unwilling staff

• Plateau of ambulation when rehabilitation discontinued because insurance stopped paying

for it

• Loss of independence

Recommended Steps

Culture, environment, health care services, coordination and integration with the community, and

resident quality of life are domains that need to be made a focus and priority within Autumn

Gold (Leff, McNabney, Riess, Samus, Sheehan, 2018). Taking steps to improve the listed

domains will help prevent similar events that left Tim’s family and friends upset.

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Culture can be improved by staff demonstrating trust, transparency, love, courage, and leadership

(Leff, McNabney, Riess, Samus, Sheehan, 2018). Culture can also be changed by the following

operations at the staff level: staff engagement, staff satisfaction and appreciation, quality

improvement, governance, philosophy of care, and emergency preparedness (Leff, McNabney,

Riess, Samus, Sheehan, 2018). Satisfaction surveys can go out to both residents and staff every

Sunday. If an event happened that was satisfactory or non-satisfactory the following week, it can

be reported. Autumn Gold must keep record of all survey results for legal purposes. Incentives

for staff and recognizing those that are excelling and staying on task is a must. It is

recommended that more staff be hired to help with those residents that are difficult. This will

lower the patient load for the staff, allowing more time with those that are difficult. Had staff,

other than Mia, taken the time to get to know Tim, his continuity of care could have had a

different outcome. Additional staff can help ensure that the desired etiquette of entering an

apartment is followed and services are more effective and in a friendly, caring manner. Changing

the culture will provide staff and residents the feeling of freedom and satisfaction.

Changing the environment by updating physical design, the stability of the environment, and

safety systems will help residents feel surrounded by love and enriched away from home.

Accessible and coordinated quality medical and nursing services, advance care planning,

medication management, wellness and prevention, elder abuse prevention and response,

management of care transitions, and disclosure to residents and families are health care services

that need to be brought back into focus (Leff, McNabney, Riess, Samus, Sheehan, 2018). It is

important to inform residents and their families and friends that Autumn Gold is not in charge of

hospice. If Tim’s family had known this in the beginning, they may have not been as inclined to

file a complaint. Starlite could have been contacted sooner and Tim could have received

maximum comfort care sooner. A contract should be signed at the time of move in that

recognizes that hospice is contracted out and Starlite is responsible for all provided hospice care.

When asked what they missed most about living at home, 35% of residents at an assisted living

facility reported physical independence (Ball, et al., 2004). Remaining independence depends not

only on the resident’s attitudes and abilities but on the ability of the environment to compensate

for and enhance individual competence (Ball, et al., 2004). A policy must be created stating that

staff will knock, slowly open the door, and announce themselves and their reasoning for wanting

to enter. If staff are seen or residents report that staff are not abiding, a write up should be

completed. In addition, coordination and integration with the community can provide a sense of

independence by creating meaningful activities, establishing relationships with the community,

giving back to the community, providing transportation into the community, and allowing

residents to continue their civic duties, such as voting. Transportation should be available to

residents three days a week and have a set schedule and route for stopping at certain shops.

Lastly, resident quality of life can be increased by setting goals and expectations upon moving

in, providing resident engagement and rights (dignity, autonomy, privacy), focusing on food,

nutrition, feeding, hygiene, mobility, preservation of independence, prevention of avoidable

harm (falls, abuse, safety), sense of belonging, family engagement, and spiritual needs

(providing a minister/pastor) (Leff, McNabney, Riess, Samus, Sheehan, 2018). After every two

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TO: Ms. Foster, Chairperson of the Autumn Gold Board of Trustees FROM: Ms. Finnegan, Executive Director of Autumn Gold DATE: June 14, 2020 SUBJECT: Tim’s last years and his daughter’s formal complaint Findings Tim had many health issues- chronic obstructive pulmonary disease (COPD), mild congestive heart failure, a partially blocked carotid artery, urinary incontinence, high cholesterol, a reset hip, and difficulty swallowing. In addition to health complications, behavioral issues became evident while residing at Autumn Gold. Tim often ate alone, when he was still eating, in his apartment and preferred little to none social interaction. Tim worked with a Speech Therapist to help improve his swallowing reflux. Tim was intolerant of those with few intellectual accomplishments, especially women who were superficial and unaccomplished. He often yelled at staff to leave his apartment or became upset when they entered suddenly and did not explain the reasoning for the visit. Care conferences took place to assess residents. Tim’s conferences were one-sided and a condemnation of his behavior and threats of termination, rather than consulting with family and friends on how to achieve ...
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Tags: chronic obstructive pulmonary disease health issues Speech Therapist Autumn Gold Ativan prescription