Reexamining the Condition of Health Care for the Elderly

Last month, after suffering what appeared to be a stroke, 84-year-old John Ainley was taken to a hospital from the board-and-care facility where he resided. He was discharged from the hospital about 24 hours later.

And that's where we pick up our story, one chock-full of disputes between Ainley's regular caretakers and the hospital.

Both Ainley's stepdaughter and the director of the facility where he resides believe he was released too soon and without proper guidance for his follow-up care. They openly wonder whether Ainley's Medicare status played a part in the hospital's decision.

The hospital disputes that, saying Ainley was properly discharged and that his condition and treatment were explained to his caretakers.

I'm not proposing to arbitrate the matter but to suggest that it highlights the increasing public anxiety about the future of health care--and, especially, for the elderly who don't have private health plans.

Ainley and his wife have resided at the C & R Home of Orange for about six months, according to Ainley's stepdaughter, Jean Portigal of Orange. The facility provides food and shelter, reminds residents to take their medications and provides periodic nursing care.

Last month, Portigal was called to C & R when her stepfather showed signs of a stroke. She said he couldn't use his right arm, couldn't stand without help, couldn't speak and couldn't control his saliva. Paramedics arrived, and he was taken to St. Joseph Hospital in Orange.

Portigal said doctors originally diagnosed a mild stroke. By the next day, they had downgraded the diagnosis to a TIA (transient ischemic attack), Portigal says. TIA is described in the "Merck Manual" (a physicians handbook) as a condition "of sudden onset and brief duration (usually minutes, never more than a few hours). . . . The attacks are often recurrent and at times presage a stroke."

That afternoon, Portigal visited Ainley and felt he wasn't able to return to C & R. Portigal said she went home and, a short time later, received a call from the hospital saying her stepfather was being discharged.

Portigal said she was "stunned" to hear that, so convinced was she that Ainley wasn't ready. She says the nurse told her that Ainley could walk, take water and, in addition, that C & R officials had been notified of his condition and said they could take care of him.

Portigal said she went to C& R to wait for Ainley, who arrived wearing a hospital gown, a restraint jacket and still attached to a catheter. Portigal says no written or verbal instructions arrived with her stepfather, only a listing of what medications he had taken that morning.

Rudy Pe, the owner and administrator of C & R, told me this week that he never told the hospital that he could handle Ainley if he was exhibiting stroke symptoms. "The problem is, they sent him back home with a catheter still in him. We're not prepared to handle that. Besides, he was not strong enough to stay at my place. If he falls down, it's my responsibility."

Pe described Ainley upon his arrival this way: "He could hardly talk, his hands were shaking when he was eating, food was spilling all over, but they told me on the phone he could eat and walk by himself. But when he got here, he walked a few steps but we had to guide him."

Pe didn't think Ainley should have been discharged. "It's not my decision. If he's there [at the board and care], we can't send him back to the hospital, so we tried everything we could do. In my opinion, he should have stayed one more or a couple days in the hospital before being discharged, either to rehab or my place."

To care for Ainley, Pe said, he asked Ainley's nurse and a home health aide to come to C & R every day for two weeks, instead of their less frequent visits. Over the next several days, Pe said, Ainley gradually regained some strength and control.

I asked Portigal if she might be too close to the situation to assess her stepfather's condition. In other words, I suggested, the doctors might have known best.

She insists she has factored that into her thinking. "It's very personal with me," she says, "and I told them immediately he was not ready to be released. I'm not a doctor, but I could see what condition he was in. He was not clear, he was disoriented. I didn't realize how bad he was until he got to the board and care and I saw how feeble he was. . . . "

Citing patient confidentiality, the hospital wouldn't discuss Ainley's case in detail. St. Joseph spokeswoman Valerie Orleans said, however, that patients aren't discharged unless they or their relatives are informed of their condition and medical options. She said that was done in Ainley's case. She also said it isn't uncommon for a patient to be discharged with a catheter.

Portigal disputes she was ever notified of Ainley's imminent release. She has complained both to the hospital and to state hospital officials about Ainley's discharge. Orleans said her understanding is that the state has absolved St. Joseph of any improper procedures, but a health department official told me this week that the investigation is still open.

Portigal says she is "not a vindictive person, not a crusader," but she is concerned about hospital economics and how it may affect care. "My feeling is that this is happening way too much," she says. "I think it's the small tip of a very, very large iceberg."

Dana Parsons' columns appears Wednesday, Friday and Sunday. Readers may reach Parsons by writing to him at The Times Orange County Edition, 1375 Sunflower Ave., Costa Mesa, CA 92626, or calling (714) 966-7821.

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