EP.27【Story】Patients over COVID-19- Nursing Home

"Diseases don't pick people, but they will find the weakest point in society to attack." This time I want to share with chronically ill patients under the epidemic. In addition to kidney dialysis patients, they are also the hardest-hit group. Although they are relatively small, But it is often encountered in clinical practice.

These chronic disease patients may be hospitalized urgently due to urinary tract infection, pulmonary edema, and stroke. After discharge, they are unable to take care of themselves, and the family support system is insufficient. No family members can regularly help patients change diapers, suction sputum, and pat their backs. They need third-party assistance to take care of them. . However, due to the severe epidemic situation, all hospital beds have been confiscated and must be provided to patients with new coronary pneumonia. In addition, there are many restrictions on nursing homes under the epidemic. How should these people be cared for?

Story introduction

A 90-year-old grandma, with a plump body, a knife on her feet, and a history of diabetes, high blood pressure and mild kidney disease, was hospitalized due to urinary tract infection complicated by septic shock before the outbreak, and was transferred from the intensive care unit. After going to the general ward, the family finally breathed a sigh of relief, but the grandmother's serious illness caused serious deterioration of her body functions and needed more care than before.

Although grandma's children are very filial, the children take turns to take care of grandma during their stay in the general ward. They need to force-feed grandma 4 to 6 times a day. Since the grandmother weighs more than 80 kilograms and the children are not young, the process of taking care of the grandmother is often overwhelmed. In addition, grandma closed her eyes to rest most of the time, and often whispered unconsciously in her mouth, and sometimes suddenly moaned in the middle of the night, waking up the family members who were accompanying the sick, making everyone's sleep quality poor.

Although grandma's vital signs are stable, she still needs to be taken care of by others after she is discharged from the hospital, and her children still have to go to work during the day, which is quite distressing.

Regardless of whether there is an outbreak or not, the function of the hospital is to provide beds for acute patients, such as fever, pneumonia, urinary tract infection, etc. When the acute problem is resolved, or the acute problem turns into a chronic problem, it will generally arrange for discharge, so that the hospital bed can be reserved for others acute illness. For such multiple chronic diseases and bedridden patients with nasogastric tube, multiple people are required to take care of them when they are discharged from the hospital. However, due to insufficient family support systems, they usually seek assistance from nursing homes. However, there are also many restrictions on nursing homes under the epidemic, which makes these patients and their families have nowhere to go.

Post-hospital care

1. 90% of the patients return home, and the symptoms of these patients can usually be cured or directly resolved. Taking dialysis patients as an example, they are hospitalized due to uremia or pulmonary edema. They can be discharged after cleaning the toxins, and they can be dialysis regularly in the future.

2. 20% of patients will have chronic problems after acute problems. For example, the elderly are disabled after stroke. Although they have received rehabilitation, they are no longer able to take care of themselves, and their family members can barely take care of them.

3. 10% of the patients themselves have multiple chronic diseases and are old. Because they are completely incapacitated after a certain incident, they need to be fully taken care of by others, but their family members cannot afford it regardless of human and financial resources.

solution

1. Long Photo 2.0

Clients: Demented persons over 50 years old, Aboriginal people (mountain and flatland) aged 55-65, disabled or debilitated persons over 65 years old, and persons with disability handbooks.

Service content: home care, community care, transportation, assistive device service, respite service, home environment improvement, etc. For some peritoneal dialysis patients, the attendant will go to their home to assist in changing peritoneal dialysis fluid, or feeding the patient with medicine; some Will help the elderly to bathe, assist in cleaning the home. Respite service is a concept of short-term baby care. If the family caregiver feels that the patient is out of breath, they can apply for institutional respite service, and the patient will be sent to the institution for a few days, so that the family caregiver can rest.

Long photo 2.0 is divided into three types

A-level unit (community-integrated service center): There is at least one in a township area, which must have home services and day care, and play the role of matching B-level units and C-level units. When the elders and their family members who need long-term care services provide the needs, the A-level unit draws up a care plan, and then dispatches the case to the B-level and C-level units in the neighborhood to provide actual services.

B-level unit (complex service center): There is at least one in each secondary school district. The service targets are those who need long-term care services for dementia and disability, and there are units for home service, community care, and institutional care.

Class C unit (Xiangxiang Changzhao Station): There is at least one in every three villages, and there are transportation vehicles to pick up and drop off. People can gather in one place to sing, dance, share meals, and provide services such as social participation, health promotion, and prevention and delay of disability.

Usually large and medium-sized hospitals have a discharge preparation team that can assist in providing relevant social resources for patients and their families and let them know about the service items of Long-term Care 2.0. However, under the raging epidemic, the above three categories are somewhat suspended. If you feel that you are unable to take care of patients at home, you can call the long-term care line 1966 to make an appointment.

The maintenance organization

(1) Nursing home

Clients: The elderly or the sick who are completely unable to take care of themselves.

Service content: Provide three-tube service (nasogastric tube, tracheotomy tube, urinary tube), and 24-hour nursing care.

(2) Long-term care center

Clients: Patients who are unable to take care of themselves and have chronic diseases.

Service content: Long-term care-type long-term care centers can provide services in three halls, and nursing-type long-term care centers can serve patients with two intubation tubes, and can also serve without or only using one tube. There should be a nurse on duty 24 hours a day.

(3) Nursing centers (commonly known as nursing homes)

Service Objects: The elderly who live alone who need long-term care, the elderly who have no major illness but can take care of themselves, and the elderly who want to live at their own expense.

Service content: An environment that provides basic health services, sports and leisure spaces, and a health care notification system.

If the patient can take care of himself and his family members can take care of him, of course he chooses to go home.

If the patient is unable to take care of himself, his family can help him or her to maintain his basic life, and he can apply for long-term care 2.0.

If the patient cannot take care of himself, he can only choose a medical care center. If there is a need for three tubes, a nursing home is bound to be chosen. If there is no need for three tubes and the patient cannot take care of their own lives, then a long-term care center or a nursing home should be considered.

In fact, the emergence of long-term care 2.0 and nursing institutions has provided great help to families with patients at home. For example, there was a grandfather in his 80s who lived alone, and his children were all working in other places. He was quite talkative every time he returned to the clinic. Although he had kidney disease, he didn’t eat on time, and he often took drugs and supplements from the radio station indiscriminately. It is not stable, sometimes even two or three times a month to the emergency department, usually due to low blood sugar, pulmonary edema or sudden deterioration of the kidneys, causing edema of the feet to be sent to the doctor. When he was hospitalized, he had a deep discussion with his family and suggested applying for the long-term care 2.0 meal delivery service and home care, so that Grandpa could enjoy a better quality of life. Sure enough, Grandpa rarely came to the emergency room in the middle of the night. At present, he only regularly returns to the outpatient clinic to get medicine. It can be seen that the above services can not only reverse the patient's condition, but also a great boon for the family.