Educating assisted living/skilled nursing staff about type 1?

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DrAmazon posted on Sun, Dec 5 2010 8:03 AM

I'm the primary caregiver for a 68 year old Medalist (58 years diabetic).  Mom lives in an assisted living facility, and I am struggling with the misconceptions and outright WRONG information that many of the staff have about how to treat her.  Many do not seem to know or understand that there is a difference between type 1 and type 2.  Several of the staff seem to be constantly blaming her for the swings in her blood sugar.   They just don't seem to understand that her ability to live with the disease for 58 years and still have her feet, kidney function and eyesight demonstrates that both she and I do have some idea how to care for her.

The RNs are mostly OK. I'm having more trouble with some of the Medical Technicians who administer the medications.  One example is the long battles I've fought to ensure that she is given her Lantus every night, even if her blood sugar was low earlier in the day.

I could post for pages about my struggles, so I'll stop here.  Any ideas?

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jen1229 replied on Sun, Dec 5 2010 11:18 AM

 I don't understand why a technician is administering medication.  I thought it had to be a nurse or doctor. 

I totally understand how you feel.  I was in the hospital once (I'm type II) and they came and game me my insulin and then my lunch was late coming and I went low.  If the clock says it's time to administer meds they do it regardless. 

If a tech is administering meds, and they are not being administered properly, you may have a course of action.  Personally, I would look for a better placement, but if that is not possible, you may have to go each night and ensure that she is given her Lantus. 

Have you discussed this with her physician?  Can't he call in an order?

 

 

Jen  - LevemirConfused and Novalog Wink A1c 5.8

 

 

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Julia replied on Tue, Dec 7 2010 8:16 AM

This is a problem in all types of settings and with all levels of medical staff.  When I was at my regular endo visit last month, he took a call from a doctor in a hospital about what to do about a Type 1's continuing very high blood sugar after a colonectomy for cancer.  I sat there and listened to my endo explain to this DOCTOR responsible for treating hospital patients the difference between Type 1 and Type 2 and that Type 1's always need a basal insulin - either Lantus or the pump.  When he hung up he told me that every hospital is this way and that even though this man and his wife had been telling the staff for a week that he needed basal insulin, they were continuing to treat him under the Type 2 "sliding Scale" protocol.  What's a Type 1 to do?

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Medication aides, or medication technicians are usually passing meds in the assisted living.  This is a bit of a surprise to me also.  I've talked to a local geriatric care manager about the situation.  She says that at this facility, the techs seem to run the place.  The management doesn't seem able or willing to reign them in.  Once again, I wish I would have talked to her sooner.  

 

http://www.wisegeek.com/what-does-a-medication-aide-do.htm

 

The majority of the staff are personal aides working for close to the minimum wage. The folks who distribute medication need as little as 16 hours of classroom instruction in some states to qualify for the job. Even in Virginia, which is known for its strict rules, the training requirement jumps to just 48 hours.

Read more: 10 Things Your Assisted-Living Facility Won't Tell You - Spending - Deals - SmartMoney.com http://www.smartmoney.com/spending/deals/10-things-your-assisted-living-facility-wont-tell-you-10401/#ixzz17WLPE8Zs

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jen1229 replied on Wed, Dec 8 2010 7:40 AM

It started with Nurse Practitioners and PAs.  They are physician wannabees who either couldn't get into medical school or did nowt want to spend the years in school and residency before  being able to practice.  Then there are the Pharmacy techs that allow these mail order pharmacies to provide drugs at a lower cost than a drug store because they have 50 techs being supervised by one pharmacist.  Mistakes get made that could kill people if they don't notice before taking the med.  And now doctors don't even have to go to the hospital to visit their patients because they have "hospitalists" (although these are actual physicians) who see you while you are in the hospital.  What is the sense of having a PCP if they don't see you when you are in the hospital?  I think we should go back tot he old days when physicians were physicians, and nurses were nurses.  Let medical PROFESSIONALS do the treating and if someone wants to be a physician let them go to medical school.

Jen  - LevemirConfused and Novalog Wink A1c 5.8

 

 

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T1gal replied on Wed, Dec 8 2010 8:30 AM

You may have already tried this.  But how about a prominently displayed white board in your mom's room with an instruction about the lantus, backed up with a note from her doctor in her file to state clearly that Lantus is to be given regardless of blood sugar?  Also, have you considered an insulin pump?  Maybe you could go every 3 days to change out her site?  You would know she is getting her basal insulin.  Staff would be responsible only for monitoring her blood sugar and administering meal boluses, but the pump could be programmed to do the math for them.  Would require fairly frequent blood sugar monitoring to make sure there wasn't a delivery problem, but those are pretty rare.  Don't know your mom's mental state, but pumps can even be "locked" so that a code is required to operate it.  This is a difficult situation, and your mom is fortunate to have you to care for her.

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Susan replied on Thu, Jun 30 2011 6:03 AM

Hello there,

I am a gerontologist and came across your post about being a primary caregiver for your mother. In my opinion, the long-term care industry isn't prepared to deal with patients diagnosed with diabetes, especially type 1.

You may want to consider the following:

1. Locate a geriatrician and/or geriatric multidisciplinary team.

2. Also, perhaps your mother may benefit from insulin pump therapy and CGMS.

Hope this helps!

Susan

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