Trends in Long-Term Care - U.S. Senate Special Committee on Aging

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elevated, and this aga<strong>in</strong> was found to be the fault of dehydration, as
shown by her response to rehydration.
The patient also had significant elevations of blood sugar and blood
sodium levels, also reflect<strong>in</strong>g severe dehydration.
In addition, she had an <strong>in</strong>fected decubitus ulcer on her buttocks, and
she also had ulcers on the ankles and hips.
I have one more illustration I would like to give you.
Mrs. Z, a 69-year-old lady with a history of high blood pressure,
coronary heart disease, and a history of a stroke. This lady was <strong>in</strong>
a nurs<strong>in</strong>g home prior to December. We have no records from that
home. She was apparently transferred from the home and was subsequently
sent to the hospital.
On the 23d of December, I diagnosed diabetes, but she had no
medication for diabetes.
Accord<strong>in</strong>g to the scant <strong>in</strong>formation from the nurs<strong>in</strong>g home that was
sent <strong>in</strong>, no ur<strong>in</strong>e or blood tests were done to check on the status of
diabetes.
The only <strong>in</strong>dication of illness noted on the transfer sheet, was
on the day of transfer, the patient felt fa<strong>in</strong>t, and she was put back
to bed.
In the hospital aga<strong>in</strong>, we found the same k<strong>in</strong>d of severe dehydration.
decreased sk<strong>in</strong> tone, no sweat.
The patient was found to be about 30 percent dehydrated, a very,
very dangerous condition, and there did not appear to be any way <strong>in</strong>
which this condition could have developed suddenly.
It reflects the diabetes for a long period of time relat<strong>in</strong>g to progressive
dehydration, and the comatose state, and the patient was f<strong>in</strong>ally
sent to the hospital.
Aga<strong>in</strong>, the treatment was fairly simple and fairly successful, <strong>in</strong>
terms of dehydration, she was given <strong>in</strong>travenous fluid, and that part
of her problem was resolved.
In many cases, we have some successful results. Frequently the
patients will die, sometimes on the way to the hospital, and <strong>in</strong> the
emergency room.
There are some other problems frequently seen I would like to
state.
The severe problems that on transfer to the hospital, many of these
patients were sent with little or no <strong>in</strong>formation about their past
medical history, what has been bother<strong>in</strong>g them, what k<strong>in</strong>d of treatment
they are gett<strong>in</strong>g <strong>in</strong> the nurs<strong>in</strong>g home.
We have to start from scratch. The experience with these patients
be<strong>in</strong>g hospitalized, rehabilitated, fixed up, sent out to the nurs<strong>in</strong>g
home, and come back a week or 2 later with the same problem, sometimes
the patient would cause it, sometimes it was pla<strong>in</strong> obvious.
The patients who were on low-salt diet, compla<strong>in</strong>ed they were given
food with high salt, and they were given th<strong>in</strong>gs such as cornbeef, which
they were not supposed to eat. but they got it anyway.
Families compla<strong>in</strong>ed that patients who need help with feed<strong>in</strong>g don't
get it, and the next step is malnutrition and dehydration, the effects
of which I just described.
I can only speculate on the basis for the poor condition, on the
neglected appearance of these nurs<strong>in</strong>g home patients, and obviously,
the problems of the care of the chronically ill for the aged are great.