MRSA Contracted in the Nursing Home

Joan has been helping an elderly (former) neighbor for many years, acting as her next-of-kin, healthcare proxy etc., etc. She is 93 years old and quite cantankerous, and currently is in the most beautiful Nursing Home you could imagine, with large double-occupancy rooms (huge, actually), about 40 patients in all. It took more than a year to find and get into this facility, and on top of which the patient hates change and puts up quite a fuss and it takes her and the staff a while to get used to each other.

Joan's friend has tested positive "at a low level" for MRSA. MRSA is a staph infection that is resistant to most drugs.

This is a huge problem.

She went to the hospital with some pulmonary edema (my words) and they put her in the ICU over the weekend as they managed to stabilize her. Part of routine intake procedure in the ICU is to do a nasal swab for MRSA. This is the test that was positive. We don't understand what "at a low level" means, we've been given no specifics.

What we have been told is that the nursing facility she is at can't take her back because they have to give her a private room, or give her a roommate who is positive for the same strain of MRSA.

Talking with the nursing facility, they don't seem as steadfast against having the patient return, but what a nightmare this is. Medicaid won't pay for the room at the nursing facility to be held for more than 10 days which will expire either this Friday or Saturday. That means that between now and then we need to find her another "acceptable" facility as the hospital is just about ready to release her -- in fact is expecting to release her on Thursday, Thanksgiving Day. But there's nowhere for her to go. But the hospital won't be paid for holding her. But there's no place to go.

We are trying to arrange for a "retest" of the MRSA swab, but apparently she's on antibiotics so the test wouldn't be valid, and procedures require that she be found MRSA free 3 times in a row to be considered "clean" anyway.

We are trying to see if her roommate already has MRSA but can't yet get the nursing facility's Dr. to approve the testing, which will then also take a couple of days to obtain a result.

Now we hear from the hospital that the Director of nursing at the nursing home is saying "no way" to the patient's return, while the nursing home director is telling Joan that he's willing to work with the situation, needs more info and certainly might take the patient back.

Her monies have been exhausted -- spent down to about $1,500 to qualify for Medicaid, and her expenses since (like hearing aids, and dental work) has basically wiped that out. The current nursing home will hold her bed past Friday for her at the Medicaid rate of $189 a day (even though the bed is empty), and we suppose that we will cover it for a few days if there is a possibility of arranging her return there.

We were supposed to be in Connecticut this Thurday...

Finally, since Joan has been in close contact with her, Joan should probably be tested...
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Wow what a situation! I am so sorry you have this hanging
on you, it's not an easy thing to have to deal with.

I don't really have any answers. Do you have an area
agency on aging? I wonder if they could be any help. It
seems like the most dire situations lately are the ones
that fall through the cracks. There has to be some way
of covering her needs at the very least.

I don't know much about MRSA. We got a letter from the
school district saying we have some cases here, but it wasn't
very informative. It did not say that any kids testing positive
had to stay home - which made me wonder how infectious
it is and how much close contact it takes.

I hope you find a few answers, and quick. I wish I had something
more to offer.

Having gone through much of this with my mother in the last few years she was with us:

In NY (and I assume MA) a hospital can't discharge a patient without an appropriate placement - ask for a patient advocate;
My mom had MRSA as well and was in snd out of three facilities (one in MA) and hospitals - so placements are possible; and
none of us contracted MSRA including my father who had reponsibilty for her care so I wouldn't worry about Joan.
I am not sure of your specific state and facility rules. I do know that MRSA is very much everywhere. We get people in (to the hospital) from nursing homes all the time who are MRSA positive. I don't know if the facilities they come from have them in private rooms - but I doubt it. We don't have that many NH's with private rooms.
The families seem surprised that we gown and mask - but we do mostly to cut down on possible transmission to the other patients we are caring for. They apparently don't do this in the NH's.

Unless Joan has some open areas, or was spit/coughed on in close proximity to this lady, she really is at low risk. Did they say where in her body the MRSA is? (Sputum, urine, in a wound?) This determines possible modes of transmission.

I hope they get this all worked out. How bad to be happening, and during a holiday too. Just makes it that much harder to get sorted out.
I'm sorry to hear that Ron, sounds like a very frustrating situation. Good thoughts to you that all will be resolved with the least amount of frustration.
I second what Dawn has said. MRSA has been around, all around for years. It is only recently that such an issue has been raised. My Dad has been MRSA + for years, he thinks it's a "good" thing because every time he goes tot the hospital they have to give him a private room :roll:

The danger of infection is to the elderly or immunocompromised. Joan should be fine. I never worry about being around my Dad.

As far as the Nursing home goes, they are just being BUTT HEADS. I suspect that if they checked they would find a large protion of the population is +, I can't imagine them not wanting to know so they could house that population together. I cnnot believe they won't work for you.

Does the hospital have a Case Manager or Discharge planner who is working wiht you??? They should be able to help resolve this.

ANd yes, unfortunately you are right the MRSA test needs to come back negative 3 times to be considered "gone" :cry: , that is pretty standard. But not always impossible to do especially if her colonization is low.
What a frustrating and difficult situation, especially during a holiday week. :twisted: I've never had to deal with anything like this, so I have no words of wisdom or advice. I do wish you the best of luck for a quick and suitable resolution. :)
I have no words of wisdom either-- but- I will be hoping it all works out.
When will Joan be tested???
How is it going ron? Cant offer a hint of advice, only symathy and concern.
They held off discharging until Friday. Joan has gathered all of her bolongings from the wonderful nursing home and is waiting to see to where they will send her.

Like a good little sheep. Both Joan and the patient.
Did Joan contact the Case Manager??
The Case Manager is the person who contacted Joan and who is placing the patient, so I guess the answer is yes.
In my hospital the Case Manager is responsible for discharge planning and in the case of Nursing Home pt responsible for making sure htey HAVE a place to go.

I hope she finds somewhere even better than the previous one!!!
Tasker's Mom wrote:
In my hospital the Case Manager is responsible for discharge planning and in the case of Nursing Home pt responsible for making sure htey HAVE a place to go.

I hope she finds somewhere even better than the previous one!!!

I agree. Some places put up a good front, when all they really care about is the money and covering their own ....! Good thing you found out now, instead of later. That Case Worker may have to be made to do her/his job, especially with the holidays.

Hope your next report has some good news. My experience with nursing homes has been at times very stressful. Joan is a dear for taking on the responsibility for this lady. You too, Ron.
You are absolutely correct!

Joan IS a dear for taking on the responsibility for this lady and me too.
I would like to throw in a plug for Case Managers, it is most likely the most difficutly job in the hospital. Just before my Cardiac Rehab job I took a job as a Case Manager, and only lasted 9 months.

It's an awful spot to be in, fighting with Dr's, Insurance Companies, unrealistic families and all the while trying to do what is best for the patient.

I don't know what your experience with Case Managers is Mop Head but most don't need to be "made" to do their jobs, and around the Holidays it is made even more difficult by families (NOT YOU AND JOAN, RON) who want to dump their loved one off and have arrangements magically made for them to be "taken care of" during the holidays because they don't want to bother.

Medicare and all Insurance companies have criteria for admission and stay in a hospital and if that admission criteria is not met it is the job of the Case Manager to get the Dr. to discharge and the family to take the patient home. You cannot even imagine how difficult that is.

In the case of a patient waiting for nursing home placement, THAT meets criteria. But Nursing home beds, in most areas, are not easy to find and the wait can be lengthy. Add the special needs of a patient and it becomes very difficult to find placement.

Case Managers work very hard to meet the needs of the patient and the family in aq system that is designed to make them fail.
Instead of a Toys-R-Us warehouse or a Kids-R-Us warehouse we now frequent the Grands-R-Us warehouse where all of the Grandmothers and Grandfathers are stocked on a shelf until they are returned to the Manufacturer.

She is now at a lousy, decrepit, pack'em in nursing facility. It's like all of Joan's hard work to get her into that beautiful place is gone. The nice place was so eager to have her there as a privately paying customer, paying a much higher rate than Medicare and getting fewer services like laundry.

She is now on an antibiotic, so the MRSA retesting can't even begin, so it's at least 3 weeks before she'd be eligible to transfer back, assuming the tests were negative and if they even really want her back.

In the meantime, it's off to the beautiful facility to pack her things up and bring them to our attic once again. I hope when Joan is all alone and in a nursing home that some angel like Joan comes along to repay this, but I have little hope of that happening.
Ron, my heart goes out to you. I have seen alot of Nursing Homes this year while doing my Ambualnce clinical and some are just AWFUL. I cannot even imagine why they are allowed to exist. They say that the statistics are against ending up in a Nursing Home but there sure seem to be alot of folks that wind up there.
Tasker's Mom wrote:
I don't know what your experience with Case Managers is Mop Head but most don't need to be "made" to do their jobs, and around the Holidays it is made even more difficult by families (NOT YOU AND JOAN, RON) who want to dump their loved one off and have arrangements magically made for them to be "taken care of" during the holidays because they don't want to bother.

Oh, goodness! I was not meaning to step on anyones toes, least of all yours Tasker's mom. It was a generality and voiced from experience. It seems here anytime there is something to be done "it happens on a holiday/weekend" and of course, the staff you need to aide and advise you is not working. They have the expertise, but for me, when I have needed it, it has not been unavailable. They do not work 24/7 here and here case workers are not called in. I was only empathizing with Ron and Joan.

Ron, for you and Joan, I hope you can continue to work to get your friend into a place where she can get the best care possible.
In my hospital, as in most large hospitals, Case Managers are available 24/7.
I spent the first part of my day dealing with a major computer malfunction here at International Headquarters.

I spent the second 3 or 4 hours packing, transporting and unpacking and storing the belongings of a nursing home patient in limbo. How she accumulated so much STUFF in a little more than a year... Joan :evil: .

I spent the third part dealing with the computer issues...

I spent the fourth part watching the Patriots play football.

I am spending the fifth part dealing with the computer malfunction.
Poor Ron :ghug:
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