xPAP in nursing homes / geriatric and hospice facilities

dataq1 · Post by **dataq1** » Mon Mar 31, 2008 6:13 pm

Can anyone comment on use of xPAP in nursing / geriatric / hospice facilities. I was visiting with my 87 year old father in his nursing home where he is bed fast. He could only stay awake for short periods of time. I had asked the nursing staff if they had any patients on xPap therapy, and if so how did they insure that patients were "masked" if there was no controls on how or when might fall asleep? After discussing it with the head of nursing, they had never had any patients on xPAP. There was an (unstated but) underlying tone that OSA patients never get to be "that" old.
By the way, I didn't tell them that I am an OSA patient.
Does anyone have experience with how OSA is handled in these facilities?
Are patients daytime sleep monitored so that they can have XPAP applied?

Claire · Post by **Claire** » Mon Mar 31, 2008 7:42 pm

Hi, this is an interesting question and one I've wondered about as I have 95-year-old mother-in-law in a senior's residence. I was thinking of asking the nurse if anyone was on CPAP. But I was also betting that no one was. People of that generation who had OSA are probably dead from related stuff such as heart disease and high BP.

I suspect we may have to wait until we get there to see how CPAP is handled in these homes.

Claire

bap40 · Post by **bap40** » Mon Mar 31, 2008 9:12 pm

I recently was sitting in my DME's office and they recieved a phone call from a 93 yr old man, wanting to exchange his current CPAP for a new machine. So there is a least one old guy out there using.....

rested gal · Post by **rested gal** » Mon Mar 31, 2008 9:39 pm

bap40 wrote:I recently was sitting in my DME's office and they recieved a phone call from a 93 yr old man, wanting to exchange his current CPAP for a new machine. So there is a least one old guy out there using.....

That he's been using cpap treatment for no telling how long, might be a big part of the reason why he's into his 90's and still has the mental and physical ability to think about what he needs, pick up the phone, make a call, and handle dealing with his DME himself. Good for him!

As for nursing homes... one of the saddest stories I heard...sadder to me than the thought of elderly people in long care facilities who might need cpap but aren't on it... was a man describing a horrible open sore on the bridge of his brother's nose. The brother was in a nursing home, would be there until he died -- bedridden flat on his back, unable to move, mind still intact but with great difficulty communicating.

The staff did put the cpap mask on him every night. I don't know about daytime sleeping. The mask was gouging the sore deeper and deeper. If he had wanted to take it off, he was physically incapable of doing that. My guess is that even if he had begged them not to put it on him, they still would have. Doctors' "orders" have to be followed, you know. I don't know what his brother finally did about it, if anything.

Since even a lot of DMEs can't "get it right" with mask choices and mask fittings with "regular" cpap users, I'd hate to think what people whose pain might be routinely ignored could be put through -- having a leaky mask cinched down tight by non-cpap-users working in some long term care facilities.

Be careful what we wish for....

Bearded_One · Post by **Bearded_One** » Mon Mar 31, 2008 11:18 pm

I suppose that it all depends upon the type of facility. There are assisted living facilities with care givers who really do care about their residents.

A resident who has a sore on their face caused by a CPAP mask is inexcusable. A small developing sore that has been noted and measures are being taken to treat and prevent the sore is one thing, ignoring the sore and continuing to use the mask is quite another thing.

Even if a resident is capable of putting their own mask on, a sore, from any cause, should be noted and investigated by staff. Meal times are more than just a time to feed the residents, it is an opportunity for staff to observe residents for signs of conditions, including a sore on the face, that require investigation.

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Slinky · Post by **Slinky** » Tue Apr 01, 2008 2:56 am

My mother wasn't on CPAP, but let me tell you about nursing home care. An experience I've personally had and many others I've talked to as well.

As long as family is able and willing to vist OFTEN, almost daily, AND unannounced on an irregular basis, the patient gets good care. IF the family is only able to visit on a regular basis or not often, maybe just once a week, DO NOT COUNT ON GOOD CARE!!

We were fortunate to get my mother in an advanced assisted living care home. Tthis was a facility where there was never a urine spell, etc. I occasionaly ate supper w/my mom and the food was good. Even more fortunate it was convenient between my home and my workplace. In addition, my job was paid on an evaluated work hour day of 8 3/4 hours, meaning I got paid the same whether it took me 6 hours to do the job - or 12 hours. The first two years I was able to stop every day on my way home, what time I got there varied considerably and the amount of time we were able to spend together varied as well. My mother got EXCELLENT CARE. My sister and/or a friend usually visited or took her out over the weekend.

The last year and a half of her life my sister had moved out of state and the friend had moved out of town, my stepmother was in another less assisted living care facility also not too inconvenient between my work and home and while my evaluated work day remained the same more responsibility was added meaning more actual work hours. I was spread too thin. My daughter assisted me w/the visiting but she had two young daughters, a husband who worked out of town a lot and neither facility was particularly convenient between her work and home.

While true my mother's condition had deteriorated some, still her mind was slow but intact. But her care by the facility deteriorated in direct correlation w/the amount and number of times we were able to visit. Her care at the last was abomnable. If I took off work a day and dropped in unexpectedly I would find her tied in a wheelchair. She was no longer allowed to go into the enclosed yard (the building was a large square w/a beautiful yard in the center of the square). Things began missing. She wasn't always as clean.

As my stepmother required more assistance the cleaning ladies at her facility began taking advantage. She was legally blind w/extremely limited vision. Cleaning fluids in an empty pop bottle were left on her kitchen cupboard, she drank some by mistake. They began hassling her about providing rides to her doctor, etc. despite that was included in the cost of her care. The cleaning ladies would do her small favors ... and accept money for it, cheating on the change. The less frequently we were able to visit or take her out, the more her "spending money" was running short. She ended up dying bleeding out as the result of erosions/ulcers in her stomach from the cleaning fluid. She was 89 but her mind was still pretty much intact.

The point I'm trying to make is that the care a patient receives in these assisted living facilities and nursing homes is directly related to the amount of time family is able to spend w/them and the number of unannounced, irregular visits. Care by the staff is DIRECTLY RELATED to the number of times family can visit.

Julie · Post by **Julie** » Tue Apr 01, 2008 4:29 am

I often think about ending up in a home, even a really good one, but on Cpap (me, not the home ) and having a) no one to fit the mask on properly, b) no one to scratch my nose when infinitesimal fibres are in the mask, and c) no one checking my smart card.

Slinky · Post by **Slinky** » Tue Apr 01, 2008 4:33 am

Julie wrote:I often think about ending up in a home, even a really good one, but on Cpap (me, not the home ) and having ... no one checking my smart card.

Heaven forbid, you don't know your nightly data!! Yer truly addicted, Julie!!

Make sure you have a good supply of PadACheeks on hand!!!

dataq1 · Post by **dataq1** » Tue Apr 01, 2008 6:05 am

Julie wrote:I often think about ending up in a home, even a really good one, but on Cpap and having a) no one to fit the mask on properly, b) no one to scratch my nose when infinitesimal fibres are in the mask....

Exactly. When I consider what I do today to maintain my therapy (daily mask cleaning, fresh distilled water for the humidifier, check for leaks, adjusting for leaks during sleep, make sure I don't doze off during the day while watching boring TV programs) I have great difficulty visuallizing getting that help after I'm disabled in a nursing home.

Banned · Post by **Banned** » Tue Apr 01, 2008 7:43 am

Slinky wrote: In addition, my job was paid on an evaluated work hour day of 8 3/4 hours, meaning I got paid the same whether it took me 6 hours to do the job - or 12 hours.

Hey gyrl,

That's sort of a sad post, but at least you were there for her when you could be. I've never heard of an evaluated work hour day. What kind of job were you doing? Today, work life must be allot simpler, you just work 8 - 10 hours a day and get paid for 8.

Banned

bap40 · Post by **bap40** » Tue Apr 01, 2008 8:08 am

My daughter started her medical career in a nursing home, actually in the demetia wing. The care was actually okay depending on the amount of staff. That was the key there. Not enough staff and not enough good care. She came across quite a few patients whose family did not visit at all or just very little. She actually sat with one dying woman who laid her head on my daughter's shoulder, basically a stranger to her in her state of mind. The family was notified of her impending death and their response was "call us when it is over".... How sad is that????

KansasRT · Post by **KansasRT** » Tue Apr 01, 2008 8:35 am

I have several patient's in nursing homes/facilities that are on CPAP/BiPAP. I take the equipment out to the patients just like I would at home and go over cleaning and mask fitting. I also go out when they have problems. Most of my patients do great. I have a few that struggle. I also provide machine downloads to the staff. Most patient's didn't have studies, because a 90 year old person dosen't really need the trauma of a sleep study, CPAP is trauma enough. Most of the patients I have seen in facilities actually have very good CPAP care and compliance.

Fredman · Post by **Fredman** » Tue Apr 01, 2008 7:24 pm

[quote="KansasRT"]I have several patient's in nursing homes/facilities that are on CPAP/BiPAP. I take the equipment out to the patients just like I would at home and go over cleaning and mask fitting. I also go out when they have problems. Most of my patients do great. I have a few that struggle. I also provide machine downloads to the staff. Most patient's didn't have studies, because a 90 year old person dosen't really need the trauma of a sleep study, CPAP is trauma enough. Most of the patients I have seen in facilities actually have very good CPAP care and compliance.

snoozeandlose · Post by **snoozeandlose** » Wed Apr 02, 2008 7:56 pm

I'm an occupational therapist and am sort of the cpap vigilanti. I've found that the nursing staffs in long term care are very undereducated on what sleep apnea is and how cpap works. One patient was put on oxygen and nursing thought he no longer needed his cpap. Duh. I now do home health and always ask if the patient snores. Often if the reply is yes the patient is using a cpap.

Lots of patients don't understand they can get a new mask or that they need to get new cushions. Most do not go back for followup visits. One patient's machine was 10 years old as was the mask. I told him to get back to the sleep doc, get a new machine or at least have the old one checked to make sure the pressure was okay.

However, I was put under for an hour long procedure and was told to bring my cpap. I Also was in the hospital a few weeks ago and they knew to have the RT hook up my O2 to my machine. It's probably just a matter of time before the medical professions gets up to speed.

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