ComplaintsforTransitions LifeCare

• Initial Complaint

  07/11/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I told her that we did not want vitals checked, and she respected that however she did not do any type of assessment on my mother other than that. The visit only lasted approximately 15 minutes. we left feeling very overwhelmed with the meds she was on and when to give pain meds. And more meds had been ordered for us to give her. Thank god we called ********* before running down the road because the meds were not ordered. No bed was delivered as we were promised. Next day my mom is declining quickly. Call back to ask about nurse coming out nobody called back. Called again to get a phone call back about meds and nurse coming out and equipment. Was told we were supposed to to have this and that which we didnt. This was back and forth the whole time of the 3 days my mom was in there hospice care. Not going to go step by step with how bad this was handled. But the last piece of what would have provided me closure. My mother passed away at 11:07 pm and we called the hospice number right after this. It took the nurse over 2 hours to come out. She declared death at 01:05 the next day. I am now fighting with transitions over this. My experience with him as been a nightmare, I would not wish this on anyone. The one last thing to at least make it right and took you over 2 hours to show up at our house. And not once did you she say sorry for your lose lets see what we can do. She literally argued with me. My mother had ***** and blood pooling that shows it was 2 hours. If I could do it over again, I would have called 911 and time of death would be the correct time on the day. But they are now fighting me on time of death as the next day. This is now keeping me for closure because I cant get my moms ashes back to Friday now. And we are talking a whole difference of 24 hours now with the date being placed. This is a very big deal to me. And they wont thing I wanted was the correct time of death and they cant even do that correctly.

  Business response

  07/19/2024

  NURSING ASSESSMENT at ADMISSION 
  The nurse arrived at the home to conduct the initial assessment of the patient on 7/7/24 at 1pm. The nurse was asked to not do ********************* by the patients daughter, and the nurse complied with that request. The patient was assessed to have a palliative performance score of 30% indicating she has extensive disease and unable to do any activity, unable to care for herself (total care), her intake of food was normal/reduced, and she was essentially bedbound. The nurse assessed body systems (neurological, respiratory, cardiovascular, gastrointestinal, skin, urinary, nutrition, pain, environmental/safety, and caregiver status).  Patient was assessed to have a pain score of 3 out of a possible 10 (zero indicating no pain and 10 indicating severe pain). The daughter and patients niece were given instructions on when to give pain medications and verbalized understanding. 
  The admitting nurse reported that she reviewed all the discharge instructions provided to the family from the hospital. The nurse also stated that she offered to show the family how to turn and change the patients brief, but daughter declined the education stating she already knew how to do that from her EMT experience.  The time log for this visit shows a time in of 1pm and a time out of 2pm. 
  The admission nurse further reported that patient was sitting on the bedside commode upon her arrival and that the family had transferred her back to bed. At the time her visit was concluding, Patient was in bed and eating a grilled cheese sandwich. 
  Another nurse visited the home at 5:15pm on 7/7/24 to deliver supplies needed: briefs, wipes, chux, gloves, barrier and ointment. 
  MEDICATIONS 
  Our Nurse Liaison for UNC Hospital discussed with daughter to which pharmacy she should request UNC should send prescriptions.  The admission nurse educated the daughter on the comfort medications and let daughter know that she would have to pick up medications at the local *********. 
  In a clinical note dated 7/7/24, the nurse documented that local fill of medications called in by UNC Provider to ********* in Zebulon. We later found out that the prescriptions were not received by the local pharmacy. Our nurse contacted our provider and new prescriptions for morphine and Ativan were sent via electronic scripts to the local pharmacy. Our nurse verified the prescriptions were received by the local pharmacy, which they were. Our nurse let the daughter know the prescriptions would be ready for pick up after 3:30pm.
  As far as the daughter feeling overwhelmed about the medications and what to give to the patient, the nurse had gone over the medications, especially the morphine and Ativan. The nurse reviewed the name and description of these medications, the doses, route of administration, duration of medication therapy, intended use and expected actions of the medication therapy, and techniques for self-monitoring medication therapy.  The family verbalized understanding.
  DURABLE MEDICAL EQUIPMENT (***) 
  Transitions LifeCare contracts with an accredited *** supplier. When TL was made aware of the issues surrounding *** delivery, we completed a feedback form which is used to track any issues brought to our attention. A meeting was held between our Chief Operating Officer and Director of Care Navigation and the contracted *** company on 7/9/24 to discuss the late delivery of the hospital bed and other needed equipment.  The *** company opened an investigation on their end and assured TL that they would take corrective actions to prevent any further incidents.  
  Niece called TL on 7/10/24 at 10:35am asking to speak to a supervisor regarding the time of death of patient. During a conversation between the niece, VP of Organizational Excellence (VPOE)/Chief Compliance Officer, on 7/10/24 at 10:45am, the *** issues were raised again. At the time of the conversation, VPOE was unaware of the meeting that had been held with the *** vendor. ***** also brought forward issues that had happened since admission and VPOE captured all the points brought up on a new feedback form and the organization investigated each point. One of the issues was that the patient didnt have any supplies or sheets. In clinical notes on 7/7/24, it is noted that UNC was to medicate the patient for pain prior to transport and supply chux and briefs for the patient. 
  In the clinical note dated 7/8/24, the nurse documented that she had a call with a contracted *** supplier confirming that the delivery will be that evening and that the *** company would call the family with the estimated time of arrival. 
  RAPID DECLINE OF PATIENT  
  In the conversation between niece and VPOE on 7/10/24, ***** stated that they were told by a hospital staff member that patient had a couple months to live. The patients PPS score of 30% at time of admission revealed extensive disease and her PPS score had dropped to 20% two days later. 
  The patient received a nursing visit the day after admission (7/8/24) by an on-call float nurse, and the following day (7/9/24) by the RN case manager. The family accessed our on-call system and nursing directions were provided over the phone on multiple occasions. 
  At the nursing visit after the admission, nurse spent approximately 2 hours in the home and provided extensive education and provided supplies. She noted that Patient was actively dying. The nurse added the imminent death care plan which would trigger daily visits to the patient by either the nurse or social worker to support the patient and their loved ones.  
  PRONOUNCEMENT OF DEATH 
  While Transitions LifeCare believes that daughter recognized the time of death for her mother, the pronouncing nurse must list the date/time they assessed the patient to be lacking a pulse, respirations.   
  Records obtained from our contracted answering service indicate the call coming in from the family to report the death at 11:27PM and our triage nurse called the family back at 11:29pm. The triage nurse informed niece that the nurse would be delayed due to the high volume of calls that evening.  
  The nurse who was coming out to pronounce the death left her prior patient visit at 12:17am on 7/10/24 and it took 43 minutes to arrive. 
  The nurse arrived at the home on 7/10/24 at 1am and pronounced the patient at 1:05am. Daughter informed the nurse of the time of death that she witnessed, which was at 11:07pm on 7/9/24, and nurse explained that the time of death must correspond with when she was in the home and assessed the patient to be pulseless and not breathing, which was 1:05am on 7/10/24. 
  
  SUMMARY 
  This patient was referred to our program in the last days of her life. We acknowledge the challenges with durable medical equipment delivery and have worked with our contracted vendor to ensure any further instances of delays in equipment delivery. 
  While it may have seemed like a short admission visit, the nurse completed a thorough assessment covering all body systems, reviewed the discharge summary instructions from the hospital, and made sure prescriptions were sent to the local pharmacy as the discharging hospital did not provide any medications/prescriptions at time of discharge. According to the nurses time log, she was in the home for an hour. 
  A member of our nursing staff visited the patient daily and multiple phone calls were answered by our triage staff who provided instructions to address issues as they arose. 
  While we believe that with the daughters past professional experience she would recognize when the patient died, nurse practice acts, State law, and organizational policies prohibit a nurse from falsely documenting the time of death. We strive to return calls and dispatch nurses as soon as possible to patients homes in accordance with our policies and in line with our mission and vision. On this evening, because we received the phone call at almost 11:30pm, the time of death was not pronounced until the next calendar day. 
  We (the patients daughter, other family members, and Transitions LifeCare staff) all did the best we could for the patient who was referred for end-of-life care within just days of death. We will continue to offer support to the family members through our grief support department if desired. 
  Transitions LifeCare acted in good faith to address the issues raised by the family members in this case.   

  Customer response

  07/22/2024

   
  Complaint: 21971184
  
  I am rejecting this response because:
  
  The company is telling lies of the events that occurred and they occurred. This company does not care about anything but money. The lied about what the nurse went over with the family and how everything was handled. I would not recommend this company to anybody. Especially seeing how the story has changed to cover their ***** and lie about what actually happen. Shame they dont have any good nurses or staff. Our family and my mother suffered at their lack of care. Shameful to try and say supplies were brought by UNC when they werent. Thank god for my job giving us supplies. Lack of communication and equipment by the company. Not to mention one of their head people was afterwards wanting to harass me with phone calls and emails. Nothing they say or do will fix their lies. I just hope ***** comes back 10 fold on them! 
  Sincerely,
  
  *********************************

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