Thursday, July 28, 2011

Letter to a Rehab Director: Part III (four part series)

This is the third post of the series.   (click here to read Part I)     (click here to read Part II) 

My elderly relative was recuperating in a Rehab center. This list of problem issues was found at the Rehab. To read the entire letter, you must click on Part I and Part II of "Letter to a Rehab Director" series.

Nutrition is a critical part of healing and rehabbing. In order to receive good nutrition, one must eat good food, food that is appetizing, food that is healthful. The food at The Pillow Elderly Home reminded me of public school cafeteria food served in the 1950s when Velveeta, processed cheese food, was considered cheese, Wonder Bread was considered bread and Geritol was miraculous for your health: products heavily marketed and highly suspicious. Pillow Elderly Home's food was heavily marketed, processed and highly suspicious. Evocative of Tom Colicchio's culinary endeavors or a typical NYC restaurant's achievements, your menus sounded great on paper. And that's about it. If this is hyperbole, then why did I see a lot of the patients' trays left in the kitchen area half full of food and the refrigerator stuffed with food items brought by patients' family members from the outside, something our family and friends also did. Mrs. White ate very little of your food. Aesthetics fast. Perhaps you are encouraging an aesthetic, monastic existence. Fine. Our family does have a dear cousin in Frosolone, Italy who is a Catholic and of the Franciscan Order. He is a monk and he often fasts for his church members' healing. However, he never has those who come for prayer, fast, especially when they have been weakened by surgery, achy immobility, side effects of meds and stress, and need to be strengthened and healed. If you are going to encourage your patients to live the fasted life, please give them a choice whether or not they would like to achieve healing through alternative fasting treatments like The Master Cleanse, but don't advertise your rehab as a rehab which provides good nutrition and healthy food choices encouraged by appetizing meals. Yes, you are a large institution. But Jacques Pepin prepared industrial sized meal portions for Howard Johnsons when old Mr. Johnson was thriving as were his restaurants. It can be done! I am not suggesting you hire someone like Jacques Pepin (before he was a "celebrity chef"). I am suggesting that you BEGIN TO CONSIDER the nature of healing and how nutrition, healthy food and proper preparation is a critical part of it, especially for the elderly who are very prone to not receiving the full benefit of nutrition because their digestive systems don't efficiently process nutrients as younger bodies do to receive optimum fuel for body restoration, so integral to healing.  I am suggesting you live up to your quality of care mission statement. And that involves being concerned about appetizing, healthful food which doesn't need necessarily to be "expensively" prepared. It should be carefully prepared, with ingredients which were fresh at the inception of preparation; if they are frozen later on, fine. But let them be fresh, not processed, with as few additives (chemicals) as possible.

Thrush is a fungal disease individuals can get when they are on antibiotics for a long period of time. All of your nursing staff, even your aides should be on the lookout for Thrush when patients come from any of the hospitals, their bodies saturated with antibiotics, their immune systems weakened. Thrush coats a patient's tongue white. Thrush nullifies one's taste buds and decreases their appetite. It is fungal and the elderly, (particularly those with catheters and Urinary Track Infections, taking antibiotics)...and those taking antibiotics to stave off infection so their surgery can heal...get Thrush. It is underdiagnosed. And this is a problem because patients need optimum nutrition and a strengthened immune system. Thrush debilitates both. With Thrush and bad food, the elderly don't get optimum nutrition; their immune system is further weakened when it should be strengthened. If unappetizing food is being served, all the more reason NOT TO EAT IT!  With Thrush it is twice as unappetizing; in fact it tastes downright horrible. When my relative was admitted to your rehab, we knew she was battling Thrush. By then she was on the medication and mouth wash and we were bringing her food from the outside and special protein shakes and yogurt, phyto greens and her vitamins and organic soups and home cooked meals or take-out and she was eating despite still getting over the Thrush. Mrs. White didn't know she had contracted Thrush; she didn't feel like eating and didn't feel right. Her niece, remembering her mother had it, identified it in Mrs. White's mouth. Then both nieces created a food plan including yogurt and the protein shakes and Mrs. White gained weight. Even with the medication abating the Thrush, none of the family believe that Mrs. White would have gained weight and recovered as quickly as she did on the rehab food. It was so unappetizing, she would have gone hungry rather than eat it; going hungry, her stomach would have shrunk and she would have lost more weight instead of strengthening her immune system. Your rehab food is obviously not a priority but it should be. You do not want to waste money on food that is mostly thrown away. Thrush and/or other side effects of meds that kill your patients' appetites and skew their taste buds are most likely a contributing cause to your food being left uneaten. Checking to see if patients have Thrush should be a priority. The quality of the food should be improved. Patients need to be given every chance at their disposal to want to eat. They should not be given every excuse at their disposal not to eat. They need to rehab...become stronger, not weaker. I asked my nurse friend about your poor quality of food. She did say not all hospital food and rehab food are created the same. And that is the point!!! My sister-in-law was rehabbed at Rehab Y out on LI. She particularly commented that the food in the rehab was better than the food at the hospital (Hospital Blue). If there were any place perhaps that you could shine and show a difference and compete, it might be in your food plan and your staff's diligence in checking for something that kills the appetite like Thrush.

Sleep and rest are critical to healing. My relative was awakened many nights overhearing the aides laughing and joking in the hallways. She could not get back to sleep after she was awakened. Then she was expected to rise early in the morning when the aide came in. But she was exhausted because she was up a good part of the night because of the loud noise and activity in the hallway. Aides must respect the patients' needs to heal and rest. Social networking should be done outside the rehab, not during evening hours when patients need quiet to sleep. 

(click to read Part IV, the conclusion of the series)

No comments: