Change of treatment after acute care?


#1

Hi all.

My dad has been in intensive care in a hospital in Italy (where he lives) following a dysphagia event in late July and has been transferred to a hospital ward in post-acute chronic conditions.

Unfortunately dysphagia was not diagnosed early enough by our family and the medical staff (he was treated for low sodium levels and dehydration after admission to A&E) and he suffered from Parkinson’s medication not being absorbed, as it was getting into the lungs.

Nasogastric intubation was actioned very late (almost two weeks after being admitted to the hospital), and aspiration at that point revealed presence of pills in mucus. After this the nurses started crushing PD medication and administering it via NG intubation.

One day after NG intubation, his conditions worsened and he was taken to ICU.

He stayed one month in ICU and had blood transfusions and surgery for tracheotomy and PEG, slowly healing from the lung infection. Parkinson medication was not changed, Sinemet pills crushed and administered via PEG and NeuPro plasters added to the therapy. His treatment plan timings were changed to suit the nurses rounds.

He arrived to the hospital walking and with good mental conditions, but now needs very frequent aspiration, is no longer able to move and not able to communicate.
His eyes show motility, and there are moments when he seems to try saying something and show consciousness.

The ICU surgeons transferred him to an internal medicine ward yesterday, stating that he is in post-acute chronic conditions and they can no longer keep him there.

We’ve been asking for a specialist PD neurologist to visit dad since he arrived to the hospital, but have not been able to talk to any neurologist at all. We have asked once again this morning.

Is there any similar experience of post-acute treatments where a PD specialist can vary the PD medication treatment to improve conditions?

We’re also not sure if home care or a nursing home should be the next steps.
Is this the moment for palliative care only?

Thank you in advance for your responses and help.
Francesco


#2

Hi Francesco I’m going to change to PM.