I’m William Beerman, author of the book, “Mary Regina’s Nursing Home.” In recognition of C. Diff Awareness Month (November), I am sharing the following from my personal life experience.
The disease C. Diff (Clostridioides difficile) is the most common healthcare-associated disease. It generates a half million infections a year and elderly persons in nursing homes are especially at risk.
I manage a Facebook page called Nursing Home Monitor, so of course, I’ve known for months that relatives of nursing home patients were banned from visiting their loved ones because of the COVID-19 virus.
But I didn’t expect to see the heartbreak of the nursing home personal visitation ban dramatized right before my eyes.
As I was delivering election information to a nursing home in Las Cruces, NM on October 27, 2020, a patient on a gourney and her daughter were checking in at the front desk. When they were finished, an attendant wheeled the patient away, and I heard the daughter say quietly, “I am so sad I cannot go with my mother.” The check-in host answered, “Yes, it is very sad.”
A transfer from a hospital to a nursing home is stressful enough these days. But it can be worse with the serious complication of C. Diff, an antibiotic-resistant bacteria that causes uncontrollable diarrhea.
The admission of the patient October 27 reminded me of the day I admitted my own mother to a nursing home in Pittsburgh in 2011 after she had a short stay in a hospital for repair of a broken hip. The nursing home turned out to be a bad one. But we could not get my mother transferred out because she came down with C. Diff.
C. Diff is contagious and requires the patient to have an isolation room. Medicare paid only a few dollars more for an isolation room than it paid for a semiprivate room. So any nursing home that accepted my mother would lose a lot of money because it would have to devote a room for two to just one patient. Nursing homes that we called while trying to transfer my mother said they had no isolation rooms available.
C. Diff played a big part in the death of my mother, who had been living independently before she broke her hip. She was an excellent candidate for rehab. But she died 30 days after being admitted to the nursing home, with C. Diff and a half dozen other afflictions.
The nursing home told me my mother had probably gotten C. Diff because the hospital had given her a heavy dose of antibiotics just before releasing her. The theory was that the dose wiped out benign bacteria and cleared the way for the antibiotic-resistant C. Diff to run rampant through my mother’s bowels without competition.
You can read about a lot of ways to fight C. Diff at the Peggy Lillis Foundation website https://cdiff.org, or https://peggyfoundation.org/ , or at the C. Diff Foundation website: https://cdifffoundation.org/ They are trying to raise awareness of C. Diff, and the fact that antibiotic use is the most common risk factor for C. Diff. The Peggy Lillis Website cdiff.org has a petition you can sign.
But one way to fight C. Diff that appeals to me is for the hospital patients being discharged to nursing homes to discuss the issue of antibiotics and C. Diff with the hospital staff.
This year the government Centers for Medicare and Medicaid Services — CMS — issued a rule that requires hospitals to provide discharge planning consultation for patients being released to nursing homes and other settings. You can discuss use of antibiotics with the hospital staff and select a nursing home that is appropriate for you. You are less likely to end up in a poorly rated one by accident.
Check out the guidance about selecting an appropriate nursing home and making your antibiotic treatment preferences known through the new CMS discharge planning rule at CMS’ Discharge Planning Rule Supports Interoperability and Patient Preferences | CMS.