How can you neglect a patient and live with yourself?

[brainkandy87]

Alright, so I need to vent (I seem to need to do this a lot, maybe I shouldn't work every day). EMS brings me a 93 year old man from a nursing home who fell from his chair and hit his head. Non-urgent, head lac, no biggie. Until, of course, I get him undressed.

This poor old guy was totally AAO and coherent. He had been moved to the nursing home because his wife couldn't take care of him alone any longer and they have no family. He's just old and fragile. I get his pants off just to assess his skin to see how well he's being taken care of and... he has cellulitis all up his right leg and he's red in his groin and backside. The doc is with me when I do this. He semi freaks out because there was no mention of the leg in his NH papers and the pt himself didn't really know he had cellulitis.

The patient starts to tell us how he's neglected at the NH. He is put in his room early he says, around 7 or 8, alone and without being checked on. He says he can't get anyone to help him get up to go to the bathroom or bring a urinal and is consistently wetting himself and laying in it until morning because no one checks in on him.

I call the NH and they tell me he's being treated for a wart on the bottom of his foot and they soak it in warm water. And he's not on any medications. Despite his being on medications per his paperwork. So at this point, I'm ******. I call his wife who was the POA and was very knowledgable when I spoke with her. She explained to me how he had been complaining to her about the care at the NH. When I asked her about the cellulitis, she said every day when she came to see him, they had socks and shoes on him so she never saw his leg. So, I hotlined the NH for neglect.

Throughout his entire stay in the ED, he just went on and on about how grateful he was for us just being there for him, taking care of him, paying attention to him. Even when I was bandaging his head, he went on about how gentle I was and that I never need to become like the people at the NH. I teared up when I had to go tell him we were sending him back to the NH. He just had the saddest look I've ever seen when I said that. All he wanted, he said, was to go back home, where he could be with his wife and not have people neglect him every day.

I just do NOT understand how anyone, whether it's a nurse, an aide, or a clerk could even witness neglect and let it go. When do people lose their ability to care about another human being? They might be old, but they are still humans with very real emotions and not all of them have dementia. The only thing this poor little old man wanted in the world was to be cared about. He wasn't needy or mean or anything less than kind. It's a tragic thing how far some people deviate from the line of caring.

[Lunah, MSN, RN]

*hugs* This is one reason I'm VERY grateful that my ER patient population has changed to a younger crowd, for the most part .... patients like this break my heart. I am quite certain nursing homes are being asked to do more with less, but ... ugh. Vent away, brother.

[sapphire18]

This breaks my heart, also. Ugh:(

[LoveNeverFailsIII]

This breaks my heart. Though I am not a nurse yet this is the reason why I want to be a nurse. We're all human and each of us never want to deal with neglect and long for the emotional and physical connection. This is absolutely heartbreaking and makes me teary eyed.

Vent away....

[nohika]

It's part of why I left LTC. :/ If I was lucky, I'd see a resident 2-3 times in an 8, 9-hour shift. That was it.

Breaks my heart to know this still happens.

[JZ_RN]

I agree that this is sad and clearly neglect, which should be reported, and shame on that NH.

HOWEVER- Before you go and bash on NH- many "A+O" patients REFUSE care (I have to go beg and plead with some of the guys at mine to let us wash their reddened behinds and they refuse creams and showers, etc) and cellulitis hurts, why didn't he say something?

And if you want to complain about the neglect complain about that NH's management cause if it's anything like where I work the nurse has 50 patients and the aide has 25. Top it all off with 7-8 hours of med pass in a 12 hour shift and up to 3 hours of charting, doesn't leave much time for patient care.

sad but true. I do my best and stay late to do busywork but it's physically impossible for us sometimes to negotiate with a patient to get cleaned up who refuses and strikes out at us (hitting) when we make attempts, plus do all the "total cares" as well. do we try? Yes. It comes down to money for most NH and they don't care that they are cutting staff and hurting patient care, and killing their nurses and aides to get the basics done.

[*4!#6]

I worked in a nursing home for three years. There are two sides of the story and I can see both.

First, there are people who are lazy. I was an aide, so I can't speak for nurses, but when you work as a nursing assistant everyone knows what kind of nursing assistant you are. Most of the people I worked with worked their butts off and I loved working with them. But a few people were the kind of "undress them and toss them in bed and move on" types (I worked evenings). I.e. no pericare, no oral care, etc. A lot of these people were fired or left. However I know some are still working there, despite being reported for to higher ups for neglect. So yes, there can be staff in the nursing home who were neglectful to residents. And it drove me CRAZY. I could barely stand to work with these people, and then they would get mad at me for "taking to long" with the residents -- well sorry I took 2 minutes to wash this poor lady's face! Okay, enough ranting on that.

The other side of the story, what you might not see working ER, is the staffing in nursing homes. I would often be solely responsible for 12-15 residents, most of which had severe dementia. The nurses at my nursing home had 30 patients to med pass, so I did all patient cares. You can image trying to do all cares, plus two/three baths, on severely demented patients that are frightened and do not want to cooperate. Residents who look sweet to visitors but behind closed doors, they are spitting in my face, throwing their own feces at me, punching me, and cursing me because they're scared and we are just trying to turn them, but they don't understand. It takes a lot of patience and is time-consuming. You just can't get to everything on everyone despite. And when you have AAOx3 patients, sometimes those are the ones that you just can't get to because of the demented lady climbing out of bed every 4 minutes, the lady who calls us to use the toilet every 15 minutes, or the total care turn q1h patient with liquid stools constantly. Chronic understaffing is a huge problem. So while it may seem like it's the staffs fault, it is also a system problem.

Sorry for the long post, this is something that hits home and it makes me VERY angry that this kind of neglect is allowed to happen -- whether it is a staff member, or more of a systems issue due to understaffing. But my other point is, don't just point blame at the staff ... it is not always their fault. Also, like the above poster said, I have had patients refuse all cares repeatedly.

[JZ_RN]

I am not trying to condone neglect in any way, please understand, I know that neglect is unacceptable. However, don't assume the aides and nurses at these crappy NH aren't trying or are lazy or don't care. Since facilities only care about the bottom line, they don't allow enough time, staff, or supplies for caregivers to do what they would if we were properly staffed.

[notpuurfctbtgdenghns]

Venting away and to have your heart broken does not really help the situation. The OP at least called the NH and inquired about the redness on his groin and cellulitis to his right leg. This 93 y.o man's wife has not been too excited about the care he received at the facility. Perhaps the OP can do further by consulting someone in the DSHS.

[Autymn]

Un Fing Believable. What I don't understand is ...you see investigative reporting done on such places -- and it often does turn up a lot of information that the neglect is created at the TOP, administrative and NS ownership levels. And WHAT is the result? A few get fined, here and there are some staff changes.

Pfft. Right here on our own boards there are a myriad of posts that outline the hoops jumped through for the annual ring-side show when inspection time comes. Our professional Nursing workforce is very aware. Thank whatever God you worship that there are a majority of those who work in care and nursing positions that go that extra mile - else where would these elderly end up? Why doesn't the state authorities do unannounced spot-checks. Why is the corruption so deep that no thing is done when these cruel issues are uncovered?

I have my sites set on a career path that will enable me to make a difference in legislation, and the carrying out of policy related to Nursing Homes and elder care facilities. It will cut a tiny swath, but I will get everything done I can along my path.

Thanks Brainkandy for taking action in the midst of your care for the one person. This is repeated time and again by those who both care about their job, their career and who actually have an nth degree of compassion to ferret out those who act inhumanely, directly and indirectly.

Glass-Half-Full,

Near the boiling point today.

[kcmylorn]

Does anyone not see, why these all these CEO's and adminstrators who are ALL making conscious "business decisions" to cut the healthcare staff in ALL our healthcare industy, why these buggars should not be prosecuted? When are we as healthcare worker going to stand up and demand these top adminstrators be held criminally accountable and responsible for what they are doing, for thier actions!! When is this going to happen???

The staffing is so inadequate in LTC and hospital in patient units but these CEO's and administrators take no efforts to cut their pay to provide decent staffing and care for patients. They only think of themselves. I too am at a loss for how some one who understands the amount of time and work it takes to take care of an any inpatient- LTC or hospital can continue to allow staffing level to be where they are. They are eaither very callous and greedy or are just plain stupid.

As the Ed nurse- you report this to the DOH, the DOH investigates and fines and flaggs the facility, the nurse or nurses assigned to the patient get fired, the CNA's get written up, re educated in patient care points or fired.

When in reality The nurse(s) assigned to the patient has 30-60 patient's just like him to be responsible for in 1 eight hour shift( all the RN and LPN duties that go along with it- medication for 30-60 LTC patients would be enough to choke anyone.) The CNA is a CNA with 30 patients to clean, toilet, feed, set up, change.

This patient's wife is either (1) paying out of her own pocket each month( approx$6,000-8,000/ MONTH) Medicare is figured into the cost some where but it is not much because this is not medicare's only patient, another alternative (2) would be for the patient and wife to have some kind of long term care insurane which given their age is highly unlikely. or (3) she has had to sell her home or sign it over to the state for it's real estate value to pay for his continued stay and then file for Medicaid( welfare). I would venture to say this wife had to do the third alternative as most elderly do have to do now a days. My guess is the wife is living with a relative.

In medicare's(CMS) defense- they have cut funding on facility aquired injuies and therefore reimbursments putting the responsibility of patient care quality on the facilities. And rightfully so. CMS has said-"we are no longer going to reimburse a facility for decub injury for a hospitalized patient that occured in the facility, or a UTI" I am not up on what the cuts are to LTC. Home Health has also been hit. In other words, in my opinnion, CMS is leaving the patient managment up to the facilities. These facilities( which is all of them- hospital and LTC) who have been cutting staff to bare bones are now faced with a choice- either keep you poor staffing levels, that are keeping money in greedy administrators personal wallets and keep eating the cost of treatment for these HAI, injuries or bite the bullit, cut your own salary and hire more staff to take of these patients the way they are supposed to be cared for. The CMS cannot and isnot going to keep shelling up reimbursment rates to perpetuate the Fraud Waste and Abuse that has been going on in our healthcare industry- top administrators getting rich off the licenses, personel and at the expense of the patient.

The only way I know of to combat this garbage with these administrators and CEO's - is to stop getting made and angry with the patients and families when they come in to the ED, on the hospital units, in the LTC facilities and educate, educate, educate every one of them who come at you. Encourage the militant in these patients and families. Start your own war. Tell them who is making the money decisions for cutting nursing staff, tell them to report ( Mr/Ms CEO and administrator with the big bucks) as the cause of the shotty patient care. Give them the CEO's and administrators name and how much money these suckers are earning at everyones expense and where to report( the Dept of health, the local dept of aging, the newspaper,patient advocacy groups, the Obudsman. the state and federal legislators, the govenor, the president himself) Get these families and patients as peed off as you are. Tell anyone who brings the subject of healthcare up to you- in the grocery store, in the mall, out having a cigarette, at church !!, in school, at the PTA meetings.

This is what I have started doing. Most people don't know what these administrators and CEO's make and how facility funding goes down. Most nurses don't know- it's time we became informed and shared the information to the"consumers"

[mindlor]

Profit and healthcare should never be used in the same sentence.

Until all healthcare in the US is rendered by not for profits things like this will continue to occur.......