Venting...Hosp pts coming from skilled nursing facilities

Nurses General Nursing

Published

Before I begin.........I want to say this....I am NOT saying that all SNFs are like this....

I cared for a pt this weekend. 97 yr old black female. Admission dx: sepsis, UTI, fever. s/p right AKA. My blood boils every time I think about her!!! :angryfire She hails from a certain chain of nursing homes. Her skin condition is horrendous!!!! And that is saying it mildly!!!! Her skin is sloughing off in sheets (10 cm x 10 cm)!!! It is almost like she is a burn pt. The sore on her coccyx is just as bad! If I could stage it beyond a Stage 4, I would! Down to the bone! The smell is horrific! Tunneling beyond belief! Most importantly, this poor woman is in terrible pain because of her skin! You go in and assess her, she is unresponsive (other than eyes opening). However, when we provide incontinence care and turn/position her, she becomes combative - an instinctual thing I think. And this is even after giving her 2 mg of morphine! It breaks my heart. This pt also had been oozing stool w/ every turn as reported to me by the admitting shift. A rectal check revealed an impaction. I must have digitally removed 3-4 pounds of stool from this poor woman. I also changed her foley. The crap that came out of this foley, not only from the inner lumen, but also around the outside.........made me gag. I think that I actually saw a couple of maggots! This foley was in way in the hell too long!!! Now, let's talk about her PEG tube and that nasty-a**ed purulent material coming from the stoma!! OMG! This pt has outlived most of her relatives - no children, no siblings. The closest she had to family was a couple of great great nieces who live several hours away. They made the drive and were absolutely horrified of the condition of her!! There is talk of them suing the SNF. This pt has been referred to hospice. She is receiving palliative care only.

WHAT IS IT WITH SOME OF THESE NURSING HOMES THAT THEY COULD LET A HUMAN BEING GET LIKE THIS???? It burns my butt every time. I see pts coming from this particular chain in horrific shape! It makes me want to report this chain of SNFs for elderly abuse!! (I am going to call the ombudsman first thing in the morning - woke up too late to really do anything today - work nite shift). I am soooooooo damm angry!! :angryfire It scares me that I will/might be in this same sitation some day. It horrifies me although I will make sure my kids know that I will come back to haunt them if they allow a nursing home to do this to me!! I have had a headache ever since I first came into contact w/ this particular pt on saturday. I remember other pts. One came from the same chain but totally different city. She was in almost the same shape! Huge decub. Actually took 4 boxes of 4x4's to pack it. And that was just the sacral decub. We won't go into the 5 other stage IV decubs that she had. Then there was this other man. Total of 16 stage 4 decubs!!!!! And yet another woman.......22 stage 4's!!!! Interesting note here...all of these pts were black. How in the hell can they get away w/ this???????? I understand that staffing is always an issue but............there is ABSOLUTELY NO EXCUSE for this! When I have other pts whose families are making plans to transfer them to this particular place, I want to scream and tell them not to. Run far far away. Am afraid to do this for fear of retribution. After all, the pts from these so-called "skilled nursing" facilities do bring big dollars to our hospitals. I can't, in good conscience, continue to stand by and do nothing. These places need to be stopped from disrespecting these people! From what I understand, these particular institutions are for those who can't afford better. Kind of the equivalent to being buried in a "potter's field". I think that all nurses, aides, and especially administrators at these places should be legally charged w/ elder abuse!

Thanks for letting me vent and sorry this was so long. If anyone has ever run into this same type of situation and was able to make positive change, I'd be very interested in knowing how you did it.

I've talked to the ombudsman. She will be contacting Dept of Facility Services which licenses nursing homes. I suspect that they will be calling me. The ombudsman has assured me w/ allegations such as mine will definitely warrant an on-site investigation. It's too late for my pt as I suspect that she will soon die, but hopefully it will save others from the same kind care, or rather lack thereof.

Good for you for doing something about this. it is ridiculous for a pt that can't take care of herself to be "cared" for in this manner. i work in a ltc facility and we have a wound nurse that measures every wound in the facility weekly. if a treatment is not working we change it immediately so the wound can be resolved. there is no reason any pt should have multiple stage IV decubs if they are being cared for porperly. i commend you for standing up for these pts when they can't do it for themselves. :crying2:

Specializes in Inpatient Acute Rehab.

I cried when I read this! This is such inhumane care! The staff would not treat their animals this way!! This needs to be fully documented, pictures need to be taken, and the state department of health needs called. That is outright neglect and abuse! They should shut the palce down if that is the kind of care they provide. I wish I knew where that place was. I never want to send anyone I love or even remotely care about there!!!

[We made do-nuts to put on her foot to keep the pressure off. We had her foot healed up in no time flat.QUOTE=LPN1974]

I'm sorry, but if we were ever found putting donuts or (filled up plastic gloves for that matter), anywhere near a patient in this day and age of special mattresses, wound care courses etc: we'd get hung drawn and quartered.

For the most part, I disagree w/ you on this one. I agree w/ the OP's who state that some ppl come to their SNF w/ their skin in terrible shape. Now that is to be more expected because the general population is not educated. But we are educated! I worked in a state institution for the developmentally disabled. The non-ambulatory residents were tube feeders for the most part. They couldn't "get up or take care of themselves". They were also incontinent. They were not able to move at all. In the 8 almost 9 years that I worked there, I NEVER EVER saw a single decub! These residents were moved every two hours...without fail. They never ever had ANY skin problems. Now I understand that the elderly are different...their skin has lost a lot. However, the residents who lived at the state institution had other issues which made them very susceptible to skin breakdown...i.e. contractures, meds, etc. Again, no decubs...ever!

In a long term SNF, one MIGHT understand the development of one decub. Things happen. However, once a skin problem is identified, there is no excuse, IMO, for it to get beyond a stage II. Let alone for one person to get multiple stage III and IV decubs! In my thinking, that is TOTALLY UNACCEPTABLE. To me, this is the result of one or two things. Either the staff supposedly caring for these residents just don't give a rat's behind or the staffing is horrific. In either case, heads should roll!

Think about yourself in the future. Would you feel differently if it was you? Would you be accepting of a stage IV if it was your mom or one of your grandparents???? What if your child was involved in an accident that made him/her totally dependent and s/he got that way??? Would you still be so non-chalant.

Another of the issues that led me to believe that this was just sheer neglect is the fact that the foley was very old and that there was a maggot in there! And, let's not forget the 4 pounds of crap that I dug out of this woman. Again, I am going to go back to the state institution. We NEVER had an issue with constipation like that! Staff were excellent at documenting stools. If a resident didn't have a respectable BM at least qod, they were given suppositories or enemas. IMO, there is no reason for a person to be soooo incredibly FOS!

I could not have put this better myself Stidget, we have several individuals in our place who are confined to bed for varying reasons, even those with horrendous appetites(30 patients in total) don't have a mark on their wee frail bodies. We are as short staffed as anyone else is in this profession, however there is wayyy too much research out there on pressure care, and wound management etc, for any nurse to make an excuse for an area even getting as far as stage 4. As soon as a red mark is evident, action needs to be taken (special mattresses, dietician, 2hrly turns....... the lot) documented, and photographed, and direct observation of the area.

Wound dehiscence is different if you're in surgical, these patients may have other underlying causes, at a push. Peripheral vascular disease and resulting leg ulcers!!!! mmmmmm, a problem that can be managed effectively with the correct input from various members of the multidisciplinary team.

I still cannot get my head round the story you have told Stidget, it's inhuman.

If anyone is interested in a site for wound care. I'm in the middle of my wound management course at University and came across this great place.

http://worldwidewounds.com

Stidget, can I ask what IMO means????? please let us know the outcome of this horrible situation. Having been a nurse who blew the whistle on bad practice several years ago now (and still suffering for it, but they can't sack me, 'cause they know I told the truth), I'd like to know that justice is being served for this poor lady, and anyone else being cared for in this manner.

For those who are interested, no news. I haven't rec'd any calls etc. I don't think that I will suffer any repercussions. I blew the whistle on a SNF and I work at a hospital that sees a lot of those SNF residents. Believe me, my brain has been all over on this one. I might be viewed as a malcontent at my place of employment and if they get wind that I did this, they might make my life a living hell. But I really don't care. As soon as my lease is up, I am going to do the travel nurse thing. Thanks to all of you for your support and caring. For the first 2 days I obsessed over this. I am now finally able to get on w/ things at least to some degree. Thanks again all!

IMO = in my opinion

For those who are interested, no news. I haven't rec'd any calls etc. I don't think that I will suffer any repercussions. I blew the whistle on a SNF and I work at a hospital that sees a lot of those SNF residents. Believe me, my brain has been all over on this one. I might be viewed as a malcontent at my place of employment and if they get wind that I did this, they might make my life a living hell. But I really don't care. As soon as my lease is up, I am going to do the travel nurse thing. Thanks to all of you for your support and caring. For the first 2 days I obsessed over this. I am now finally able to get on w/ things at least to some degree. Thanks again all!

[iMO = in my opinion] AHHHHHHHHHH!!!!!! I see, easy when you get the heads up, cheers m'dears.

Specializes in Long-term care, wound care.

:angryfire :angryfire :angryfire Holy s**t! That is just horrifying! It literally made my stomach turn just reading about that poor woman. Can you imagine the absolute misery she must be in? No wonder she's combative.

Places like that are the reason that nursing homes get such a bad rap. One bad apple has to ruin it for the whole bunch. I agree with the others, they need to be reported!

Specializes in Education, Acute, Med/Surg, Tele, etc.

When we have patients with chronic skin care issues, those people are documented fully on their condition and reasons for the condition. We chart with all treatments and once a week to update the condition to see if it is healing or not. We are very diligent on skin issues, and if we have a patient with chronic poor skin (nonmoble, poor eater, skin cancers, chronic pressure areas not relieved by many tactics..which do occur...etc) boy do people know we are working on it (I send those notes in with paramedics about skin care tx and duration of tx...it is also on our MAR's that are copied for paramedics/hospital before they are sent out, and to the MD with any visit).

We also encourage MD's to have home health nurse's help, or suggest dermitologists or wound care/ostomy home care. There is always something someone can do to try to heal wounds, and document document document!

Any news?

No news yet. I've been watching the local news. I do know that there have been a lot more cars parked in their parking lot. So maybe that is a sign of either better staffing or state inspectors being there. Either way...nothing absolute yet. When/if I hear anything, I will let you all know.

Specializes in Med-Surg, Geriatric, Behavioral Health.

Hey, if a patient rolled into the hospital like this from home...we consider it abuse and neglect. It should make no difference if from a LTC/SNF. Buddy, I tell you, if my loved one in a facility had this, I'd be after that facility's license real fast and talking to my lawyer regarding damages and the cost of treatment/rehab.

This truly saddens me beyond belief. Our older folks are the cornerstone for our ways of living. They are our greatest national resource.

What you all are doing is the best thing that "we" can do. Let the outside world know what is going on.

I have seen some of the same neglect here in Upstate New York. It seems that the ones with attentive relatives fair the best. If there is no one to be an advocate for these folks, then they are the ones who suffer.

I'm thinking that Staffing may be part of the problem. That was my biggest concern when I was still working. There is so much to be done in this field it seems that All that can be done while trying to correct some of these problems is to be loud and vocal.

God bless you all for careing. You will be rewarded for this. Thank you for this article and the responses that I have read.

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