Yikes! Another bad observation at an LTC facility - page 8

YIKES!!!!! That's about the only word I can express about this one. Got off a weekend night shift (through my agency) at a nursing home I have never been to previously. I prefer to stick to... Read More

  1. by   sallyrnrrt
    Sorry you had such a horrible experience. I've been an Geriatric RN for nine years--just left it for Rehabilitation nursing, but NOT for experiences like that. Just needed a change. Let me say I'm sure places that like exist, but they are not the norm. Most people working in and managing long term care facilities are caring; a situation like you described would never happen where I worked or anywhere I am familiar with. There is no excuse for that--not lack of staff or time or money. Unfortunately, all the public hears about is stories like yours. They don't hear about the overwhelming majority of people and places that are working hard with not enough resources or staff, held to impossible standards by the Powers That Be. The elderly in this country deserve far more than they are receiving. It's a darn shame.
  2. by   BHolliRNMS
    Sounds like you had a horrible experience in long term care. However, you should not assume all long term care facilities are horrible places. I have had bad care in hospitals, ers, etc. I am the DON at a 120 bed skilled facility. Our in-house acquired decubitus rate is 0.8%. We have 14 medicare (skilled patients), 4 hospice in our mix. Our restraint usage rate is 2.67 %. We have one resident with a foley catheter. We have 4 residents who are bed bound at their own request. Our facility does not have any inappropriate odors. Yes, we have staffing nightmares like everyone else. I am subject to go to work at any hour day or nite seven days a week. It takes a lot of time away from my family. I am never "off work" I always have a phone and a pager with me...even in church. I have had one day away from the facility in the past ten. I was awakened at 3am tues nite due to the death of a hospice resident. I have taken care of one resident with maggots in a wound....when his family brought him for admit, we found the maggots. He was filthy and had been living in a car. I love caring for my elderly residents. I love each of them like family and know their family members by name. Some are very difficult to love.. as are many of us. Much to my dismay, much of my time is taken from resident care and given to laywers. We have a lot of lawsuits thanks to commercials in our area and people who assume that all nursing home staff are criminals. Nursing homes are easy targets these days. I will give you some examples: family received $500.000 more or less when their dad fell and broke his neck....the fracture in his neck was not severe...he was transported to the local ER immediately after falling, where he was seen by MD and xrayed. He was returned to the facility diagnosed with no injuries. THe family did not hold the ER doc or the radiologist or the hospital responsible for anything. Case 2: transported 84 y/o female to ER with n/v at 8pm. Family did not answer phone when we tried to contact them. Resident fell in the hospital at 0600 and broke her hip. Son sueing nursing home....not hospital...he says we were negligent and didn't tell the hospital what to do to prevent this accident. Case 3: Resident went home on Friday. Returned to facility Sunday afternoon. When nursing staff went to the car to assist her out, she was dead. Family sueing nursing home for "not coming to the car quick enough to save her." etc. Nursing homes are a refuge for many elderly persons who cannot live alone. Ours is a clean and happy place where people love each other. Don't give up on caring for the elderly. As Donny Osmond sang, "one bad apple don't spoil the whole bunch."
    The owners of my facilty came two months ago and gave every employee 50cents to $1.00 /hr raise "for doing a good job." I have lots of new equipment from low beds, to air beds and wc's and gcs and whirlpools, lifts, scales,etc...whatever I tell them the residents need. For the past two years, the owners have also given every employee a monetary Christmas bonus and a bonus for good state surveys.
    Last edit by BHolliRNMS on May 21, '04 : Reason: ps
  3. by   Hellllllo Nurse
    Quote from BHolliRNMS
    . Don't give up on caring for the elderly. As Donny Osmond sang, "one bad apple don't spoil the whole bunch."
    Your place sounds like the exception, not the rule. I worked LTC for years, as both staff and agency. I saw where deaths were covered up, documents falsified, and abuse of residents by CNAs was ignored. I have seen places with roaches, holes in the floors, places where linens were locked up and hidden from staff to save $$, where Crisco from the kitchen was the only supply available for a skin barrier, and pt beds were literally 50 years old, and rotting. I overheard one DON where I was staff, praising the kitchen manager for buying foods that the residents did not like, because they were eating less and this saved $$ on the food budget.
    This same DON told a pregnant CNA who started having contractions while on duty, that she would be fired if she left to go to the hospital.

    I have seen nurses threatened with termination if they did not clock out and keep working, because overtime was not permitted.

    Several times, I had to go a drugstore and buy cups and straws for med pass, because the facility kept running out and not ordering. I have also bought resident's meds at a drugstore with my own money, because we could not get meds.

    I have worked shifts at probably about 20 nursing homes, and never saw one where I would be comfortable if someone I loved were staying there.
  4. by   NursesRmofun
    Very, very sad story. How did they pass their audits, I wonder?
    Last edit by NursesRmofun on May 21, '04
  5. by   DOCS RN
    Inmates in State prisons get much beter care. You would not believe what we are forced to give away. I am glad to hear that one among us has the guts to call a spade a spade and deal with the deplorable conditions found in this nursing home. My hat is off to you. Thanks.
  6. by   southernchickrn
    All I can say is HOW disgusting! Your story reminds me of my first semester in nursing school. We did our first clinical in a nursing home. Now I had been in nursing homes before and this one looked like a country club: no urine smell, carpets were clean (persian rugs at that!), the dining area was set up like a 5 star restaurant and the patients rooms were all clean and sunny looking. One week my instructor told me that I would be getting the "queen" of the home. She was about 90 years old, very feisty and "ruled the hall" that she lived on. When I went in to see her she was very quiet, and seemed to be in pain. Upon inspecting her PEG tube, she had gastric juices coming out and it was very infected! I got my instructor to ask her what I should do. She got the necessary supplies and put a new dressing on her PEG tube. When she checked the chart the night nurse had a notation that read "dressing dry and intact with no signs or symptoms of infection". Now I was a brand new nursing student with only 6 weeks under my belt but I knew an infected site when I saw it. That site looked like it had not been taken care of in days! My instructor made her own note in the chart and told the DON. The pt eventually went to the ER later that week to get a new PEG.
  7. by   BHolliRNMS
    I have worked in several long term care facilities in south ms and have never seen any of the things you are describing. I have had many residents return from hospitals rural and city...with multiple decubiti and broken hips.
    If I ever did witness anything so deplorable, I too would immediately call the state health department and the board of nursing and the attorney general's office.
  8. by   RNwendy
    Quote from BHolliRNMS
    I have worked in several long term care facilities in south ms and have never seen any of the things you are describing. I have had many residents return from hospitals rural and city...with multiple decubiti and broken hips.
    If I ever did witness anything so deplorable, I too would immediately call the state health department and the board of nursing and the attorney general's office.
    Aint that the truth, holli!! I know we have our "problems" in LTC but the condition my patients come to me in FROM the hospital at times is horrible! LTC gets a bad rap many times. I have also noticed recently that many of my patients that come to me from hospitals are confused. After talking to the families, it's amazing to find out that they were "strapped" down in the hospital for this or that AND given tons of meds to keep them sedated. Chemical AND physical restraints? No wonder the poor pt is confused, agitated and/or combative!! It's amazing what a couple of days OFF these meds and NO restraints do for the soul!
  9. by   Justus
    Eddy - you honor all !
    I wish I could say that your post surprised me but frankly I've seen it all before. There are good/ bad LTC's but in my experience the scales tip in the bads favor.

    As to the question of how do they get away with it...
    This has been some years ago but when I was training as a CNA and our LTC was reported to state we were given advanced notice of their arrival. The worst decubs were sent to their Dr.'s during the visit, others just happened to be in the whirlpools and still others were being visited by family who believed this place was just great.
  10. by   nurseem
    I commend you on reporting this horrible place. how depressing to think that this stuff actually goes on! my grandma is 93 and is in a nursing home and i don't know what i would do if this stuff was happening to her:angryfire . its just sad and really makes a person angry that some people just disregard human life the way they do.....doen't anyone in these positions such as DON have a conscience (sp?) any more???? you did the right thing don't even thing twice abou it.

    Quote from eddy
    Thanks for all your support and advice everyone. It makes me a little less depressed to see all of you agreeing with my actions. While I know I did the right thing, it was probably one of the most difficult things I have ever had to do. I didn't give myself a choice. I knew I had to report what I saw, but it didn't make it any easier. I actually have a friend on the board of nursing here. I talked to her this am and she flat told me not to worry about this. They have been aware of this place for quite some time but were actually waiting for something like this to happen. They are working with an MDS inspector, the local elder care initiative president, JCAHO and the state attorney general. She hinted that they have made it through evaluations in an unethical manner, but she did not expand on that. Basically, she said they had managed to avoid real trouble, and so their hands were basically tied until I filed my complaint. All indications from my conversation point to them shutting the place down.

    I found out a little background info on the small corp that owns the facility. They seem notorious for this type of condition in most of the homes they run. I spoke with a few nursing friends, and they all had a story or two about this corp's facilities. Most of them said that the owners/investors would sacrifice letting residents rot to save a buck on staff wages and benefits. While those are my friend's words, I tend to believe them now.

    The sad part about all this is that those residents were wonderfullllll. They were all so appreciative and polite. They were actually a pleasure to work for. It is amazing how they have been mislead. They should have been yelling and screaming at me, but they weren't. I had to fight back tears all night because all I wanted to do was take them all home with me and "fix" them. Well, you know how unrealistic we all can be in moments like this. These were great people being lied to and in my opinion tortured.

    We need to start standing up against money grubbing owners and investors. It's time we ALL started reporting substandard care when we see it. For the sake of our own mothers, fathers, grandparents, friends and fellow co-workers.... we OWE it to them.

    As nurses we can only do so much with what we are given. If we do not have the tools (staff) we need to take adequate care of our patients, we ALL suffer (patients AND workers). I refuse to accept the excuse that there aren't enough qualified workers out there. The bottom line is if there aren't enough, then it's time to close... NOT run short staffed and put people through hell. It's not an excuse, it's an act of selfishness and greed.

    Again, thank you all for your kind and supportive words. It comes at a time when I can really use them.
  11. by   Town & Country
    I worked last night as Charge Nurse at a LTC facility, and I swear it will be the last one I ever work..... :angryfire
  12. by   BHolliRNMS
    RNWendy, you are so right! It doesn't matter if my residents go to the local rural hospital or a major hospital in the capital city or any senior care unit....it is far more common for them to return with decubs and broken bones and increased confusion and decreased ability to care for themselves, along with increased incontinence than when they left. But, hospitals pay joint commission to survey them. I dread sending my residents to the hospitals, because when I visit them they are wearing posey vest and trying to feed themselves.
    There is one hospital I deal with that has MRSA in their OR...don't know how come they can't figure it out...but I am always left dealing with it in the nursing home.
  13. by   woundcare nurse
    [QUOTE=eddy]BadBird --- While I have mixed feelings on this particular family (assuming there is such) finding out, I wouldn't ever be the one to tell them. Depending on their situation sometimes discovering things like this is worse than being ignorant to them. It's not my place, nor my right. I have chosen to go through this process in the most ethical and legal way possible. I would never get a job in this state again if I did such a thing. Plus, others in nursing would always wonder if I would cross that line again, and next time it might be them I'm reporting... not my idea of an enjoyable career to look forward to. Not to mention I would likely lose my license for telling them, and yet it really wouldn't do anyone any good. I did my part, which is to notify people who ARE in a position to break the news (should they elect to). In addition this information is available upon request by the family. They just have to ask. Hopefully they do. Facilities are required by law to turn over such information. However, they are not required to let you know they have it.

    Catsrule16 --- Actually they (Medicare) are already involved. [/QUOTE

    I am Curious as I was reading through this thread, What state do you work in? I am in Georgia and We as nurses have the responsibility to notify the family/caregiver of any and all changes in condition esp. a decubitus ulcer. I have or should say our facility received a citation a few years ago for not reporting to a residents daughter that resident had returned from the hospital with a decubitus ulcer, when in fact the ulcer had already healed when we got her back so the state only issued a level A citation.. This is a biggy in GA. not sure the Fed.Tag # But md and family must be notified of any significant change in condition or care..... and I would say this was a major issue that the family should have been made aware of. Although, I would not have wanted to be the one to tell them, I've had to call the family for a lot things i preferred not too.:imbar That truely ourages me.:angryfire about the maggot infest.. I have been in LTC for 22 years and the last 6 doing wound care only, and I have yet to have had maggots in any of my wound beds... Thats just unacceptable...!!!!!!!!!!!!!!!!!:angryfire :angryfire :angryfire :angryfire

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