Yikes! Another bad observation at an LTC facility

  1. 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 hospital work when I can just because of what I am about to say.

    Came on to the shift at 2200. As seems the usual, I had to sit and wait for report until 2245, already putting me behind for the night. I had to scramble to get caught up, but that's nothing new. Since we were running short 2 CNA's I was also putting in double duty answering lights and doing other aide work. No biggie as I always do this anyway, just usually as a helping hand not out of complete need. Still no suprise (been there done that). However, about 0200 I floated over to the other unit to cover a nurse who went home due to "female problems". She told me that she was having a "heavy flow", and so I left it at that. Now, I am covering my original unit as well as this lady's as well. No biggie, except I knew everything wasn't going to get done. A call light came up on this new unit as I was passing by, and I didn't see a CNA on the entire unit, so I went to help out. I got to the residents room and asked what I could help with. The gentleman promptly said, "my back is itch'in". I told him I get that all the time myself with a smile, and I asked him if it was okay to help him sit up. He pleasantly agreed that it would be fine. He also said "you sure are nice compared to most of the folks here." When he sat up I discovered the most terrible DC I've seen in a long long long time. It was so deep a 3 1/2 inch swab could be inserted all the way in and barely touch tissue. But that's not really the issue. It was full, and I mean FULL of the biggest maggots I have ever seen. When he sat up, they fell out all over his bed. I was shocked (not in a "gross! look at that!" way, but a "how the h*ll could this go unnoticed!?!" way). I cleaned the wound and got all the maggots (I think). Then, took another look inside. What I believe I saw was the back of his right lung. I quickly took a look at his chart (which took me about 30 minutes to even find as it was tucked away at the unit nursing station under an old notebook, NOT where it is supposed to be). This man was on a rotation to prevent bed sores!!!!! I called the DON, who said she would "call it in" with a yawn of disconcern. I also asked if she was aware that the LPN from the other unit left. She said that she was aware, and I would have to cover. I told her I would do my best, but we were pretty short all around. I asked her if she considered calling the agency for a nurse. She said NO WAY! We're not paying for a full eight hour shift if the person is only going to be there for 5 or so hours! Inside, all I could think was how rediculous she just sounded not caring an ounce for her residents care and well-being. I then charted what I discovered and the Doc arrived shortly after, VERY angry. He said (QUOTE), "They oughta shut this d*mn place down. Too cheap to pay for staff, and too cheap to use a d*mn agency." I replied with "I'm actually agency through ********." He then said, "That suprises the h*ll out of me! I have been on them for months now to get some help in here. In fact, I told them I would quit as the primary here if they didn't. Looks like they are trying to do just enough to get by. humph! Typical!"

    Shortly after this conversation and about a 30 second exam of the resident, the Doc called for a transport. He said, "don't worry about messing with this. I'll take care of it. You have 40 other people to worry about. That's when I realized I actually DID have 40 other people to worry about!

    I knew only the MOST BASIC requirements were going to be taken care of for these poor people tonight, but I hunkered down and started to try to accomplish the impossible. Meds got passed, the Doc stayed and did a couple foley's then did dressings on about a dozen residents!!!! Wow, what a cool guy!!! But of course, just about nothing else was done. I also discovered two other residents that were on scheduled turns were NOT being turned. Jeeeez!!!! And where in the world are the aides?!? I had only seen one aide (on my original unit) since I had been there (the aide issue is another story in itself).

    Needless to say, when the DON came in an hour late (grrrrr!) I gave a report from h*ll to her. I told her that she needed to get some more CNA's in here and a nurse that cares more about patient care than a mild discomfort. She said something like, let's not talk about THAT and talk about all the things that you left undone. I was about to explode!!! I told her that unless I would have been able to split into 6 people last night, there was NO WAY that these people were going to be cared for properly. I also expressed to her the lack of attentive care the residents were getting. They were lucky to get a water refill in a 12 hour span, some clearly hadn't been bathed for weeks, and on and on and on. She rebuttled with something to the effect of, we aren't made of money and walked off! Seriously, she walked off!!!

    I have never done this before, but for the first time ever I reported a facility to the state. God help those poor folks at that h*ll whole.

    I know that agency won't cure the shortage of qualified nurses and nurse aides in this country, but in my opinion, if you need help and people are suffering as a result of such short staffing, it's time to call them in and in droves!

    Sorry for the book... I had to get this off my chest.
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  2. 118 Comments

  3. by   Youda
    <<<<I have never done this before, but for the first time ever I reported a facility to the state. God help those poor folks at that h*ll whole.>>>

    Thank GOD you happened to be the nurse the agency sent. Please follow-up to be sure the state DOA does an inspection. You might call them back and say you believe the residents are in "immediate jeapordy." That will get the inspectors in there within 24-hours. If there were any Medicare patients there, also notify the Medicare Fraud hotline. They are now prosecuting for "Medicare Fraud" when residents in LTC do not receive the care that Medicare is paying for them to have.
    http://www.medicare.gov/FraudAbuse/HowToReport.asp

    If you are feeling especially motivated, wait until the inspectors are in the building, then tip the local newspapers about why the inspectors are there "a complaint about immediate jeapordy." Don't give details, because you can get in trouble for violations of patient confidentiality. But, when the media contacts the state, the state will give them the particulars!

    If this poor soul was also a Veteran, contact the Veteran's Administration. Recently there has beena big push to protect veterans from the substandard care in nursing homes. You could get that facility banned from referrals for any veterans.

    This kind of story just makes me sit here an cry. It just really hurts me to see this kind of care. Again, thank you for being there and doing the right thing.
  4. by   eddy
    UPDATE: I just got a call from my agency. I am a DNR (do not return) at that facility. Not exactly a big shocker there. The staffer also told me that the DON is filing a complaint with the board for abuse and neglect! After I explained the whole thing to my staffer she was speechless. She came off with an accusing tone at first, but by the end of my lengthy story, she was literally in tears. She said she had known there were some minor problems there, but nothing to this extent. She apologized for sending me there, and said that she would be having a chat with the administrator tomorrow. I'll let you know if anything else develops.

    Aparently someone at that facility has somehow been made aware already of my reporting them. That was so fast it's scarey!

    Also, there is a handy website that has a public list of all facilities in my state with defencies. Guess what? No violations as of the most recent 4 evaluations! Anyone else get a funny feeling about that?
  5. by   Brownms46
    Dear eddy,

    This has got to be the moment sickening, and at the same time heartbreaking story I have heard or read yet. I thank God that that Doctor was there. Praise God for his willingness to help you and those residents, and that administrator should find her place in hell soon! My Lord...it's hard to even take in all that you have written, but I soooo glad you reported them, and you can bet your loving heart, that the administrators empty threat is just that empty! She knows she can't even afford for the nursing board or anyone else to look into this!

    And she even in her wildest dreams expect you to ever walk back into such horrible conditions. I know in your heart you would want to be of assistance to those poor people left in the place, but that place DOES need to be closed!

    Thank God for you hanging in there, and taking that gentleman's complaints to heart and taking the time to see what was bothering him. My God!
  6. by   JailRN
    Wow, what a day, er, night, I feel for you, good for you for reporting them I probably would have chocked the DON and been in jail, ah yes, and they don't want you to return, good, who'd want to go back ther anyway, feel sorry for the residents, but you can't protect the whole place. You did a great job woth what you had.
  7. by   duckie
    I'd bet you $$$$$$ that doc would back you up!!!!!!!
  8. by   tattooednursie
    I know how you feel. When people leave the place understaffed it really pisses me off. Tonight I got on shift and discovered that only me and one other CNA were going to be on tonight for 70 residents. It is dangerous to the residents. We do not have the time to get everyone out of bed that needs to be out of bed, and we cant do our showers under those conditions and It is not safe for us either we can hurt our backs or residents trying to hurry. Its ****ing ridiculous, i dont think anyone even bothered to try and find some one to come in.

    Still I think that is no excuse for maggots to be crawling out of some ones back, thats just ****ing nasty.
  9. by   cargal
    That is freakin unbelievable. What is it about LTC that these things are allowed to happen? Is it the staffing ratios set forth by the state that permit poor staffing? Is it the management? Do nurses make such poor managers or do they start becoming administrators with a DON cap?
    Yesterday I was told to take a 96 yo off of Hospice and put her on Medicare skilled- Shouldn't the family make that decision? This industry sucks for seniors.
  10. by   nakitamoon
    eddy~~~ of course you did the right thing by reporting them,,,, thank god,,,

    doesn't surprise me that they don't want you back,,, you rocked thier 'boat',,, didn't go with the flow of substandard care,,,,

    Thank goodness for the doctor and his attitude,,,, I hope the state steps in and sees these residents recieve the care that they deserve,,,,,

    & you deserve a medal,,,, for making it through the shift,,,, doing the best you could,,,,, Bless you,,,,,

    ~~~kitamoon
  11. by   nursedawn67
    Eddy you did the right thing...WTG on assessing that man and making him sit up....the poor guy that must have been agony for him. And the worst thing is you know he can't possibly the only one in that condition! You and that Doc definately deserve a pat on the back!
  12. by   Mkue
    OMG, how horrible ! I think you did the right thing also by reporting them. And thank goodness for that wonderful Doc!

    I don't see how in the world you could be accused of any wrongdoing.. that's absurd.

    I agree with Nakitamoon, you deserve a medal for hanging in there and trying to do the work of ?? people.

    And the DON?? omg.
  13. by   JAYNE :DANCE:
    BLESS YOU FOR REPORTING THAT FACILTY TO THE STATE.......SOME OF THOSE RESIDENTS I BET DO NOT HAVE ANYONE THAT CAN BE THEIR VOICE....ONCE AGAIN GOD BLESS YOU..........YOU ARE AN ANGEL
  14. by   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.

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