Mother's hip fx in nrsg home - page 2

I would like some advice from LTC staff and others including any LNC's regarding an incident which happened to my mother. In January at change of shift from days to evenings a CNA put her on the... Read More

  1. by   NRSKarenRN
    As former PA ombudsman, I can understand you not wanting to move your mother but she deserves the care ORDERED by the physician. Call the ombudsman office to report your concerns and stress your desire to have care regemin followed and want smoother working relationship with the facility. Unfortunately, what you have described is quite common in many SNF today due to lack of staffing and reimbursement rates. Although things are not all kosher there, this facility still has some possitive features or I'm sure you'd would have Mom transfered out long ago. Getting a medical assistance bed AND keeping it can be huge undertaking in some areas of the US.


    Ombudsman Program
    Missouri ombudsman program consists of volunteers serving residents of nursing homes and residential care facilities to provide support and assistance with any problems or complaints. Complaints concerning abuse, neglect and financial exploitation should be reported first to the Missouri Division of Senior Services Elder Abuse Hotline, 800-392-0210. Individual volunteers are recruited by Area Agencies on Aging (AAAs) or their service providers. Following screening and training, the volunteer is assigned to a facility that has agreed to participate in the program. The ombudsman receives orientation to the facility and its procedures, prior to making regular contact with the residents.

    Having a volunteer assigned to a particular facility provides the most accessible means of complaint resolution. Missouri's Long-Term Care Facility Regulations include resident access to the services of an ombudsman, 13 CSR 15-18.010(15).
    Ombudsman volunteers strive to reinforce the importance of residents rights

    http://www.dhss.state.mo.us/Senior_Services/ombud.htm


    CALL THE OMBUDSMAN's OFFICE PRONTO!

    Any facility that can afford to feed several thousand PLUS fireworks should be able to afford the communication device your Mom needs.

    Check out Consumer handbook plus other info at the state site.

    Consumer Handbook
    For Residents and Family of Long-Term Care Facilities

    http://www.dhss.state.mo.us/Senior_S...s/ombud/ch.htm


    re previous facility:
    "I made 37 allegations against them and they were cited for 3!!! The nurse from the state called them and told them that a complaint had been filed against them!!! So
    much for the element of surprise!!! I had 4 rolls of color pictures for evidence of filth and feces and urine everywhere. WHAT DOES IT TAKE? A DEATH??? "
    The Office of Aging usually cites a facility for the most serious of charges that they see have the greatest impact on patient quality overall. Sometimes it DOES take a patient death to get things changed unfortunately.

    Documenting and fowwlowing up complaints with ombudsman and local office of aging along with opt-ed pieces to your local newspaper have been known to work.

    Consider undergoing ombudsman training yourself so that you can make a difference in another facility. With your insiders understanding, might help to spure changes and educate other family members about resident rights.

    Will keep you + Mom in our thoughts and prayers. RE lawsuit, sounds like you have some ammunition.

    Best wishes.
  2. by   pappyRN
    Thank all of you for your concerns. I sure don't feel so alone now. My sister is so discouraged about nurses it almost makes me embarrassed to be one.

    I doubt if we will ever be able to resolve our differences to a point where we can all be friendly and happy. There have just been too many instances with this particular corporation to forgive.

    I believe the law firm will rpobably want me to wait until I hear their answer before I contact Ombudsman. I can't call the doc yet because I don't know where he fits in in the whole matter legally.

    The CNA quit as did the *****y RN. The lawyer said "there's no better employee for having loose lips like an EX employee".
    I don't know about that- they sure are free with info that I would get crazy about if I was their supervisor.

    By the way. The DON is the Administrator's daughter and she's pregnant and doing absolutely NOTHING! The head of maintenance is their cousin. His wife is an RN there and the two ADON's-one is the MDS nurse- are sisters. NEPOTISM!!!

    You can't even begin to imagine what I am privy to at this place.

    I can't remember the last time my mom was offered a drink of water outside of having it at a meal. She gets a sip with meds.

    I am unable to be a volunteer for the Ombudsman program due to my health which is very precarious.

    There are two nice nurses on evenings but neither one is very smart or on the ball. They just don't get it.

    As far as the thik it is concerned my mom REFUSES to use it anymore unless she feels like it. The speech therapist is worthless. She has NEVER advocated for any of the pts in the proper use of thik it. She could care less and she doesn't want to talk to me- that's why she called the admin to talk to me.

    My sister is the sweetest little thing you would ever want to meet. After the admin made her sarcastic comments about the lack of private duty nursing she turned into a furious beast. She will not even talk to or acknowlege the administrator.

    I'm the big mouth because my family relies on me to be the "medical/nursing heavy"!

    The next time I post I'll tell you some more about OT this time.

    May God forgive me but I pray each night that God will take my mom so she gets peace. I can barely drive the 5 miles to the home now. It will be impossible if we had to move her.

    In the meantime I will DEMAND that they care for her like they should whether they hate my guts or not.

    Warm regards,
    PappyRN
  3. by   pappyRN
    Well, it's official. You won't believe it but I just received a certified letter from the attorney saying they have decided not to pursue a claim because it is their opinion that the cost of litigation in this case outweighs the potential for recovery (of damages).

    It's hard to believe. I think I'll go throw up now!

    My physical symptoms are so exacerbated I am miserable. And now this. I guess there is no hope for getting decent care for mom. I just don'[t know how much more of this I can put up with. I'm almost afraid to let my sister know about the latest fiasco in this saga. I just feel like crawling in a hole.

    The following is a copy of a letter to the editor in the St. Louis Post Dispatch from yesterday.

    Elderly are ignored
    I was deeply touched and grateful for your powerful July 14 editorial regarding the deaths of four women at the Leland Health Care Center( these were the people who died from the 95 degree temperature on the 3rd floor without air conditioning and the nursing home that the St. Louis County Grand Jury refused to indicte). We see the same disregard for the rights of the elerly across the nation- from the state licensing agencies,the ombudsman programs,local police, coroners, state's attorneys, state police, attorneys general, legislators, the Department of Jsutice, all the way to the White House.

    Those few individuals who dare to care all too often have their legs cut out from under them.

    In contrast, the press has sone a good job of exposing abuse,neglect and crime, especially in the past few years. Yet there is NO public outcry,not from the people on the street nor from the nation's pulpits.

    How is this nation's attack on hte vulnerable who must live in nursing homes any different from Saddam Hussein's attack on his own people? Is it any less human because it is sanctioned by all levels of our government?

    Our nation has become callous and heartless. I shudder and fear for it's future.

    Violette King
    Nursing Home Monitors
    Family-Controlled Surveillance
    Camera Project

    Right now I'm so overwhelmed but I think I will try with a different law firm when I feel better. There's a two year statute of limitation but it happened on January 18, 2002 so we're still ok with the time factor.

    Any thoughts or comments? There is ABSOLUTELY NO WAY that I can move my mom. She is on Medicaid and even at the current facility there is a TWO YEAR inhouse waiting list for a medicaid bed.

    Neither my sister nor I are able to take care of her in our homes even with substantial help. Both of us are in marginal condition with our many health problems.

    Financially,it would be impossible to contribute to her support. I'm on disability and my husband has been unemployed and looking for work for the last year.

    Warm personal regards,
    PappyRN
  4. by   Tookie
    Sigh

    after reading this l have to think a little whille before l can answer this - frustration, anger, bewilderment and just shaking ny head is my reaction

    l wonder if simply ageism is at play here.

    l find this hard to grasp - have you thought about going ot the media - ie - we have 60 minutes and other variations that love to get their teeth into a story like this - you have good documentation

    All l know is where is our value sytem whe we trat our aged people like this.
  5. by   pappyRN
    Tookie,
    thanks for your reply.
    I think my sister adn I have just about decided that they win-we give up. It looks like my mom is just another old wothless person who's case can't make enough money for the lawyers.
    I'm in a really bad pain flare(RSD) right now and even my breakthrough meds aren't really working. My symptoms get worse with stress.
    My sister is having blinding headaches and waiting for her docs office to call and give her a time for a brain MRI. We're both worn out and fatigued beyond belief.
    All I can say for them is they better look out if they do or don't do one more thing. The CNA woh has my mom on days had the audacity to say that she really is brushing my mom's teeth daily. The reason there is so much toothpaste left in the tube is that she has a spin brush and the head is small!!! She must really think we are dumb.
    Anyway, I put one of those travel tubes of toothpaste in my mom's bathroom so I can see how fast it is being used up. Of course,I have the date and time on it when I put it in her medicine cabinet.
    I will NEVER go to a nursing home. If I satyed home and died of neglect it wouldn't be much different from my mom's situation and wouldn't cost the state and federal gov't anything.
    Have a great night,
    PappyRN
  6. by   futureccrn
    Dear pappyRN,

    I am so sorry to hear how your mother is being cared for in this Nursing home. I worked in a LTC facility as a new grad and had previously been a CNA my last year of nurisng school.

    It was almost impossible to be caring for 15 or 16 patients in this nursing home that I worked at. The state considered us to be adequately staffed but they counted the LPN's and the Charge Nurse, an RN in the staffing numbers. They never lifted a finger to help us CNA's out, they all claimed that they had a bad back and couldn't possibly lift a resident let alone answer a call light. That doesn't excuse the shoddy treatment that your mother is receiving at this facility.

    I would move her out ASAP! Call the Board of Health in your state. In PA, when someone calls the state to report misconduct in the Nursing home setting, the state had to do an inspection in so many days. I'll be praying for you! Stories like this make me sick!
  7. by   kmchugh
    Pappy

    Like everyone else has stated, your thread infuriated me beyond my ability to express. What you describe is nothing short of elder abuse. Like everyone else, my first thought was "you need to move your mom out of there NOW!" But, you have said you can't move your mother due to financial and health considerations. I understand that, so we must look for solutions that don't include moving your mom.

    First, contact the ombudsman IMMEDIATELY. File a complaint, including everything you know. Force an investigation at that level.

    Next, every state has a state run agency that certifies, monitors, inspects, and polices nursing homes. Contact your state board of nursing, and find out who exactly in Missouri performs that function. Then, contact that agency, and file a complaint.

    Next, contact the state board of nursing, and file complaints against the RN, CNA, DON, Administrator, and anyone else involved. Explain to the board exactly what occurred, and how the personnel you are filing a complaint against reacted, both to the fall of your mother, and your later attempts to discuss the situation with them.

    Next, what you describe is nothing short of elder abuse. Elder abuse is a crime. I personally would contact my local police department, and report the incident as a crime.

    Also, continue to pursue legal action. If one firm turned you down, there may be others willing to take the case. There may even be an attorney willing to take the case on your mother's behalf on a pro bono basis. It sounds to me as though you are not strictly after money, but rather you are after better treatment for your mother.

    First, I would make an appointment for a meeting attended by you, your sister (if you wish), the DON, and the Administrator. I personally would make the appointment for about 1 or 2 pm, so that I would have time to contact all of the above agencies before attending this meeting. On the day of the appointment, I would contact the ombudsman, the state board of nursing, the agency that licenses nursing homes, and the police all on the same day. I would make a record of exactly what you said, and exactly what the responses you received were. In contacting these agencies, be direct, forthright, and honest. Don't let emotion cloud the issue. Be factual.

    Then, I would go to the meeting. I would be unemotional and factual in this meeting. I would start by telling the nursing home personnel that I believed my mother had received substandard care before, at the time of, and particularly after her fall. I would be clear that such substandard care, and substandard care in retaliation for being a "wave maker" will not be tolerated. I would then tell them, without being too specific, that I had already taken action to see that the incident, and the home, were investigated by proper agencies. If, during this meeting, anyone from the nursing home becomes angry, yells, or whatever, let them rant and rave to their little black heart's content. It is vitally important that you and whoever is with you maintain composure, and not lose your temper. When their rant is finished, tell them you also consider their behavior abusive, and will report that behavior as well. DON'T TELL THEM YOU ARE CONSIDERING PURSUING CIVIL LEGAL ACTION! Don't give them any warning of that. I would further be clear that you have only begun, and that further interaction with my mother better be strictly loving and compassionate, or I would pursue further action. Let them ponder, after all you have already done, what "further action" could be. Be clear, you are willing to take every LEGAL measure, within your rights and your mother's rights, to ensure she receives quality care.

    If you cannot be sure that your sister will hold her temper, don't include her in this meeting. It might even be worthwhile to pay an attorney, or other disinterested third party, to attend this meeting. That way, you have a witness to the events of the meeting. Perhaps the ombudsman's office can provide such a person.

    This is essentially the equivalent of a tactical nuclear strike, that they cannot do anything about.

    Be strong, be assertive. You are facing a tough fight, but you are tougher. My thoughts and prayers are with you.

    Kevin McHugh
  8. by   adrienurse
    You are talking about ONE experience in ONE nursing home that has been a bad one. There is no such thing as a perfect nursing home, but most do the best they can under the circumstances that are imposed on them. Please do not be so quick as to accuse all nursing homes as being as bad as the one your mother is at.

    A very hardworking and tired LTC nurse.
  9. by   pappyRN
    Hello Adrienurse,

    Actually this is the THIRD nursing home my mother has been living in. This also doesn't count the skilled nursing floor of the hospital she was admitted to last June when she had her CVA's.

    As far as accusing ALL nursing homes forgive me for NOT saying the ones where I live. I'm sure your facility is fine with dedicated staff but the hard, cold truth is these are not.

    The incidents I relayed in my post are just the tip of the iceberg. I don't have the energy or time to post all of them.

    We removed her from the 1st home on the advice of the Ombudsman office. The facility received her and still had not admitted her until the following Tues. We took her home and tried to care for her ourselves. Her Foley was draining dark brown urine, she was severely dehydrated because she wasn't offered any fluids at the nrsg home, and she had a UTI.

    To this day they are unable to bill Medicare or Medicaid because they were too lazy to complete the admission procedure since she arrived on a Friday afternoon.

    After reviewing no less than 12 homes we had to place mom in the facility she resided in before the current one. This was after another prolonged hospital admit to address the numerous medical problems from her admission to the previous home.

    I haven't even told you all the things she suffered in the 2nd home. Let it suffice to say that I made 37 allegations against them with the Div.of Aging and they were cited for the most serious. Like- the virtual lack of ANY infection control procedures. The surveyors told us that in a 3 day period they were unable to observe ANYONE washing their hands! They also said they were afraid to have lunch there on any of those days.

    My mom developed life threatening bacteremia from MRSA and was taken to the ER in shock. No one even knew it that she was ill. Temp= 102+. BP was low and she was tachy.

    She had an MI at the 2nd facility and the nurse insisted by phone she was having epigastric pain and dosed her with Maalox. Again, when we got there she was almost dead and she was transported to the hospital in bad shape and was in the ICU for 3 weeks. They weren't going to transport her and also told the EMS NO LIGHTS ADN SIRENS because she has a DNR. That does not mean "DON'T TREAT". It simply means if she has an arrest- DON"T RESUSCITATE HER. At the hospital they didn't even admit her to telemetry because of the DNR. AGAIN, they interpreted DNR as DO NOT TREAT. Imagine their surprise in the am when they got her enzyme results and had to call me! The nurse was reprimanded for failing to notify the doc regarding the change in her condition and for failing to send her to the hospital until several hours had elapsed. These are just the highlights.

    I won't bore you with any other details but I think by now you might be able to understand how frustrated we are. We are tired and ill.

    Like I tell the staff- what if this was your mother? Would you sit by and let it happen?
    There are NO MEDICAID beds available.

    Both my sister and I are in fairly bad shape physically. Emotionally, we are both a wreck.I am permanently disabled as is my sister. There are no offers of help from anyone else in our family here to help with this situation. How they can live with themselves is beyond me.

    The facility she's in was a way the corporation was trying to pacify us. They flaunted how pretty and wonderful the place is. Yes, it is pretty.
    We looked at no less than 12 facilities before she was transferred to this one. Not one facility had less than something like 25 PAGES of deficiencies and they weren't for little things either-
    No meds given to ANYONE in a 24 hr period. No aspiration precautions when ordered. NO oxygen when ordered. Medication errors galore. Not enough food portions given to pts. NO hydration measures employed for aphasic patients. And etc. ad nauseum.

    I apologize if you take this personally but it was NOT intended in that way. I'm just looking for some rope to hang onto and some light at the end of a very frightening tunnel. My doctors have told me that I need to disassociate myself from these problems. I, on the otherhand, am a realistic person and not that is just empty advice because they don't know what else to say to me. Like they would just abandon their mom.

    I'm just going to take some time to regroup and then deicide what to do. Any and all prayers are welcome.

    I never want my husband and children have to go through this and I'm pretty sure after living through this- they don't want to either.

    Warm regards,
    PappyRN

    Does anyone know when the Div. of Aging cites an individual nurse, do they contact the State Board of Nurse Examiners for further action? This nurse was already on probation for a DWI.
  10. by   Tookie
    pappyRN
    How is your mum now
    This has been discussed now for a few days and l was wondering how she is at the moment
    Your distress is so evident - you have had so much good suggestions here from other posters who know your system - as l do not. - However just letting you know l was thinking of you, your sister and especially your Mum today.
  11. by   pappyRN
    Dear Sandra,
    Thank you for asking. Mom has another UTI and is being treated with antibiotics again. She's been slurring her words a lot more. She's also drooling and choking more frequently. I have been able to convince her to use the Thik it more than she had been. Her hip continues to be reddened.

    Like I said, I'm going to try and regroup then take these suggestions and map out a plan that works for us. My sister will definitely have to be in agreement as I am unable to go this alone.

    We have a family conference scheduled on July 31. Should be interesting.

    A long while back we had added my mom's name to the list at a religious run LTS. Supposedly, at the time she was the very next female Medicaid admit from the outside. They were clear that any inside assisted living residents whose condition changed as to require skilled care would have first preference. It is a very large facility and there are many people over the age of 95-100.
    My mom has 3 friends there 2 of which are 102 and the third is 104. She knew them from her senior community where she resided before her CVA's last year. All three are still in the assisted living quarters.

    The home is run by the nuns and it is immaculate. The only deficiency cited was something about a lightbulb and the glass being cracked on one of the fire extinguisher doors! The only problem is the distance and especially the neighborhood. There's a lot of drive by's and gunfire. The crime area in that part of the city is bad and my husband and my BIL have both said they refuse to allow us to drive their without them.

    I talked to mom about pursuing that option and she's worried that she will hardly ever see us.
    That's if there's an opening.

    Ultimately, it will be her decision as she still makes her own decisions. We will weigh the pro's and con's of staying vs transferring. But like I said- it is a very BIG IF whether the religious home has a female Medicaid bed available in the nursing home division.

    Warm regards,
    PappyRN
  12. by   Youda
    First, let me say how sorry I am for your Mom's pain and situation. Having a loved one in pain is heartbreaking. From there, let's get to some practical solutions. You've already talked to the Administrator, so contact the corporation with a complaint. At the same time, find out the hotline for abuse and neglect for your State. It is usually under Health and Human Services, Division of Aging, or some other agency that regulates nursing home care. Don't spare the details when you talk to them. Now this is very important: ask the State Agency to remove your mother from that home due to a situation of "immediate jeapordy" in the forms of neglect, emotional and verbal abuse. (Let's call a spade a spade here). Next, contact an attorney. A nice personal injury one should do the trick. Then, when the regulating agency finishes their investigation, you can hand it to the nice attorney, because if the situation is as you stated, there will be fault to the nursing home and you can take the nice happy gang to court and they can learn firsthand why they ought to be giving better care. Good luck to you! And, please, please, don't delay. Get moving and get this stuff done now. Oh! If you want to pursue the Medicare fraud, I'd do it, too. There's a hotline number you can find easily by doing a search of the internet search engines. Again, good luck and don't let this one go. The conditions in this nursing home are deplorable and MUST get corrected. If you can't do it for your Mom, then please do it for all those folks there. They need an advocate very badly.
    Last edit by Youda on Aug 9, '02
  13. by   Catsrule16
    Definately file a complaint with the State Surveying Agency

    Division of Health Standards and Licensure
    Missouri Department of Health
    PO Box 570
    912 Wildwood Drive
    Jefferson City, Missouri 65102-0570

    Phone (573) 751-6271
    Fax (573) 526-3621
    EMAIL: Lois Kollmeyer dhendr@mail.health.state.mo.us

    Cut and Paste your messages posted on this site and email them to the Director. Be firm. Contact your congressman and senator and inform them of what happened. Contact the regional office of CMS (HCFA).

    I have worked in long term care and know it's not a perfect place but this makes LTC providers, not to mention Nurses in general look bad. We are human and we do make mistakes, but sounds like a huge mistake was made here. Good Luck!

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