A weird one

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Got a 67 yr old into the unit tonight,down for at least 72 hours, EMTS called "because of the smell from the house".

Advanced cellulitis of both lower extremities, gangrene in one foot,maggot infestation of legs, thighs and perineum. Stage 2/3 sores of the buttocks, perineum, and rash in every fold.

Daughter states saw pt. 2 weeks ago, saw nothing wrong other than usual recaltricance and "bad legs",went on vacation. Other daughter supposed to do check, no clear answer on who saw Mom last.

I am not believing this, though daughter states Mom is "difficult",family has tried intervention through APS, thwarted. She did tell me that when she last saw Mom, she was not able to get out of a chair, even when daughter tried to help.

I consoled daughter, though I was suspicious about some of her answers.

Was I wrong to suspect, at the least, benign neglect?

I now feel bad about suggesting that given Mom's state, she might want to consider the presence of fleas in the house and discard the clothes she wore while cleaning the area Mom was found in.

Am I wrong to think that the effort made by this family was superficial at best?

Was I out of bounds to try to protect this woman by hinting that the house might be a breding ground of pestilence?

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Hey Cate!!!

That seems weird to you?? Ah, perhaps I'd seem critical if I said you must have a very fortunate--even sheltered?--life? (I swear--I'm not being critical!!!)

I was talking to the dtr of a pt some yrs ago, here in Fla. She's an administrator at a LongTermCare place. I made some complimentary reference to her attentiveness to her Mom in contrast to the large number of "disposable people" around us: the elderly, the homeless, the foster-care children.

"OH JOHN!!!" she replied, "you have no idea." She estimated that at any time, 65 to 75% of her Pts have NO family contact for perhaps years at a time.

We are sadly a 'civilization' that has made non-productive people disposable and forgettable.

Sadly

Papaw John

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Specializes in cardiac/critical care/ informatics.

I would hope that at the very least APS is involved, there is neglect whether it is just self neglect or family neglect. Obviously the patient can not take care of herself. If she was having trouble get out of a chair then why wasn't the family doing more. I agree with papawjohn we do live in a disposal society and unfortanately that includes family. :(

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Thanks for the followup, friends.

I STILL don't have a handle on this families dynamics.

Pt. was transferred out of CCU to tele.

The daughter seemed so caring, but if you knew your mother had a hard time getting out of a chair with you to help, would'nt you at least suspect she could not do it on her own? Maybe get some help BEFORE leaving on vacation?

She stated that they called APS, and were told that as long as MOM stated she did not want to go into hospital; there was no recourse.

It simply seems to me that a woman with her medical problems, "her legs have been bad for sometime", (hell, they were gangrenous and swollen beyond belief), living in a house covered in both human and canine excrement; with no food should have been a prime candidate for APS intervention.There is no way the family could not have known she was in dire straits (the smell alone would have tipped you off).

Obviously, if she is living in squalor, unable to provide for her basic care, then she is NOT rational, and requires an intervention.

Does APS just take the easiest route?

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