Venting...Hosp pts coming from skilled nursing facilities

longtermcarern · Apr 12, 2005

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

in my 25 years in the ltc field, I have only seen a couple of patients like this. In this day and age, no one should ever get this bad. Being tube fed, they had the ability to give her the proper nutrition she needs to help maintain her skin integrity so it surely must of been inadequate care. Has the DR had any labs drawn, albumin etc to make sure she was receiving the proper nutrition?

We do need to keep in mind, it takes one shift of neglect, 8 hours, to start a decube. Kennedy ulcers can appear in under 8 hours. I have seen many a decube come from the hospital on a surgical patient. Just the time they lay on the operating table is enough to cause a decube in our most fragile people. the nursing home your patient came from should most definitly have an investigation from the state. Please do report them and keep us informed of the outcome.

Chad_KY_SRNA · Apr 12, 2005

Those poor old people. My LTC was recently purchased by a chain company, we have never been fully staffed but I get mad as heck over finding tiny stage two areas or big stage one areas :angryfire. Call any government agency that will listen to you. I have seen deep stage fours from poor home care but as soon as they hit the floor they get cleaned and packed. Twenty Two Stage Fours :angryfire ! I would probably have to sit down and cry after that :crying2: . I can't believe that they have gotten away with it that long. Good luck, kick their butts up over their heads.

RNKITTY04 · Apr 12, 2005

I could not finish my breakfast after reading this post. I would really like to get a hold of her medical records and do some research, ie..... how long has that foley been in? G-tube? etc... Definatly call someone please, this has been put in your hands for a reason. Maybe it's the best thing you will ever do as a nurse, its definatly one of the most important.

Please let us know what happens.

stidget99 · Apr 12, 2005

I have a call into the ombudsman. Waiting for a return call. Have decided to try doing something about it anonymously first. If I don't see any action, I will do whatever I have to do to get these institutions up to at least the humane level! I will keep you all posted on what happens. This particular pt is likely to be "the" pt that will haunt me all of my life. :crying2:

stidget99 · Apr 12, 2005

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.

studious · Apr 12, 2005

Hi there,

I'm so sorry you are having to witness this clear and absolute lack of care towards these individuals. I am a Staff Nurse in Scotland, and we definately do not do pressure sores in our sixty bedded unit. Unfortunately, there is the odd patient due to chronic illness or pre-existing illness that develop the odd red mark on a prominance, or leg ulcers that caught quickly can be well managed, with close obs and a great multidisciplinary input.

I am in complete agreement with yourselves that this cannot be allowed to go on. Like you I reported bad standards of care over ten years ago, and have just recently stopped being bullied and harrassed because of what I did.

It's a tough tough battle, but please know you are doing the right thing for these patients, I did not leave for a quiet life, because I knew that if I did nothing would change for the patients in our care. I am in a different unit though, with standards of care that are extremely high. Hang in there, please it will be worth it, elderly people need folks like us to care for them, like they cared for theirs. These people have had a life, were mothers and fathers, had children, worked hard, fought for their countries, and they all have a story or two if people have the heart and will to listen. They deserve all that we are able to give them. A clean bed, a nice bath, hospital food???a kind word, or a cosy blanket. What does that cost.

studious · Apr 12, 2005

P.S

If you need support, or are feeling down, please post. It looks like like you'll have plenty support here.

ariella · Apr 12, 2005

I work in a SNF. I am new to this site and I will be honest and say that there are lots of things I wish were different in nursing homes. However, it is true that unless you have walked the walk, it is too easy to as you say "have your blood boil." I worked home health before SNF and the most horrible neglect I have seen to date was in some of my patients who were "supposed" to be cared for by family members at home. I will not even approach any of it in writing here because it is still too upsetting.

Now I will give my viewpoint as a nurse in a SNF. We have patients that come to us from home when the family finally faces that they aren't able to care for them properly. They come to us with heel ulcers and sacral ulcers and usually malnourished and dehydrated. Sometimes due to poor circulation to extremities, it takes months to years for the wounds to heal. This is with pressure mattresses, heel floating, nutrition supplements, etc. Many of our patients don't eat and drink adequate amounts and the family doesn't want extreme measures so they slowly waste away. The dehydration and frequent Uti's are common because many of the elderly in our facility no longer "get thirsty" and they retain urine. Some hold it in because they don't want to soil their brief so they get frequent infections for that reason. It would be great if we could get all our patients up to the bathroom every two hours but many are overweight and most are nonambulatory. We simply do not have the staff to do that. I will not lie and say we haven't had skin breakdown to start in the facility but I will say that there are usually many factors to be taken into consideration. As a student nurse, I had an elderly male patient assigned to me. He had cellulitis and both feet had horrible wounds. I remember being very upset because his nurse just looked at me and said "I wouldn't waste my time on his feet because they aren't going to heal. He will probably lose them." At the time, I thought it was cold and unfeeling but now I know she was just being truthful. I never give up though and I have had pts 80+ to get well and be able to return home. I was feeling really down afew days ago and thought no one appreciated us-like we are the bottom feeders of nursing. Our facility Dr. came in to review some pt charts and make rounds. He was there most of the afternoon and observed all that we do and encounter. He turned to me and said "I don't know how you nurses do this day after day." I know our facility would be better if we had more staff but we work hard and care about our patients more than any one realizes.

nursedawn67, LPN · Apr 12, 2005

stidget99 congratulations on doing the right thing! You are to be commended for doing your job and caring. (((hugs))) Decubs can be easily treated and prevented in many patients (I have seen the odd patient...though few and far between...that no matter what decubs are unavoidable, but they get special treatments and are kept manageable). But from the sounds of the facility/company you are talking about they are just downright neglectful and abusive. And because of that one company they give all LTC/SNf facilities a bad name. At my facility if they get one red mark that resembles a stage 1, they are started on a drink called Arginaid, vitamin c and multivitamins...they also get many skin sheets, nurses notes and extra chartings as they are being monitored for their healing. We even do skin sheets and the like on just a simple scratch...which we all know can turn out to be a major skin breakdown in the elderly. Our MARS reflect if they have skin issues, we chart in there that we have monitored/checked that particular skin issue. It just burns my fanny to hear that this goes on! :angryfire Once again congratulations on doing the right thing...and we are all here for you if you need support.

CoffeeRTC, BSN, RN · Apr 12, 2005

Some might flame me for this, but short staffing is no excuse for decubitus like the OP reported. Yep a stage one might happen, but for goodness sake...multiple stage 4s...I just checked our counties nursing home reports. We have at least 115 in our county..all on regular licences...You should look in to these....some are an eye opener.

I mentioned calling the police, because this would have been my knee jerk reaction. Yep there are proper steps to take, but it takes forever and these homes can go on abusing their residents. I can't tell you how outraged/ sickened I am.. :angryfire The news people would love to take action on this one.

Okay.....the other side to this..is the Kennedy ulcers and the family involvement like another poster stated. Often times we get people like this from home...yep we do! Takes forever just to give them their first good bath.

To the OP.....thank you for taking some action!!

teadrinkr · Apr 12, 2005

Stidget- what a horrible situation! I hope the ombudsman is able to bring about a positive change in that facility.

Arielle- I agree with you . Not all ulcers are due to poor nursing care. The SNF I worked at admitted many patients from home, with stage 4 ulcers, that other facilities would not touch. We had a good wound care program. It is sad that the only family available to care for some of the elderly at home are elderly themselves. They do the best they can and it is a very hard thing for them to realize that sometimes it is just not enough.

Antikigirl, ASN, RN · Apr 12, 2005

Ombudsman definately!!!!! Please do!!!!!!!

I work in an assisted living facility and I must crow that we are the BEST in skin care! I was amazed at how the CNA's and Nurses really solve these issues as a high priority! Greatest skin around and I can heartfully and thankfully boast about that!

The only probelms we face with skin issues or other types of neglect is when they are recently transfered from other facilities. We always wind up dealing with decubes or other skin issues. Have had some horrid examples come in from other facilities, and emotional issues as well from neglect or abuse from the previous facility. It brings me to tears, but...once they are with us..top notch TLC and care, even with limited staff!

Our staff reports EVERY skin issue! Even having to do an incident report on an older dime sized bruise! All, even a pimple that bleeds gets treatment by staff till resolved. It is tedious to take it that far, but keeps us looking at that skin to ensure it is all in tact and doing well! We go overboard sure, but it has paid off in a great reputation, and now other facilities know that if our residents come back with skin issues (or others of course) we will be reporting them!

Thankfully our paramedics also do report any neglect or abuse signs and symptoms to ombudmen so it can be investigated (some times it goes straight to police). That is helpful because they really see the difference between facilities and can really pin point when things aren't right!

It is mandatory in my state to report these issues, so if it is in your state, I would certainly do that because not doing so not only adds to the cycle, but can wind you up in big time trouble and a potential neglect charge as well (neglecting to report).