Venting...Hosp pts coming from skilled nursing facilities

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

    I cared for a pt this weekend. 97 yr old black female. Admission dx: sepsis, UTI, fever. s/p right AKA. My blood boils every time I think about her!!! :angryfire She hails from a certain chain of nursing homes. Her skin condition is horrendous!!!! And that is saying it mildly!!!! 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! You go in and assess her, she is unresponsive (other than eyes opening). However, when we provide incontinence care and turn/position her, she becomes combative - an instinctual thing I think. And this is even after giving her 2 mg of morphine! It breaks my heart. This pt also had been oozing stool w/ every turn as reported to me by the admitting shift. A rectal check revealed an impaction. I must have digitally removed 3-4 pounds of stool from this poor woman. I also changed her foley. The crap that came out of this foley, not only from the inner lumen, but also around the outside.........made me gag. I think that I actually saw a couple of maggots! This foley was in way in the hell too long!!! Now, let's talk about her PEG tube and that nasty-a**ed purulent material coming from the stoma!! OMG! This pt has outlived most of her relatives - no children, no siblings. The closest she had to family was a couple of great great nieces who live several hours away. They made the drive and were absolutely horrified of the condition of her!! There is talk of them suing the SNF. This pt has been referred to hospice. She is receiving palliative care only.

    WHAT IS IT WITH SOME OF THESE NURSING HOMES THAT THEY COULD LET A HUMAN BEING GET LIKE THIS???? It burns my butt every time. I see pts coming from this particular chain in horrific shape! It makes me want to report this chain of SNFs for elderly abuse!! (I am going to call the ombudsman first thing in the morning - woke up too late to really do anything today - work nite shift). I am soooooooo damm angry!! :angryfire It scares me that I will/might be in this same sitation some day. It horrifies me although I will make sure my kids know that I will come back to haunt them if they allow a nursing home to do this to me!! I have had a headache ever since I first came into contact w/ this particular pt on saturday. I remember other pts. One came from the same chain but totally different city. She was in almost the same shape! Huge decub. Actually took 4 boxes of 4x4's to pack it. And that was just the sacral decub. We won't go into the 5 other stage IV decubs that she had. Then there was this other man. Total of 16 stage 4 decubs!!!!! And yet another woman.......22 stage 4's!!!! Interesting note here...all of these pts were black. How in the hell can they get away w/ this???????? I understand that staffing is always an issue but............there is ABSOLUTELY NO EXCUSE for this! When I have other pts whose families are making plans to transfer them to this particular place, I want to scream and tell them not to. Run far far away. Am afraid to do this for fear of retribution. After all, the pts from these so-called "skilled nursing" facilities do bring big dollars to our hospitals. I can't, in good conscience, continue to stand by and do nothing. These places need to be stopped from disrespecting these people! From what I understand, these particular institutions are for those who can't afford better. Kind of the equivalent to being buried in a "potter's field". I think that all nurses, aides, and especially administrators at these places should be legally charged w/ elder abuse!

    Thanks for letting me vent and sorry this was so long. If anyone has ever run into this same type of situation and was able to make positive change, I'd be very interested in knowing how you did it.
    •  
  2. Visit stidget99 profile page

    About stidget99

    Joined: Feb '05; Posts: 432; Likes: 115

    73 Comments

  3. by   Jo Dirt
    Why isn't this facility reported to the state? Here in Tennessee, most of the healthcare facilities have had the fear of God put in them by the state to the point of it being ridiculous. BUT...the facility where I worked in LTC had an excellent reputation for patient care, thanks in part, I'm sure, to pressure from the state.

    Do you think these patient's are being singled out and neglected because they are black, or because there happen to be more black patients in these particular nursing homes? I can't say I have ever run into discrimination (racial) in the nursing home. I *have* run into discrimination based on economic and social status. We have even been told to give *special* care to a particular patient because they are r/t so and so (whether black OR white)...that is what I find disgusting and I won't do it.
    Last edit by Jo Dirt on Apr 11, '05
  4. by   stidget99
    Quote from LPNtoRN
    Why isn't this facility reported to the state? Here in Tennessee, most of the healthcare facilities have had the fear of God put in them by the state to the point of it being ridiculous. BUT...the facility where I worked in LTC had an excellent reputation for patient care, thanks in part, I'm sure, to pressure from the state.

    Do you think these patient's are being singled out and neglected because they are black, or because there happen to be more black patients in these particular nursing homes? I can't say I have ever run into discrimination (racial) in the nursing home. I *have* run into discrimination based on economic and social status. We have even been told to give *special* care to a particular patient because they are r/t so and so (whether black OR white)...that is what I find disgusting and I won't do it.
    I just woke up and dreamt about this poor woman for the few hours that I was able to sleep. I don't think that it's a racial issue. I think that it is definitely more of a social/economic issue. Those people who can't afford the higher priced nursing homes end up in a place like this. I am most definitely calling the state on this one. I would not be able to feel good about myself/profession if I stood by and did nothing. I am still incensed at all of this. My heart is breaking.
  5. by   leslie :-D
    Quote from LPNtoRN

    Do you think these patient's are being singled out and neglected because they are black, or because there happen to be more black patients in these particular nursing homes? I can't say I have ever run into discrimination (racial) in the nursing home. I *have* run into discrimination based on economic and social status. We have even been told to give *special* care to a particular patient because they are r/t so and so (whether black OR white)...that is what I find disgusting and I won't do it.
    dang, i would hate to think it was because of racial discrimination. if these pts are all from the same chain of snf's, i would definitely report this to your dept of public health and get an investigator out there asap!

    leslie
  6. by   jnette
    oh Stidget...

    I could hardly read what you wrote.. these atrocities enrage me and so deeply sadden me. I can hardly stand to read about stuff like this. It is truly appalling that this is allowed. I can't begin to imagine HOW anyone can sleep at night knowing those in their care are so shamefully neglected.

    I'm with you.. I could cry all night just thinking about it. It's criminal, truly.. no other way to describe it. Sure would love to expose places like that.. with pictures of all the decubiti and all.. the works.


    Please let us know hwat progress you are able to make in persuing this.. if any.

    Sorry you had to witness this.. and more than once. There has to be some accountability somewhere. I wouldn't/ couldn't do this to an animal !
  7. by   CHATSDALE
    it probably wasn't racial disrminiation but esp older blacks had ndetected hypertension and the result was strokes which left them vunerable to being bed bound
    regardless...you must take up the gauntlet and stand up for those who can not stand up for themselves...
    call the state board .. the ombudsman idea is good too...you can make anon report to either or both
    this is your duty
  8. by   CoffeeRTC
    Ummm...I work in a LTC facility and the first thing I would have done after stabilizing the pt would be to call the police!! This is actual abuse :angryfire
    :angryfire OMG how could this be happeninig ?? Just to be sure...are you sure this is a SKILLED nursing facility and not a personal care home? I know about bad facilites (and corporations), but this is just sick!!!
  9. by   SmilingBluEyes
    omg report this to anyone who will listen. expose that dump for what it is......a total dump.
  10. by   jnette
    Quote from michelle126
    Ummm...I work in a LTC facility and the first thing I would have done after stabilizing the pt would be to call the police!! This is actual abuse :angryfire
    :angryfire OMG how could this be happeninig ?? Just to be sure...are you sure this is a SKILLED nursing facility and not a personal care home? I know about bad facilites (and corporations), but this is just sick!!!
    You know, that really crossed my mind as well, as I do find it criminal.

    I just didn't know if this was a possibilty or were there other avenues to persue first.. or just how to properly go about it. But, yes.. it IS abuse.. no question about it !
  11. by   SmilingBluEyes
    I agree. this is elder abuse.
  12. by   VivaLasViejas
    Count me in.......this is DEFINITELY criminal neglect/abuse, and every authority that deals with nursing homes should be called in to investigate, and shut 'em down if need be.

    How can anyone leave a frail elderly person to marinate in their own waste until their skin breaks down?! Don't these workers think that just because someone is old and sick, they don't have nerve endings as sensitive as anyone else's, and that they feel pain?? And how can any corporation dare to charge thousands of dollars per month for this type of 'care'?!

    Oh, don't get me started on LTC again.........I really do not want to go there........ :angryfire :angryfire :angryfire I know that not all facilities are bad, but there are SO many that are just plain awful, if not to the residents, then to their employees. The system itself sucks, and not all of that is the fault of the management companies and CEOs, but enough of it is that I don't know how some of them can sleep at night.
  13. by   germain
    You owe it to residents of these homes to report to DSHS, the police, ombudsman, everyone. Let us know how it turns out, and if you'd really like to help, contact your ombudsman and see about becoming a volunteer.

    It is scary, these McNursing homes won't pay for adequate staffing, people suffer every day for it, all because our society won't even look at the situation because its too disturbing. THis is an issue very close to my heart, that we have to take back our long term care facilities as part of our communities.

    Good luck
  14. by   longtermcarern
    Quote from stidget99
    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.

close