Yikes! Another bad observation at an LTC facility

Specialties Geriatric

Published

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.

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.

It just makes me sad to think of that poor old chap with those maggots. You definitely did right thing - pity others didn't do same thing before you saw it so it didn't have to go that far.

While your story is horrible, it really doesn't surprise me. Not putting down the honorable profession of nursing, but there are some bad apples out there and the state agencies and NH administrators don't pay enough attention. My mother was killed in a NH about a year ago by a RN who had a long history of medication errors, paitent assaults, etc. All the state people did was write up violations against the NH. The state attorney general brought homicide charges to a grand jury but they didn't prosecute. The RN told the grand jury she was having a "bad stress" day and they took sympathy on her.

The bottom line is that NH administrators and owners treat these elderly people like farm animals. When reported to state agencies, all they get is a simple slap on the wrist. I could have done better by having my mother boarded at a animal hospital. It's a lot cheaper, she would have gotten walked twice-a-day, bathed once-a-week, and fed twice daily......

If you'd like to check out just how common this is, visit this website. There are other similar websites, just do a search.

http://www.memberofthefamily.net/usmap.htm

Eddy, God bless you for speaking out for those poor patients.

You are a hero and a damn good nurse!!

:kiss

Brian, thank you for that link. Although I was horrified at the story, it only confirms what I already know. And, it is somewhat helpful to know that those outside the "industry" are starting to notice. It just makes me fume, though, to hear the response of the corporations when I see their investor relations information showing huge profits each year.

Specializes in MS Home Health.

YIKES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

renerian

After reading this I was horrified. I am doing my first clinical rotation in a LTC and was commenting on how well run it is comparing it to the facility in this story.

They came up with the fact (don't know if it is true) that a flies entire life cycle is 3 days. Also, the maggots will only feed on necrotic flesh, not viable tissue (it is used sometimes to clean wounds...). Students... LOL So, this wound was infested sometime within the past 24 hours and not dressed / looked at in 24 hours -- that time was my point. Especially if this pt had a hx of decubs... what happened to the turn Q2?

I have yet to see a decub in this facility. I don't know the staff ratio, but they seem to be able to do what they need to do. One lady (99 year old LADY) each day has her camisole, stockings, makeup and jewelry on. One of the students was assigned to her, and had forgot her earrings and combed her hair differently. A CNA noticed, brought her back to the room and combed her hair the way the resident liked it, and got her earrings on.

I think I must be LUCKY to have seen a good facility for my first experience. As to the smell there, I did notice smells, but nothing hits you too bad. Sure, you smell the code browns but in general this is a clean, well maintained place.

My God!!!!!!! I am appalled and speechless!

You kept saying "And where were the NA's?" Am I understanding that there were no NA's on the unit you were pulled to? YOU were that mans guardian angel. I can see why the other nurse went home with "female problems." After realizing what she was getting herself into she decided to NOT stick around. But,it was a good thing she did leave otherwise you would have not been pulled there to find your suprise. Kudoes to you and a big ^5 for reporting this place to the state...You handled yourself very well in this great big bad situation. New Job perhaps?

For me, I tend to have a lot of new jobs. Almost every time I go in to work it's a "new job". That's both the beauty and the draw back of agency work. Every day is a new day, but it also brings its own set of unique challenges.

I've been to a LOT of places, and I've seen a LOT of disturbing things. Yet, I have never seen ANYTHING so bad as this. I mean, I am used to going to facilities that have problems. Afterall, that's really the only reason why I am there. However, there are problems and then there are outright cruelties. This was a cruel environment for everyone involved, pts and workers alike.

Night owl - In response to your CNA question... Well, according to the daily sched there were 3 CNA's on that night. Usually they have 5, with 2 on each unit and a floater. They were confirmed short 2, but we all know that if everyone works together and nurses are willing to help CNA's with their workload, even going this short, things can get done and done properly. It may not be fun, but it can be done. However, the only CNA I saw all night was the one that I had on my original unit. She was a hard little worker, bless her heart too. The other two CNA's were never accounted for. It is unknown whether they were no call no shows or there was a scheduling error (intentional or accidental) or if perhaps they abondoned the shift at some point during the night. The lone CNA busted her hump to do what she could, but the bottom line is that she couldn't do it alone. Judging from the condition of the residents I have no question in my mind that this situation is more the norm at this facility than anything.

The LPN that left early did not chart any work. She did absolutely nothing. I have since learned that she has been employed there for a little over 2 years. My belief is that she took advantage of the situation to get a night off and stick the guy who "didn't know any better" with the load. I have zero respect for her as a nurse. She was the night charge 5 to 6 nights a week of that particular unit. She should have caught this resident's problem just like the day and eve charges should have. My feeling is that the only people left at this dump, with the exception of the CNA I worked with, were people who didn't care. They were hardened to the conditions, did as LITTLE as possible and were only there for a paycheck.

While it most definately is the fault of administration and the owners/investors, the blame also lies with the employees in this case. THEY SHOULD HAVE DONE WHAT I DID A LONG TIME AGO!!!! That doesn't make all the employees there bad, but it does make them either ignorant, careless or too afraid. I don't accept "too afraid" as there are jobs galore in nursing in my area. They didn't have to stay, and they most definately are not heros for doing so. So while I want to say the general statement that "it's all the administration and owners fault"... IT'S NOT!

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