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 toliet and left her there alone. She was told to ring the call light when she was finished and the CNA shut the door and left.
Last June, my mother had two CVA's at the right basal ganglion. She is now hemi-plegic on the left. She can move her lt leg a little and can transfer with mod-max, mostly max assist by one-two persons. With max assist she can take a few steps in PT with hemi-cane and two staff members. Before the hip fx she was able to walk 25-35 ft with hemicane and 2 person assists.
The day of her fall she was found by her regular CNA- the one who toileted her was not her regular caregiver. She was laying on the floor with her body halfway out of the bathroom doorway. She called the RN to her room. The nurses notes state that my mother said she was trying to get herself back into her wheelchair which my mother vehemently denies that she said. It also states that the RN did ROM and the RN charted that there were no bruises or marks- however- my mom c/o a lot of pain when they STOOD her to get her back into her w/c and then a few minutes later when they STOOD her to put her in bed. They called the doc and based on the info the nurse gave him he ordered a FEMUR X-ray. The portable service came and did the film. The results weren't ready until approx 9 pm that evening. In the meantime they again STOOD her to go to dinner and yes they had her sit up in her w/c even though she was complaining of pain. Then after they had the results of the x ray the CNA was instructed to again STAND her to get into bed. Prior to then she was assisted by two CNA's to stand but nonetheless she had to stand. Mother screamed bloody murder and collapsed onto the bed.
The RN in charge that night is one that absolutely hated me. She was haughty when she told us mom's x-ray was neg. so "there shouldn't be any reason she is c/o so much." When the CNA put her to bed for the night I looked at my mom's thigh and hip. There was a very large bulge close to her groin and she was complaining a lot of groin pain. She could not straighten her leg or have any tension on it. I had to inform the RN and LPN of my findings because they certainly knew nothing about it.
The next day her regular day CNA told me that she had repeatedly told the LPN in charge that mom was in a great deal of pain. She said the LPN told her that my mom HAD to get up for breakfast and lunch and reminded her that the previous night's xray was neg. Approx 1PM, the CNA insisted that the LPN come to the room because my mom was in agony and the pain meds were not holding her. She finally decided to call the doc and send her to the hospital because she was crying and crying. She called us and told us tomeet our mom at the ER.
Yes, she did fx the head of the femur. I also found out she hit her head- no notes about neuro checks or that it had happened. At the hospital they also discovered huge swelling and bruising on her left elbow which was NOT noted in the nurses notes and her elbow was Xrayed. The staff at the home did not know about the elbow bruising and swelling. I called the charge nurse on my mom's division at the home and informed her that my mom's hip was fx. I also asked her approx how many times she was stood on her leg before it dawned on anyone that something was wrong. She said she couldn't possibly answer that question. Mom had surgery and was in the hospital for 5 days. The nursing home charged us $700.00 for a five day Medicaid bed hold!
She returned to the nrsg home. On the day of the return the staff was very hostile to my sister and I. We talked to the nursing staff about making sure mom was comfortable, etc. But the *****y RN was in rare form, almost manic. She was so hyper and psyched up and was yelling at us when her tone should have been normal conversation. My sister and I then went to see the administrator. Sis asked very politely asked that my mom NOT be left alone on the toilet again. The administrator started yelling at my sister and told her she couldn't promise anyone would be with her when she was placed on the toilet because "we don't do private duty here"! My mom is unable to "right" herself if she starts falling to the left side because of the paralysis.The ***** is no longer employed at the home. She was asked to give her resignation for some questionable illegal behavior on the premises of the facility according to the CNAs.The home denies it and says it is a personnel matter that they can't discuss but that they assure us it wasn't because of drugs. Right!!!
They have since admitted to us that she should NEVER have been left alone on the toilet. BUT... my mom suffers each and every day with hip pain. She is barely able to assist herself and doesn't walk more than 2-3 ft with MAX assist. My sister and I both have numerous health and pain problems and are unable to lift her or her wheelchair. So, now we just take her out for rides but we end up coming back in about 45 minutes because she can't stand to sit on her butt due to pain. Of course, since she is Medicaid they "plateaued" her in skilled PT a little less than 2 and 1/2 weeks after surgery and returned her status to restorative therapy. Previously we had requested 5 days of restorative therapy and they complied. This time I was told by the PT that the front office will NOT approve any more than 3 days of restorative therapy for MEDICAID patients.
She is now doing "restorative" therapy but I had to take her to the ortho surgeon a few weeks ago because she c/o pain when her leg was internally or externally rotated. It turns out that her lt knee had become contracted. Even though their PT notes indicated that they were doing all sorts of things such as ROM during her restorative sessions. The ortho doc said "B_ _ _ S_ _ t! They are putting her in a w/c at 6am and keeping her there for several hours or this wouldn't be happening". They had the asst. administrator call me and tell me that the PT said her knee is NOT contracted. I told her that she could take that up with the ORTHOPEDIC SURGEON whom my mom had seen 4 days prior to her call. I then told her what he said about leaving her in the w/c for so long and she shut up like a clam. I offered to call him and tell him that they disputed his medical diagnosis and needed him to call them so they could tell him he was wrong but she declined.
She has recently developed a pressure area on her lt hip- reddened but skin not broken - 2nd time but they don't straighten her out when she is listing to the left side. They just walk past her and ignore it. We have asked that she be put to bed after meals but that's just a wish also. They hung a q2hr turn schedule above her bed but that is an absolute joke.
What they keep forgetting is my mom is almost completely aware and not DEAF and CONFUSED like some of them think she is. She repeats everything they say about her and other patients to us. She just laughs at us when we ask if they turn her on nights.
Moving her to a different facility is out of the question. This is the only Medicaid bed available around here and believe it or not this is the best facility we could find! It is impossible for us to care for her at home and neither one of us has the room for her.
In May her PCP ordered a voice amplification system for her since she is aphasic and dysphonic from the CVA. It was ordered on May 17, 2002. She still doesn't have it. The speech therapist called me and said they had some systems but they were broken and that her supervisor said she had no intention of getting them repaired. She said the family would have ot buy her a system. Told us it only cost about $25.00. WRONG- $200.00+ !
Administrator said she would look into it. Told her that when I called the 800 # for Medicaid they said the home should provide it. Told her to call them herself- " I said you know the number for providers to call- I used the 80 number for patients. That was on June 15 and I still haven't heard back from her.
How long can they wait before implementing an order that was written on MAY 17?
My sister and I have had a meeting with a lawyer for the purposes of filing a negligence suit against the nursing home and it's staff.
I forgot to tell you. When I took her to the ortho surgeon just recently I had called the portable xray service and told them that he wanted to see the film from the day of injury. He really didn't but I did. Guess what? The film was of the DISTAL 2/3 of the FEMUR! I asked the ortho if the head of the femur was supposed to have been included and of course he said yes. BUT THEN he said " sure is a nice xray of your mom's left KNEE!!!
Makes sense to me now. About a week ago one of the RN's was joking that they had taken the wrong xray by the time they had figured out it was her hip that was fx! They found out when I called them from the ER. The ER staff was livid that she hadn't been sent to the hospital the day before when it happened.
What's the first thing you think of being injured when an elderly patient falls? Duh, the HIP!!!
Mother was moved to this facility last November because in the previous home (same owner) she developed bacteremia from MRSA - no one knew she was sick with a 103 temp and low bp and tachycardia. My sister and I figured it out when we kissed her hello. ER staff said it was a good thing we brought her in when we did because she would have died if we didn't.
ALSO, another time she c/o chest and arm pain for over 8 hrs. Nurse kept telling us over the phone that it was abd pain and that it was just indigestion and that she looked ok to her. I got to the home in the afternoon and called 911. She had an MI and went on to have 4 balloon angioplasties and 3 stents during the next 3 critical weeks. I called the state on them for that and they were cited for not informing the doc of the seriousness of the situation and for not sending her to the hospital sooner. The state surveyor nurse from the dept of aging also cited them for the lack of any infection control practices. 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???
Now, the lawyer says IF they decide to take our case we have to call the division of aging again and make a hotline complaint for her hip fracture. He said they would not be able to take our case unless we were willing to do that.
I can not do this much longer and neither can my sister. Why can't I just be my mom's daughter and not have to be her nurse? Neither my sister nor I are well enough for all of these preventable problems. We are not asking for her to be treated like a queen just like they would want their own mom treated.
They hadn't brushed her teeth from Dec 22, 2001 to Feb 27, 2002 and when we confronted them at a family mtg they said they would take care of the problem. I replaced her toothpaste tube on Feb 27, 2002 and just removed it from her room on June 24, 2002. There is barely any squeeze marks on the tube! It's alost cause.
There are NO nurses notes from March 15, 2002 to April 22, 2002. Then only one entry and none again until May 8, 2002. Is that LEGAL???
Please help me with your opinion.
Thank you,
PappyRN
Any opinions??
