Mother's hip fx in nrsg home - page 3
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... Read More
Aug 9, '02Occupation: RN Specialty: correctional, psych, ICU, CCU, ER ; Joined: Jun '02; Posts: 620; Likes: 85You poor dear. I think after all you've been through and all that your Mom has been through, I too, would pray for her to leave this earth. I can't add anything to what everybody else has said, so
HUGS< good luck to you and yours.
Aug 9, '02Occupation: RN in Nursing Education; House Supervision; Editor RNdex Joined: Mar '02; Posts: 427; Likes: 9Pappy,
Yours has to be one of the most horrific stories I have ever heard.
Is there a TV consumer advocate in your area? Contact him or her. Does you area have a newspaper that is part of a major chain? This company/NH is a prime candidate for an eager investigative reporter.
There's nothing like a little publicity for getting someone's full attention.
God Bless you and your Mom.
Aug 9, '02Occupation: MDS Coordinator Joined: Feb '02; Posts: 168The office of the federal inspector!!!!!! Think out of the box, who is above state? The Feds. Believe me when they are called, and the wheel that grinds, wins on this. I work in a LTC as the MDS cord. But I have years of exper. as the admit RN for home care. We had one case when the state, medicare/medicade looked over a concern a pt had, finnally the top dog came in, the FED's. Trust me, they have the power. The feds didn't find anything wrong, but d/t the persistance of this family they did come in an investigate. They will w/LTC.................God o mighty how have you managed this long. Is the LTC a chain? Tex
Aug 10, '02Joined: Nov '00; Posts: 931; Likes: 18Was this a Missouri LTC home? If so, there is a 1-800 number for reporting abuse and neglect of the elderly. If you call and report half of what you wrote here, they will be in that home within 24=hours! Believe me! This isn't as bad as you think it is, it's worse! Get on the phone! NOW!
Aug 10, '02Joined: Nov '00; Posts: 931; Likes: 18Missouri Division of Aging Abuse and Neglect Hotline:
Sep 1, '02Occupation: LPN Joined: Sep '01; Posts: 227; Likes: 5I am so sorry to hear of what is going on with your mom.
I can relate as my mom is in a facility because of many falls and the last fall, they thought that her hip was fx'd. It turned out not to be a complete fracture but a hairline fx. There is question now whether she will be able to go "home"(senior hsg), so we are looking into assisted living. I work in a long-term facility and it's hard for me to go and visit mom, watching her in her wheelchair just sitting there etc...........I hope and pray that she will be able to go into assisted living. Even where I work, which is supposed to be "a very reputable facility", I see patients that are treated badly. Just last week, I had to tell one of the cna's to "take a break" as she was very rough and mouthy to one of the patients. I am fairly new there(almost 4 months)and a new nurse, but I am not going to put up with co-workers who are uncaring etc...................I believe it when you say that your moms teeth weren't brushed in so long and so on. I have seen patients that were not getting mouthcare, pericare etc..........the thing is what are we supposed to do, check up on each patient? I find myself doing this and it really angers me. We don't even have a regular supervisor yet. ARGGGGGGGGG
Your post also struck a nerve, because we have one patient in particular that has broke her hip and had a replacement done. Anyways, she gets tired of waiting for an aide to come so she goes into the bathroom in her wheelchair, stands up herself to go. This is when her roommate rings to tell us that she is in the bathroom alone. It's not just this one time, it's daily.....her daughters are aware of this and can't understand why nobody comes when she rings for help.............management tells the family that she is not the only patient there and they cannot expect to have others drop everything for her etc..........very fustrating for the patient and family. I see so much bull and it's getting to the point where I don't know if I want to work in long-term anymore. No wonder they pay more than hospitals, nobody probably wants to work there. I wish that I had some answers for you, but I know what it's like when you are limited to facilities because of insurance or lack of it. All I can suggest is reporting the facility and has tiring as it gets, you must stay on top of them. I know that it's very time consuming and very aggravating but you must do this.
Hang in there,
Originally posted by pappyRN
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.
Sep 1, '02Occupation: worker bee Joined: Aug '01; Posts: 444; Likes: 26I am so sorry this happened to your mother. Please know not all of LTC is as callous. Prayers to you and yours.
Sep 2, '02Joined: Dec '01; Posts: 3,165; Likes: 59So sorry to hear of your mom's problems. (((((((hugs))))))
Would it be possible to get a private-duty helper for her for a few hours a day? Like, after supper, this person would do personal care, put her to bed early, and visit a little?
(Oh, and take notes on the actual care provided by the facility....)
Sep 16, '02Occupation: Pediatric Home Health Joined: Jul '01; Posts: 17Hey PappyRN
I have a friend that has a loved one in a SNF in Aurora, Missouri. She is having a terrible time with the facilty. A med tech gave this pt 5 times the normal dose of Haldol for a geriatric patient with an additional dose of Ativan at the same time. The pt refused the med. But the med tech gave it to her anyway saying that it was her "water" pill (Lasix)
The family is contacting state agencies to report this and other problems.
Hope your mother is doing better,,,and I hope your health is improving.
Sep 27, '02Occupation: rn in dialysis,hemo and cald Joined: Sep '01; Posts: 62You might also include your minister in thisd group.He/she might be able to help you maintain your "cool"
Oct 1, '02Occupation: Nurse Joined: Aug '02; Posts: 86; Likes: 2PappyRN,
I CAN'T BELIEVE THIS !!!! I AM FLOORED!!! IF I WERE THERE I WOULD BE SPITTING FIRE FROM MY MOUTH !!!
There are very clearly SEVERAL issues here. Of course the first one that sticks out with neon lights is NEGLECT AND PHYSICAL ABUSE.
We all know what that is. However did you know that medicaid PAYS the LTC facility for a 7 day bedhold whenever the patient goes out to the acute facility ?????? Medicare doesn't but Medicaid/Medical DOES. WHY DID THEY CHARGE YOU? Get you money back.
I am sorry but when I was done with this facility I would probly own it !
Forget the other owner. He may have found out he was indirectly involved with this LTC facility.
CALL the Ombudsman. This is their specialty !!!!!
Everyone there IS a MANDATORY abuse reporter. Don't take pitty on them for the place they have put themselves in. In California if an Administrator has failed to report abuse or has prevented anyone from reporting abuse it is a CRIME punishable by 6 months in jail and $500.00.
The bitc_y RN who is no longer working there is not off the hook. She is also a mandatory reporter. The CNA, everyone who has been involved with her care and has not reported it.
You have to find the strength from somewher and make these people answer for what they have put your mother thru.
When abuse results in great bodily injury the fines and jail time go up.
In my facility if the patient needs eyeglasses, hearing aids, splints, dental work, whatever we eat it as we only get a set fee for their admission. THEY MUST PURCHASE THE HEARING AMPLIFYER.
Stop approaching this facility to correct these active deficiencies. DOCUMENT, DOCUMENT, DOCUMENT, DOCUMENT, everything, everyname, every detail. Don't worry about the statue of limitation you have time. Get the Ombusdman involved. They are not there for the facility. They are in a way an extention of a survey team. I would also take pictures of your mom with these bitc_es in the background. This way you can identify them easily to others if needed.
You mother deserves the be turned, to have her teeth brushed, the have thick it proportioned correctly. Hey, thick it.... has anyone read the label lately ??? Our supplier has the consistency proportions RIGHT ON THE CAN ....... I guess that was for stupid people so they don't have to guess. A fracture .. physical abuse. Did they even call you to inform you or did they let you find out when you came in ...... F tag 157 "notification of change of condition" Did they notify the doctor, family and resident of each and EVERY change of condition.
To leave her alone is an act of neglect. To shut the door even know she is toileting can be isolation since she is unable to move on her own. Not providing basic care ... neglect. Not giving her the appropriate pain releif ..... neglect! Even if they are medicating to the max of what was ordered they have the responsibility to call the doctor and get the appropriate pain relief meds. Pain the 5th vital sign!!!!!!! Regarding her lost ROM - In her quarterly MDS they should be measuring the joints each and everyone of them. How can they state if there has been a decline or improvement of ROM???? New pressure areas = neglect !!! Not following a physicians order for the amplifyer is a delay in treatment which is neglect.
I would get the ombudsman there pronto. They are patient advocates!!!!!! not facility advocates !
Call the numbers given to you here by the other people who posted messages. They are right on target. Call the newspapers, radio stations, tv news programs, ombudsman, state licensing, medicare, medicaid - (double billing for a bedhold to you and medicaid is also fudiciary abuse and fraud), JCAHO, Adult protective services, and anyone else who can help you.
That place will shatter to the ground when they get these people in to survey them at the same time.
In California I can look up the facilities and see how many deficiencies that had on their surveys. Do this --- you can see what their bad habits are.
If you have health problems now you may end up in this place one day. If your family has responsibilities that prevent them from being able to care for you it could happen. You have more than one reason for doing this.
Please sound the alarms !!!! In order to recieve Medicare each facility must adhere to responsibilities in the Medicare contract. The same applies to Medicaid. This is what gives the surveyors the right to come in and survey us.
They should feel like your mom is contributing to their paycheck and retirement. They are lucky that I am not there.
I am usually a very calm, cool headed person. NOTHING FIRES ME UP LIKE ABUSE DOES. This summer in California we were sent an inservice from the department of justice, office of attorney general. The topic was "Your legal Duty - Reporting Elder and Dependent Adult Abuse". Some of the examples of abuse given are actually things you stated happened to your mom. Even not providing your mom with the correct consistency of fluids is abuse. I know what I am talking about. Since June I have given approx 20 inservices on this. The class is one and a half hours long. It was very simple and straight forward. Abuse is illegal and will be prosecuted. I would also call your district attorney. Print out your posting to use as part of documentation. You have it all there.
I am so upset that I can't think straight, And it is late here. Please keep up informed as I am sure we are all astonished by this. This gives us all a bad name to think there are nurses out there who are capable of this.
good luck and check back anytime you need more moral support we are here for you and your family.
Oct 1, '02Occupation: Home Health Patient Education Resource Nurse Specialty: 10 year(s) of experience in Hemodialysis, Home Health ; From: US ; Joined: Aug '02; Posts: 21,359; Likes: 7,204Pappy..
As the others have already stated, reading your posts was heartbreaking. It is truly a nightmare. I see it so many places and it has always infuriated me beyond words. It simply makes my blood boil. I just don't understand how these people can live with themselves, much less sleep at night. Do they not know that they, too, may someday end up in the same place? Would they want to receive the same LACK of care, respect, concern and tx.?
I'd better leave it alone...I could ramble on about this for weeks.. has always been my pet peeve. Such injustices are beyond my ability to comprehend.....totally inhumane. I just don't understand.
((( ))) to you, your sis, your mom.
Oct 4, '02Occupation: RN and blogger extraordinaire Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych ; From: OR, US ; Joined: Sep '02; Posts: 26,953; Likes: 44,682Pappy: I'm a resident care manager in an Oregon LTC facility who would be THRILLED to have your mother in my unit!! Since that's theoretically impossible, however, I would advise you to contact a geriatric care manager in your area to help you find an alternate placement. You MUST get your mom out of that snake-pit of a nursing home, and the company that owns it must be forced to fix it or shut it down.
These are some of the most egregious violations I've ever heard of in this day & age, and if you'd had decent legal representation you could've probably OWNED that place by now. Just because your family isn't filthy rich, does not mean that you have to "let them win". Please, don't give up!! You can get help from your state Legal Aid, the Ombudsman's Office, and if they aren't helpful, you can write to your state Governor and legislators. Your mother's right to live out her final season of life with dignity and loving care MUST be respected---all state and federal regulations are designed with that in mind. Use them!!Last edit by VivaLasViejas on Oct 4, '02