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.
I see this all the time in hospice. We have a small facility for those patients who cannot be cared for in the home. When we admit them we automatically get out the supplies for wound care and fecal impaction. Nearly every patient we take in requires this attention. These patients are coming in from both home and LTC. Some of the worst offenders have been the Board and Care residential facilities. A lot of these patients do not even qualify for Board and Care (able to independently take meds, B&B, ambulate, etc). Nearly all of them have S4 decubiti with extensive undermining and about 200 lbs of impacted stool (exaggeration, but you get the point). The staff in most these B&Cs are unlicensed, uncertified and incompetent. I really don't understand why they are permitted to exist.
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).
I love reading your post, but just wanted to ask...It sounds like you have alot of residents that need skilled care? The assisted care facilities in our areas are soo poorly staffed, a skin care program is far from thier thinking..
You have got to run your but off every shift with what you have to do.
Specializes in Education, Acute, Med/Surg, Tele, etc.
Oh yes, the most of the residents in our area of the assisted living, which we call dependant care are seriously in need of more skilled nursing care. And there only being one nurse per shift really pushes things to the limits! The CNA's do all direct care and med passes for their service areas, approx 12-13 folks per area! It is a race to do it all, but we have a great set of CNA's and floats that really know the seriousness of hygeine and skin care (including deligent oral care too!). I work with some of the BEST CNA's and very proud and honored to say that!!!!! They are so selfless and knowledgeable! Makes a huge difference even with bare bone minimum staffing! (we all know the value of teamwork!).
But I would really watch these assisted living situations, many are being put in there and are rarely let go, even if their conditions aren't appropriate for our facility. Once family sees how lovely these places are, they tend not to want their loved ones to go to more skilled facilities because of the media scares/horror stories they have heard about 'homes'. And it isn't like my company encourages other placement ($).
But us in the trenches (as I say) do everything we can for those wonderful folks...they are like family on a huge scale! LOL!
Stidget- First of all, good for you for caring enough to be a patient advocate.
This made me want to cry. This is the reason I quit working as a CNA in LTC. The facility I started working at as a teenager was awesome. I hardly ever remember us being short staffed. We had a nursing agency we worked very closely with, and the staff that was called in was familiar with the facility and clients. That is the only place I would allow a family member to be placed. Later on, I worked at two specific LTC facilites, one of which is commonly know as "Killa Villa". I was subjected to racial abuse (I was the only white CNA- never thought I would be made fun of and be put thru that kind of treatment, esp when I didn't do anything to someone to begin with). I worked there 2 weeks, and that was it. Another one was going thru management changes, and the new admin staff was weeding out "problem" employees. We would start our 3-11 shift with 3 CNA's (about 40 total care pts, 10 assist-care pts), and by 4, one of the employees could have been sent home or fired. Mgt failed to tell us we were now short staffed, and we were left scrambling to take care of all the clients. I worked there about a month. We frequently did not get a dinner break, but then the DON told us we would be written up if we did not take a dinner break (b/c they could get in trouble with the state), so we would usually clock out and return to the floor so we could get people to bed and get them changed (the was 10pm at this point). I was sick with the care I could not give, and quit. I remember they got so mad at me because I was sick (bacterial infection...fever in August, wearing sweats and fleece, but wanted me to come into work).
When I worked for a transport company, I remember having several calls to SNF to take pts to ED. Went to one place, woman had not eaten in almost 2 weeks, severaly dehydrated. I called the city EMS b/c I could not get a BP (she was awake, but I was so concerned, not willing to take trip with ALS onboard). When I asked what she was going to be seen for, the RN (LPN?) waved her hand and said "Oh, you know, everything". I quickly came back with "If I walk into the ED and say she's here for everything, they're going to laugh at me. What is she going for?" Response? "Oh, she's not acting right. Hasn't eaten in about 2 weeks" :angryfire Ever have one of those urges to reach out and "touch" someone? How can you let someone go two weeks without eating and not tell anyone??? While doing clinicals in ED, and woman was brought in by another transport company. EMT's said RN told them she could not get a BP (Emt asked if she wanted him to get it! LOL). The RN in the ED actually called this nurse at the SNF and chewed her out... "SO you couldn't get a BP and you didn't call 911?" Response? "Well, this company got here faster" ED RN: "Who taught you CPR?" :stone Wal-mart?
Thanks to everyone for your support. I can't tell you all how much I needed it. I mean you all know, you can talk to family and friends about issues like this but they end up saying....you guessed it............"I couldn't do your job". My family thinks that I am on the verge of a mental breakdown because I have been so weepy about this. I guess ppl just don't understand unless they've lived the life of a health care provider. I really want to be able to take a break from all of this but I can't seem to get my mind off of that pitiful woman's face. The horror in her eyes when I told her that we were going to clean her up. And this coming from an essentially non-repsonsive person. I hope to be able to get some dreamless sleep over the next 20 hours or so. God help me if i have to care for this woman again. God help the doctor if he hasn't addressed her pain issues!!!!!!
No update yet. Haven't heard from the Div of Facility Services. However, I have talked to a few co-workers and we will be watching the local news closely as if this gets out, I am sure the general population will be outraged!
Thanks to everyone for your support. I can't tell you all how much I needed it. I mean you all know, you can talk to family and friends about issues like this but they end up saying....you guessed it............"I couldn't do your job". My family thinks that I am on the verge of a mental breakdown because I have been so weepy about this. I guess ppl just don't understand unless they've lived the life of a health care provider. I really want to be able to take a break from all of this but I can't seem to get my mind off of that pitiful woman's face. The horror in her eyes when I told her that we were going to clean her up. And this coming from an essentially non-repsonsive person. I hope to be able to get some dreamless sleep over the next 20 hours or so. God help me if i have to care for this woman again. God help the doctor if he hasn't addressed her pain issues!!!!!!
No update yet. Haven't heard from the Div of Facility Services. However, I have talked to a few co-workers and we will be watching the local news closely as if this gets out, I am sure the general population will be outraged!
Please remember that despite the fear this patient may have in her eyes, you are helping her! Hopefully she realizes she is in a different place and you and your co-workers actually CARE about her well-being. I can only pray she is finding some relief from her pain, and some comfort in finding out she is cared for. -Andrea
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.
I also believe there are many conditions that have to be taken into consideration.
I had a patient once, in a SNF, got a stage 4 decube on her heel.
We got her up in a chair everyday, and put that foot in this little whirlpool foot tub, with betadine and water, let that solution run around on her foot a couple times/day. {That foot tub was the neatest thing, I've never seen one like it anywhere else.}
We made do-nuts to put on her foot to keep the pressure off. We had her foot healed up in no time flat.
So if conditions are right, some decubes can be healed.
But what about when conditions are NOT right?
Another patient I took care of, had decubes on her backside. She had no appetite for months prior to getting the decubes, and would eat very little, and the family REFUSED a G-tube until just a few months there on the last, just before she died. And this lady was a full code. They finally got that changed and made her a DNR.
People who no longer can get up and take care of themselves, won't eat, are incontinent, they're going to start breaking down no matter what you do.
You can put in foleys, and G-tubes all day long, but when the body is tired and worn out, keeping it alive is just prolonging the agony and the inevitable.
You are what all nurses need to be..your pts are blessed to have you looking out for them...God luv ya!
I second that! I applaud you and healthcare workers who take a stand for those who cannot no matter what the cost. :icon_hug: I would have called the police firsthand. I would involve the state congressman too. That patient deserved much better care. She's not an animal, but a human being.
I also believe there are many conditions that have to be taken into consideration.
I had a patient once, in a SNF, got a stage 4 decube on her heel.
We got her up in a chair everyday, and put that foot in this little whirlpool foot tub, with betadine and water, let that solution run around on her foot a couple times/day. {That foot tub was the neatest thing, I've never seen one like it anywhere else.}
We made do-nuts to put on her foot to keep the pressure off. We had her foot healed up in no time flat.
So if conditions are right, some decubes can be healed.
But what about when conditions are NOT right?
Another patient I took care of, had decubes on her backside. She had no appetite for months prior to getting the decubes, and would eat very little, and the family REFUSED a G-tube until just a few months there on the last, just before she died. And this lady was a full code. They finally got that changed and made her a DNR.
People who no longer can get up and take care of themselves, won't eat, are incontinent, they're going to start breaking down no matter what you do.
You can put in foleys, and G-tubes all day long, but when the body is tired and worn out, keeping it alive is just prolonging the agony and the inevitable.
For the most part, I disagree w/ you on this one. I agree w/ the OP's who state that some ppl come to their SNF w/ their skin in terrible shape. Now that is to be more expected because the general population is not educated. But we are educated! I worked in a state institution for the developmentally disabled. The non-ambulatory residents were tube feeders for the most part. They couldn't "get up or take care of themselves". They were also incontinent. They were not able to move at all. In the 8 almost 9 years that I worked there, I NEVER EVER saw a single decub! These residents were moved every two hours...without fail. They never ever had ANY skin problems. Now I understand that the elderly are different...their skin has lost a lot. However, the residents who lived at the state institution had other issues which made them very susceptible to skin breakdown...i.e. contractures, meds, etc. Again, no decubs...ever!
In a long term SNF, one MIGHT understand the development of one decub. Things happen. However, once a skin problem is identified, there is no excuse, IMO, for it to get beyond a stage II. Let alone for one person to get multiple stage III and IV decubs! In my thinking, that is TOTALLY UNACCEPTABLE. To me, this is the result of one or two things. Either the staff supposedly caring for these residents just don't give a rat's behind or the staffing is horrific. In either case, heads should roll!
Think about yourself in the future. Would you feel differently if it was you? Would you be accepting of a stage IV if it was your mom or one of your grandparents???? What if your child was involved in an accident that made him/her totally dependent and s/he got that way??? Would you still be so non-chalant.
Another of the issues that led me to believe that this was just sheer neglect is the fact that the foley was very old and that there was a maggot in there! And, let's not forget the 4 pounds of crap that I dug out of this woman. Again, I am going to go back to the state institution. We NEVER had an issue with constipation like that! Staff were excellent at documenting stools. If a resident didn't have a respectable BM at least qod, they were given suppositories or enemas. IMO, there is no reason for a person to be soooo incredibly FOS!
Ever have one of those urges to reach out and "touch" someone? How can you let someone go two weeks without eating and not tell anyone??? While doing clinicals in ED, and woman was brought in by another transport company. EMT's said RN told them she could not get a BP (Emt asked if she wanted him to get it! LOL). The RN in the ED actually called this nurse at the SNF and chewed her out... "SO you couldn't get a BP and you didn't call 911?" Response? "Well, this company got here faster" ED RN: "Who taught you CPR?" :stone Wal-mart? 
:icon_hug: I would have called the police firsthand. I would involve the state congressman too. That patient deserved much better care. She's not an animal, but a human being.
HisAlone
27 Posts
I see this all the time in hospice. We have a small facility for those patients who cannot be cared for in the home. When we admit them we automatically get out the supplies for wound care and fecal impaction. Nearly every patient we take in requires this attention. These patients are coming in from both home and LTC. Some of the worst offenders have been the Board and Care residential facilities. A lot of these patients do not even qualify for Board and Care (able to independently take meds, B&B, ambulate, etc). Nearly all of them have S4 decubiti with extensive undermining and about 200 lbs of impacted stool (exaggeration, but you get the point). The staff in most these B&Cs are unlicensed, uncertified and incompetent. I really don't understand why they are permitted to exist.