Venting...Hosp pts coming from skilled nursing facilities

Town & Country · Apr 20, 2005

That link about worldwidewounds doesn't work..........

been there · Apr 20, 2005

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.

As a prior DON in skilled nursing facilities I agree this is criminal abuse. The DON is responsible for the condition of every resident and the actions, or inactions, of each nursing staff, and, each staff member is responsible for his or her actions/inactions. Please report this to the ombudsman. Also, it would be good to invest in a polaroid camera, take photos of each wound on admit and have witnesses sign and date each picture. Let the ombudsman see these , and she or he can report this to the nursing boards if necessary. I would make copies on a copy machine to keep and date/sign the copy. Also, why hasn't the survey noticed this??????? I realize that staffing is an issue ie: one CNA for 25 bedbounds is not unusual but skin condition IS A BIG ISSUE WITH LICENSING AGENCIES FOR NURSING HOMES. I don't think race is an issue because State funding and lack of family attention play a major role. Now...I have taken polaroids of residents who were wound-free when they were sent to the hospital and returned to us within the 10 day window with decubes. It became a habit to photograph butts and shoulders before transfer with the family present because one hospital was notorious for lack of minimal skin care. Your case is horrid and inexcusable and is definitely abuse. Your state Elderly Services department is another avenue you may want to take. They deal with abuse. God Bless You for getting angry.

nurseygrrl, LPN · Apr 20, 2005

That is an awful story. I work for a skilled nursing facility and am VERY proud of the care our patients recieve. Our staff goes above and beyond the call of duty when it comes to our residents. Being that we see them everyday, they are like our second family. I cannot imagine staff treating their daily charges like that! What a horror! We take the best care of our residents that we can, short staffed or not, we all pitch in and get the job done.

I have half HIV residents and the other half psych. Most of my HIV guys are from the streets and come to us in sad, sad shape. They are so appreciative of anything we do for them because they aren't used to the TLC. Some of them are so sick that they have had G-Tubes placed, can't talk, can't walk...we get them up and running again for a much better quality of life.

Our psych guys have been coming to us from old psych facilities that have been closing down left and right. Most of them have been in and out of these institutions all of their lives...and most have been treated HORRIBLY...It feels good to be able to show them that we care.

My point is...How can people treat opther people so badly?!?!?! Don't they have a conscience?

SmilingBluEyes · Apr 20, 2005

My point is...How can people treat opther people so badly?!?!?! Don't they have a conscience?

obviously not.

LPN/TXnurse · Apr 21, 2005

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.

Hi I am usually just viewing posts without responding but after reading something as appalling as this I felt compelled to post. First off I don't understand with as many skin issues as these people you quote have that the facility hasn't been slammed by the state. I am a treatment nurse for a 200+ bed facility (LTC) and don't have any skin issues like described here. My facility is poorly staffed but we still do our best. I have a total of three major decubes....a stage 3 (present on admission from a hospital), a stage 4 on a hospice patient (present on admission also from a hospital), and another stage 3 (present on admission). I have other decubes in the facility that I acquired with the position. I've only been in my position since the middle of February and am trying diligently to resolve these areas. But I just can't imagine how these skin issues have gotten that out of hand without someone reporting before now. I am by no means taking up for the facility that these people are coming from but from a LTC viewpoint the origin of some of those areas may have been present on admission BUT the facility had an obligation to not let those areas get worse. It is absolutely scary to think that one day I will be old and possibly have to depend on the pieces of ***Sh*t** that are out there in this world. I would not be able to sleep at night knowing that I let someone get in that condition. And not only one person but a whole facility of people have allowed this to continue by not calling the proper authorities. And if they are scared of getting in trouble for calling that's what an anomynous (sp) call is for.

Michelleroth1 · Apr 21, 2005

I wish it wouldnt happen but it does Im a CNA in Lancaster Pa working at a Facility we call "GHETTO MANOR" We get patients like that from other homes i am caring for a patient now with a stage 4 on the inner thighs RT and LT 16cm x 11 cm the femor is exposed. he has them on his hips and coccyx as well. he is quadroplegic from a fall he is alert and oriented. but he fights with the other nursing assistants whenever they try to give him care or position him My Facility is four floors I rotate all floors about 8pm everynight i get a page to report to his floor. He moans he dont wanted cleaned up and they should stop moving him around i give him a standard speech on "its to help you heal up and get your butt outta my facility" my friends will clean him and reposition him while i talk. He is one of many we get here I work some of the best nurses and assistants and some not so good. those of us who care and want to make a difference seem to out last those dont Thank God

The patients I receive dont just come from other SNF they come from hospitals to

We sent a young patient about 25 yr old car accident severe head trauma he has a trach and a foley he is mildly responsive some voluntary hand movement he began to show signs of pnemonia. he was in good shape out two weeks and back His grion area is completely exscoriated I cleaned him up got my nurse to get zinc oxide for me and put in a change of condition Its us the CNA or PCA who are responsible for letting this happen or preventing with proper care It takes so little time to prevent these i have seen so much in a year and after all this I am still starting nursing school this fall I must be crazy. well off my soapbox I vented a little thanks for listening

mwaldon · Apr 21, 2005

As a DON of a very productive SNF unit, I must add my two cents. We receive patients from area hospitals that are in the same type of shape. I have done much research into the wound issues and have taken part in our states quality init. We were part of a pilot program for wounds. Many of these wounds are unavoidable due to disease process. However, when we get a bad wound patient, we look into all areas that could have caused the problem, e.g. medications, diseases, nutritional issues etc. We try and reverse what we can, however, in the meantime if this same patient has to go back to a hospital, their staff ASSUMES we did this to them, when in fact we received them in this condition and sometimes this condition was unavoidable. Now I grant you there are times that neglect could play a part, and if you suspect that. REPORT IT TO YOUR STATE AGENCY! :) Thanks for listening.

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.

stidget99 · Apr 23, 2005

Update: I found out that the pt died of septicemia. No surprises there. And please, don't misunderstand me. I am not saying that all SNF/LTC are like this. Nor am I saying that all wound issues are caused in these places. I was just saying that this particular chain of LTCs is known for poor/neglectful care. I sincerely apologize to anyone that I inadvertently offended.

I have not heard from the ombudsman nor any other state agencies. The parking lot has been abuzz so I suspect something must've happened but I don't know for sure. I haven't seen anything in the news either. Thanks to everyone for their care and concern. You really helped me get through a very very difficult time. ((((Hugs to all)))

One other note/question....isn't it illegal to take pictures, esp those areas that most would be considered to be private in nature, without expressed written consent of the pt or guardian? And if we did pass these pictures on to the authorities, wouldn't we be violating the HIPPA laws???? Seems to me that a LTC facility would be able to get consent on admission for various activities (i.e. birthdays, advertising, etc) because of the projected length of stay but hosp would not be able to take pics for any reason. The only exception I can think of would be during a medical procedure (i.e. during a colonoscopy or UGI).

Compassionate_Nurse · Apr 23, 2005

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 have worked in a Florida nursing home in Dowling Park and if I had to be put in a nursing home this is where I would want to be. They treat their residents very well. I too have also seen the prominent members of the community weather it be social or econimic being treated better and have wittnessed administration asking us to do so. I refuse to treat anyone better than the other. They all get treated equally with dignity and respect.

studious · Apr 23, 2005

Update: I found out that the pt died of septicemia. No surprises there. And please, don't misunderstand me. I am not saying that all SNF/LTC are like this. Nor am I saying that all wound issues are caused in these places. I was just saying that this particular chain of LTCs is known for poor/neglectful care. I sincerely apologize to anyone that I inadvertently offended.
I have not heard from the ombudsman nor any other state agencies. The parking lot has been abuzz so I suspect something must've happened but I don't know for sure. I haven't seen anything in the news either. Thanks to everyone for their care and concern. You really helped me get through a very very difficult time. ((((Hugs to all)))
One other note/question....isn't it illegal to take pictures, esp those areas that most would be considered to be private in nature, without expressed written consent of the pt or guardian? And if we did pass these pictures on to the authorities, wouldn't we be violating the HIPPA laws???? Seems to me that a LTC facility would be able to get consent on admission for various activities (i.e. birthdays, advertising, etc) because of the projected length of stay but hosp would not be able to take pics for any reason. The only exception I can think of would be during a medical procedure (i.e. during a colonoscopy or UGI).

Hi Stidget,

I was so sorry to hear about your patient. Like you, I'm not surprised either, but I do know she will have received the best care in your facility, even if it were only for a week or so. I hope it was a peaceful end for her. As far as I know, it is not illegal to take photographs in hospital, as it is mandatory these days to photograph and document pressure ulcers for legal purposes, in case anyone decides to sue. This lady may have family that will want to do that. As these pressure sores were there when she arrived at your facility there will not be any come back on yourselves. We always photograph Ulcers if we get patients with them. So we are able to physically see them getting better, check and document treatment regimes etc: It's considered part and parcel of holistic care over here. Although I appreciate you may have different policies and practices over in the States. It's a difficult one. But considering the complete lack of care this lady received before coming to you, I feel justice needs to be served for her sake, and others who are still going through it. Take care Stidget, and know your doing the right thing budd!!!!!

Best wishes Tania

Michelleroth1 · Apr 24, 2005

stidget becareful hun about pictures it does violate Hippa laws of privacy you need pt or legal representive permission to take them most LTC's post it No Cameras Allowed on permises. We all know why and it has nothing to with patients rights. Hang in theyre hun youll make it through this. I lost 3 patients this week alone one HIV and two CHF i knew all three for over a year and the other CNA's waited till i got in so i could do the post mortem cleaning on the HIV Pt We go to school we graduate the state registers us But still they fear everything Im rotated to every unit with a problem and still i survive you will to i hope there are nurses like you to work with when i graduate school. Its your type of caring that gives me hope and drive to become a licenced nurse hugs Michelle

stidget99 · Apr 24, 2005

Thanks michelle and studious. I appreciate your thoughts/care/concern. I asked around today (?tonite). No pics allowed w/out consent.