Venting...Hosp pts coming from skilled nursing facilities

[stidget99]

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.

[studious]

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

Unbelievable!!!!!!!!!!!! I can't believe they have all these do's and don't do's, a nurse can be written up for the slightest thing, but when it comes to documenting evidence of obvious abuse by a facility, they don't want to know. JEEEEEZ!!!! Looks like they are out to protect each other, and forgetting the patient, or their rights. Keep your chin up Stidget.

[LPN/TXnurse]

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

Just wanted to let you know I wasn't offended at all. and here's my I think you have to have consent from POA for any kind of pictures and for pictures of wounds you're facility would have to a protocol in place for taking pictures and tracking etc....but in the case of abuse and neglect if the authorities were involved..police, adult protective services, elderly protective services, state or something that pictures could and should be taken for evidence. that's worth looking into and contacting some authorities and asking those kinds of questions just to know for future cases ( :angryfire god forbid any more of our elderly and disabled are like this :angryfire). it is sickening to know there are people out there who take care of people and let them get like this.

[dbscandy]

Why didn't the MD report this as soon as the pt was admitted? Didn't he have that legal obligation? I know if this had been a child, it would have been done. Why not for the poor elderly lady?

Also, another point of this is that the family (from hours away) was horrified to find their relative in this condition. A word to families: mom, grandma, grandpa will get much better care if you're visible. Sorry, but for some, I said SOME, facilities, this is true.

Hopefully, stidgett, good will come of this lady's suffering, thanks to your willingness to speak up.

[CoffeeRTC, BSN, RN]

Yeah....why didn't the doc report this? If it was a kid with bruises, they would be all over this.

[mwaldon]

I also believe that it should have been reported immediately. If a patients condition even for a second makes you think abuse, it should be reported and followed up. In my state elder abuse is reportable as is child abuse. I think it is our duty as health care professionals to report any.. neglect and abuse PERIOD!! No cover ups, no placing blame on others..

[tiskathleenherself]

I have reviewed the initial post and all of your responses and understand how you can believe that this type of thing is an atrocity. It is and you are right.

I have done years of research regarding the situation. There are many reasons that the atrocities that you mention occur. None are acceptable.

The large chains have been notorius for looking pretty, marketing the heck out of the community and making false promises to residents and their families. And they are being sued like crazy. The facilities blame the lawsuits on lack of tort reform, too many plaintiff's attorneys and lack of federal and state funding to allow them to provide good care. (Yet one of the most successful plaintiff's strategies is a "profit over care theme, when suing large chains.) The plaintiff's bar's motto is "regulation through litigation." They believe that if they sue these facilities enough, someone's going to wake up and figure out that they better provide good care or else!

As you probably are aware, many of the large chains are filing for bankrupcty and are downsizing. One former large chain couldn't sell their facilities and actually paid another chain $13 million to take them off their hands!

Staffing is horrendous. It's worse in assisted living. Some states don't even mandate a minimum staffing level. Skill set of care staff is marginal, at best.

As a nurse, you are obligated to report blatant abuse and neglect. Call the Ombudsman or the state agency. They will investigate. The state surveys all facilities, but frequently, things are 'cleaned' up in anticipation of their visit, including increased staff and making things look nicer than usual. Having the state come in unannounced on a compliant investigation allows them the opportunity to see what's really going on.

Lack of risk management (It's not required, so it isn't done.) and true quality assurance are a big part of the problem. Facilities are required to have a quality assurance program, but the only true requirement as far as what this means is that they must have a QA committee meeting on a quarterly basis. There's no guidance as to what should occur during a meeting or how to make it work. My crusade is to educate and teach risk management practices in an attempt to improve quality of care.

[stidget99]

My crusade is to educate and teach risk management practices in an attempt to improve quality of care.

What a great crusade! If only more would join in, stand up and be heard! And if they are not heard the first time........stand up and scream until you are heard!!!

[tiskathleenherself]

What a great crusade! If only more would join in, stand up and be heard! And if they are not heard the first time........stand up and scream until you are heard!!!

Thanks for the support. I travel the country, doing my sales pitch to facilities and healthcare associations. It is astounding how hostile a lot of these providers are to the concept of risk management. There is a great deal of denial that they are doing things wrong. Usually I can't get their attention until they've felt the pain of a monetary loss from a lawsuit, which is a shame. I spoke before one state's healthcare association and it was actually said to me, "We don't need risk management. Nobody sues anybody here in this state." (!) A statement like that says a lot. (Unless it hurts "me", I don't need to make a change to improve the quality of care.) It's been a very frustrating uphill climb, but we are not going to give up. I've had a great deal of positive response from organizations and facilities in Florida, which has been extremely encouraging. However, it took a LOT of financial pain in the Florida long term care environment with litigation, before anyone would pay attention. Hopefully, other states will follow suit.

[lisamilgrim]

I worked in a nursing home here in Arkansas and we have state inspections yearly and anytime something is reported as being wrong. Someone should definatly report this to someone so something can be done. This could be our family someday and I wouldnt want anyone treating my family this way.

[stidget99]

I worked in a nursing home here in Arkansas and we have state inspections yearly and anytime something is reported as being wrong. Someone should definatly report this to someone so something can be done. This could be our family someday and I wouldnt want anyone treating my family this way.

As per my previous post....I did report it to the ombudsman and they in turn reported it to the state. But not that nite (i.e. I did not call the police). I am ashamed to admit this but I was afraid of retaliation. Shame on me! I have kicked myself over and over on this and will be sure to be one of those things that will haunt me forever. I still haven't heard anything at all about this whole issue. I sure do hope that the family took pics and sues the crap out of them!!!

[mwaldon]

As per my previous post....I did report it to the ombudsman and they in turn reported it to the state. But not that nite (i.e. I did not call the police). I am ashamed to admit this but I was afraid of retaliation. Shame on me! I have kicked myself over and over on this and will be sure to be one of those things that will haunt me forever. I still haven't heard anything at all about this whole issue. I sure do hope that the family took pics and sues the crap out of them!!![/QUO

Do not kick yourself for what could have been done. Life is about learning, take that experience and turn it into a learning experience. You will no how to handle things like this in the future. We are all human and make mistakes. But truly the only mistake you can make, is one you don't learn from. Keep taking care of the people with love and care and you will make a difference.

[lost_as_an_easteregg]

I agree. this is elder abuse.

I'm a cna and I work in a nursing home. Someone asked the question if maybe this happens to this woman because she was black. Honestly, where I work, it's the ones who don't have family or friends visiting regularly, are the ones who are least taken care of. It's sad but true. We owe it all to the cna's and nurses who don't really enjoy their jobs and are not really there to help people. There are only a couple of bad seeds in our facility, and the rest of us have to take up their slack, which is so unfair. But they switch us from hall to hall and when I work on a hall the week after those two, you can tell there are certain ones that aren't taken care of, and it's the ones who have no family. I suppose they think if a daughter or neice doesn't come to check on them and complain, they're ok. We've never had anyone in as bad shape as this poor little lady, but I honestly believe if they didn't rotate the workers on the halls we would have several. It's bad that you have to take care of problems that should never exist anyway, I commend you for caring enough to call the ombudsman. I have seen nurses blow it off and walk away.