Yikes! Another bad observation at an LTC facility

[eddy]

YIKES!!!!! That's about the only word I can express about this one.

Got off a weekend night shift (through my agency) at a nursing home I have never been to previously. I prefer to stick to hospital work when I can just because of what I am about to say.

Came on to the shift at 2200. As seems the usual, I had to sit and wait for report until 2245, already putting me behind for the night. I had to scramble to get caught up, but that's nothing new. Since we were running short 2 CNA's I was also putting in double duty answering lights and doing other aide work. No biggie as I always do this anyway, just usually as a helping hand not out of complete need. Still no suprise (been there done that). However, about 0200 I floated over to the other unit to cover a nurse who went home due to "female problems". She told me that she was having a "heavy flow", and so I left it at that. Now, I am covering my original unit as well as this lady's as well. No biggie, except I knew everything wasn't going to get done. A call light came up on this new unit as I was passing by, and I didn't see a CNA on the entire unit, so I went to help out. I got to the residents room and asked what I could help with. The gentleman promptly said, "my back is itch'in". I told him I get that all the time myself with a smile, and I asked him if it was okay to help him sit up. He pleasantly agreed that it would be fine. He also said "you sure are nice compared to most of the folks here." When he sat up I discovered the most terrible DC I've seen in a long long long time. It was so deep a 3 1/2 inch swab could be inserted all the way in and barely touch tissue. But that's not really the issue. It was full, and I mean FULL of the biggest maggots I have ever seen. When he sat up, they fell out all over his bed. I was shocked (not in a "gross! look at that!" way, but a "how the h*ll could this go unnoticed!?!" way). I cleaned the wound and got all the maggots (I think). Then, took another look inside. What I believe I saw was the back of his right lung. I quickly took a look at his chart (which took me about 30 minutes to even find as it was tucked away at the unit nursing station under an old notebook, NOT where it is supposed to be). This man was on a rotation to prevent bed sores!!!!! I called the DON, who said she would "call it in" with a yawn of disconcern. I also asked if she was aware that the LPN from the other unit left. She said that she was aware, and I would have to cover. I told her I would do my best, but we were pretty short all around. I asked her if she considered calling the agency for a nurse. She said NO WAY! We're not paying for a full eight hour shift if the person is only going to be there for 5 or so hours! Inside, all I could think was how rediculous she just sounded not caring an ounce for her residents care and well-being. I then charted what I discovered and the Doc arrived shortly after, VERY angry. He said (QUOTE), "They oughta shut this d*mn place down. Too cheap to pay for staff, and too cheap to use a d*mn agency." I replied with "I'm actually agency through ********." He then said, "That suprises the h*ll out of me! I have been on them for months now to get some help in here. In fact, I told them I would quit as the primary here if they didn't. Looks like they are trying to do just enough to get by. humph! Typical!"

Shortly after this conversation and about a 30 second exam of the resident, the Doc called for a transport. He said, "don't worry about messing with this. I'll take care of it. You have 40 other people to worry about. That's when I realized I actually DID have 40 other people to worry about!

I knew only the MOST BASIC requirements were going to be taken care of for these poor people tonight, but I hunkered down and started to try to accomplish the impossible. Meds got passed, the Doc stayed and did a couple foley's then did dressings on about a dozen residents!!!! Wow, what a cool guy!!! But of course, just about nothing else was done. I also discovered two other residents that were on scheduled turns were NOT being turned. Jeeeez!!!! And where in the world are the aides?!? I had only seen one aide (on my original unit) since I had been there (the aide issue is another story in itself).

Needless to say, when the DON came in an hour late (grrrrr!) I gave a report from h*ll to her. I told her that she needed to get some more CNA's in here and a nurse that cares more about patient care than a mild discomfort. She said something like, let's not talk about THAT and talk about all the things that you left undone. I was about to explode!!! I told her that unless I would have been able to split into 6 people last night, there was NO WAY that these people were going to be cared for properly. I also expressed to her the lack of attentive care the residents were getting. They were lucky to get a water refill in a 12 hour span, some clearly hadn't been bathed for weeks, and on and on and on. She rebuttled with something to the effect of, we aren't made of money and walked off! Seriously, she walked off!!!

I have never done this before, but for the first time ever I reported a facility to the state. God help those poor folks at that h*ll whole.

I know that agency won't cure the shortage of qualified nurses and nurse aides in this country, but in my opinion, if you need help and people are suffering as a result of such short staffing, it's time to call them in and in droves!

Sorry for the book... I had to get this off my chest.

[renerian, BSN, RN]

I had posted earlier YIKES to your post but here is another LTC/SNF nightmare that happened to me today. I report today for my first day on the floor at 6:45am. I show up at 6:30a and my new security chip they gave me to get into the building does not work. I use the security phone to call the security to let me in and of course no one comes or picks up. NO one comes to be banging on the door. I keep calling finally after 20 minutes someone comes and lets me in and I am of course late for my first day. I clock in and get up there and the night super in the middle of change of shift starts berating me in front of about 10 residents and all the staff-she is literally yelling at me. I ask her can she please stop yelling and can we go in the office or chart room. Wow that pissed her off big time, she told me to leave and she would have the DON call me if I still had a job. She took me off the schedule. IN shock and totally embarrased, I leave. The DON just emailed me they are relieving me of my job. Apparantly the secruity man checked the records and my number never showed up. I again told them it kept blinking red. They don't believe I was outside for that long......so they are releasing me from their job.

Go figure. Pretty upset ........

renerian

[Vsummer1]

Consider yourself LUCKY then. You don't want to work with a bunch of people like that and it is best to find out NOW rather than later!

[renerian, BSN, RN]

Thanks summer! I do consider myself lucky. Looking for a job is such a pain though.

renerian

[BadBird, BSN, RN]

I would also consider notifying the family and telling them that I would testify in court for them, that should shut the administrators up. Good luck

[Youda]

BadBird, bad idea. Although I sympathize completely with the sentiment, this is a violation of patient confidentiality which can get you in trouble with your BON. Only the patient has the authority to approve the release of any medical information, even to his/her own family. Also, the BON frowns on a nurse who contacts a family about things like this when he/she is not "on the clock" and the patient-nurse relationship no longer exists. Check with your BON. This is really uneithical and shouldn't be done, no matter how tempting it is! :)

[Catsrule16, RN]

Eddy,

Ever think of sending your night from heck to the Medicare Fraud Unit? It's a shame facilities like that get our hard earned dollars when they don't provide the care.

[eddy]

BadBird --- While I have mixed feelings on this particular family (assuming there is such) finding out, I wouldn't ever be the one to tell them. Depending on their situation sometimes discovering things like this is worse than being ignorant to them. It's not my place, nor my right. I have chosen to go through this process in the most ethical and legal way possible. I would never get a job in this state again if I did such a thing. Plus, others in nursing would always wonder if I would cross that line again, and next time it might be them I'm reporting... not my idea of an enjoyable career to look forward to. Not to mention I would likely lose my license for telling them, and yet it really wouldn't do anyone any good. I did my part, which is to notify people who ARE in a position to break the news (should they elect to). In addition this information is available upon request by the family. They just have to ask. Hopefully they do. Facilities are required by law to turn over such information. However, they are not required to let you know they have it.

Catsrule16 --- Actually they (Medicare) are already involved.

[BrianWhitfield]

We found out about my mother's death due to abuse and neglect through the local TV stations. A nurse at the facility turned in an "anonymous" tip to the state health department. The state health department came in for a surprise investigation and called in the state attorney general's office for a criminal investigation. The local TV stations found out that the state health department was doing an investigation and contacted me. Until then, the story the nursing home administrator and ombudsmen gave me was that she "died in her sleep". They still don't know for sure who the nurse was who reported the event.

[RNConnieF]

As I posted in a previous thread, you should see what $7000.00 a month plus medications can buy; a private suite with bedroom, bathroom, sitting area, and a kitchenette with fridge and microwave, daily housekeeping, 24/7 CNA assistance with ADL's, and 24/7 professional nursing care including medication administration. Should lack of funds subject our parents to the environment reported here? The acceptable minimum standard of care for our seniors is disgraceful. We should be ashamed at the way we care for our elderly.

[cargal]

RNConnieF stated:

"The acceptable minimum standard of care for our seniors is disgraceful. We should be ashamed at the way we care for our elderly."

I agree totally. When did DON's stop being nurses and become suits? When they can't see past potential definciencies and census while staring at one of their resident's sitting in the cold hall without their sweater, glasses and yelling with NO ONE validating them- toget the paperwork done- it is disgraceful.

Blessings,

[Youda]

This is totally gross. But, as usual, my curiosity gets the better of me. I started to wonder just how long that poor man had gone without care. This is what I learned:

Infestation by maggots is called myiasis. Myiasis generally occurs in conditions of filth. The majority of infestations are caused by flies laying eggs in a decomposing or decaying flesh. One species of fly will lay eggs in "organic" material without decomposition of the tissue. Flies begin to lay their eggs in/on around 10-minutes after death and the life cycle of flies is often used in forensic medicine to help determine time of death.

The life cycle of the fly takes around 6-20 days depending on the species. So to answer my question, how long did this man go without care? Consider that he first had to lay long enough for an open decub to form, the decub to become infected with enough exudate to attrack a fly, and then another 1-2 days for the eggs to hatch into maggots.

I figure he layed there without any care, bathing, or help for around 3-7 days.

[renerian, BSN, RN]

shivers........

renerian