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.

[fiestynurse]

Check out this previous post regarding LTC and Whistleblowing:

https://allnurses.com/forums/showthread.php?s=&threadid=20102&highlight=Whisleblower+Nurse

[cadeusus2004]

You got it. Write 'em up. You don't have options here. As the man said, "Hoist them up the flag pole and watch them slowly twist in the wind."

Hope you charted the living daylights out of the man's decub and your interventions. The facility can't touch the documentation 'cause its a federal felony to obliterate clinical documentation.

Please call your malpractice insurance company and notify them. That way they won't be sandbagged when the s--t hits the fan and the facility wants to blame you. the insurance company likes to keep the premiums and doesn't like to give any money out.

Cross this hell hole off your list and tell your friends to do the same.

[stevierae]

I read through every single post and I am speechless--all I can say is "Oh, my." Yes, I have seen maggots in wounds--when I was a Vietnam Era Corpsman, or when people scratched under their leg casts with a wire hanger and caused an open, festering wound--again, not since the Vietnam Era.

Eddy, you are a hero. Was the nursing home chain Beverly Enterprises? I am not afraid to put the name in print--they have been the subject of lawsuits since the '70s. I am glad you were there to advocate for that elderly gentleman with the

"itch" --there are far too many cases of wrongful deaths in nursing homes today. You were that man's guardian angel. If Medicare is involved, hopefully they will be fined and shut down. Keep us informed.

I live in Oregon, where we have the Assisted Suicide Law; actually meant for terminal patients who choose to take their own lives and end suffering. The opponents of this law should read about what these poor nursing home residents Eddy describes are experiencing on a daily basis, with so few to advocate for them--truly a fate worse than death...thank God Eddy spoke up....

[cadeusus2004]

This one will hit you.

In some places they actually make dressings with maggots inside the decubs. The maggots eat the dead tissue and seem to cleanse the wound. Lots of articles on it in the Index Medicus. Of course, these are special maggots for wound care only and come in little bottles. A semipermeable dressing is put on them. I encountered this working in Canada.

But, open wounds with maggots? Oh, man!

[eddy]

At the moment I am somewhat "gagged" in what I am allowed to say about this situation specifically. I WILL say that things are looking "very good", and I really do thank each and every one of you for the support and kind words.

The important thing for all of us to keep in mind here though is that I am no hero, I only did what I felt was "the right thing to do". I would hope that anyone in my shoes would have done the same.

As many people have said throughout this conversation, don't let this discourage you from considering a nursing home as your place of employment. Things will only improve for our elderly if more good nurses get into the field, and it can be an incredibly rewarding career. I firmly believe there is no better place to truly make a difference than in long term care. However, should you see things that you would not wish to have happen to you or a loved one it's time to pipe up and do something about it. Don't be a martyr and simply chug along and kill yourself in the process. In the end, you are only helping the greedy owners of these places, and you'll be of no good to anyone, including yourself, if you can't function due to burn out, fatigue or injury. Rather take action and follow through with it. Go through the proper channels and cover your butt, as revenge is just around the corner if you present any angle for it. But, for everyone's sake TAKE ACTION!

Again, thank you everyone. I will update you if and when I am allowed to do so. :)

[sallyrnrrt, ADN, RN]

Sorry you had such a horrible experience. I've been an Geriatric RN for nine years--just left it for Rehabilitation nursing, but NOT for experiences like that. Just needed a change. Let me say I'm sure places that like exist, but they are not the norm. Most people working in and managing long term care facilities are caring; a situation like you described would never happen where I worked or anywhere I am familiar with. There is no excuse for that--not lack of staff or time or money. Unfortunately, all the public hears about is stories like yours. They don't hear about the overwhelming majority of people and places that are working hard with not enough resources or staff, held to impossible standards by the Powers That Be. The elderly in this country deserve far more than they are receiving. It's a darn shame.

[sallyrnrrt, ADN, RN]

Sorry you had such a horrible experience. I've been an Geriatric RN for nine years--just left it for Rehabilitation nursing, but NOT for experiences like that. Just needed a change. Let me say I'm sure places that like exist, but they are not the norm. Most people working in and managing long term care facilities are caring; a situation like you described would never happen where I worked or anywhere I am familiar with. There is no excuse for that--not lack of staff or time or money. Unfortunately, all the public hears about is stories like yours. They don't hear about the overwhelming majority of people and places that are working hard with not enough resources or staff, held to impossible standards by the Powers That Be. The elderly in this country deserve far more than they are receiving. It's a darn shame.

[sallyrnrrt, ADN, RN]

Sorry you had such a horrible experience. I've been an Geriatric RN for nine years--just left it for Rehabilitation nursing, but NOT for experiences like that. Just needed a change. Let me say I'm sure places that like exist, but they are not the norm. Most people working in and managing long term care facilities are caring; a situation like you described would never happen where I worked or anywhere I am familiar with. There is no excuse for that--not lack of staff or time or money. Unfortunately, all the public hears about is stories like yours. They don't hear about the overwhelming majority of people and places that are working hard with not enough resources or staff, held to impossible standards by the Powers That Be. The elderly in this country deserve far more than they are receiving. It's a darn shame.

[BHolliRNMS]

Sounds like you had a horrible experience in long term care. However, you should not assume all long term care facilities are horrible places. I have had bad care in hospitals, ers, etc. I am the DON at a 120 bed skilled facility. Our in-house acquired decubitus rate is 0.8%. We have 14 medicare (skilled patients), 4 hospice in our mix. Our restraint usage rate is 2.67 %. We have one resident with a foley catheter. We have 4 residents who are bed bound at their own request. Our facility does not have any inappropriate odors. Yes, we have staffing nightmares like everyone else. I am subject to go to work at any hour day or nite seven days a week. It takes a lot of time away from my family. I am never "off work" I always have a phone and a pager with me...even in church. I have had one day away from the facility in the past ten. I was awakened at 3am tues nite due to the death of a hospice resident. I have taken care of one resident with maggots in a wound....when his family brought him for admit, we found the maggots. He was filthy and had been living in a car. I love caring for my elderly residents. I love each of them like family and know their family members by name. Some are very difficult to love.. as are many of us. Much to my dismay, much of my time is taken from resident care and given to laywers. We have a lot of lawsuits thanks to commercials in our area and people who assume that all nursing home staff are criminals. Nursing homes are easy targets these days. I will give you some examples: family received $500.000 more or less when their dad fell and broke his neck....the fracture in his neck was not severe...he was transported to the local ER immediately after falling, where he was seen by MD and xrayed. He was returned to the facility diagnosed with no injuries. THe family did not hold the ER doc or the radiologist or the hospital responsible for anything. Case 2: transported 84 y/o female to ER with n/v at 8pm. Family did not answer phone when we tried to contact them. Resident fell in the hospital at 0600 and broke her hip. Son sueing nursing home....not hospital...he says we were negligent and didn't tell the hospital what to do to prevent this accident. Case 3: Resident went home on Friday. Returned to facility Sunday afternoon. When nursing staff went to the car to assist her out, she was dead. Family sueing nursing home for "not coming to the car quick enough to save her." etc. Nursing homes are a refuge for many elderly persons who cannot live alone. Ours is a clean and happy place where people love each other. Don't give up on caring for the elderly. As Donny Osmond sang, "one bad apple don't spoil the whole bunch."

The owners of my facilty came two months ago and gave every employee 50cents to $1.00 /hr raise "for doing a good job." I have lots of new equipment from low beds, to air beds and wc's and gcs and whirlpools, lifts, scales,etc...whatever I tell them the residents need. For the past two years, the owners have also given every employee a monetary Christmas bonus and a bonus for good state surveys.

[Hellllllo Nurse, BSN, RN]

. Don't give up on caring for the elderly. As Donny Osmond sang, "one bad apple don't spoil the whole bunch."

Your place sounds like the exception, not the rule. I worked LTC for years, as both staff and agency. I saw where deaths were covered up, documents falsified, and abuse of residents by CNAs was ignored. I have seen places with roaches, holes in the floors, places where linens were locked up and hidden from staff to save $$, where Crisco from the kitchen was the only supply available for a skin barrier, and pt beds were literally 50 years old, and rotting. I overheard one DON where I was staff, praising the kitchen manager for buying foods that the residents did not like, because they were eating less and this saved $$ on the food budget.

This same DON told a pregnant CNA who started having contractions while on duty, that she would be fired if she left to go to the hospital.

I have seen nurses threatened with termination if they did not clock out and keep working, because overtime was not permitted.

Several times, I had to go a drugstore and buy cups and straws for med pass, because the facility kept running out and not ordering. I have also bought resident's meds at a drugstore with my own money, because we could not get meds.

I have worked shifts at probably about 20 nursing homes, and never saw one where I would be comfortable if someone I loved were staying there.

[NursesRmofun, ASN, RN]

Very, very sad story. How did they pass their audits, I wonder?

[DOCS RN]

Inmates in State prisons get much beter care. You would not believe what we are forced to give away. I am glad to hear that one among us has the guts to call a spade a spade and deal with the deplorable conditions found in this nursing home. My hat is off to you. Thanks.