Yikes! Another bad observation at an LTC facility

Specialties Geriatric

Published

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.

Specializes in ICU, cardiac.

All I can say is HOW disgusting! Your story reminds me of my first semester in nursing school. We did our first clinical in a nursing home. Now I had been in nursing homes before and this one looked like a country club: no urine smell, carpets were clean (persian rugs at that!), the dining area was set up like a 5 star restaurant and the patients rooms were all clean and sunny looking. One week my instructor told me that I would be getting the "queen" of the home. She was about 90 years old, very feisty and "ruled the hall" that she lived on. When I went in to see her she was very quiet, and seemed to be in pain. Upon inspecting her PEG tube, she had gastric juices coming out and it was very infected! I got my instructor to ask her what I should do. She got the necessary supplies and put a new dressing on her PEG tube. When she checked the chart the night nurse had a notation that read "dressing dry and intact with no signs or symptoms of infection". Now I was a brand new nursing student with only 6 weeks under my belt but I knew an infected site when I saw it. That site looked like it had not been taken care of in days! My instructor made her own note in the chart and told the DON. The pt eventually went to the ER later that week to get a new PEG.

I have worked in several long term care facilities in south ms and have never seen any of the things you are describing. I have had many residents return from hospitals rural and city...with multiple decubiti and broken hips.

If I ever did witness anything so deplorable, I too would immediately call the state health department and the board of nursing and the attorney general's office.

I have worked in several long term care facilities in south ms and have never seen any of the things you are describing. I have had many residents return from hospitals rural and city...with multiple decubiti and broken hips.

If I ever did witness anything so deplorable, I too would immediately call the state health department and the board of nursing and the attorney general's office.

Aint that the truth, holli!! I know we have our "problems" in LTC but the condition my patients come to me in FROM the hospital at times is horrible! LTC gets a bad rap many times. I have also noticed recently that many of my patients that come to me from hospitals are confused. After talking to the families, it's amazing to find out that they were "strapped" down in the hospital for this or that AND given tons of meds to keep them sedated. Chemical AND physical restraints? No wonder the poor pt is confused, agitated and/or combative!! It's amazing what a couple of days OFF these meds and NO restraints do for the soul!

Eddy - you honor all !

I wish I could say that your post surprised me but frankly I've seen it all before. There are good/ bad LTC's but in my experience the scales tip in the bads favor.

As to the question of how do they get away with it...

This has been some years ago but when I was training as a CNA and our LTC was reported to state we were given advanced notice of their arrival. The worst decubs were sent to their Dr.'s during the visit, others just happened to be in the whirlpools and still others were being visited by family who believed this place was just great.

I commend you on reporting this horrible place. how depressing to think that this stuff actually goes on!:o my grandma is 93 and is in a nursing home and i don't know what i would do if this stuff was happening to her:angryfire . its just sad and really makes a person angry that some people just disregard human life the way they do.....doen't anyone in these positions such as DON have a conscience (sp?) any more????:uhoh3: you did the right thing don't even thing twice abou it.

Thanks for all your support and advice everyone. It makes me a little less depressed to see all of you agreeing with my actions. While I know I did the right thing, it was probably one of the most difficult things I have ever had to do. I didn't give myself a choice. I knew I had to report what I saw, but it didn't make it any easier. I actually have a friend on the board of nursing here. I talked to her this am and she flat told me not to worry about this. They have been aware of this place for quite some time but were actually waiting for something like this to happen. They are working with an MDS inspector, the local elder care initiative president, JCAHO and the state attorney general. She hinted that they have made it through evaluations in an unethical manner, but she did not expand on that. Basically, she said they had managed to avoid real trouble, and so their hands were basically tied until I filed my complaint. All indications from my conversation point to them shutting the place down.

I found out a little background info on the small corp that owns the facility. They seem notorious for this type of condition in most of the homes they run. I spoke with a few nursing friends, and they all had a story or two about this corp's facilities. Most of them said that the owners/investors would sacrifice letting residents rot to save a buck on staff wages and benefits. While those are my friend's words, I tend to believe them now.

The sad part about all this is that those residents were wonderfullllll. They were all so appreciative and polite. They were actually a pleasure to work for. It is amazing how they have been mislead. They should have been yelling and screaming at me, but they weren't. I had to fight back tears all night because all I wanted to do was take them all home with me and "fix" them. Well, you know how unrealistic we all can be in moments like this. These were great people being lied to and in my opinion tortured.

We need to start standing up against money grubbing owners and investors. It's time we ALL started reporting substandard care when we see it. For the sake of our own mothers, fathers, grandparents, friends and fellow co-workers.... we OWE it to them.

As nurses we can only do so much with what we are given. If we do not have the tools (staff) we need to take adequate care of our patients, we ALL suffer (patients AND workers). I refuse to accept the excuse that there aren't enough qualified workers out there. The bottom line is if there aren't enough, then it's time to close... NOT run short staffed and put people through hell. It's not an excuse, it's an act of selfishness and greed.

Again, thank you all for your kind and supportive words. It comes at a time when I can really use them.

I worked last night as Charge Nurse at a LTC facility, and I swear it will be the last one I ever work..... :angryfire

RNWendy, you are so right! It doesn't matter if my residents go to the local rural hospital or a major hospital in the capital city or any senior care unit....it is far more common for them to return with decubs and broken bones and increased confusion and decreased ability to care for themselves, along with increased incontinence than when they left. But, hospitals pay joint commission to survey them. I dread sending my residents to the hospitals, because when I visit them they are wearing posey vest and trying to feed themselves.

There is one hospital I deal with that has MRSA in their OR...don't know how come they can't figure it out...but I am always left dealing with it in the nursing home.

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. ;)[/quote

I am Curious as I was reading through this thread, What state do you work in? I am in Georgia and We as nurses have the responsibility to notify the family/caregiver of any and all changes in condition esp. a decubitus ulcer. I have or should say our facility received a citation a few years ago for not reporting to a residents daughter that resident had returned from the hospital with a decubitus ulcer, when in fact the ulcer had already healed when we got her back so the state only issued a level A citation.. This is a biggy in GA. not sure the Fed.Tag # But md and family must be notified of any significant change in condition or care..... and I would say this was a major issue that the family should have been made aware of. Although, I would not have wanted to be the one to tell them, I've had to call the family for a lot things i preferred not too.:imbar That truely ourages me.:angryfire about the maggot infest.. I have been in LTC for 22 years and the last 6 doing wound care only, and I have yet to have had maggots in any of my wound beds... Thats just unacceptable...!!!!!!!!!!!!!!!!!:angryfire :angryfire :angryfire :angryfire

UPDATE: I just got a call from my agency. I am a DNR (do not return) at that facility. Not exactly a big shocker there. The staffer also told me that the DON is filing a complaint with the board for abuse and neglect!

Also, there is a handy website that has a public list of all facilities in my state with defencies. Guess what? No violations as of the most recent 4 evaluations! Anyone else get a funny feeling about that?

those bastards. i wish i knew what state you are in -- i would never work there. if state does not do their job then contact federal to do it. i have no advise but it makes me want to cry, what you went through! interesting note-- in new mexico now they are conducting investigations of LTC facilities by sending in private investigator disguised as residents-- they actually live in the facility for a time. one facility has been closed so far. i read about it in the AARP Bulletin (association for retired people). go new mexico!
This is a biggy in GA. not sure the Fed.Tag # But md and family must be notified of any significant change in condition or care..... and I would say this was a major issue that the family should have been made aware of.

That F tag, woundcare nurse, would be F 157. Notification of change. Citations are resident outcome based. When looking at the entire picture, did the resident experience a negative outcome? Did the resident get the proper treatment even though the family wasn't notified? This is a biggy where I work too. With the level of the citation at the "A" level sounds like it meant that the potential for harm to the resident was none. In this case, I can see where the harm from not notifying the family is evident but who first noticed the pressure ulcer developing or worsening? That should have been the person to notify the family.

Specializes in Peds Homecare.

:angryfire I work for a staffing agency. I clicked on the link to check out the bad nursing homes. I saw the place I am currently doing staff releif in. Let me tell you about my day thursday. I reported to the supervisor's office at 0645, early, as usual. Was told you will be on this floor from 0700 to 1100 and then you need to go to this floor from 1100 to 1500. Said ok with my usual smile and headed for the elevator. Mind you this is the same supervisor that I had a previous discussion with about being charge and med nurse for 46 patients on the day shift. I ended up calling my agency and some how another nurse was found to help staff the floor.So I arrive on the floor and am told you will be on this floor the whole shift, I said np. I keep waiting for the other nurse to show up. This is an alhz. floor with 46 pts who can't even tell you their name, oh and no name bands mostly either, or they have gotten so wet you cannot read the names. It is getting later and I want to get going. Finally at 0720 the night nurse counts with me. Still waiting for the other nurse. Called the supervisors office, where is the other nurse? Oh she is coming she had to count off on the other floor. Get report, she reads so fast hard to keep up. Finally the other nurse shows up. We start our fs and early meds, at 0840 I am told she has to leave and go to another floor due to a GPN being left on another floor with 46 residents all alone. :eek: Now I realize it was all a trick because he knew that if he told me from the start, I would have again called my agency to report the dangerous conditons this place wants me to work in.( By the way, I have been an nurse for 25yrs in Dec.) Standing there again in somewhat of a shock, but determined to do what I have to do to get the meds out. The 's that are CNA's on the floor see my face and say, don't worry we will help you with the resident's names. Thank God for those sweeties. I keep working, finally get meds passed to all the residents for am med pass at 1200 :uhoh3: . Run to the elevator down to have a smoke, yes I know smoking is bad for me. Back up to the floor in approx. 10 minutes. Do ac lunch fs. Wait a few more minutes, then grab the first cart to do pm meds. By this time my head is pounding from the stress, but I have told myself all day that I can :crying2: when I am done passing meds and my work. (Oh, I didn't tell you, when I first realized I was it for 46 residents I didn't know, I called my clinical supervisor at my agency to report what conditions I was working under, and she agreed it was not safe. Also note, no NM on the floor, no other nurse but me from the agency. :uhoh21:) FINALLY at 1430 I am finished with meds for the floor. Now mind you, I have not had anytime to give any of the residents any individual attention, other than to give them their meds. One resident swears at me and asks, why are you late giving me my meds? I go into the little break room on the floor and try as I might to stop them, silent tears run down my face. I think to myself, is this what is has all come to? Is this what I set out to do 25yrs ago in December, when I walked down that aisle with my rose and diploma? :o I know in my heart it is not.

the woman who wrote in about the sore with maggots? that is a pretty compelling image. maybe she could talk or write to sixty minutes--you know, the news magazine?

on television? or 20/20? if it were me, i would just make the biggest fuss. sometimes local news programs feature issues like that too.

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