Aaaarrgggghh! I'm beginning to hate P's nursing home

[TerryJ2]

Idjits.
If you can't treat it with-a drug, and it's not broken or bleeding, it doesn't exist.
Time for her to move. I'm going to talk to her about it today ... her birthday.

P fell yesterday, around 7 a.m. They found her next to her bathroom, on her bottom. Her right shoulder and arm hurt, so they called the physician's assistant, who ordered an xray. They called me around 9:30 a.m. I'm hoping they only called me so late because they didn't think it was serious.
I went in around noon, but P seemed to be doing very well and I was wondering what her status was. She went to the bathroom, and there was a wet diaper pad on the bathroom floor that stunk to high heaven, she had poop on her sheets, and poop on the back of her nightgown. So I changed her into a new nightgown as she came out of the bathroom, and as I helped her slide her arm through the sleeve, she shouted in pain. She showed me the spot, and she could move her fingers, but only lift her arm 45 degrees, so I figured out it was a sprain. She must have tried to catch herself as she fell.
This a.m., I called and spoke with-a nurse, who told me that there was no break. I asked about a sprain or strain, and if P could get ice, heat or other therapy. Nurse simply repeated herself (I hate it when people do that. Like you're deaf.)

Nurse said P is already on medications. This time *I* slowly and carefully repeated myself and said, "What about heat or ice or other therapy for a sprain?"
"There are no other orders from the dr."
OMG. A regular robot, following orders. What a wiz.
She's going to lv a msg ... but no doctors come in today.

So husband is going to do something. He's got the expertise and the equip, if she needs any therapies. I will have to arrange for her to lv the bldg so we don't get into trouble, because he's not licensed to practice on their property. Grrrr.

Like I said, if it's not broken or bleeding, there's nothing wrong ...

Thanks for letting me vent.

 

[susiestar]

Chances are that situations like this are EXACTLY why she wanted to give the nurses fancy underwear, etc.... In some homes you get MUCH better care if you give the staff "gifts" like that. in my opinion it is extortion and that is why I mentioned it to you. P has probably heard about this from others and may think that if she had given more/better gifts they would have given her ice.

This facility (I just cannot call it a "home". Just. Cannot.) may be run such that with-o a dr's orders NO treatment can be given for medical problems. I would check into that. I would also raise holy HE77 for her being left in a waste soaked state. They need to be checking on her every hour or two to see if she needs to be changed. ESP as she is a high fall risk and has problems with her bowels.

I would find a new home for her. When you are looking, ask about these issues. Can staff give ice or heat therapy for a sprain even if a doctor hasn't ordered it? (There may be a state law about this) and do the docs routinely write orders for that to be given in cases of breaks or strains or whatever. Is there a doctor available every day? I know my Gma's retirement home let them see their reg docs if they had them. If they didn't, or their doctor did not respond they had a doctor who would come to see them. It was an expensive svc but one we felt was needed. When she was in a rehab facility after a crisis to build herself back up they had docs who came in every day for am and pm rounds. Gma used to gripe because the pm doctor was a jerk who just wanted to get out and didn't do much. She liked the am doctor because he took care of business and left orders for stuff like ice and heat, etc... (It did NOT hurt that the am doctor was "a cutie", LOL! Gma appreciated a nice looking man right up to the end.)

I am so sorry that P is hurt and the staff is full of idiots with NO compassion. Thank G. she is close enough that you can help and visit. This would be so awful for her if she was somewhere with no one who could monitor things. You are a really good person to care for her.

 

[Hound dog]

THEY DO NOT NEED doctor ORDERS FOR ICE!!!

Terry this is gonna sound weird, but I grew up basically in nursing homes. The grandma raising me thing and my Mom working them for about 15 yrs before she became a nurse. Plus volunteer work I did and my own employment in one.

I would have thrown a two ton hissy fit from hades!

Ok, folks, falls happen even in the best of nursing homes with the most attentive staff. Seriously, they do. Sometimes it's because the patient refuses to wait for staff assist. Sometimes the patient doesn't need staff assist but trips, stumbles, misjudges something, whatever. It just happens. Terry I don't remember if P requires staff assist to walk or not.

But waiting to call you for 2 hrs is a NO GO. No excuse. You should have been called asap, even if they were waiting on dr orders for xrays and the like. Not giving her ice to help with pain and swelling is just plain mean and unecessary.

As for the poop and the reeking depends on the floor.........you need to ream them a new one until they're in tears. And then file a formal complaint with the director of Nursing in the facility for ALL these things. The DON can't make heads roll if she has no clue what is going on.

I got a call from mother in law's nursing home yesterday. It was weekly skin check day and the nurse had found a 1 cm by 1/2 cm bruise on her fanny. She asked mother in law if she knew where it came from and mother in law said that the raised plastic commode seat is a tad loose and tends to pinch her when she sits on it. Nurse called in a work order and it was repaired within a couple of hours. They will keep tabs on the bruise until it is gone, and continue to keep me informed. And yeah, while most of the time I stare at the phone and think "did you really need to call me over something so trivial?" , yeah they do so I can't come back and say I was never told and accuse them of abuse/neglect.

by the way, yeah there are also times when you may find your loved ones with poop on their clothing. Even in the best of places staff do what they can to prevent such things......but sometimes don't find out about it until after the fact. I've had more than a few of those surprises myself. And if a facility is understaffed (and 99 percent of them are terribly understaffed) then it is even harder to keep up with all your patients.

I'm guessing though that P can get up to the bathroom......if poop was on the bed someone should have noticed when she fell.....same for her clothes........and just where did this xray take place that no one noticed???

mother in law is stubborn and bull headed and about as independent as I am (which is a ton). She is also a fall risk so they had bed alarms, chair alarms, and the like. A few months ago I was contacted and told they had removed all the alarms. mother in law would ignore them anyway or shut them off and get up to go to the bathroom without assistance. There is no reasoning with her. She refuses to wait no matter how much we try to explain to her they can't always get to her the sec she hits her call light. mother in law will fall in the near future. And I won't be blaming the facility.

I'd say you need to find a new place asap.

Hugs

 

[susiestar]

Very good points, Lisa. I don't have as much familiarity with nursing homes and remember eons ago when I was in high school being told by a nurse at one that if the doctor didn't order it they couldn't do ANYTHING that could be construed at medical treatment, even giving ice. I was a volunteer and one patient had a swollen knee. Chances are high I was getting the run-around, but I was about 13 at the time.

The hissy fit followed by formal complaints sound like good ideas. The comment about the expensive underwear that P gave to a nurse was because she may have thought that it would help get them to treat her better, because another patient told her it would help, or even because a staff member made a comment. Either way, if gifts are still happening you need to ask about their policies.

I hope that these things help.

 

[DammitJanet]

Its very true that falls can happen in the best of places.

I was in a very good rehab...or so I think. I would rate it as good. Even then, I was one of those patients that simply didnt quite get the fact that I needed help with getting to the bathroom all the time and I fell several times. Boy did they tsk tsk at me while calling my home to tell them.

 

[TerryJ2]

Thank you all.
I'm filling out applications as we speak.
I was going to give P a tour, but now I will just take over. I mean, she's got to be sick and tired of that place by now, anyway.
She has been so wobbly and shaky lately, and so unable to walk unassisted, I asked for a re-evaluation by the dr. I told two nurses but I think only one wrote it down.
One complained last night that P keeps her door closed so they can't see her and it helps if the door is open and they can see the pts while they go up and down the halls. P keeps it closed because it is very loud, and most of the people who work there are just loud, in terms of upbringing and culture. Sigh.
Then she said there were only 3 people on staff for X amt of rms and the pts can't all get a lot of attention. I think the board of dir and state are unrealistic about how many people it takes to staff a place like that, especially on weekends. Do they really believe that pts don't fall or need help on weekends?
You lose privacy and peace, but you get a bit of pain relief and attention.
Yes, I will write up a complaint.
Thank you all!

 

[susiestar]

Understaffing IS a problem and it does cause the quality of patient care to decline. THAT is NO excuse for not automatically providing ice or a cold pack to a patient who has fallen or otherwise sprained or strained something. Period.

Common sense seems to be something the staff seems to lack. Otherwise they would know that she needed ice, etc...

I am glad you are filling out applications. Visiting on a weekend is probably an excellent way to get an idea of how things REALLY are at a facility.

WHY do they think they need almost no staff on weekends? I know some of the services are not offered then, but that is when things are bound to go wrong.

I hope the next home is more like a home and has people who have common sense and more compassion working there.

Has husband been able to treat her yet? I imagine getting her out of the home is a pain. I wonder if there would be a market for a chiro who visited nursing homes with portable equipment? If medicare and/or other insurance would cover it there might be a niche there, a real untapped market. There is a chain of dentists across my state that ONLY sees medicare/medicaid patients. The owner/majority shareholder is the husband of a girl I knew in high school. Everyone told him he would go bankrupt if he did that. Within 5 years of opening his own practice doing just medicaid/medicare he built a larger, much needed office, brought in 2 partners and in the next five years he opened offices across the state. There were almost NO dentists who accepted that insurance because it can be slow paying and difficult. Even with the recession his business is growing fast. Maybe because of the recession???

I know your husband owns his own business and thought this might be an interesting idea for y'all to kick around? Otherwise ignore it!

Hugs to you, husband and P. And difficult child, of course. Does he visit with P? How well does he handle it?

 

[TerryJ2]

Bravo to your friend, Susie!

husband handles P very well. He usually asks her a question about her past to get her talking.

He is very good at explaining things to her. She has a rotary cuff injury. No one at her place told her that.
He put a Chinese herbal patch on her and it helped, but when I took it off tonight she nearly went through the roof. (Shades of my dad ripping Bandaids off my knees when I was a kid!) He will stop by Tues and give her another one. I think she's had enough of our poking and prodding for now.

He skipped going today ... needed a break. Can't blame him.