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My mom is in short term rehab at a skilled nursing facility and I would like opinions regarding the following.
Background. Mom is 88- was very independent- driving-taking care of all her own affairs and very active. In Oct. she was diagnosed with sciatica and admitted to rehab to gain strength. During the past 2 months- she has been admitted to the hospital 3 times and therefore lost the bed at the rehab, so she has been in 3 different rehabs. She didn't have sciatica, but had 2 fractures on her pelvis. Developed a blood clot as well as a hematoma that got infected. Was on heavy duty narcotics for pain. Also developed stage 3 bedsores. In the past 8 weeks, she continued to decline but no one knows why. Completely confused, can't eat, can't walk and is by far the worst patient I have ever seen.
Four days ago, I had had enough. I demanded we figure out what was the problem. All drugs were stopped, except tylenol for pain. Mom is slowly making a comeback, but I feel it is an uphill battle.
Below are some examples- (remember- mom can't stand, walk on her own- they need to dress her, she uses a bed pan-totally replies on the staff. They use a lift to get her out of bed and into the wheelchair.) I am there everyday for several hrs at different times throughout the day, although last week I missed 4 days due to a committment out of town.
During the time I was gone she didn't brush her teeth at all (I know because she had a new tube of toothpaste and it wasn't open when I returned. She has not had a shower in 3 weeks- not sure if they wash her- she doesn't know. I haven't seen her being washed.
No matter what time I show up in the morning that is when they come in and get her dressed. If I am there at 7- staff comes in when I arrive. If I get there at 11- that is when they come in.
The rehab had a dr come in to evaluate her last week, due to confusion, etc. The dr asked the following: How many children do you have? Mom pointed to me and said 1. I reminded mom about 2 siblings that passed away. The dr said, do you have a high school diploma? Mom said, no. Mom has a GED but the dr never asked about that. The dr. also asked the day and date. Mom wasn't sure. She knew it was December, 2014 but that was it. No where is the day and date posted in her room or anywhere in the facility that I see. I don't know the date sometimes. After this extremely short session, 3 questions the dr came to the conclusion, yes mom is very confused. No kidding.( I bought a white board for her wall, and I now write the date and time on it and other important notes.
The facility appears to not have enough staff. Moms roommate needs assistance to go to the bathroom. When she was finish, she had to wait for 37 minutes (I timed it), until someone could put her back in her chair.
Also, moms clothing keeps disappearing. I left Sat at noon and returned Sunday at noon- in that time 2 pairs of her pants disappeared. She had 6 pairs of pants, now she has 4. I do her wash, so they aren't in the general population wash. No one knows where the clothes are.
I could go on and on as to things that have happened. I understand mom is not the only patient, but how often do I complain? Who do I complain to. I do think mom gets better care than other patients because I am there. I am more that willing to assist if needed, but I am not trained, Opinions/suggestions?
Based on the information you gave, I consider that to be substandard care. You can contact you state's Department of Health. Most states have a Department of Aging in the Dept. of Health. Unfortunately, if these things are going on with you as involved in her life as you are, I would fear that talking to the facility administration would only get you a "band aid," so to speak.
If you cannot find those phone numbers, you can always find the number of the Ombudsman that serves your area. Facilities are required to post those. But, what you describe is serious enough that I encourage you to contact the Department of Health or Aging. Your county nurse may be able to help you get a contact number, or your local Welfare Office. They all have the state directories.
I wish you and your mother the best.
Oh, write down as much as you can. The toothpaste. Bathing concerns. The amount of time the roommate sits in the bathroom waiting for someone to return.
The laundry is a tough one. If her clothes got soiled, an aide might have kindly put them in the wash, not realizing that they probably aren't marked and the may be in the laundry room or someone may have thought they "look like something Mrs. So-and-so would wear." Logistically, keeping track of clothing can be a big ordeal. The facility should reimburse you. That is customary.
BranDCalf, thanks for your response. That is exactly what I was looking for.
I feel really bad for other patients, but I need to advocate for my mom. I live 3 hrs from her, I am her only living relative. (we have a few cousins in the area but that is all). Friends visit her daily, but I have been there almost daily since the beginning. My family medical leave is over after the holidays. We are planning on her moving to my home, but at this time we can't even transport her.
Background. Mom is 88- was very independent- driving-taking care of all her own affairs and very active. In Oct. she was diagnosed with sciatica and admitted to rehab to gain strength. During the past 2 months- she has been admitted to the hospital 3 times and therefore lost the bed at the rehab, so she has been in 3 different rehabs. She didn't have sciatica, but had 2 fractures on her pelvis. Developed a blood clot as well as a hematoma that got infected. Was on heavy duty narcotics for pain. Also developed stage 3 bedsores. In the past 8 weeks, she continued to decline but no one knows why. Completely confused, can't eat, can't walk and is by far the worst patient I have ever seen.
Four days ago, I had had enough. I demanded we figure out what was the problem. All drugs were stopped, except tylenol for pain. Mom is slowly making a comeback, but I feel it is an uphill battle.
Below are some examples- (remember- mom can't stand, walk on her own- they need to dress her, she uses a bed pan-totally replies on the staff. They use a lift to get her out of bed and into the wheelchair.) I am there everyday for several hrs at different times throughout the day, although last week I missed 4 days due to a committment out of town.
They should've caught the fractures on the x-rays. Any technician, nurse, physician, or even a therapist can identify a fracture of the pelvis from looking at the x-ray. It sounds like she probably had a secondary fall that caused the fractures, whether it was in the skilled nursing facility or at home.
The blood clot and bedsores probably shouldn't happen if she's in a facility. Since you didn't specify the nature of the blood clot, it's difficult for anyone to draw any conclusions. Ordinarily, she should be getting moved around to prevent those two things from happening, either in the course of therapy or just to change her sleeping position. Maybe there's somethine else going on with your mom that's limiting these services (see confusion below).
Quote:
Originally Posted by Pupmom
During the time I was gone she didn't brush her teeth at all (I know because she had a new tube of toothpaste and it wasn't open when I returned. She has not had a shower in 3 weeks- not sure if they wash her- she doesn't know. I haven't seen her being washed.
There's a shower room where they take mobility-impaired patients at least once a week to give them a shower.
Quote:
Originally Posted by Pupmom
The rehab had a dr come in to evaluate her last week, due to confusion, etc. The dr asked the following: How many children do you have? Mom pointed to me and said 1. I reminded mom about 2 siblings that passed away. The dr said, do you have a high school diploma? Mom said, no. Mom has a GED but the dr never asked about that. The dr. also asked the day and date. Mom wasn't sure. She knew it was December, 2014 but that was it. No where is the day and date posted in her room or anywhere in the facility that I see. I don't know the date sometimes. After this extremely short session, 3 questions the dr came to the conclusion, yes mom is very confused. No kidding.( I bought a white board for her wall, and I now write the date and time on it and other important notes.
It's not uncommon. They usually ask name, birthdate, and today's date. Since you didn't indicate what they did about it, such as test for UTI, test her blood sugar, or provide nutrition, there's not a whole lot of to go on to form an opinion.
Quote:
Originally Posted by Pupmom
The facility appears to not have enough staff. Moms roommate needs assistance to go to the bathroom. When she was finish, she had to wait for 37 minutes (I timed it), until someone could put her back in her chair.
It happens. I've heard the worst time is right after dinner when a lot of patients have to be prepared to go to bed at the same time and the bathroom assistance can sometimes require a couple of aides.
Quote:
Originally Posted by Pupmom
Also, moms clothing keeps disappearing. I left Sat at noon and returned Sunday at noon- in that time 2 pairs of her pants disappeared. She had 6 pairs of pants, now she has 4. I do her wash, so they aren't in the general population wash. No one knows where the clothes are.
It's very common. Check the laundry room but you will probably never find it. We lost all the red slacks my mom had. It could be the patients or the nurse's aides. They ask you take an inventory of articles of clothing you brought, but it's mainly for your use when you check out. You can put her initials on the clothes. Even if you specify you'll do the laundry, the staff will sometimes take the soiled clothing anyways.
Ichoro- Thanks for your input.
Mom didn't fall- no one even thought of fractured pelvis until 2 weeks into the ordeal. By that time, the therapists were trying to get her to walk but she was in excruciating pain- everyone told her she was going to endure pain to overcome the sciatica. (When this first happened, my son was with my mom for the first 2 days, I was out of the country, so no family members were with mom for 8 days - friends visited, but that is all-did she fall once she was at the rehab, maybe. I hope not. (No one ever told us that she fell and she was so confused by this time she wouldn't remember). The doctors told me she just had brittle bones.
The blood clot was in her leg. I mentioned several times I thought her leg was swollen. Finally they did an ultra sound (I think) and discovered the clot. She developed the bedsore in the rehab so I guess they were not repositioning her enough or this would not have occurred.
I do know where the shower room is at this facility. I ask everyday and they tell me they will put her on the schedule.
As far as asking what day of the week and date it is, my problem with this is that she is in a room that does not have a clock or calendar. How is she suppose to know? There is a white board. I was told there use to be a staff person that had the job of writing down the date, name of the nurse and aide as well as the therapy schedule. This position no longer exists. I started writing the info on the board for my mom, so now she knows. But how are patients suppose to know if it isn't posted anywhere. Some of these patients never leave their rooms.
Yes - right after dinner is the worst time to get assistance.
And I understand losing clothes is very common. But at the rate we are losing her clothes, she won't have any by next week!!!!
I did have a conversation today with the social worker. Once I aired my complaints/questions everyone was much more attentive to my mom. I also questioned if my mom had underlying medical conditions that I didn't know about. The answer was no. Her biggest problem right now is the 6" by 7" open sore on her leg from the hematoma and the bedsore. The day shift assisted her today and she stood, pivoted and sat in her wheelchair. She did this 3 times today as well as 30 minutes of PT. Each time she improved and gained some confidence. Tonight after dinner, the staff refused to allow her to stand, pivot and get into bed. They also refused to take her to the bathroom, she needed to use the bedpan. When I questioned why there was a change from dayshift, I was told it wasn't written in her plan. I will tackle that issue tomorrow.
I believe the staff is OK, but there is a lack of staff and this is a problem with the administrative people of this corporation. I don't want to move her to another rehab, I feel that would cause even more confusion, and I am not sure another rehab would be any better in this area.
I've been told that bone breaks can also occur in transferring patients, having had my technique corrected by the therapists. The orthopedic specialist would usually do a DEXA bone scan. You can ask for the report.
A swollen foot and ankle should be easily visible to the medical staff. She must be doing a lot of sitting. I was told to put on compression socks and elevate her feet on a foot stool. Foot exercises were also recommended (but she won't do them). It sounds like the doctor and nurses don't spent much time with each patient until a crisis arises, and it's up to the nurse's aides to pass on routine observations (which won't get done since they don't have the training).
If they're not dressing her until you get in, you can probably bet she's not getting breakfast. I used to bring in food everytime I visited because she needed to eat before therapy. Talk to the dietician/nutritionist (as I received a call from the nutritionist when my mom didn't eat). They can put her on a supplemental drink called Boost. Strawberry Glucerna is another one they gave my mom.
An OT may have been present during the day when she was permitted to stand. They and the rest of the PT staff won't be there at night.
Last edited by lchoro; 12-15-2014 at 09:31 PM..
Reason: added Glucerna for diabetics
In 3 different Rehabs, kept losing her bed after she went to the Hospital? And I'll bet, when you wished for her to return to a certain Rehab center, they said: Sorry we're full!
Do you know what's behind that saying, oftentimes? Sorry we're full?
And have you ever heard one of the staff members say to you: we're understaffed? Where I work, we can be fired for saying that, as it instills fear in the residents! No point in asking that question of an Aide or Nurse: Are you understaffed today? You simply won't get an honest answer!
As I always say: put yourself in the place of an owner of one of these facilities, and ask yourself, given the litigious nature of these facilities, whom would you admit to your facility, the residents that would be the less taxing on the staff?
As far as a patient getting better attention with family around, that's not true! I've worked with patients, with no family, no visitors at all, and if they're really nice people, I tend to adopt them and pay extra attention to them, when time allows!
I would say that you really need to get her home. At 88 she's bound to have some problems. But a large open wound is just inviting trouble in a any facility as bacteria is everywhere. Confusion can be caused by improper nutrition, overmedicating, urinary infections...which are all very common. The doctors I work for are often appalled when they discharge a patient and they go to rehab. At discharge from the hospital they just needed a bit of extra help with activities of daily living until their strength returns. However, after a few weeks in certain rehabs some of them may never go home again. Our docs will actually fight for the patients to go to rehabs we have learned to trust.
So if you can arrange for 24/7 care initially I think you should consider getting her ready to go home. Also, once you tell the facility she is transitioning to home they will be "happy" to assist your mom in getting better. If for any reason they see her as a difficult patient (she is not a walkie/talkie, she requires assistance for everything)then they will look forward to hopefully getting a less needy patient.
I'm guessing if you are not there she is not getting dressed each day, not getting washed or having teeth brushed, and not much attention paid to her at meal time. That's why she has bed sores. If they were moving her around to bathe, dress, sit up to eat she would be getting enough movement to prevent the problems. The current rehab may see your presence as a hinderance to the way they prefer to do things, or not do things as the case may be. If ou're not there, then their workload is less because it would be one less patient to care for.
When you write on the white board does she understand? Can she tell you what she did in OT or whatever that day's activity is? If there is a clock can she tell you the time? Those would be better indications of cognition than just name, date, and time randomly.
Forget keeping track of personal items. They disappear routinely.
I often tell people that it's not the broken hip that will kill you. It's the care you will receive for the broken hip and the places you will have to stay that will kill you. Get mom home as soon as you can.
The rehab had a dr come in to evaluate her last week, due to confusion, etc. The dr asked the following: How many children do you have? Mom pointed to me and said 1. I reminded mom about 2 siblings that passed away. The dr said, do you have a high school diploma? Mom said, no. Mom has a GED but the dr never asked about that. The dr. also asked the day and date. Mom wasn't sure. She knew it was December, 2014 but that was it. No where is the day and date posted in her room or anywhere in the facility that I see. I don't know the date sometimes. After this extremely short session, 3 questions the dr came to the conclusion, yes mom is very confused. No kidding.( I bought a white board for her wall, and I now write the date and time on it and other important notes.
The facility appears to not have enough staff. Moms roommate needs assistance to go to the bathroom. When she was finish, she had to wait for 37 minutes (I timed it), until someone could put her back in her chair.
Also, moms clothing keeps disappearing. I left Sat at noon and returned Sunday at noon- in that time 2 pairs of her pants disappeared. She had 6 pairs of pants, now she has 4. I do her wash, so they aren't in the general population wash. No one knows where the clothes are.
I could go on and on as to things that have happened. I understand mom is not the only patient, but how often do I complain? Who do I complain to. I do think mom gets better care than other patients because I am there. I am more that willing to assist if needed, but I am not trained, Opinions/suggestions?
What a NIGHTMARE. Call your state's ombudsman to go there and inspect the joint/your mother's care. It's no wonder she "couldn't eat" with all that pain etc.
REPORT THAT PRESSURE ULCER!!! IT IS A MAJOR BIG DEAL. If they want to claim she had it when she was admitted (to any of the facilities) it will be in her intake records from her exam. Yes I realize she's been in several places. You'll have to sort it out. I WOULD BE HAVING A FIT.
Get the RECORDS/UPDATES OF HER DAILY CARE. They LOG IT IN BOOKS. How many times they move her, etc. When she has a bowel movement, etc. Of course, they CAN be lying in the books.
My mother was in a nursing home "FOR REHAB" after a stroke on a feeding tube and wasted away and died in a year. They threatened me with legal action to go to the courts for a guardianship when I wanted to bring her home with 24 hr care with RNs. (she also was insulin dependent diabetic)
1. Everything she owned disappeared repeatedly including her teeth and glasses.
2. They NEVER bathed her and was often lying in waste. In a hospital gown not even in the nightgowns I provided. They always answered me "PATIENT'S RIGHTS" When I spoke with them about it claiming that she "refused" to bathe. A woman who couldn't TALK who was half paralyzed on one side. Of course that didn't address why her bed was dirty or she got no bed baths.
3. Your mother did FINE with those questions. She was RIGHT. She only HAS ONE KID. She doesn't HAVE a "high school diploma". I'm a dog walker who lives by my calendar and I cannot tell you today's date.
Any "evaluation" should be done by an eldercare specialist/psychiatrist/neurologist. Who was THAT guy?
I don't even know where to begin with all this but here's a clock that I have and my dementia client has.
She is most likely DEHYDRATED and probably needs fluids - a drip. She should have a urine CULTURE SENT OUT for a UTI test. People can be completely out of it with either problem even appearing on LSD.
That's most likely why she fell to begin with. It's the most common cause. Dehydration and they all teeter on the brink of it.
If she has a UTI or is dehydrated it's probable that she will not be able to explain her physical symptoms ie level of pain or transferring the pain she feels to another area. IE she may be saying her back hurts when it's actually a GI problem (constipation/diarrhea or her UTI). IF she complains at all. She may just be tolerating it or think it's her pain from that fracture.
If you can afford it you can hire your OWN private care agency people in your absence to sit there in the SNF and keep watch. Help her with hygiene, eating, DRINKING WATER, observing, talking with her noticing symptoms, etc. An agency will also do the laundry etc.
I'm not sure I can follow what's going on ...she's there to rehab her pelvis fracture? What idiot "diagnosed" her with "sciatica" after A FALL!!!!!!!!!!!!!! Was she admitted to a hospital then sent directly to the SNF? WHY WAS SHE ADMITTED TO THE HOSPITAL THREE TIMES?
Was she EVEN ADMITTED or just sent out to the ER after subsequent falls or something. If you don't accompany her they will OFTEN just send her back with a "diagnosis" of "fall". They're only sending her to release themselves from liability at the SNF. If you're LUCKY they'll do a CAT scan IF SHE COMPLAINS OF PAIN ie "I fell and now my head hurts". But if she doesn't have a complaint they ship her right back to the SNF/ALF. With NO tests.
Whenever you are at a hospital you can find "the Advocate" who will navigate the system with you and help you achieve the proper treatment.
These are important "details".
The priorities are from what I can see:
Get the urinalysis sent OUT FOR A CULTURE not just spun...to rule out a UTI or get the PROPER antibiotic
Get that pressure sore below level two - THIS IS EXTREMELY SERIOUS
Make sure she's eating and DRINKING WATER at least 125 oz per day is necessary which is often gotten in food AND water.
"Just a tylenol" may not be right. She may need pain meds to even want to eat/drink or MOVE. AND can be causing NAUSEA/ side effects.
Get a REAL DOCTOR like an orthopedic specialist to examine her and her films. OR TAKE NEW ONES so you know WHAT her STATUS is.
Figure out what you need technically to get her home or move her even to an ALF with an Extended Care license. If she can afford it. IE you can't go to an ALF with that pressure sore it has to be below a TWO I think. Or right AT a two. IE how ambulatory does she have to be?
BTW, even in my dementia client's EXPENSIVE ALF, one day I see a CNA come in rooting around my client's closet. I go "Can I help you?" She goes" Oh Kate told me to come get a bedspread/blanket". I go "WHY"? She goes: "For Room 300". !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Of course I said "These are Mrs Doe's POSSESSIONS, if you want to BORROW SOMETHING you have to go through ME FIRST".
Which explains why I've noticed two or three blankets I bought missing.
NEXT TIME she gets sent to the ER, go there, insist on an UTI test and CULTURE and evaluation for FLUIDS and they'll give her a drip if she needs it while she's waiting there for TESTS. They will ADMIT HER to the hospital wing if she DOES have a UTI where she will get a fluid drip and IV antibiotic in the ARM while she's there for usually two days for someone in her shape. They will give her a broad spectrum antibiotic until the culture comes back identifying the bacteria and CORRECT antibiotic that is required.
This all routinely happened to my dementia client until I got her doctor to ORDER a urinalysis every three weeks ongoing to catch them in time. Her family finally switched doctors lately because her former one wasn't taking this seriously enough and she apparently has always had some colonized bacteria that is NOT being addressed as a root cause or something. So far, the constant urinalysis is helping keep it below symptomatic levels. Supposedly. I'm not so sure I believe it though but I am not in charge of getting her to a specialist. Besides her late stage dementia I can ALWAYS see a difference in her when her water glass is left empty all day without reminders versus when I make her drink all day long. I also order cranberry juice with meals not coffee and she gets a glass of fake wine. If I get her to fully drink 3 16 oz glasses of water in addition to the juice I'm lucky. Especially since the ALF INSISTS on giving her her meds with a stupid 3 oz cup of water AND makes her take a few pills at ONCE versus MY request that they give her ONE PILL AT A TIME. She's PAYING for medication ADMINISTRATION but they're always in a hurry to do it quick. And even CHART THE PILLS when she doesn't take them and they leave them on the table. "for later". That's falsifying the RECORDS.
ALSO, NO STRAWS IN HER LIQUIDS. People drink less using straws (and choke more taking pills). I saw that on Bar Rescue LOL
Last edited by runswithscissors; 12-17-2014 at 05:54 AM..
As far as the pressure sore (bed sore/ pressure ulcer) - that's probably the most serious issue. I would ask specifically what they're doing about it -- the should have a wound nurse/doctor evaluating and treating.
My father developed a pressure sore on his tailbone (while in the hospital) and it followed him to to rehab centers and was open for over a year. Ultimately it didn't get closed until we brought him into our home (as soon as we could, but 10 months after the initial cause occurred) and started taking hime to a wound-care specialty clinic with follow up treatment by a home-care nurse. The rehab centers were doing "traditional" treatment which don't work on all (especially serious) wounds.
As far as the rest, unfortuately nothing you're saying sounds that unusual to me. My father was in a SNF for 6 months for "rehab" (which was never done, due to the wound on his coccys and another heel-ulcer) - he never got a shower once in all that time. (Occasionally the aides would give him a bed bath, every few weeks or so).
Is your mom private-pay or medicaid? Just curious. If medicaid, she should be eligible for home services so when you transfer her to your house (do you live in the same state) she should be able to get assistance. Medicare only has very limited home-care options, so there's a fairly large difference between the two programs.
As far as "transporting" her (You said you want to bring her to your home but you can't transport her) -- you might want to take a look at her estate/funds and determine whether your want to wait for the rehab to get her able to be transported in a car, or whether you want to pay for medical-transport? For my mother, we transported her by ambulance (michigan to southern ohio). 250 miles = several thousand dollars (she was on Oxygen at the time for CHF).
It was worth it, because once we got her here I was able to take charge of her care and we had another 4 years with her. I am confident that if she'd stayed at the SNF in Michigan she'd have been gone much more quickly due to all the problems (and lack of oversight) she had during her 2 months in their facility.
So if you're serious about bringing her into your home, you might want to consider getting her there sooner and then trying to get her problems healed, rather than waiting for them to heal first (as in my father's case, his wounds never healed at their facility, yet we had them healed within 6 months of bringing him into our care).
best to your and your mom - truly sorry you're having such an ordeal.
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