Serious event at Skilled Nursing

Caregiver,wow that's alot to happen and for you. I never understood the ombudsman concept and how to find that. Right now the facility is trying hard to help her so I am wary of ruffling feathers while she is so vulnerable. I have considered future actions if she succumbs to any of what has been brought on. She has also lost alot of cognitive function but I am not sure if that is partly due to constant pain medications. It has been made known to me she was only to be lifted with hoyer and 2 person assist. As I said the aid was fired that day. I am trying to work presently with the help they are providing as we hope (even blindly) she might improve. We also go much more often and stay and try to deal with needed issues. At present all this is being billed to Medicare so we are not paying out of pocket.

My mother fell in between 2 Aides in the house & needed emergency surgery 5 years ago. She has dementia & is immobile & incontinent. 5 years ago she was losing her ability to walk or stand too long …& she was becoming combative. She survived the surgery..stayed 10 months in rehab/ pvt pay SNF. I took her home 4.5 years ago. I’m so burnt out even though I have pvt pay home caregiver for 35 hours a week. I purchased lift machine that the nursing home was using..the stand assist lift. With this, she is transferred from bed to wheelchair or to commode. The CNA from SNF trained me how to use it while she was a resident there. My mother has not fallen once in 4.5 years from a transfer. However, this past February, since she has dementia, she unbuckled her seatbelt on wheelchair & thought she could walk, fell & required stitches. She was in short term rehab 2 weeks & I took her back home. Long story short, your mother should have 2 aides operating hoyer transfer for her incase stand assist lift not available. No shortcuts with one CNA…who probably was not regular one. They have to know each patient’s care plan, Have Ombudsman notified & file complaint. Unfortunately, these falls can happen anywhere. Hugs 🤗

Speak to a personal injury law firm that offers specialty in nursing home neglect and abuse. Most of them will not take a penny from you unless they take the case and recover damages.
The lawyers will get all the exact facts. They know how to investigate.
All nursing homes will lie when an incident happens or they will blame an incident on the lower-pay CNA staff. The aide's actions being 'strictly against protocol' is probably more likely the charge nurse instructs that the residents have to be dressed and up by a certain hour because it looks bad for them to still be in bed. Very likely the CNA has been transferring your mother like this for a long time. It's also very likely she's been doing so with her supervisor's permission if the Hoyer isn't available.
If you talk to a law firm, the lawyers will speak to the CNA who was let go and you'll probably hear a very different story than what you're being told by the facility.

They have taken a bone sample to get a biopsy. They want to get a vacuum pump to help the wound heal faster. The doctor has to order that. I feel as though everything is in slow motion. We had to ask them to change her meals so that the choices are easier for her to eat. Otherwise she tries and food gets all over her. She can't sit too upright due to her legs and bedsore. She also has cognitive issues and sometimes can't form words. This feels endless.

Riverdale, I'm glad she is a bit improved.

We found that mobile x-rays were the best thing ever once transport became a huge issue.

Call the ortho office and ask if they can order the 6vweek films they want from the mobile service the SNF uses.

Yesterday's Xrays were canceled due to her bedsore infection. I think just as well since it is 4 weeks post op and nurse at surgeon's office said standard Xrays were 6 weeks post op but no one could give me a solid reason why they were doing them at 4 weeks. It's an ordeal to get her anywhere in her condition. The wound nurse will be at the facility tomorrow. She is the best person to speak to right now.

She was 91 on Sunday. We brought birthday cake and left what we didn't eat for the staff. She seemed to enjoy most of it. I also brought her this pretty pink drink from Starbucks. She loved that. She is drinking Boost twice a day. She seemed a little better on Sunday. I am going today again with drink at lunchtime. Thanks for your wishes. I hope I might have a little better news tomorrow regarding the wound.

Just catching up with your updates Riverdale. What's happening today, Monday? Sending hugs and prayers your way.

Thx for the update. The x-rays are for the fracture. The x-rays are low grade so I would not worry about them. All hospitalizations are a concern; especially because of Covid. Is your mom getting oral or IV antibiotics? The former usually will cause diarrhea (which could complicate her situation more because of dehydration) and the latter might not, but should be more effective, but is normally done inpatient. You have to determine if you are satisfied with mom’s treatment at the SN. Can her previous outside Primary Care Physician review your mom’s prognosis; like a second opinion for you? Watch her vitals for the white blood count and fever.

The wound is infected. She is on a 7 day course of an antibiotic for it. She turns 91 tomorrow and we can go but will wear gowns,gloves as well as a mask. They said she did not need to be in the hospital,that they could treat it at the facility. I was just thinking the worse regarding hospitalization. They did not say that to me,I just feared it. I also feared that if she is in the hospital that only one of us would be allowed in at a time to see her. I don't know if they will still want to take her on Monday to the surgeon's office for Xrays is she is infectious. This is 4 weeks post op and the nurse said they do Xrays 6 weeks post op but no one can give me a straight answer as to why they are doing Xrays now if they have to do them again in 2 weeks. We also did not learn the results of the nature of the wound until after the surgeon's office was closed for the day. Sorry to have caused confusion.

As far as SN not wanting to take her back is nonsense. Who is telling you these stories? You have the right to take care of your mother. The SN cannot preclude you from seeking more professional help for your mom in the hospital.

Your husband is wondering why your mom is not hospitalized. If I were you I would ask the house doctor to order it. All hospitals have wound care physicians on staff. If he refuses take her to the ER yourself. Maybe a skin graft is possible or needed.

So sorry, to read this. Thinking of you and mom.

Oh dang Riverdale!

I am so sorry to hear this. I pray that she isn't suffering and that whatever is meant to be will be gentle on her.

So sorry to read this update. I wish you all healing and peace

I know this is not good news in the least but I felt I should report back as some here know so much about bedsores. My mother's is beyond the worse stage. It is 3 centimeters deep. Muscle is visible but not bone. There is now an odor and oozing. They are going to start an antibiotic and a catheter. I know this could be heading to her end. My husband is wondering why she isn't being hospitalized. I worry if she is and they want to release her and the SN place doesn't want to take her back then what do I do. I did ask as many questions I could from advice here. They are using Dakins solution and putting a foam cover after changing the dressing. The culture from the wound should be known within 48 hours. Her white blood cell count is elevated but not very high. Thank you to all of you who have given me advice.

An additional comment just as "FYI": The NH brought in a Wound Care Nurse from an Agency they use, have a relationship with, or possibly referred to by the in-house doctor. If for any reason you are not satisfied with their service you have the right to request another Agency for wound care nursing services. Personally, I have found that referrals from a Hospital Social Worker very helpful, because they usually will get feedback about Home Health Care Agencies.

I don’t have advice on this, but am so sorry it happened. My mother was a two person assist for every move and I’d have been mortified if she was ever dropped. Prayers for your mom’s healing

All of your mother’s information should be available for you upon request by you. If your mom had to be sent to the hospital the NH would have to copy and release that information to the hospital so the doctors know what is going-on and what medications your mom has been taking. They know what stage the bedsore is and the medicine to treat it. You can ask to be present when the nurse or nurse’s aide changes the wound. They should be using Mepilex dressing to cover the wound. It’s your mother! You are entitled to know. Ask questions.

Riverdale, I have no good advice, just much sympathy for your mom and you , going through this sad and painful process.

A wound care nurse has seen it. I can ask some of those specific questions when she is back at the facility this Wednesday. I did speak to this nurse last week. I know it is being packed with gauze twice a day(gauze removed and new gauze placed in wound). I appreciate hearing those specific terms. I know they use lidocaine to help with pain. I don't know what level it is but I will find out this week. I have not seen it. Because of fractured femurs I don't think my husband and I should try to position her in order to see it. I wouldn't want to be accused of causing her more harm. Thank you for all that information.

Bedsores and healing time: From my experience it is a slow process. The wound needs to be checked daily for progress or more deterioration. Many times bedsore prevention and healing is an art and part science. I say this because rotating a patient for pressure relief is not always satisfactory. Sometimes you need to try different body positions to find the right one that works. For example my patient had a buttock bedsore on the right side, so you think of elevating or cushioning the right body side, but that made it worse. We found that elevating the left body side relieved the pressure and it healed. This is why the bedsore needs to be looked at everyday. A keen eye witness will know how it is/or is not healing. From your description your mother has a deep wound. You should ask what stage it is. Do they take pictures of it? Do you look at it? When does the doctor look at it? Do they use promogran and medihoney for the wound? How do they clean it with saline or Vashe?

I highly recommend you to use your nose. If you smell anything out of the ordinary, get your mom to a hospital fast. I'm sure the visiting nurse would have told you this as well, I'm just emphasizing the point. Best wishes.

Countrymouse, Yes she is at least

Riverdale, is she already on a variable pressure air mattress?

Done anyone have knowledge about bedsores and general time frame of healing? My mother has been seen by a wound care nurse. Her wound has to be packed twice a day with gauxe inside the wound. She was told to lie on her side which I saw her doing yesterday after lunch. This means she is putting more pressure on the femur that was operated on but the alternative would be lying on the side that has a brace. Just a hot mess!

Riverdale, please don't think it was your job to come up with the idea on an air mattress!

Keep on top of the pain medication; I think being pain-free is so conducive to healing! ((((Hugs))))).

Thank you CT. I am very worried now that she has one. At least they seem to be taking it seriously. They have a wound nurse who visits once a week. They are also going back to an air mattress which I wish they had begun earlier. Since her fall I have had to deal with so many issues. Now I feel I was neglectful in not bringing up the mattress earlier. I remember worrying this could happen but then that thought escaped me. The changing of the dressing twice a day seems reliable. It was very difficult to see her experience such pain from the wound as well as the femur fractures.

Riverdale: Be ever vigilant about "bed sores" or pressure ulcers (same thing). My mom died from sepsis and necrotizing fasciitis (flesh eating bacteria) from a pressure ulcer on her hip. Pressure ulcers usually occur around bony protuberances such as ankles, hips, etc... At the first sight of her wound, my sister and I had her at her PCP within 5 hours. 3 weeks later, we had a visiting nurse come in once a week to check the wound (ordered by her PCP). My mom refused to keep the pressure off her wound. I'll spare you the rest of the details. This type of wound is treatable if caught early enough. Depending on the location, it might involve a colostomy and debridement surgery depending on the progression of the wound. It can progress very seriously very fast. Your mom's Dr may recommend a hospital bed with some type of fluid mattress (air or sand) to take the pressure off the wound if your mom is non-compliant. I truly wish you the best outcome. Peace.

If things get worse I would certainly consider hospice evaluation. Tomorrow she is being taken for a transfusion as her hemoglobin is low. They are going to give her around the clock pain medication. They also plan to change the dressing on the wound twice a day.

My mother has not said she has had it with life. So far no matter what happens she soldiers on. Just have to take it a day at a time.

I'm sorry to hear about the bedsore Riverdale. Do you think a hospice evaluation is in order since serious pain meds w/b required around the clock? What does the doc have to say? It's amazing how quickly things can go downhill once an event happens. Especially one of this magnitude.
Sending prayers