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Suppose I see someone with a health concern that doesn't appear to be getting adequate attention, in fact it has become alarming worse. I don't know his mental status but I think there is some level of cognitive impairment. I don't know if he has someone to advocate for him or if his advocate is fully aware of circumstances. I fully acknowledge I don't have all the facts, I only know what I see right in front of me. I know (at least I'm fairly certain) that if I speak I will be patronized and told it isn't my concern. It is hard for me to sit on my hands when I would be raising hε!! if it were my mother. What would you do?

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We are led to believe that terrible abuses are the exception to the rule, that some poor soul just slipped through the cracks and of course that is true - the vast majority of people get adequate care. But.

And often - almost always - someone knew, someone might have actually reported, but for whatever reason nothing gets done. In our infamous nurse Wettlaufer case people she worked with felt something was wrong years before she was exposed, I think I read that she actually confessed to a pastor - if she hadn't confessed to her therapist she might be murdering people still.
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I am going to stop looking up Serious Case Reviews after this because I am about to crawl under my desk and just lie there curled up in bleak depression.

But I was interested to come across this document published online by adass.org.uk,* "A Decade Of Serious Case Reviews." It is a rare thing: intelligible, thoughtful and practical. It is a determined (if forlorn) attempt to get people to learn from mistakes and *apply* what they have learned.

What it doesn't tell you (or I don't think it does, I have read the whole thing yet) is how many serious case reviews there were each year in the whole of Adult Safeguarding; and what category of vulnerability (old age, learning difficulty, physical disability, e.g.) the subjects of them fell into. Instead, they have selected SCRs from a range of categories: you can see why, but it means they don't identify the scale of the abuses going on.

But look at that figure. 1170 recommendations.
How many of those recommendations had to be made time after time?
How many have been implemented?
Who's following up?

Anyway, here's the excerpt. You can get the whole thing online if you like; or even better spend twenty minutes on Google and find the exact equivalent for your area - I'll bet there is one.

Oh, and gloriously - in one case, a whistle-blower's desperate cry for help in writing was forwarded for action to the Manager of the care home he worked in. Brilliant.

*********************
Hull Safeguarding Adults Partnership Board
Serious Case Reviews Analysis

This document collates information gained from Serious Case Reviews [74 of them] undertaken since 2003 [to 2014], by 41 local authorities.

There are over 1170 recommendations focussing on:

Practices 28%
Reviews 19%
Accountability 13.5%
Strategy 10%
Training 9%
Joint working 8%
Systems 7%
Involvement 4%
Commendations 1.5%

The settings range from:
Own home 27%
Residential / nursing home 28%
Hospital 30%
Other 15%

SCRs are not about blame – they are about learning lessons, asking SO WHAT changed, for example what has improved outcomes; look for good and poor practice; and ensure that actions happen to prevent poor practice and improve services.


**********************



* ADASS, I now discover, rather late in the day considering for how many years I have been paying attention to the subject, is:

"the association of directors of adult social services in England. [note: these are all public sector organisations; none is commercial] We are a charity and the association aims to further the interests of people in need of social care by promoting high standards of social care services and influencing the development of social care legislation and policy. The membership is drawn from serving directors of adult social care employed by local authorities. Associate members are past directors and our wider membership includes deputy and assistant directors."
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As I happen to know, for reasons I'd rather not relive, you treat scabies by stripping naked, smearing yourself (and your tearfully protesting children) from top to toe in toxic lotion and leaving it on for the specified time.

I'm imagining organising that procedure for a staff of dozens of people, some of whom will indignantly reject even the idea that they might be such disgustingly filthy people as to carry a parasite. And you have to do them all at once. It's a complicated project.

But no one among the regulators was either required or prepared to get in there and direct the operation. Why not? Do they not have the necessary legal power? Isn't this something they could legitimately pass on to the CDC?
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See also Victoria Climbié, MsMadge, but only if you're feeling especially robust. The scabies in her case is often skipped over as a detail, an example of the neglect she endured; but in fact it was the key to the entire story. That beautiful little girl haunts me.
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Article in news - Rebecca Zeni, died in a Georgia NH from scabies having been eaten alive for years
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I wish hoca had a memorial notice - but then again, I've lost count of how how many have passed in the time mom has been there.
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One of the things I find difficult at the nursing home is you are never sure why most of the people are living there or what their story is, staff aren't allowed to tell for privacy reasons and you can't very well sit down beside someone and ask "so, why are you here?". Dementia is pretty obvious, physical disabilities are obvious but you can only guess at the cause. And then there are the people who seem fine and you wonder what the heck they are doing there and one day you walk in the door and there is their memorial picture on the bulletin board, and only if you can find their obituary can you get a clue as to WTF happened to them.
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Countrymouse,
Thank you for sharing that confession with us. I am not in the habit of receiving confessions, but I just want to say:

We are responsible for today.
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"Am I my brother's keeper?"


Yes!
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Dear cwillie,

Thank you for sharing this example with us. I would like to think that I would take action and get it reported. I see so many people that need good advocates, but I know sometimes its just not possible

I try practicing using my voice. I know I have to stop worry about offending people and just do something or say something. I know saying something is not the end of it. Thinking back about my dad's care, I really believe I was too passive and too accepting. I shouldn't have been afraid to challenge the doctors and nurses.

I know we are all only human and we can't save everyone. But I hope in my heart, I am trying a little more every day to be braver about speaking up for those that can't. And continuing to fight the good fight.
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Regarding the elderly woman who died, I recall that a few months back, we had a poster whose elderly mom wouldn't see a doctor, and hadn't in several years. She fell out of bed and was in terrible pain, but would not "allow" her adult son's to call the emts. With a great deal of patient coaching, and assurances that he WAS doing the right thing, this man, who was elderly ( and perhaps a bit limited) was able to call for assistance. Indeed, his mom had a broken shoulder and was admitted. I don't recall the rest of the tale.

I wonder if some of the same dynamic existed in this case.

I know that many years ago, when an elderly neighbor died, we alerted APS to the fact that his schizophrenic son lived in the home and was not capable of caring for himself. We were told "sorry, nothing we can do". It was only when the house became overrun with vermin, creating a public health nuisance, that the son was removed to care.
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I have a confession to make. I hope I will feel better for making it, because this has been on my conscience for some twenty five years and is still painful.

In my old suburban house, I had a garden shed the window of which looked over my neighbour's fence. I had two kittens at the time. My neighbour had a mature female cat. They had all been plagued by a bullying tom cat whose territory we lived in.

One afternoon, in passing, my neighbour said "I'm sure I saw that black cat in your shed window." "Oh really?" I replied "Goodness, he is being a nuisance."

I thought no more of it. I also didn't use the shed much, having three children under ten and therefore a neglected garden.

Months passed. Then one bright day the kids, on their school break, went to get their pushbikes from the shed - and ran screaming back into the house.

I wrapped the cat's mummified remains in an old pillow case, then (I hang my head) in a bin liner, and [whisper] put it into the garbage. I was shrivelled with shame and could not think how I could ever put this right.

Well. I couldn't put it right. I hadn't listened to what my neighbour was saying. She had never said anything further. Between us, but mostly me, I starved that poor cat to death, and I don't find it any comfort to know that I didn't hear anything and I didn't see anything and if I HAD realised it was stuck in the bloody shed then OBVIOUSLY I would have let it out. I still don't know how it got IN.

I have occasionally wondered if my neighbour could honestly have believed that I was doing it to get rid of him. Could she REALLY have thought that, and done nothing?

I don't ever not check things any more.
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"Don't worry, they are old anyway" Is often the attitude these days.
In the case of this poor lady I don't think we know all the facts. Maybe the daughter was mentally challenged and simply did not know who to ask for help. Perhaps mum weighed 400 lbs and the daughter simply did not know or physically could not take
care of her. Maybe Mum fell and managed to get into that chair and could never move again.
When my hip broke a passerby helped me to my feet and I managed to get back in the car and drive home. pulled into the garage managed to haul myself into the house and collapsed onto a kitchen chair and yelled for hubby. There was no way i could get up out of that chair and the EMTs carried me out to the ambulance in that chair.
All these possible circumstances may have lead the court to treat her leniently. If she loved her mother and i assume she did can you imagine what she was going through for those two years. Many people still believe they will get in trouble if they call an ambulance. it is also possible that Mum ruled the rest and forbade daughter to call for help because she was afraid of what would happen to her in the hospital.
The press loves a good story and they make the most of the gory details. i am not suggesting that this was not reported the way it was written but the truth is that there are services available in these circumstances but they vary from area to area and of course the patient's Dr has to be involved to receive services.
As far as the neighbors are concerned maybe they thought mother and daughter were a bit strange and unfriendly. perhaps they asked how Mum was doing and daughter just said that she was fine just not able to get out now.

We just don't know so should not judge. Not everyone looks out for their neighbors like Church Mouse
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Definitely say something! What if this were your parent or maybe you one day? That's the problem with nursing homes--- too many people turning their heads. These are human beings that deserve better care. It is not going to happen until we all together do something!
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This specific situation seems to have been addressed by talking to a staff member who said the patient's family is doing something. Perhaps the family could use a hint; but without knowing the patient's health directives, you could be considered an unwelcome busybody. Furthermore, it probably violates HPPA for a staff member to talk to anybody about the gentleman's condition.

This I know: It is illegal to not report suspected child abuse. You don't need to have proof, or even know for yourself that happened. If you SUSPECT it, you are required by law to report it. I honestly don't know if this law applies to elderly abuse, but imo, it should.

If there is a local Adult Protective Service office, or County Welfare or Health office, I would hope that they would be responsive to a report of suspected abuse. There is probably a State office that responds to reports of nursing home abuse. The authorities would be able to launch an investigation unconstrained by HPPA; and if the situation is being properly addressed, then no harm was done by the report.
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What ever the why, when in doubt - speak out.

If retribution is a concern I would just contact APS, they investigate and ensure the facility that people are watching.
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A thought just popped into my head. How old is the man? Maybe the family has chosen not to do anything. He may have a bad heart and can't be put under. Maybe other health issues. The NH abides by the family and doctor's wishes. Just saying.
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CM,

Let's look at the other side for a moment. Was the woman mobile. Me personally Don't want to be stuck in a wheelchair all day. They are not that comfortable. Could she sleep in a bed? My MIL chose to sleep in a lounge chair because of her hips. It said £, I am assuming this is England. Does England provide in home services? Was the mother refusing to see a doctor. I have heard it takes months to see a Specialist?
Yes, I agree, it may have been abuse. Just showing that it's not always the caregivers fault.
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Agree: If you see something, say something...but if I didn't like the staffing, staff or way things were handled I'd be contacting the local long term care ombudsman's office and/or adult protective services. When poor or negligent care is going on the facility will want nothing more than to cover it up...it's all our responsibility to report this sort of thing; letting it go on means as the rest of us get older we will be taken advantage of, ignored or abused as well.
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As a Christian you should report it an eldercare advocate. If a person cannot speak for themselves there are advocates to help them. Abuse should not be tolerated on any level of care. Please treat this situation as if it was your loved one and help them. Contact them and report the nursing home anonymously. God will bless you for helping someone who cannot help themselves.
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Even trickier, CW. How long before he gets seen, do you know?

Is there any possibility of your just "happening" to fall into casual conversation with any family members..? So that you could shake your head in sympathy and say goodness me, perhaps if it were REPORTED TO the oncologist how RAPIDLY this is developing you'd think he could bring the appointment forward, ON REQUEST, wouldn't you...? and try not to poke them in the face or dig them too hard in the ribs.

Takes me back to watching my best friend's children's ringworm get more and more florid, while I assumed that... it's bright red and in a ring formation... what did you think it was..?

Stone me, turned out she'd had absolutely no idea and was desperately searching her house for allergens.
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This isn't a case of me seeing overt abuse, the gentleman in question has a growth that you couldn't miss unless you were blind and it is growing at an alarming rate. I know that even supposedly "harmless" squamous cell skin cancers can be deadly if they are neglected, I'm wondering what they are waiting for and if the oncologist that is making him wait has any idea he has more that a tiny lesion.
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I would send notice in writing to the higher ups as high as possible and let them know your concerns. They have more to lose and would investigate thoroughly.
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I agree with the others - ALWAYS say something.

If you're concerned, you can always start with: "you might know about this, but I need to know that you know....."
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This happened to me, kind of...when my mother was in skilled nursing home...the Haitian nurses or workers there did not like my mothers bedmate - at all...with due reason...she had dementia and would hit or call names to the Haitians, obviously my mother’s bedmate might have been prejudiced..she would not want them to touch her or anything...she would throw her food tray, when they tried to serve her...well, this was a big no bueno for this bedmate because they ended up not treating her very well..my mother was witness to it,,so my mother told me what was going on..and then I contacted this bedmate’s daughter...my mother told the daughter to call me and to that end, I told the daughter everything..I told the daughter that I did not want repercussions to my mother so to ensure that nothing is said about mom or I. She did that. The daughter reported it to appropriate people there, but it was too late anyway, her mother ended up dying - due to the nurses there. One thing I have learned...and which to was my mother’s benefit is my mother is French and Haitians speak French (Creole)...they love when white people speak their language so my mother had an advantage...but what I have learned,,,is when someone is in a nursing home, you do EVERYTHING YOU CAN so they like you...big job for an elder with dementia like mom’s bedmate and it’s terrible you have to be that way...but my mother constantly said “thank you” and “please” and all those cordials you can think of and it works.
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Sounds like your concerns should be addressed to Ombudsman. Contact info should be posted by NH in a place that's clearly visible.
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Oh it gets better and better.

Message from Google when I typed in serious case reviews and the name...

"Some results may have been removed under data protection law in Europe."

I'm sure no individuals were to blame and Lessons Have Been Learned. That's the usual conclusion.
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Make an example of her, Book? So, what, so that all the daughters who can only be prevented from confining their mother to a stinking armchair for months on end until their agonised death by fear of a jail sentence will be sent the right message?

What do you suppose the inside of that daughter's head is like right now, today? She sat and watched her mother decompose for months. Those bungalows aren't that big. Probably two bedrooms, living room, dining room, kitchen, bathroom, hall all on one floor.

It's easy for us to think "why the f*** didn't you call an ambulance, dumbo?"

I'm going to look up serious case reviews and see if there was one. But I can tell you what would have happened if the daughter had rung a typical GP. She'd have been told they don't make house calls; and she wouldn't have known a) that you can argue and b) how to argue; and she wouldn't have known who else to call.

She didn't know what to do. So she didn't do anything. And the longer she didn't do anything, the more terrified she became that she didn't know what to do. And Nobody Paid Any Attention.

I would want their phone records, their bank statements. I want to know who they were in contact with for the full two years before the mother died, so you can compare before and after the leg injury and judge how hard everybody around had to work just to ignore what was happening.
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CM, did I understand that story wrong? The daughter did that to her mother and basically got an 'out-of-jail' card? No jail time? "...handed a 20-month prison sentence, *suspended* for two years." No punishment for pleading guilty to gross negligence manslaughter?

If that's the case, there's no deterrent for others to avoid doing wrong since even if they're caught, they will get no jail time, just a slap on the wrist.
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I wish you hadn't shared that CM.
😟😟😟
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