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My mom got a blister on her foot in early January. Her Alf being concerned as it appeared very quickly had a nurse come and drain it and then the next day sent her to the hospital. After a four day stay in the hospital (they treated with antibiotics), the hospital discharged her back to the ALF, after one day back at the ALF, the in home care nurse declared her foot was not healing and they sent her to a rehab center for further treatment. I was told she could not stay at the ALF (this is a memory care faculty with a nurse on staff 24/7), they do not do wound care.


So now after 28 days at the rehab center, the doctors and therapist said she can be discharged. Contacted the ALF to let them know, they come out to do an assessment and say the wound is now a deep tissue wound and she can not return yet. I spoke with the rehabs wound care nurse and doctor plus I took her to see her own podiatrist (also a wound care doctor) last Thursday all said her foot is healing fine and things look good.


What do I do? ALF nursing director has not returned my calls. The rehab center is trying to get Medicare to continue paying for some of her care to stay there a little longer. If not it would be $385 per day expense. Crazy, how can I convince the ALF that the doctors says she is OK?

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The charge enough for memory care you would thin they can hire some nurses.
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One memory care facility I visited had a nurse only during normal business hours Monday through Friday- and at night only one aide working
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Yeah it is strange to me, also. Really just sticking with them since my mom is calm and feels safe there.
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Tattoochick, thanks for the update, we are always interested on how things turned out. Glad your Mom's foot is back to normal.

I am really surprised that an Assisted Living facility wouldn't have 3 shifts for the nurses. One would think State law would require that, unless the law allows 911 to be a substitute for a nurse.
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Sorry I never posted how things went. The wound did not require daily care, it was not being kept bandaged. Medicare was willing to pay to have a nurse come daily to ALF to check on foot until it was 100%. Rehab wound care doctor said it was not deep tissue and it would completely heal, would have been happy to keep her at the $385 per day, her foot just needed time to heal, the ALF stuff did not need to do any extra care.

Getting her back to the ALF after the 28 days I come to find out they have changed procedures. They will no longer be an RN on staff 24 hours only from 8 to 5, and they will no longer offer to give her insulin injections. So this is the real reason I believe they did not want to take her back. They should have just been honest and discussed it with me. Since she is not the only daibetic in the building they do have an outside company that comes in twice a day to check their sugars and give insulin. So we are doing that for now. We shall see how long before they have a problem with it.

I am happy with the ALF, mom mentally feels safe there, the aids are great and the memory care unit is wonderful. I will continue to keep her there for as long as I can.
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It does look as if it's the diabetes that's making the ALF refuse, wouldn't you think?

Why not ask them directly if that's the trouble, and find out whether there are any circumstances in which they would be prepared to readmit your mother. At least then you'll know where you stand.

Also, about this pass-the-parcel bit where you get left holding the problem...

"So now after 28 days at the rehab center, the doctors and therapist said she can be discharged. Contacted the ALF to let them know, they come out to do an assessment and say the wound is now a deep tissue wound and she can not return yet. I spoke with the rehabs wound care nurse and doctor plus I took her to see her own podiatrist (also a wound care doctor) last Thursday all said her foot is healing fine and things look good."

The rehab team are saying the foot is fine. Translation: this diabetic patient's foot is healing as well as can be expected in a diabetic, and there is no further benefit to be gained from her staying here.

ALF: this wound is going to need a shed-load of attention. Plus it happened pretty much spontaneously, and it's going to happen again, and we are at risk of being held responsible. No thanks.

The only solution I can suggest is that you somehow try to insist that they speak to each other, and collectively advise you on your mother's ongoing care. I.e. bang heads together. Because why should you care who provides the solution or how? - your sole concern is your mother's welfare.
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I would think that if the wound needs frequent dressing changes and is "deep" the ALF staff will not assume the responsibility of daily wound care, which can be complex. It would be best to keep her at a facility with skilled nurses that perform the wound care.  You most likely won't be able to convince the ALF staff to take her back. 
Maybe another nurse from the ALF can provide another assessment to either validate or disprove the first nurse's assessment if enough time has occurred between the first nurse and maybe the wound has improved enough for re-admission? 
I don't know much about the financial part but if the wound needs daily attention it sounds pretty acute, especially if the patient is a diabetic. Review the wound care orders to assess the complexity- does it need daily packing, twice a day dressing changes? 
Amputated toes are usually easier to heal vs deep tissue injury (although I have seen problems with these as well, every person is different).
Tough situation to be in. Sorry you have to go through this.
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Wow
I'm so sorry for what your mom has been through - does she have diabetes that this blister has become so troubling ? Also did they ask permission to drain it - I can't imagine they have a sterile tool to do so

I've seen folks not wearing socks at mom's memory care and I let them know mom should always have socks on

It was explained to me that they could treat certain stages of sores by licensing requirements but not deep ones however one resident is missing toes and they do wound care for her

Other than this issue are you happy with this facility - did you have to pay a bed hold fee while she's been in rehab?

I suppose you could involve the ombudsman but perhaps others have more knowledge on the topic
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I am pushing this post back to the front of the list. Hopefully someone with knowledge about this can answer :)
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