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Okay, my father has the beginning of what seems to be bed sores. The staff in the nursing home will turn blue in the face and tell us they are not. Being not a physician I went on line to see a picture of bed sores, well it's a bed sore problem for my father.

What in fact should be our next steps? We have requested a wound nurse. I have 3-5 times. I have never heard back from them. They recommended a dermatologist but it is in a basement of a building with no elevator. My father is confined to a wheelchair. What should we do next? We are thinking about a hospital visit? Please tell us what to do next in regarding this manner. This is so wrong, in so many ways.

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The lack of cooperation is disturbing to say the least. Most good nursing homes will do everything possible to avoid bed sores.

There must be a dermatologist somewhere in your community where there is access. I'd have this diagnosed by someone not involved with the nursing home. Then, if it is a bedsore and they won't admit it, you can take it to your ombudsman at www.ltcombudsman.org. Type in the Zip code of the nursing home for your contact. This is your representative.
Good luck,
Carol
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Take photos of the bed sores, placing a dollar bill near the sore to show the size and share them with an Ombudsman. Even better if photos are date/time stamped. Keep records of your requests and file a complaint with the ombudsman.
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Dad is in a wheelchair, correct? Then he likely has a pressure point abrasion from sitting. If he is a big guy and sedentary, this is just going to happen even at the best NH with lots of staffing. If it is still just slight abrasion, then wound evaluation will show that further action is to monitor the area.

You can go and find and buy air cushions for him to sit on and then you go and secure it to his wheelchair & any other chair in his room with velcro. Michaels craft stores has adhesive Velcro precut that works great for this. If he is really heavy, you may have to replace these very often too. This will not be a covered expense by Medicare, Medicaid or other insurance either. You private pay for this and install them. Also you can get a flowing "air-matress" installed on his bed. Now Medicare & Medicaid will pay for these if medically necessary. My mom is totally bedfast in a NH and on hospice. The hospice group ordered this the first day they came on too. But I imagine that dad is not at this point of his care, so if you want this, then it's up to family to private pay for this. The NH will have the name of a provider that brings in private pay equipment routinely at the facility.

Now the doctor can order that a dermaplast or other specialized bandage be placed on the area daily. I'd speak about having this done. This is pretty routinely done. Also the doctor can order that he get turned every 2 hours or so when he is lying in bed. Now these sort of orders are sticky in that if dad is still good on his ADL's, then he is expected to be able to shift his weight and do some things to prevent the bedsore on his own. If he is the obstinate type who just won't do simple things for himself and can, the NH is in a tough spot as to just what all they can do. When you have his next care plan meeting @ the NH, you need to discuss all this in detail so that everybody is on the same page as to what is happening, what is covered under Medicare & Medicaid and what is expected of him and nursing staff in all this. Everybody needs to work together on all this, if you are coming across as telling them they have to do everything, it is not going to work in your or dad's benefit. Understand? Good luck.
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Move your father to a new nursing home. Bedsores can turn into wounds that can end life.. A friend's mom died this year due to complications from bedsores.
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Taking pictures of the threatened areas is essential. Keep a photo-record.
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If your dad is in a wheelchair, he will need a special fusion (A) and he also needs to get back in bed every 2 hours and lay on his side (B). If he sits in the wheelchair all day he will continue to get bed sores. You need to address this ASAP or the bedsore will get worse and he could die. If they get infected they can go septic. Do what they said above. Take photos that have a time/date on them and have a witness with you who you photograph next to the bedsore (extra precaution). Call the county of health where you are located and tell them you think your loved one is in imminent danger. The reason the nursing home wants to deny this is that they can be fined$ and if they are fined too many times, shut down. If it is in stage 1, rubbing creme on it and keeping pressure OFF will help and it can be gone in a few days. I have used Puremedy creme (available on line at puremedy.) I healed a Stage 3 bedsore that my dad received after being in the hospital. I used this and covered it with Aquacel. I cleaned thoroughly with saline twice a day, applied Puremedy and Aquacel and it eventually healed. They said it would never heal because it was by the ankle, dad is diabetic and has had heart problems. I also kept his leg elevated (= to or above his heart) So, depending on how bad his sore is, and where it's located, you may need to do this. Most important, he CAN"T be putting ANY pressure on it right now. If you want to call me or email me personally, let me know. I've live through this stuff with both parents (all sores obtained in homes) and have been able to heal them. Good luck and I'll be thinking about you.
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Carry your camera where it can be seen. No need to be furtive about what you are doing, which is caring for a loved one. It is more than probable that some of the lazy and uncaring staff will be motivated to do a better job when they know you are recording.

I used to have a mini-sound recorder [H2] in my pocket for visits, especially when a clinician or physician was present.

As it was, whenever I drew attention to a problem, it was immediately seen to.

When a member of the nursing staff came into my wife's room and threw a pillow around in anger for something that had happened elsewhere, I ordered her from the room and had her unassigned to my wife. The floor sister was quite co-operative.

On another occasion, a PT was yarking my wife's legs out of bed the day after her knee replacement, ignoring my wife cries of pain. I ordered her from the room saying, "If you do not get out, I will throw you out!" I am not usually so irritated, but when someone does something that causes a patient in pain to have even more pain, then whatever it is they are doing has to stop, stat.

As I have said before, the cared for is more important than the carer. Not everyone agrees with that, but that is my philosophy. The helpless have to be helped, and that is why we are caregivers.

Carers under stress can attend support groups where others in similar situations will share their experiences and, hopefully, good advice on how to cope with difficult loved ones.
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Take pics and bring to a lawyer and then tell the nursing home you have done that and things may change right quick. Or tell them you have taken pics and will be watching if,they get worse. I can't believe they are denying it because with bedsores, there is NO denying it, the proof is on the skin!
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I think it is very important to have a doctor outside of the nursing home. This doctor can write orders and fax them to the home. That way the doctor has only an interest in your father's care.
I was pretty confused when my mother went to a nursing home, and trusted that the facility doctor would do the trick. Turns out it took absolutely weeks to get a low sodium diet for her, even though her hand swelled like inflated plastic gloves.
I have also worked in a nursing home (a long time ago) and more recently in other areas of residential care. There is a strong pecking order about who can tell the doctor what. (pretty much nobody). I also wonder how often the doctor actually examines the patient, and not just their chart.
My dad's doctor is happy to look at pictures of his behind on a cell phone photo, which can also be emailed.
Reestablish with an outside doctor who specializes in elderly non ambulatory adults.
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A doctor shouldn't have to order staff to turn patients, that should be done or family can request it, we did and provided help in turning my dad. Reminding them when he should be turned, which any time they change him if he is incontinent, they should automatically be done. I was a nurses aide for many years and that was what we did each time.
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