Follow
Share

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.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
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
Helpful Answer (0)
Report

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!
Helpful Answer (2)
Report

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.
Helpful Answer (5)
Report

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.
Helpful Answer (1)
Report

Absolutely, take pictures, let the director of the nursing home know this, also that you are contacting a lawyer, also if the person is on medicare or Medicaid if this is a bedsore acquired in the NH they may not be reimbursed for the care and it will come out of the facilitys pocket. I know in the hospitals now they are much more careful abut acquired infections in the hospital like uti from foley catheters because insurance won't pay for some in hospital acquired infections. Call the hotline for Medicaid/medicare and tell them, also let the NH admin know you are being very proactive about this. Even if the skin is just red, it can be misleading as their can much more damage under what appears to be just a little red skin. You are talking about infection, need for antibiotics, it can be a mess. Stay on top of this, but remember ,be assertive, not aggressive there is a difference, you will get better results from staff and admin by assertiveness. Don't be sarcastic as sarcasm is considered verbal aggression. I am a retired nurse and I know how this game goes. Be Assertive, no aggression.
Helpful Answer (1)
Report

Contact your local long term care ombudsman. Every state has this program. To contact call the area agency on aging in your city or town.
Helpful Answer (0)
Report

If he has bed sores -this is a problem which is serious enough that he could be sent to the hospital. If the nursing home physician is not attending to your father; either not responding or denying that there is a problem then you must act. If the nursing home will not act you do not need to wait and try to haul your father around to physicians offices. Have him sent to the hospital. If they won't do it call or take him yourself. If they physically interfere with you getting help for him call social services. The department of aging in your county most likely oversees the nursing home and can take action as well.
You and your father have rights. The staff at the nursing home have responsibilities. It is not your responsibility to diagnose your father or to come in and provide medical care for him or to be there to turn him every two hours.
The coverage for supplies and equipment varies; some plans cover these things including medicare and medicaid depending on diagnosis. don't rule out options before checking it out.
These broad responses about things on this blog are not helpful. It often sounds as though patients and families have no power or rights and that is just simply not the case - though it can be very frustrating don't give in to the nursing home line that they are simply understaffed, overworked and that your parent is a problem patient. Its nonsense. There are laws that regulate their actions and responses and in particular mandatory bed sore prevention and treatment.
Helpful Answer (1)
Report

Most nursing homes have physicians that visit at least once a week. Insist that the Dr sees the pressure spots and he will provide diagnosis and treatment. Keep up the pressure and demand co-operation. mention 'lawsuit' casually and see what effect that has.

Pressure sores are much easier to prevent than they are to heal, besides which, once the skin is broken down it is an open invitation for infections to enter.

If they argue with you till the are blue in the face, then you have to argue right back until you are purple in the face!

Make them do what needs to be done and never take 'no' for an answer.
Helpful Answer (0)
Report

Taking pictures of the threatened areas is essential. Keep a photo-record.
Helpful Answer (3)
Report

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.
Helpful Answer (6)
Report

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.
Helpful Answer (3)
Report

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.
Helpful Answer (3)
Report

I think it is important for everybody to work as a team for the elder's best interest.Whomever has the DPOA & MPOA for the elder needs to be the one to take the lead on speaking with NH staff. Are you that for your dad?
Texarkana has this spot on in being assertive but not aggressive.

If you go the nuclear route of contacting an attorney or being demanding and telling them what they "have" to do, the NH may well send you a "30 Day Notice". In the notice (which is sent to the state and their insurers), it will be brief and say something like Mr. Smith needs a higher or more specialized level of care than we can provide at this time and so Mr Smith will need to move to another facility within 30 days. If you get a 30 Day Notice, you will need to find another facility for him. They could extend the days (Medicare & Medicaid have safeguards on this) but really you will have to find another NH. So you will have to find a specialized facility that deals with wound care. This may not be easy to find.

You can take him to see an outside MD. I took by mom to see her private practice opthamologist & her old podiatrist even through she is in a NH for the first couple of years. The NH did require that they faxed over a short report that was included in mom's file @ the NH. (I could not bring the report over, had to come from the doctors office directly) This may be a good way to approach this to determine just what is happening with dad's situation from an objective third party. You can request a care plan meeting after dad sees the dermatologist too. They usually are every 90 days (at least they are for TX NH) but you can request in writing to the DON (director of nursing) for it a care plan meeting to be done the week after the dermatologist visit (so they get the dermatologists report & review it). The care plan meeting is really a good opportunity for everybody to voice their concerns. In addition to nursing, dietary & activities & social worker will be at the meeting or on CC line. For us, dietary has been especially great as they have tweaked mom's foods for her being bedfast this last year and getting items with prebiotics so that her elimination is better. What if dad is straining for bowel movements and that is causing the pressure? then dietary changes could make a difference. Really it needs to be a team approach to care. Good luck.
Helpful Answer (1)
Report

Personally I would with you're farther permission take a photo, then take to you you're fathers doctor and tell them that the nursing home is refusing to treat them early, or demand a pressure cushion which is inflated for him to sit on can also get these for a bed, to look at them they are like a ripple bed type only these are blown up then the pressure is eased, my mum has one on the chair she sits on in the living room as she does not move about much and is 83 and is very poorly..Good luck
Helpful Answer (0)
Report

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.
Helpful Answer (2)
Report

Pressure sores can be very dangerous. I don't know who at the NH you are talking to but I always go directly to the Director of Nursing and I always ask them to have the doctor call me so I can also tell the doctor my concerns and listen to what he has to say. Finally, I go the Risk Management director for the facility. I don't waste a lot of time waiting days for people to get back to me. Also, you can request a Patient Care Plan Meeting at any time. Always document who you spoke to and the date and time and what they told you. I have found that stories sometimes change and then I bring out my legal pad notes that were written down as things happened. They usually back off when I read to them what they told me and when. If you don't get anywhere quickly, have him taken to the hospital by rescue. You get seen a lot faster if you come in by rescue and they will diagnose and treat the problem and if it turns out that he does have a pressure sore, you can take a copy of the hospital record to the Risk Management people. They probably won't dispute a hospital's diagnosis. Good luck.
Helpful Answer (1)
Report

See the head Nurse, and see if there are written MD orders for turning the patient. See if they are logged into the charts. Follow the chain of command up the ladder if you have to.
Helpful Answer (0)
Report

When Imstarted my bnursing mcareer, I was tught the Four 'B's.

1. Back
2. Bladder
3. Bowels
4. Bed [pressure sores]

These are always priorities and no member of staff should need telling to attend to them at all times because they are the primary causes of patient discomfort, infection, confusion, and concomitant infection often leading to death.
Helpful Answer (1)
Report

mandmcare; what does the nurse at the facility say the "spots" are?
Helpful Answer (0)
Report

And when you say you are talking to staff at the facility, who are you talking to? Very often, the people who are most in your dad's room will be aides or LPNs, not RNs or Nurse Practitioners. Whatever you are seeing, they should be seen in person, by the Director of Nursing, the Unit Manager and your dad's physician for accurate diagnosis.
Helpful Answer (1)
Report

It is very good that you are attentive and watching for skin changes. I would suggest request for a wound assessment sheet. The nurses should monitor the area and watch for changes. If it is documented it is easier to see the changes in size and color. It will also allow the doctor, dietician, pharmacist and other specialist viewing his chart that there is a issue that must be monitored. And if it is not bed sores, what is it. monitoring the changes can help all that is involved. keep up the great support you are giving your father.
Helpful Answer (1)
Report

BEDSORES ARE WRONGFUL NEGLECT!!! It only takes a few days to get it, and months to get rid of them. Remember Christopher Reeves (Superman)? I think he fell ill to bedsores. Get a doctor in now - Period.

TAKE PHOTOS OF THEM NOW. KEEP A LOG. MEASURE THEM. RECORD YOUR CONVERSATIONS WITH THE STAFF ABOUT THE BEDSORES. ASK WHY HE ISN'T BEING TURNED, CHANGED, AND CLEANED AS HE NEEDS TO BE.
Helpful Answer (1)
Report

IF THEY GET DEEP INTO THE BONE, IT IS A MESS. MIL had them after 4 days of being in hospital. 6 months to get rid of them. Finally doctor put her on antibiotic IV one hour , twice a day. They finally got better so she could be moved back home.
Helpful Answer (1)
Report

For the record:

PHOTOS, RECORD CONVERSATIONS, MEASURE THEM WITH A RULER OR WHATEVER. Tailbone area is usually where they get it. You can get them anywhere there is pressure. Dad probably needs one of those air matresses to help relieve pressure point.
Helpful Answer (1)
Report

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.
Helpful Answer (4)
Report

I would not keep dealing w/that nursing home ....if they are denying & not listening they are not going to listen.
Helpful Answer (1)
Report

Pressure sores are direct evidence of criminal negligence. Wear a t-shirt that says "LAWSUIT" on it every time you go. Complain tio all the top brass every time you go.

Complain to the ombudsman, your city councillors, your reps senators, Governor, and even Barack. Get someone moving in the right direction.

Stand unafraid and never surrender until his needs are met
Helpful Answer (0)
Report

Insurance company may turn down claim due to NEGLECT from Nursing home. If stages are 3 ^ 4 other nursing homes will not take patient until it is reduced to Stage 1. Insurance may want NH to assume responsibilities financially if patient needs to be hospitalized.......
Helpful Answer (0)
Report

(I am an old retired nurse) I briefly worked in a rehab center and when we would get a new admission one of the checks were for any existing skin damage they came with, if any were found of course paperwork was signed by either the patient or guardian for permission to photo the skin damage which was assisgned a stage of degree, measurements etc. and we had a separate book that kept these photos which were updated to measure how well healing was doing or not, it was standard procedure. Bedsores are unacceptable. I have only seen a few cases that no matter how much you turned someone the skin was reddened but these were where death was very close and the person had absolutely no body fat. Sorry about your predicament.
Helpful Answer (0)
Report

Mandmcare; let us know how this is going!
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter