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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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Pressure ulcers are usually associated with leg weakness. Nursing homes can use the leg-pac device for leg strengthening. This will also decreased pressure on buttocks and lower spine lowering risk of bedsores. Nursing homes do not like to spend any money on prevention. Families need to pressure them into taking preventative action.
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MaggieMarshall: I think her situation is way past this. You are right, the nurses don't want to be tending to bedsores. I found that the nurses sent a note to the doctor which is at the facility quite a bit - but maybe the doctor didn't get it and of course no one followed up, so they just stick their head in the sand and do nothing. My mom is at an okay nursing home but you have to keep them on their toes all the time and when I am not getting the response I need, I take it to the Risk Management supervisor. This person does not want a complaint filed against the nursing home and will do her own investigation of the situation. Plus my mom has a patient advocate who I can call at any time to bypass all of the steps up the ladder that you sometimes have to climb. If I deem the situation is serious, such as when my mom took herself to the bathroom in her wheelchair and tried to stand up which she cannot do, and fell. I would definitely move him or put him on a waiting list for a better facility.
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Mandate. Hope it's going well!
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The nursing home must have a doctor on call or in residence. Ask for his phone number. Call him and tell him exactly where you're seeing bedsores and ask for him to check them and call you back. Get a time estimate of when he'll be doing that. Call him the next day to find out what he thinks. And then call him again. And again. Leave the nurses out of the loop since it seems they aren't helpful. You want the doctor's opinion. Believe me, the nurses don't want your dad to have bedsores anymore than you do.
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I am so sorry. I was afraid that was the issue. You need to contact elder abuse and the Area on Aging people in your area as well as the family services people in charge of nursing homes. This is legal neglect - contact an attorney who specializes in nursing home neglect. Immediately contact the Risk Management director of the nursing home to file a complaint. Keep going up the chain of command until someone listens. Do not let him go back to that nursing home. Get him on the waiting list for a new one. Bed sores are so bad but they are preventable and controllable if caught early on. Move on with a new facility. Good luck. You have my prayers.
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Wow, I have read all these wonderful suggestions. I am ready for the fight. We have brought him to the hospital and he has stage 2 bed sores. Not good. We are on the middle of a battle between the family and the care center. The social worker is a real piece of work.
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Frequent massaging of at-risk areas for the bed-bound should be undertaken with warm sudsy water. Then, the area should be patted dry, Never rubbed dry.

Anywhere on the body where the skin lying over a bone or bony protuberance is at risk. Lying in urine-soaked sheets will make breakdown more likely.

Good nursing care will prevent a variety of conditions that the indolent and could-care-less will sit by and allow to happen.


Do not be complicit in their neglect by staying silent. Holler! The louder the better! The more often the better!
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I will say for a long time the word was not understood, and thought to be no big deal, well it is. If these are not dealt with ASAP, the wound will becme infected.
mOving them side to side, getting the proper ointment, which is availabe, and yet get hold of the Area on Aging in your area.Is he able at all to walk with assistance? just some blood flow into the area can help.If you push on the area
and it turns white at all, that means that there is still blood flow ot the area, if not, get on this yesterday. These are unacceptable, and need constant watching. Good Luck, my thoughts are with you.
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Mandmcare; let us know how this is going!
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(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.
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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.......
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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
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I would not keep dealing w/that nursing home ....if they are denying & not listening they are not going to listen.
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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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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.
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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.
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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.
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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.
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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.
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mandmcare; what does the nurse at the facility say the "spots" are?
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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.
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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.
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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.
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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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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
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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.
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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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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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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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Taking pictures of the threatened areas is essential. Keep a photo-record.
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