Dad had a TIA that went unnoticed in nursing home. Any advice?

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My dad is in a NH w/ early Alzheimer's. My sister went to see him and discovered his face drooping and speech not right. NH says TIA. Eye was ill not close he speaks as tho mouth full of novacaine. That was a week ago. I saw him yesterday and was shocked at what I saw. Eye is infected. They have done nothing for him. They say there is nothing they can do. I want to know why they did not notice something was wrong. They say his vitals are good and they are just now going to get him speech therapy only because we insisted. We believe his decline started on the day before it was discovered. Should I be more concerned or let it go? I am afraid he will have a stroke and they will not notice. Should nursing staff be more observant of their patients. Isn't that what are paying them to do.

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SO sorry for this situation! My mother was in a NH after her hip surgery. She chose the facility based on it's proximity to me (so odd, since she doesn't care much for me). When I saw she'd chosen this one, I said "Mother, this place is awful, Truly--please let's find a nicer one" She said all the pictures showed a beautiful facility-- well talk about putting lipstick on a pig! She didn't change her mind until she actually got there and found out she was in a double room and that she was not going to be treated "like a queen" as they has promised.
She fought everyone there, from the director to the housekeeper. We finally were able to move to her to a MUCH more expensive place, but not after a lot of drama. The care was ok, minimal, but she did get a lot of PT, was forced to walk a lot (which she hated)...but the place was so unbearably noisy and stunk so bad. I know her recovery was much longer than it needed to be because she was not cooperative and the place was just not nice. She had to wait to be taken to the toilet, that's when she just gave up and became incontinent. She fell several times and no one came to help her.. in a couple of cases her roommate called the nurse! I could go on, but the bottom line--I KNEW this place was horrible and warned her, but she chose not to believe me. I know she was very neglected as to basic needs--she never had a shower the week she was there, and the food was inedible. She could easily have had a stroke while there--nobody ever seemed to be around.
There are excellent NHs and terrible and everything in between. Look around and see if you can get your father in a better one. Mom's ins did not cover the difference between the bad one and the good one. My sister who has money to burn paid the difference. Well worth it. The 2nd place was quiet, clean and nice.
She recovered and got to come home. Her care was excellent--but this was a much smaller and more expensive place, and NOT a long term NH, a short term facility, Maybe that makes a difference--don't know.
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Personally, having been an RN in a nursing home, I would insist on a meeting with you and your sister with the Director of Nursing, the Social Worker , the Attending Doctor and the Head Nurse on that floor to voice your concerns and get some answers and solutions. I would also try to have either a family member or a trusted friend check on your Dad at least weekly if not more. I found that the patients that got the best care were the ones with the most involved family members. I hope this is of some help. I feel so bad for you and hope that things do improve.
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Veronica actually I was thinking of my meltdown in the stroke ward, the only horrendous experience we've had at our otherwise brilliant local hospital. After a very long evening in the ER I left mother there at two thirty in the morning, believing that the detailed history the ward sister had just taken was intended for use - ha! But I was young and foolish - and got myself back there at five to eight to be sure to catch the ward round. Holy God. She was literally exactly as I'd left her, only gasping with thirst, dying for the loo, scared out of her wits, aphasic and unable to see to her left. The chart was a joke. I would say I have no idea what they'd been doing for over five hours, but I know exactly what they were doing - they were haring round after the far too many patients who hadn't had anyone with them to give a history.

Let us draw a veil on that scene. It took me all day to get it half-sorted, including a rather tense interview with mother's own cardiologist who turned up wearing his on-call physician hat instead and pretended he knew nothing about her cardiac history, presumably to aid his disguise. "Hello, Dr G, fancy seeing you here!" "I'm the Consultant Physician on duty this weekend. Your mother has had a stroke. We're not concerned about her heart." ???!!!

The next morning she wasn't even in the room. It turned out, when I finally tracked her down, that she had been a-wandering so they'd transferred her to a bigger ward with more people watching. It worked, too, mainly because she was too terrified of the other stroke patients, poor souls, to leave her bed.

All I can say is if you ever find yourself in Bedlam General the only thing you can do is keep guard and get your LO out of there at the earliest opportunity. But I don't think Gabbi's NH is as far gone as this; and also, to be fair, the one inexcusable thing I saw, the only one that couldn't be explained by simple overload, was the behaviour of a student nurse. Probably an undergraduate trainee - they all have to get degrees now. You can't just be good at looking after people any more - she had been told to observe. So, fair enough, she wasn't supposed to be doing anything useful. What wasn't fair enough was that she was sitting in the direct line of sight of a patient who was constipated, confused and in terrible pain. This patient could not understand why the nurse was sat there like a tin of milk and ignored all her appeals for help. I couldn't understand why this young lady thought it so crucial to her academic purity not to explain. Not my business to intervene. I just sat there beaming thoughts at her e.g. "Sit. Somewhere. Else. You. Callous. Little. Cow." Her and her bloomin' clicky ballpen. She'll never know how close she came to getting it rammed up her nostril.

I'm not sure how much things have changed, I suspect it's mainly the job titles and the names of the qualifications, rather than anything substantial. We used to have SRN's and SEN's, now we have RGN's and Health Care Assistants. And there still are fabulous nurses, and yes I would say the majority, at least when they're given half a chance, and then there are unfortunately a few who are thick, idle or even, frighteningly, sadistic. What seems to make the real difference is the extent to which a given organisation gets in the way of their doing their job, which is mainly a matter of leadership calibre and culture, but I think that's always been true. Though I agree that regulators' getting the bit between their teeth is bad news for almost everyone with an interest in a functioning system.
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Nursing homes are FOR PROFIT facilities. They limit their outlay of money by skeleton staffing, doing as little as possible for the residents so they don't have to spend one dime on anything, i.e. eye patch, eye medication, speech therapy. They also don't want to send anyone to the emergency department, because then they risk losing reimbursement for the bed if the person stays at the hospital for longer than a certain amount of time.

Not sending your father to the emergency department at a hospital when the facial droop was noticed is negligence. That is a drastic change that should have been diagnosed & treated by medical doctors in the hospital. The people at the NH have no right to try to diagnose what your father had/has without the proper tests & workup that a hospital would do. Unless a head CT scan or MRI was done, they could not possibly diagnose a TIA. Plus, there are usually no sequelae like a facial droop or speech problems after a TIA. TIA means "Transient Ischemic Attack", which means that there is a decreased or blocked blood flow to a part of the brain that is transient----the blood flow returns after a little while, leaving no permanent sequelae. When the TIA is happening, there may be memory loss, facial droop, speech difficulty, etc. A stroke, or CVA (cerebral vascular accident) causes permanent problems.

Even if your father has a DNR order in his records, that does not mean DO NOT TREAT a treatable condition. A DNR doesn't mean that a person does not get sent to the hospital emergency department when something happens to them.

For the NH to be dragging their feet on this is negligent. I would write a letter to the administrator, cc'd to the Director of Nursing about this incident, what your sister witnessed & what you witnessed when you went there, their lack of interest to do anything about his eye & his speech, and your dissatisfaction with their facility. Send it certified, return receipt mail----it gets noticed this way. I would make sure to include in the letter that what has happened is a state reportable incident-----that is the very last thing a NH administrator wants, a complaint to the state about improper and negligent care. Unfortunately, that is pretty much the only thing that will change anything. Otherwise, they'll yes you to death & not really do anything.

Who is your father's health care proxy? You say that your sister is DMPOA---I'm not sure what that is. Usually POA has to do with finances. A totally separate health care proxy is usually necessary.
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A DNR is just that do not rescitate. It prohibits any one from taking emergency actions to keep the patient alive such as CPR, IVs, tube feeding etc. It does not mean that treatment can not be taken for the patient's comfort like pain relief. If the patient can not swallow due to a stroke they can not be fed. The POA should have been notified and made any decisions regarding his treatment.
A HCP ( healthcare proxy) is a totally different animal, this gives the person named the right to make decisions regarding the treatment of the patient according to his wishes at the time he gave the PCP.
Accoding to the Original poster it does sound as theough the staff at the N/H did not act as professionally as one would hope. However with out the full story we can not make a diagnosis without information. We don't know if the symptoms subsided or how long that took. It may sound like a stroke to the above poster but none of us was there so all we can realistically do ask questions and point the poster to any help we know about
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My MIL had a TIA in the nursing home. She is on hospice and has a DNR SO THE JUST DUMPED HER IN THE BED(she refused to get out of the Gerry chair up to that point) and didn't medicate, feed or hydrate her for three days. It was like whoo hoo. One less to worry about. In three says she came back 100%. I changed the terms of her DNR. You can't expect the nursing home to make those choices for you. They will do what you say only if you say. Whoever has the POA must be diligent. If you can't do it you need to assign it to whoever can or will. It's a big responsibility and sometimes a lot of work.
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CM sad to say this is 2014 in the USA not 1960 in the UK where there was a Sister on every ward or floor who was there every day and knew what was going on with all of her patients, backed up by one or more staff nurses so there was always at least one RN on duty during the day who knew what was going on with each and EVERY patient. Nurses Aides? they did not exist in those days they were called student nurses who did the grunt work.
These days in the US if a nurse tells you that "his vitals are fine" it is because she has looked at the chart not because she has taken them. An Aide will run round the whole floor popping in and out of patients rooms taking the equipment with her and taking the vitals as fast as she can. A RN at in determinate intervals will listen to the heart and lungs maybe the belly and if you are lucky check for swelling in your feet.
The main problem in the USA and this applies to the medical and nursing professions is that no one is in charge to oversee the whole picture. Each PCP seems to deal with the simple things then ship you off to a specialist who does his bit then passes you on to the next one. It is very frustrating for both patients and relatives. HIPPA laws make it impossible for anyone except designated people to have the patient's illness discussed.
I realize that times have changed and most female hospital staff have famillies at home claiming their attention. It is a whole different world and basic nursing care has not changed for the better.
Please put me back in my box.
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You've received some excellent advice above. To sum this up from our perspective, having been runragged by somewhat similar circumstances:

1. Your dad likely had a stroke, not Bell's Palsy or a TIA, as the symptoms lasted more than 24 hours. Not a neurologist but see enough of them to know the difference. He needed to get to the hospital by ambulance before your sister found him that first time. If it were us, we'd insist upon that right now. If your sister has the medical powers then talk it over with her, but if you want intervention for your dad, that did not occur. If you (or your sister or your dad in his medical proxy statement) marked DNR, then it sounds like the facility acted as requested. However, if you or the family want medical intervention, the time to get it has gone way past.

2. Call an experienced nursing home abuse attorney immediately. The lack of care in the home - not recognizing an obvious stroke - caused permanent harm to your father. Their only defense will be a DNR order on his chart if one exists.
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The eye infection is not life-threatening nor could anyone have predicted his TIA. Staff does seem ineffective, and I would discuss his care with your sister who holds the MPOA. She may feel that his terminal diagnosis doesn't warrant much intervention and his previous instructions may have been a DNR (do not resuscitate) order. Without your sister making the demands, just visit your father and love him. A patch would only impede the healing process, better to let the antibiotic work and oxygen get to it. Best wishes.
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I too wonder where your POA-holding sister is in all this, but actually that is a side issue. You don't need POA to hold staff accountable for the standard of care they're providing.

And it does indeed sound shocking. I don't blame you for feeling frustrated and anxious about your father's vulnerability. Why don't people do their d*** job? It's so disheartening.

But what can you do? You need to speak to your sister, because although you've every right to act as your parent's advocate it'll carry more weight coming from someone who has the authority to, for example, move him if necessary (unlikely to be a good idea, but at least it is an available, albeit nuclear, option). You can compare notes with her and see if this casual approach has been the norm, or if previously the NH has been satisfactory; and agree between you a strategy for getting the place to pull its socks up - starting yesterday.

It's a pity you're two hours away. I know it's doable, but it still means that every visit takes most of a working day, and I know how difficult that can be to manage. Is your sister any closer than that?

Because the price of good care, sometimes, is eternal vigilance, combined with the time and patience to sit by your father like a little beady-eyed watchdog and gently persist in calling attention to his needs. Stamping and shouting are counterproductive (if temporarily a relief!), but polite, smiling, broken record techniques will eventually wear away the rough edges.

Tsk. I wonder what they mean by 'vitals'? Blood pressure, pulse, respiration, temperature - did anybody actually look at the poor man himself? I'm sorry, but I'm just heaving a sigh here. I don't know where you have to go to find a corporate culture that gives good professional people the time and workload they need to look after their patients as they would wish to.

Meanwhile, go to your nearest pharmacy and ask them for sterile dressings, telling the pharmacist exactly what they're for. Take them with you to the NH. Do NOT attempt to apply one: not only are you unlikely to manage it cleanly, unless you're trained in these things, but also there may be medical reasons for leaving the eye uncovered that you're not aware of because nobody's bothered to mention them. But then once you're there you ask again and unless there's a good reason not to they can crack on and get him comfortable.

Goodness me. I feel for you, I really do. It makes you want to weep.
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