Grandmas has a pressure sore on heel. Any advice?

My mother who was diabetic had pressure sores on bottom of her feet, one on the heel and one on the uppper pad. After months and months of treatment, the foot clinic at Mercy Hospital in Chicago developed a new skin to treat the sores and it totally healed in about two months. She also had some blackened toes that also healed over time. She lived without sores for another 10 years and passed away at age 93.

I would have the other elder relatives questioned the aunt about putting GMA in the nursing home and then stopped visiting. The staff noted no family visitation and therefore no need to be careful with GMA. She had no one to advocate for her care. With their attitude about her blackened leg, the staffs inaction reflects that they're there for the money. No need to go out of their way to improve their client's care. One goes, another will take their place. To me, with GMA'S approval, I'd move her to a closer nursing home. Then, I will see what I can do about alerting people of what happened to GMA at that place. People Google a lot. I just did on my brother lastnight and found some very detailed information on him.

FYI, after one month stay at our only hospital on this island, when it was time to change her pampers, oh my!!! She was on the foley the whole time she was hospitalized. When I opened her pamper, she was super red, painful even for the water to dribble on her private areas. When we turned her to clean the butt area, she had this hole on her right butt!! We panicked and called her home care nurse. It took months to finally stop the hole from going down deep and then to heal. One patch of Duoderm cost $10. We spent over$100, cutting it into smaller pieces.

Just went through something very similar, but with a cut mom received while at rehab for 2 months and they never noticed? I found it the day she was discharged when putting on her shoes and socks! They wanted to amputate at the hip region...I refused though they didn't want to stent at the time I went over the vascular surgeons head to head of surgery and they ended up stenting for blood flow to her legs.....try the wound care first...debriding, antibiotics... talk to her doctors about stenting her legs..yes they say it is high risk with GA but they will have to do it either way....mom's turned out great! Just have to keep an eye out for any infections...it's sad that we have our loved ones in facilities that are supposed to be experts at what they do that employ up to 100+ people but they miss the easiest things.....why do they not notice when dressing her everyday!!!We have to be the advocates for our family members and do checks as often as possible!Also small pillows to relieve the pressure while in bed.Good luck!

Contact your local long term care ombudsman and make a formal complaint regarding the care of your grandma. I'm so sorry this has happened to her, it's not right. good luck

CentralMA, thank you so much for posting about a good outcome! It give me hope to hear your story. Yes, debriding, family started to question why that wasn't happening, (and why no antibiotics), when we all started to understand that this thing was getting worse, lots worse. The nurses at the home and the Dr. that does weekly rounds there all refused that idea, (said it was "too early" to do that). Seems like a black, necrotic, 1-1/2" hole in a person's foot would need to have dead tissue out to heal, just common sense. I just don't understand what the refusal to get some basic care has been rooted in.

Moondance, yes, the term osteomyelitis is exactly the term the MD in the family used to express what he wanted her checked for. She had her 1st appointment at a wound care facility a few days ago. They debrided and pared and put her on Keflex. Shot Xray, thought it was definitive from that that the infection was not in the bone, so did not do MRI. (That's the only question in the back of my mind right now, wondering if the wound care Doc is speeding through "step therapy" in order to justify getting on a more aggressive coarse.) Dr. there ordered a recheck with her at 7 days, angiogram on that same day, recheck in 14 days so far. So looks like someone is finally being responsible! She also ordered a specific wash, wrap,
boot, and care routine to be followed at the nursing home. Auntie has been checking in every day, has found that they are NOT doing it unless pushed by her, so far. At least the family is finally all aware and working together. A move will likely be in order after trying to gain some ground by working with the wound care specialist for a few weeks. Smoke still rolls out my ears now and then about this, but yes, gaining ground, (if it is possible), getting GMA situated, top priority. But I do want this reported so they think harder about letting it happen to others! Thanks all!

That is the purpose of the Duoderm patches. They are suposed to slough off the dead tissue. Many people want them changed more often than every 7 days because they can smell but it is important to let them do their job then the sore can be cleaned out of the dead tissue and a new patch applied. This is not a fast process and the sore will heal from the outside in. When you see some bleeding during the cleaning process that is a good thing because it means the healthy tissue is begining to regenerate. Another alternative is to surgically clean out the sore and apply a skin graft but this is risky because the circulation is probably compromised and the graft will not take. Whatever means is used the pressure must be kept off the area at all times. Best thing is to prevent the sore in the first place but this is not always possible whatever the lawyers are quick to tell you. I have seen sores develope even on the ears and noses of dying patients. It only takes a few hours.

Dear New2this: My mom had one of those (ugly, black, huge) sores on her heel. It was towards the back. The nursing facility where she was staying started a thing called (de-breeding) not sure of the spelling, and they continued this for several months until they got the sore under control. After they got it so that there was just a faint red mark, they put a "bootie" on her foot so that it wouldn't rub on the sheets when she was in bed. Also, the "bootie" was kept on during the day because she could no longer fit in her regular shoe with that foot. They wanted to keep her foot from getting irritated. This worked great, but without the process to get rid of the black, dead skin, it would have been much worse, maybe even an amputation. I thankful that they were able to keep it from coming back. I would ask about this procedure if possible before they do something more drastic. Good luck with this and keep us posted on this site if you can. God Bless.

Yeah, watch those nurses. It was like treading on egg shells around them. I know they are overworked, but one of them would start loudly yelling to Jesus if you even asked for the smallest little thing. This seemed to either puzzle or amuse the residents sitting around in their wheelchairs. Some other nurses would get looks of dismay on their faces if you even walked past the nurse's desk. There was one good nurse there that was truly helpful and concerned. Try to find a nurse you feel you can trust and build some rapport. That is the only thing that got me through that awful nursing home time.

If there is any way possible go get her and bring her to a facility close to you and others willing to look in on her more often. Second, call the nurses station often to check on her. Get daily reports so they know someone is watching. MIL is bedridden and Iake sure the keep those heels off the mattress. They have a foam pad they slide under her ankles and her heels are suspended above the bed. Next, make sure she is on a "gel mattress". It looks like egg crate and it will keep her from getting sore on other spots like her spine. Don't ask for egg crate. They have an affinity to terminology. Call it a gel mattress. I went round and round with them until I stumbled on the right terminology. Last, try not to waste your energy on anger and revenge, even though it's warranted. Focus that energy on finding solutions. Be nice to the nurses and aids. They only have two hands and very under paid. Honey will get you farther than vinegar. God bless you. I know this is hard and unfair.

The trial lasted for six months, the longest criminal trial in Texas. Although the victims in that case died in a nursing home thirty years before my father's experiences, the neglect and abuse are horribly similar.

Good for the state of Texas to take that nursing home organization to trial!! If more of that would happen all around the country, these places might try to get their act together. I am so very angry at the lack of compassion these places often have. If they put half an effort into taking care of these older people that they do in self promoting or trying to profit for little effort, things would even be better. I have to wonder about places that treat humans worse than many places would treat our pets. Maybe someday these people will age and be treated badly if Karma comes around.

Medically speaking~is it osteomyelitis in her heal~infection in the bone?~Diabetic, gangrene, neuropathy?? The list goes on.....

I hear you're justified anger. May I validate that for you please. The most important issue is to have her taken care of or it could get worse, speaking from years of experience in the medical profession.

I want to reach through this machine & strangle someone now!!!! This did not have to happen...I feel angry now.
Not directed at you~~I so understand...
The rest can be dealt with as soon as she is better, hopefully.
Focus on her now.
You sound as if you have a great support system.

Start to documentate all you can, calls, paperwork, any communication you can obtain. I have found in the past going to a state representative, get immediate results, but I went in the form of an advocate for mentally ill patients of mine.

Death Without Dignity is a book about the State of Texas taking a nursing home organization to trial for murder due to neglect and abuse. Decubitus ulcers was a recurring theme. I read the hardcover edition, but the author made it available on e-book in 2013. Several times in my own book (http://www.amazon.com/Before-Door-Closes-Daughters-Alcoholic/dp/1490808949/ref=sr_1_1?s=books&ie=UTF8&qid=1424542028&sr=1-1&keywords=judith+hall+simon) I talk about battling the nursing home regarding my father's pressure sores. One of the things my personal research turned up was to provide him with a genuine 100 percent sheepskin pad for his wheelchair.

New2this. I completely understand your anger! My 92 year old Mom fell last summer and broke her arm...was sent to a 5 star medicare rated facility for rehab and in that awful place developed a stage IV pressure sore by her tailbone.She had a UTI that the idiots couldn't figure out, and they left her lying in bed for days. The uncaring physical therapist there kept telling me she had sundowners and that "old people get that way" when I tried to tell them her behavior was not characteristic of her! Mom was never diagnosed with Alzheimers or dementia and to blow off uncharacteristic behavior by saying that old people just "get that way has me livid. She was finally rushed to the hospital with delirium from the UTI they ignored, and I was told about the wound from the intake nurse at the hospital. I was stunned. Needless to say I never sent her back there and she is now at home and has a nurse and goes to a wound clinic. I did complain to the state health department...but if they go in there and don't see any problems later it really didn't vindicate anything for me. I saw they have a very huge lawsuit about something from someone else, so I am thinking that is going to be their comeupance for what they did to my poor mom. I wish you and all your Grandma's relatives the absolute best in this. These places should be held accountable!!

My husband who is in a residential care facility developed a pressure injury (DTI) on his heel. The visiting nurse explained it would eventually open up and become infected with possible dire results. I was not satisfied with that prediction so I took him to a wound care center immediately where he was properly treated and completely healed within 5 weeks. He still wears heel protectors on both feet to prevent future DTIs. I understand your anger and feel badly for your grandma but my response might enlighten others to the frequency of these pressure injuries. I didn't have a clue when this first was discovered - actually by the visiting physical therapist while I was there. So - be aware.

I will NOT make excuses for incompetence or lack of ethics. There are very good caregivers out there but just as many if not more who couldn't care less and are only there to collect a paycheck. The Senior Care industry is rife with incompetents and criminals, just as much if not more so than any other industry.
There are special padded booties which have a Velcro closure and are available everywhere in the US. These should have been put to use with your GMA from the first sign of irritation. Antibiotics, angiograms for circulation and coconut oil, ointments should have been used. Since she is not diabetic there is little excuse for this having progressed this far. The reprobates can no doubt charge more for amputation and subsequent treatment than prevention. It all comes down to the money and our Medicare/Medicaid tax dollars going to the wicked in this corrupt industry.
May they all reap what they sow.

New2, what I'm always being told (I have a short touch paper) is to remember that people are almost never setting out to be careless, or stupid, or grossly negligent, or any of the other bad things we're bound to suspect when we see vulnerable elders coming to harm. A$$-covering does go on, true, but it's too much of a leap from that to being certain that no one ever bothered so much as to check on your grandmother's heel, or that they just sat on their hands and did nothing nothing nothing while it deteriorated. There are so many potential communication breakdowns and innocent mistakes at work: the HCA who sees that the wound needs treating but doesn't know what to do or who to tell; the nurse who cleans and dresses the wound but then goes on vacation or maternity leave the following week and her notes don't get seen by her cover; the well-meaning but fat-headed visitor who removes and replaces a dressing to be 'helpful' when that dressing, however taggy-looking, needed to stay in place for a requisite length of time; etc etc etc.

There's the simple fact that pressure sores are notoriously difficult to heal, and the equally simple fact that the amount of plain time required to keep an elderly immobile person adequately hydrated and mobilised is astronomically expensive and does not compute in the typical residential setting… And that's before you add in pre-existing conditions or antibiotic-resistant infections or untoward 'events' that aren't necessarily blameworthy… It's such a can of worms.

My mother's 90, too, and I've just three weeks ago brought her home from rehab post-stroke - she's paralysed on her left side. Her heels, big toes, sacrum and (?!?) ears were highlighted by the rehab centre as at high risk of pressure sores, so I've learned to rotate her position, moisturise her skin, check for blanching at regular intervals and cry for help if in doubt. So far so good, and her skin condition is improving. But here's the thing. I HAVE got all day to make her drink, waggle her legs around, stick my head under the bed covers to check on her behind, change her incontinence pad the second it's wet. I've got just the one patient to concentrate on, and I'm here 24/7 with home aides coming in daily to help. The moral is: if this is what it takes to get one step ahead of pressure sores, then what's the cost of one-to-one care?

And if or when my mother does eventually develop a pressure sore in spite of all that, will I still be blaming myself? You bet I will.

new2this, for now try to focus on getting GMA repaired and healed. Keep an eye on the other leg, because with her circulation failing, the other foot and leg are in jeopardy. That means written orders from an MD for checking extremities and immediately reporting any changes. Sorry for GMA, hope things get better.

I'd be worried too. Joint commission on the accreditation on nursing homes should be contacted. Also grandmas local and state representatives. Senators, congressperson. Local print/broadcast media who do consumer affairs and health reporting. For tour own sake, don't be angry. It's much better for your blood pressure and cortisol levels if you do this gleefully.

Babalou, it's listed as a private nursing home, for profit, chain. Medicare ratings at have their over all score at 1 of 5 stars. GMA is happy, compliant, competent. She wound up getting the sore from being left in a wheel chair all day after she fell over some equipment and hurt her hip, said it was too painful to walk on. They looked her over, decided she was fine, but she kept saying the hip really hurt and she wanted an x ray. After a month of her being unable to walk and asking to get the hip checkout they finally did do that but found nothing broken. Ughh, this is one tough lady, if she says it hurts, it hurts. I'm so sorry about your GMA, and I'm sure too that if my GMA had been able to move around this would have healed too. But left sitting there all day with it having pressure against it only made it worse.

Guess I just don't understand. Do they get bad marks if the people need to see a Doc other than the one who makes rounds once a week? Why would they do that? Almost seems like something is being covered up, trying to hide the fall, or pressure sore, or fact no one had time to do the care on her chart, or did she just fall through the cracks? I'm sort of worried for the other people there now.

Your anger is certainly understandable. In due time, you SHOULD write letters to the various licensing agencies in Wisconsin. BUT, is this a nursing home or an assisted living facility? Or an unlicensed rest home?

My grandma died of gangrene; my aunt clipped grandma's toenails to save the expense of having a podiatrist do that. Grandma caught pneumonia and a small nick that would have healed had she been up on her feet turned gangrenous. That's the cause of death on her death certificate: gangrene.

I'm not excusing anybody here, but the frail elderly are prone to all sorts of bad stuff happening because their bodies can't repair themselves any longer.

You might also want to ask if GMA is competent and staff was asking HER what she wanted, she may have refused treatment.

Not trying to say that you're wrong, but if you decide to pursue this, you will hear many different sides to this story, no doubt. Hope grandma is doing better!

Thanks all you are right as usual. Anger a waste of energy that should be spent staying positive and encouraging GMA right now.

I guess I equate the poor little people in there with babies and pets, they're completely reliant on others to do the right basic things. After spending my life fostering, donating, volunteering to help and rehome abused and abandoned pets I am still surprised when I see a wrack of bones near death over a few cents and a few minutes a day. I guess I feel mad that people would understaff this place like that, leave helpless people sit uncared for just to try to keep the $ for themselves rather than spend some on care. I've sure heard of understaffing at hospitals, some bad stuff from family members in the field, it always goes back to the owner's greed. I sure didn't know that her "owie" was getting like that all those months, but they did, and they watched it, and let it happen. A lot of the care on her sheet was skipped, (not done), as it got worse. Their Dr looked at it last week and said to change wrapping every 3 days, he'd look at it in a month! It's necrotic, it smells, it's to the bone. If older family members hadn't driven the 8 hours up there a couple days ago and talked to that Doc to get the order to send her to wound care an hour away she probably would have sat there and died. Surely the staff knows better than this. (?)

So sad and so unfair but pressure sores do easily develope in the elderly and you have shared that the circulation in her lower leg is not good. You are so angry and looking for someone to blame and negligence may well be a facter on many levels but such emotion does not allow you to think clearly and find the best possible care for grandma. As CM says and I greatly respect her common sence set this aside and consolidate the considerable rescoures your family has and get the best possible care available which may need moving this much loved lady to a first class medical center which could be expensive. think about the next step very carefully and decide what the next best thep may be and how well your loved one will tolerate it mentally and physically. the loss of a limb to a healthy adult is devastating but to an elderly wheelchair bound person the pain relief obtained may be worth the loss of a limb hard as this sounds. But Grandma comes first. you can decide later if you really want to put the N/H owner through h*ll for the next ten years and put your own family through financial and emotional turmoil for the same length of time.

Um. I understand how angry you must feel, but for the time being prioritise your grandmother's treatment, documenting carefully as you go. Once she's been treated, and God willing has made a good recovery, if you're still incandescent with rage you can think about who to sue - or, more usefully, report to the regulatory authorities.

It's a question of what to spend your energy on, you see. First things first, get her better. Have you spoken, by the way, to your grandmother's own doctor?

My dad was not diabetic either.
He had a blood clot that was NOT diagnosed in spite of various ER visits.
He had gangrene develop and very quickly grew on his foot.
I was filled with anger, but as my story progressed, I had to chose whether to focus on recovery or "revenge".
He went to ER again various specialist later they wanted to set a stint to prevent clog from going to lungs, then dependent on the circulation, proceed with the amputation. Dad was 89, his circulation below the knee was minimal, the doctors wanted to take the entire leg or at least to the knee. I wanted them to do the least. I knew at his age, any more than the foot would kill him from depression, he needed hope to walk again. I advocated, I pleaded, I prayed and I stayed in the hospital room until I spoke to every single doctor. They amputated half of his foot and scrapped/ removed his heal almost to the bone. He was none weight bearing for close to a year but he worked out every single day and by end of year he walked again.
I will not lie to you the post op year was rough, anesthesia and morphine can make the elderly very batty and combative, but we got past that her recuperated mentally as well.
He lived another three happy years. I can only imagine how guilty I would have felt if he had required and not survived further surgeries, but I really felt he would have made that choice himself....BTW he was cognizant, but afraid and he asked me to decide for him.

I share this in detail, because there are some similarities and I had a happy ending


Advocate for her the best you can, these things are very complicated and you never know how they will work out....the only measure of success is that she know you love her and you are in her corner.

I wish you and your grandmother the very best.
L

new2this, so sorry for your GMA. I know you feel grief and guilt for not being able to do more. Maybe if you had lived closer you could have done more.
As far as the lawsuit, you would need firsthand knowledge of some sort of neglect, documentation that you saw this and you told them and they failed to use due diligence. Too late. All the money in the world won't bring GMA back to good health. Just be closer, make her comfortable if you can. That is what she really needs now.

Thanks Captain, I wish it were so. GMA isn't diabetic. She had a fall last summer, hurt her hip though didn't break it. Basically, she was off her feet more than normal for a few weeks, and a little sore began on her heel, due to her sitting in a wheel chair. The idiots at the Manor ignored this, as it went from small red spot, to ulcerated pink owie, to black owie, to, GMA needs her leg cut off. OMG. She has a large, talented, extended family, and I will see to it that all our talents are used. Sorry, don't mean to sound so negative to you, I know you are a good guy and a friend, ...I am sorta pissed about this at the moment. Wow. (?)

the sore may be diabetes related and a natural progression of an illness .