My mom has too many overwhelming medical issues to be a candidate for surgical repair of a hip fracture. Early on, we were told the hip would eventually "stabilize," and if she was lucky, would stop producing pain. The ortho specialist has been having the hip x-rayed monthly, and continues to tell us it's "not healing," but he hasn't given any direction to her nursing team at her nursing home, nor explained to any of us what is to be done to try to get it to heal. Actually, we thought that it was already a forgone conclusion that it WON'T heal, since the two broken parts cannot be put back together without surgery. Is there a different meaning to the word that I'm not getting?? We don't understand why he's monitoring it with x-ray, but appears to have no plan of action. When we asked what to expect, how this is likely to play out, he mumbled something about not seeing too many of these cases (hip NOT surgically repaired), as most people have surgery and get it corrected. I have asked her nursing home about getting a second ortho opinion, hoping to get some direction from a doctor who HAS seen this scenario before. My mom has been on bedrest 24/7 since the hip fracture, so now has bedsores on her heel and both calves. One of the calf bedsores is very deep, and into the muscle, and is draining and (despite antibiotics) clearly infected. The heel tissue is necrotic, but hasn't sloughed off yet. It is LARGE. I am sick, scared, and confused, and not sure what to do to help my mom. I am pushing for her to be sent to a wound care specialist, and also to have a bone scan to see if the rest of her bones are as fragile as her hip bone apparently is, in addition to the ortho second opinion consult. Suggestions?? Anyone else been through this with a loved one?
okay, in case you don't read through all that - I'm hoping you'll skip down to this - PLEASE let us know what happens with wound care -
that was the worst part of what happened with dad - even with him being unresponsive he definitely responded to the pain from that because, yes, he definitely went through the same thing as far as the debridement - his tissues were definitely necrotic - but now, having said that, not entirely sure he was actually having debridement on necrotic tissues because seems like the necrosis came later after he'd been in the icu bedridden for a week but thinking they had one of those air mattresses on the bed in there and that he had the other stuff although his necrosis was mainly on his foot but hadn't sloughed off; what they were telling me would happen; don't believe anything about his calves; his main wound care was his back, which was draining - another thing -
ASK WOUND CARE - about microbial pads - that's what they used on my dad's draining back but they said they were a sample that had been given them by the company to try - not sure but what they said dad was the first patient they'd had to use them on and they loved them - they don't have to be changed as often - they're much more absorbent - so that they're not nearly so painful - BUT - they are more expensive for a hospital to buy - and hate to say, so don't know if Medicaid would be a factor or not - dad wasn't on it, but then like said they were samples anyway, so not even sure if the hospital decided to start buying them or not anyway although I did tell the CEO how so good they were - but would be so much better for your mom so PLEASE at least ask about them - and if they don't know what you're talking about please feel free to msg me or something and I'll get in touch with dad's hospital and find out more about them;
not really sure dad's back sore were actually that deep and down into the muscle but they were still painful enough - can hardly imagine what your mom may have to go through - but then actually not really sure he really was having to have actual debridement then - that may have come from yet another earlier incident where he fell and cut his head when we went to wound care on an outpatient basis and pretty sure they did then - would go in and pick out where it would be beginning to scab over, etc. but that wasn't nearly like somewhere where it would get down in your muscle, although even then it was painful enough, at least seemed to be at the time, but nothing like the back deal later that wasn't even like that but with the back he was having to be turned - and was being - every 2 hrs. - and even that was painful even when they didn't do anything else -
so are they even saying anything about the hip at this point at this new hospital or has that been "overtaken by events" as my husband would say?
but to go back I think they were trying to be careful at that point re pain meds especially with him being unresponsive otherwise especially because at that point they were still hoping he would come out of it even though it had been well past the usual 72 hr. time period by like probably double at that point; like said, had been a week, which seems to be why, at that point, they started talking about palliative and hospice and keeping him comfortable but also like said earlier we - well, I - somewhat based on things dad had already said based on his other earlier known conditions - which sounds like you didn't already know about these other chronic health problems they've found your mom to have, which we'd found out about them with dad 2 yrs. before - were past fighting mode -
having said that I was in your position - although not the exact same issues - with my mom with her hip - she wanted to fight so as long as she wanted to I fought right alongside her but...
my heart goes out to you with this wound care stuff though - it was bad....but necessary if she wants to get well - but maybe with palliative working with wound management on pain management she'll make it through and everything will now work out - hope so for you both -
let us know
As far as pushing the nursing home to act: put your demands in writing and send it certified mail to the nursing home. Report them to the agency that supervises nursing homes in your area for the pressure sores. Kick them where it hurts and keep kicking until you get what you need for your mom. They can kick you out I suppose but maybe that's not a bad thing. Bed sores are unacceptable. Start laying down a trail of paperwork. Every conversation should be in writing. If they only talk to you, the YOU write a letter back to them saying what they told you and insisting that if the letter is incorrect they send you written notice. iN other words, get your self prepared for legal action. Prays for you and your Mom.
I would also be requesting a care conference to discuss a thorough plan of action and contingency plans. If would help if you have another family member or friend, just to even out the numbers. Sometimes there are so many staff members they outnumber the patient's representative significantly.
Make lists of issues, proposed action, who will be taking it, interim results, and alternate plans of action. Put them on the spot, gently but firmly.
I don't at all like the sound of your mother's bedsores or what I would consider negligence in allowing these to occur. She should be on a rotating pressure mattress and turned regularly and frequently. Or they can put inflatable calf cuffs on her lower legs.
I would find my own doctors, getting referrals from someone you trust and not rely on the nursing home. Try to find a reputable wound care specialist as well as an ortho doctor for a bone scan. That's a good idea to determine if anything else is going on.
Nonoperable hip fracture: If there are multiple other issues, I can understand that surgery would be dangerous. I'm not a medical person, but it seems that if the fracture isn't set, it would heal in the position it's in. But i don't have any experience on this issue. My mother was, however, on nonweight bearing status for 6 weeks because of the nature and position of her fracture. It's been about 15 years and I don't recall what kind of PT she got, but if she did get it, it was in bed.
If the fracture isn't healing, the consulting ortho doctor should at least advise you what will happen. I'd search for someone outside the nursing home and get a second opinion.
I think sometimes it's easy to feel that the doctors at the rehab facility can be relied on and you don't need your own doctors. We learned quickly that's not the case. (I also caught one defrauding Medicare; we documented, I reported him, and Medicare eventually did concur with my finding.)
And BTW, I'd be documenting all the conversations and interaction you have with the medical staff. I hope I'm wrong, but I see problems on down the line.