My mom has fallen at the nursing home twice, I don't know what to do. - AgingCare.com

My mom has fallen at the nursing home twice, I don't know what to do.

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She was given gabapentin, without me knowing. I do not have POA, but I talk to her every day and see her on the weekends as she is 60 miles from where I work. She used to take tramadol for pain with no side effects, the doctor (who I have never even seen) ordered gabapentin for pain. It caused her to become extremely drunk, cannot stay awake, then she began seeing things that were not there. At her cardiologist she saw pumpkins growing in the parking lot, in her room she saw people who were not there, someone reaching for something, etc. She fell once 2/18 then again on 2/20. The last time she got a black eye, a huge hematoma on her head and cuts to both of her arms. She has a huge bruise on her right breast from the first fall. I was told the gabapentin was dc'd on Tuesday, but I found out yesterday it was not. I am waiting on the Nursing Director to call me as well as Quality Assurance. She is there for therapy only, she does NOT have dementia. She suffered cardiac arrest on 1/22 after her potassium crashed to 2.1 and after I had requested she be tested for a UTI as she had not been feeling well all week. I am afraid they are not watching her properly! I don't know what to do, her 100 days will be up 2/28 and now after the fall I am afraid she has had a set back. She was GREAT last week when she saw her cardiologist!

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Thank you rocketjcat, I am keeping an eye on the hematoma as it too is not going down. She is having the pooling all the way down to her chin and both eyes are not black and blue and many other colors. She has what looks like a scab on her hematoma. She goes to see her primary doctor on Monday afternoon.

They had her on 400mg of gabapentin, which I agree, everyone reacts differently. If everyone had hallucinations as my mom did, I am sure that med would be used differently or not at all. She didn't react well, but no one seemed to pay attention. They literally blamed her for her falling!

She is already set up for nursing home care and therapy as she is being discharged tomorrow. Her insurance will not pay past Wednesday. Her primary doc will set her up with more home care for showers and such.
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Reply to filly1969
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Just a note regarding the bruising....My mom fell and hit her head similar to yours. Huge goose egg on her forehead, next day the mammoth black eye with blood pooling. I know it’s horrific to see this! The black eye eventually dissipated and turned greenish and then yellow within a week. The goose egg never bled but developed something like a scab and didn’t shrink down. After the LPN didn’t like the look of it, she allerted her Nurse Practitioner who agreed, and summoned a wound specialist. She put medicinal honey on it for 2 days to open it up, then removed the large blood clot. It healed completely in a few days. Amazing. She said the blood clot would never have disapated. So I’m just offering some things to watch for, if the goose egg doesn’t look like it’s going down.

Regarding the meds, you didn’t say your mom’s dosage, but Mom had been on low dose tramadol (100mg) and gabapentin for nerve pain (400mg) for years without side effects. Gabapentin is used for more than just seizures. However as she aged and lost weight, we thought the combo might be contributing to her extreme sleepiness, so we’ve cut back the gabapentin down to 200. We may go lower as long as her arthritis pain doesn’t increase. She also started on a low dose Zoloft and started to "see things" like your mom did. After ruling out UTI, I ordered the Zoloft stopped and the hallucinations stopped too. It’s so hard to figure out the side effects of medicines/combos as they can effect everyone so differently. It’s imperitive you stay on top of her meds and their administration.
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Reply to rocketjcat
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Thank you all for your comments, concerns and advice. I called DCF over the weekend, the nurse supervisor was basically downplaying the medication she was on, "it was JUST a nerve pain medicine", "She was ONLY on it for three days", etc., I told her it is a SEIZURE medication! My daughter was on Depakote and Klonopin for seizures and they knocked her out so badly the teachers thought it would be a good idea for me to have her put on Ritalin! Of course her Neurologist said absolutely not! I asked her "Can you tell me that it is completely impossible for my mom to have hallucinations on this med or any other medication?" She said NO...duh! The DCF investigator was shocked to see her face, I wish I could share the pictures here, the blood is now pooling down under her chin, she still has a goose egg bump on the side of her forehead. She is bruised on her right breast, and left hip that I know of, she has a cut on her left arm and abrasions on her right arm. Now the nurses are coming in every time they hear something to ask her if she fell...over kill much???

I am going to call an attorney today, someone who seems to have very good reviews in my area. I pray this is the right way to go. So much to think about! I hope I don't lose my job, my supervisor told me last Wednesday "You need to do something with your mother so you can go back to school, have your brother take care of her"...as if I am thinking about school right now. My brother lives 1500 miles away, he has a small child and a house to pay for, plus a rental house. What is wrong with people??? I asked him what he meant by "do something with her" Do I euthanize her? Sell her? Are you kidding me???

All I can do is shake my head!
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Reply to filly1969
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Filly, I've just skimmed through the other answers as opposed to reading them all, as I typically do, so I don't comment on something others have already. But today I don't have the time, but I did want to share a few thoughts as I felt my blood beginning to boil at the lack of proper care your mother is receiving.

First, I think the focus now is twofold:

1. Getting her out of there and into a reputable place ASAP, and
2. Figuring out a way to get a Medicare extension.

1. Make a checklist of things to look for in a rehab facility; contact the local or state ombudsperson and find out which rehab facilities to avoid. Then interview them; I realize this is time consuming, but it'll be worth it. There will be different staffing levels and activities on the weekend, but try to go before and/or after mealtime as well as during mealtime because that's often when the patients get less attention, especially if meals are served in a common area as opposed to in the rooms.

2. In the meantime, document everything negative: incidents, dates, personnel involved, your own cardio's and other doctor's position, refusal of the rehab staff to accept the orders, etc. Ask the ombudsperson about these and if they're grounds legal action. But don't tell the rehab staff about any of your background investigations.

My thoughts are that there might be some vitiation of the Medicare time limit if care was improper, if not plainly against medical standards of proper care.

3. Ask the cardio, or other regular treating doctors, if they have any recommendations not only on placement elsewhere but on extending Medicare care, in a competently managed facility. Perhaps they'll script for an extended stay, at another facility.

4. Alternately, and depending on whether she experienced orthopedic injuries or setbacks from the falls, your treating ortho may recommend thereapy.

I recall reading sometime ago in one of the Medicare and You booklets that PT can be extended if another injury, of a different physical location, occurs. I don't recall though whether that's for in-facility PT or through home health care.

5. CAVEAT: I am not current on Medicare regulations on extended therapy for in-rehab injuries. You might even contact Medicare, recognizing that they won't give you specific information on your mother's particular situation, so present your questions as situational and hypothetical, as opposed to specific.

6. This is a lesser option, but ask your doctors about Palliative Care. It's not hospice; there's not a need for a terminal diagnosis; it's care for chronic conditions. You might be able to get it for home care, along with home therapy, and bring your mother back to better health.

PC is still somewhat of a new construct, as I've been told with companies which I've contacted. Some don't really do anything except make a monthly phone call or send a nurse out at specified times, and I found it really hard to find one that did more than that. But it might be different in different areas. And it's worth a try b/c (so I've been told) is paid for by Medicare.

7. Contact an elder law attorney whose website indicates she or he handles rehab issues. Some of these attorneys specialize in medical neglect at rehab facilities, as opposed to focusing on estate planning documents. It might cost a few hundred dollars for a short conference, but these attorneys should know their way around Medicare as well as the bad rehab facilities.

A conference might be a good idea, but I can pretty well guarantee that the staff will close ranks, plan to outnumber you and outflank you, and you'll feel defensive. Plan to bring an elder law attorney as described above, but DON'T tell the staff beforehand. You want to catch them offguard. Even if the attorney does not much more than take notes, scrutinize the staff with firm and concerned countenances, and raise a few eyebrows, it will likely prevent the staff from ganging up on you.

If you do have a meeting, demand specific action, by department and staff level, and with an outside deadline. If you have an attorney and the staff waffle on response, look at the attorney with a concerned look. Sometimes these "looks" can scare the staff into worrying about liability issues.

And don't tell them that you're planning to find another facility.

I hope this helps. I've been through 2 situations in which care was unsatisfactory; the first time a meeting with staff resolved the issue, but three of us in the family made a practice of spot visits (during which time I caught a psychiatrist saying "hello, how are you", and then charged Medicare for an actual visit. After I reported him to Medicare, eventually I was notified that they were actually taking action.)

Good luck; you have a rough road ahead of you, but once you find a good rehab facility, it'll be much better for both of you.
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Reply to GardenArtist
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It is time to file a complaint with Medicare, can you imagine the poor folks who do not have a loving advocate? I went ape s**t with a rehab/skilled nursing home because of similar incompetence . I thought I was going to go to jail, not getting vital meds, changing meds the specialists prescribed, feeding him ensure and cookies every time he asked as a diabetic. Administrator was the most wishy washy mealy mouth coward i ever had the displeasure of dealing with, staff covering for staff, department heads covering for staff and administrator covering for them all. It was all about the money, they told me that he needed to stay for another month, this was 1 week into stay and I was already a PITA advocate, lots of questions, show me the chart, already saw administrator. Of course they were going to address it, thank you for bringing this to our attention, so if course I was willing to give them a chance. 2 days later they got a letter from his Medicare replacement plan that they would only pay through the 4th, which was 2 days away. Oh he has miraculously made huge strides and can go home, see he can transfer from wheelchair to bed and back again, isn't that wonderful. Are you crazy. I promptly moved him to a facility that actually cared if he rehabbed or not.

I am so sorry that you are going through this, it is hard enough with an ailing parent, I pray that you find some place where mom can get back on her feet and back to her life. Please file a complaint with the powers that be in your state, these places will never change until they are forced to.
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Reply to Isthisrealyreal
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Report this thru the chain of command or talk to your Ombudsman.Social services should have their number or look to see if it is posted in a hall.They can help
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Reply to Abf1202
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I've read on the forum that detailing your concerns in writing and making sure they get to the appropriate people is a good first step, followed up by face to face meetings. And mentioning involving the ombudsman tends to get their attention - you might want to actually call them, not just threaten.
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Reply to cwillie
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I am quite involved, I always have been. The problem is, her cardiologist ordered labs and INR to be sent to him weekly while she is there and they haven't even done that! I don't think POA will make a difference with them. The doctor is practically non existent. She has cellulitis, they put her on Kephlex for that but only once a day. When her cardiologist saw that he was not happy as he said it was way too low of a dosage. I believe they put her on it just to keep me quiet and say they did it. Getting not enough antibiotic is not good! I don't know what they are thinking! He told them to take her off the zaroxolyn due to having the potassium crash, but they put her back on metolazone even though he didn't want her on Lasix and another strong diuretic. I am just frustrated and beside myself right now! I am concerned she will have to stay longer if she can't get that medication out of her system and can't get up to move around. Before all of this, she was up walking around at home and caring for herself!
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Reply to filly1969
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Are you thinking that Mom may need to stay there longer? Are there discharge instructions for her? Is there someone with a POA? Have they been informed of what’s going on? I had POA for my mom and I was always notified of falls, changes in medications, and anything else unusual that happened with her. If there is no one with a POA, someone needs to get one. I learned that the only way to find out exactly what was going on is to become very involved, as much as my time would permit. Staff seemed to know I was always there and very involved in my mom’s care. I know they appreciated it.
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Reply to Ahmijoy
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From personal experience ... Gabapentin is AWFUL for older folks!! My Mom (70 - no major health issues) took it for a few days and promptly took herself off of it. She said it made her feel loopy, lightheaded, and disoriented. My MIL (83 - dialysis patient) was prescribed gabapentin and shortly after valtrex for shingles. She was on the gabapentin for appx 14 days and the valtrex for 2 days when she could suddenly not stand or walk and could not speak a coherent sentence. We stopped the meds immediately, it still took several days for it to leave her system. She remembers nothing from the 3 weeks surrounding this incident.
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