• 07-22-2012, 07:24 AM
    JohnMichael
    When bad nusring homes kill good people
    Time for the black suit once again. A gentleman in my care who is an Alzheimer's patient was taken to the hospital with difficulty breathing. Some Alzheimer's patients have swallowing problems. If the food and water is not going to the stomach it ends up in the lungs. He was diagnosed with aspirational pneumonia.

    After several days in the hospital he was transferred to a nursing home. He entered the nursing home on Thursday night and due to ignorance and neglect he was dead by Saturday morning.

    This same weekend his grandson was getting married. All the family was out of town and I was asked to check in on him. I called his son Friday night to report that he was knocked out by the Ativan the nurse had given him. Yes it is great to sedate someone who has trouble swallowing an hour before a meal. I decided since he was not going to eat I would return in the morning for his breakfast.

    His intake of fluids was low due to the fact his drinks had to be thickened. He refused to drink or maybe I should say eat any water or juices. Even though he was not drinking or eating much they continued to medicate him.

    Saturday morning I stopped in and he was even less responsive than before. I called the son at 9:30 AM to tell him his father was really zonked and I said I was going to ask the nurses to please not give him anymore Ativan. I went to the nurses station and I mentioned that his pulse was only 52 BPM and someone suffering from dehydration usually has a faster pulse. She asked the Aide to check his vitals and I requested swabs to clean his mouth and some thickened liquid to try to get him to drink. I asked when and why was he last given some Ativan. She said he kept calling out and saying he had trouble breathing several times so she medicated him.

    At 9:45 AM I called the son back to tell him his father had passed away. He asked if I was kidding. Yes I have an odd sense of humor but joking about death with a family before the wedding is not part of my repertoire. I told him I wanted to call him before the nurse starts calling the names on the chart since they were all together at the wedding. I handed my phone to the nurse and he told her who he wanted contacted and he would tell his mother. I just could not imagine how that would be for her to receive that call on what was to be a happy day.

    Now for what I think was the cause of death. He had such little fluid intake and was still being medicate routinely that I think he reached toxic levels from the Ativan. He was becoming jaundiced. I also wonder if his breakfast that the aide claimed he ate just bites was fed to quickly and that is why he was having so much difficulty breathig again. I would guess they fed him in bed with little elevation of his head.

    When he complained of difficulty breathing I wish they had helped him into a chair and given him a breathing treatment. That would have been so much more benficial than another Ativan. R.I.P.
  • 07-22-2012, 09:00 AM
    dean_martin
    This may sound cold but it's meant to be a practical, real-world warning. Most nursing home admission documents contain an arbitration agreement. Even if the patient lacks the capacity to contract the arbitration clause is enforceable when a loved one signs the stack of documents on their behalf. Check your state's laws to see if you're waiving the right to trial by jury when you admit your elderly loved one to a nursing home.
  • 07-22-2012, 09:17 AM
    JohnMichael
    Quote:

    Originally Posted by dean_martin View Post
    This may sound cold but it's meant to be a practical, real-world warning. Most nursing home admission documents contain an arbitration agreement. Even if the patient lacks the capacity to contract the arbitration clause is enforceable when a loved one signs the stack of documents on their behalf. Check your state's laws to see if you're waiving the right to trial by jury when you admit your elderly loved one to a nursing home.


    A good tip to families. As his caregiver I am not privy to paperwork. The nice thing about their incompetence was they never asked if I were family and answered every question I asked. Maybe they have not heard of HIPAA yet.
  • 07-22-2012, 05:22 PM
    JohnMichael
    Should I share with family what happened or just say it was a peaceful death? I think they have a right to know but is it really any benefit? I doubt the outcome would have been any different. One way by nature and another by human error. Which would bring more comfort?
  • 07-23-2012, 02:59 AM
    Feanor
    Quote:

    Originally Posted by JohnMichael View Post
    Should I share with family what happened or just say it was a peaceful death? I think they have a right to know but is it really any benefit? I doubt the outcome would have been any different. One way by nature and another by human error. Which would bring more comfort?

    dean_martin raised the question of litigation; if this is an option, then probably you should mention your concerns. An autopsy would be necessary before cremation, of course.

    Other then that, you are in a better position to judge what's best for the family than any of us. There are certainly people who would be distraught unnecessarily and purposelessly by the thought that a loved one might have died through negligence.
  • 07-23-2012, 03:11 AM
    Hyfi
    Quote:

    Originally Posted by JohnMichael View Post
    Should I share with family what happened or just say it was a peaceful death? I think they have a right to know but is it really any benefit? I doubt the outcome would have been any different. One way by nature and another by human error. Which would bring more comfort?

    JM,

    This hits so close to home as my wife, her family, and I are dealing with a pretty similar situation. Her dad has Dimensia along with every other symptom you described in your opening post. (which I have made several copies of to hand out to the family)

    Pop is in a Catholic Nursing Home and there is barely an ounce of compassion or competence in the Nursing and Physical Therapy staff.

    Because of the fact that he can no longer do anything for himself, or speak hardly, along with having to be fed and the horrid thickened diet, they have put him through hell already. They dehydrated him to the point of a bladder infection. They gave him medications without telling the family that broke him out in the most horrific facial and body rash and tried to blame it on the lotions we provided for dry skin. Once we found out what the drug was, we looked it up and EVERY symptom he had was the exact side effects of the drug.

    Next they put him on a Parkinson drug for muscle stiffness and it started causing tremors and other Parkinson related side effects and again we had to point it out and have it DCed.

    This has been an ongoing battle for over a year now. You get just about nothing for $10K per month except complete incompetence and a head nurse that sweeps it all under the rug and lies to your face.

    Two weeks ago we went and my wife was feeding him while I disinfected his room. I went in with them and the first thing I noticed was that he was not wearing his glasses, but some other pair. When we brought it up to his nurse, she immediately lied saying he saw the Eye Doctor and got new glasses. Of course nothing was ever authorized and he did not see anyone. When I asked where his old ones were, she told us they were in his room. I searched and they were not. When I said he wears bi-focals, she snapped that they make them without the line. So I put them on, I wear transitions, and they were just a single script and they were beat up and scratched, yet they put his name on them and forced him to wear the wrong script for 4 days until I caught it, then lied about it. They came to us an hour later with his real ones, which were most likely sitting in the med cart where they are supposed to go at night.

    I could go on and on with this crap and it makes my stomach turn.

    Here is what really sucks. We can put our pets to sleep and we call it HUMANE. But we are forced to keep people alive at all costs, including abuse, neglect and more....

    Thanks Church and Religion!
  • 07-23-2012, 04:20 AM
    Hyfi
    If you are in any way certain that there was in fact negligence, I would pass it on to the family.

    These A-Holes need to be held accountable and the only way to bring about change is to take the hard road and expose it and demand more than incompetence today's society breeds and holds up as the norm.

    We have made such a stink at St Mary's in Cherry Hill NJ that they jump and run when they see us come in as well as talk behind our backs and say sarcastic things under their breath, which we hear or hear about.

    When you call this place and are on hold, you get this big spiel about how caring and compassionate and professional they are bla bla bla. I think every employee there actually needs to listen to it once because the message they give is not even in the same world as the care they provide while the Nuns walk the halls clutching at their Rosaries and having all kiss their asses. What a bunch of two faced hypocritical idiots that run this place!
  • 07-23-2012, 09:31 AM
    Feanor
    Quote:

    Originally Posted by Hyfi View Post
    ...
    Here is what really sucks. We can put our pets to sleep and we call it HUMANE. But we are forced to keep people alive at all costs, including abuse, neglect and more....

    Thanks Church and Religion!

    My mother-in-law recently moved from retirement/assisted living to a nursing home after suffering a mild infection and a fall. She's been there about 12 days so far, and things don't look too bad.

    However she'll be 103 at the end of August, (if she makes it, which is likely), but is despondent and depressed about loosing the last shred of her independence. She is a very religious person and prays daily to die, but she would never consider suicide because it would be defying God's will. (Assisted suicide is still illegal here in Canada in any case.)

    Personally if I were to contract Alzheimers or the like, I would immediately massively over-dose on my heart medication or blow my brains out with my .38 spl, and if God doesn't like it He can sent me to Hell and/or eff himself.
  • 07-23-2012, 10:34 AM
    JohnMichael
    Quote:

    Originally Posted by Hyfi View Post
    If you are in any way certain that there was in fact negligence, I would pass it on to the family.

    These A-Holes need to be held accountable and the only way to bring about change is to take the hard road and expose it and demand more than incompetence today's society breeds and holds up as the norm.

    We have made such a stink at St Mary's in Cherry Hill NJ that they jump and run when they see us come in as well as talk behind our backs and say sarcastic things under their breath, which we hear or hear about.

    When you call this place and are on hold, you get this big spiel about how caring and compassionate and professional they are bla bla bla. I think every employee there actually needs to listen to it once because the message they give is not even in the same world as the care they provide while the Nuns walk the halls clutching at their Rosaries and having all kiss their asses. What a bunch of two faced hypocritical idiots that run this place!



    The family did ask me what I thought might have been a contributing factor in his death. I asked if they really wanted to hear what I thought. They felt I would be more honest than the doctor or nursing home. I told them what I observed and now it is up to them to proceed however they see fit.
  • 07-23-2012, 10:49 AM
    Hyfi
    Quote:

    Originally Posted by JohnMichael View Post
    The family did ask me what I thought might have been a contributing factor in his death. I asked if they really wanted to hear what I thought. They felt I would be more honest than the doctor or nursing home. I told them what I observed and now it is up to them to proceed however they see fit.

    Good, because this world is plagued with complacency and if nothing is ever said, nothing is ever corrected.

    My mother in law is pretty distraught over the whole deal and is absolutely no help in trying to maintain some semblance of dignity for her husband. Every time we bring anything up that should not be happening, we get the same old "nothing is perfect", "we have to pick our battles", "lets not start trouble" bla bla bla

    I usually go off on her telling her that if everyone dealt with things the way she does then nothing would ever get fixed when broken. Also that she is paying these idiots $10k a month and ALL their money except for $109k and half a house is soon to be gone with nothing to leave to their children and that we should expect nothing less that good care.

    I hate complacency!
  • 07-23-2012, 12:12 PM
    JohnMichael
    Quote:

    Originally Posted by Hyfi View Post
    Good, because this world is plagued with complacency and if nothing is ever said, nothing is ever corrected.

    My mother in law is pretty distraught over the whole deal and is absolutely no help in trying to maintain some semblance of dignity for her husband. Every time we bring anything up that should not be happening, we get the same old "nothing is perfect", "we have to pick our battles", "lets not start trouble" bla bla bla

    I usually go off on her telling her that if everyone dealt with things the way she does then nothing would ever get fixed when broken. Also that she is paying these idiots $10k a month and ALL their money except for $109k and half a house is soon to be gone with nothing to leave to their children and that we should expect nothing less that good care.

    I hate complacency!



    I wish I had the answers on how to fix nursing homes. Even finding good and trustworthy in-home caregivers is tough. I do the work because I like it and I wish others would look for the joy I find in it. I make such great connections with my clients.

    The gentleman who just passed did not want help at first. A stranger coming into his home and helping him shower is enough to make someone feel very vulnerable. Naked, sudsy and how is this big guy going to handle me? As we talked he mentioned where he worked and I asked if he knew a gentleman who had worked there. He was hired by him and then I told him that was my grandfather I mentioned. That was my in and he was willing to give me a try.

    My other family I am working for had a hard time convincing their parents they could use some help. I was introduced to the family and the mother recognized me from the time I helped her in the hospital. I just had my three year anniversary with them.

    I would like to be a job coach for care givers. Teach them how to invest themselves with their patients, clients and or residents. If you can make a connection with them as a person who has contributed throughout their lives instead of just someone old that needs your help. There are so many heros and heroines in those beds.
  • 07-24-2012, 02:49 AM
    Feanor
    Quote:

    Originally Posted by Hyfi View Post
    ...
    I usually go off on her telling her that if everyone dealt with things the way she does then nothing would ever get fixed when broken. Also that she is paying these idiots $10k a month and ALL their money except for $109k and half a house is soon to be gone with nothing to leave to their children and that we should expect nothing less that good care.

    I hate complacency!

    That's part of the end-of-life healthcare issue; there is some outrageous statistic about how much of the total cost is for the last year of life.

    $10,000 month is scary and depressing. My aforementioned mother-in-law pays C$2200 month thanks to Ontario Health subsidies. Nursing homes here are also regulated by the the Provincial Dept. of Health. Care is not always what it should be, but there is a mechanism to complain to the Provincial regulator -- the process is posted on a wall near the entrance of the nursing home where my mother-in-law is located.
  • 07-24-2012, 05:54 AM
    bfalls
    All these stories bring back such tragic memories. My 79 year old mother had fallen at home on her ankle and broke it. She had to go to a rehab center before coming home.

    The first weekend my father stayed with her most of the time. On that Saturday they called the nurse because my mother had to use the rest room. She wasn't able to get up, so an attendant had to help with the bedpan. My father, also 79 couldn't help her. The nurse's response was they are understaffed and that my mother was 12th in line for a bedpan. Two tours later she was still 5th in line.

    My mother ended up soiling herself. This went on all weekend before my sister and father could get her to another facility. As a result she developed sepsis. It started to attack her organs. She fought it for over a week while in and out of consciousness in intensive care. She had to use the assisted breathing mask since she couldn't breath on her own.

    She made it out of the hospital and into another rehab center only to die from complications a few days later. The first rehab center was reported, but we never heard the results.

    This happened at one of the better Savannah centers. I can only imagine what happens at some of the others.
  • 07-24-2012, 01:08 PM
    ForeverAutumn
    John, I'm sorry about the death of your client and for your loss.
  • 07-24-2012, 03:51 PM
    JohnMichael
    Quote:

    Originally Posted by ForeverAutumn View Post
    John, I'm sorry about the death of your client and for your loss.


    Thanks ForeverAutumn, he was a great guy. He was a Veteran of WWII and served 4 years. He survived two plane crashes, malaria and a bout of typhus. He came home fell in love, married and fathered 6 great children. He lived a simple life and worked hard to raise his family. He was kind and gentle with a great sense of humor. 63 years ago he married his wife who was from a different faith and it was predicted that the marriage would not last. I like to think of him looking for his mother-in-law in the after life to see if she changed her mind.

    One day when I was at their home the front of the newspaper had an article about a local case of domestic violence. His wife stated that he had never hit her and he quickly responds with "not yet".

    I do not think of this as a loss as much as I do a gain. Had he not been in need I may have never met him. My life is better for having known him.
  • 08-14-2012, 04:44 AM
    StevenSurprenant
    John, I understand how you feel and hospitals are not any better.

    My mom went into the hospital for an elevated sugar level from diabetes. They got that under control and she was recovering to the point of going home, but then her condition changed similar to what bfalls described in his post and she died from the same complications, just as his mother did.

    Every time I would go to see her, the nurses were at their station talking or entering data into the computers rather than caring for the patients. Once when I went to see her I opened the door to her room and saw her on a porta-potty. She was crying and yelling out for help because they had left her there for so long that she was in excruciating pain. She was a big woman and so they had to use a lift to get her into and out of bed.

    There's more to this story, but I'm sure you get the point.

    There are good care givers out there, like yourself, but it seems that for many, it's just a paycheck.