Hello. My Mother had picture perfect health for 87 years until late April of this year. Exercised, ate good, had lots of friends & close family, went to doctor appts and was healthy. Then she fell in her yard and broke her elbow. She was wrapped up and sent back home. Then 2 weeks later she fell in her kitchen and broke her shoulder on her other side. That was the first hospital visit since having a child. From there she went to a Rehab center at a Care Facility. This was all new to her three daughters. Dad has passed. She fell out of bed twice in the first week. (didn't break anything) and then she seemed to be getting much more forgetful. Is it the onset of dementia or is it nursing home related? She can't walk on her own, has become incontinent, has lost a great deal of weight. She has a pressure ulcer on her coccyx that is considered "unstageable". What in the world does that mean in real life? We have to pull answers out of the staff at the nursing home. No one tells us anything. No updates. We have to ask and ask and ask questions over and over and over to get anything. They want "conference calls" between 10a and 3p. We all work and in jobs where we are unable to take an hour call during this time. Now her wound has e-coli in it. The place is so expensive and terrible. It's dirty, they run out of basic supplies, paper towels, towels, sheets, etc. Yet it has a 4.5 out of 5 rating, is in a "good" part of town and looks fabulous on paper. Any suggestions? Help? Thank you.
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My mother was catheterized in order to help keep the area dryer. That however can cause frequent UTI's. Eventually my mother had about 4 types of pain medication for this condition.
I would be happy to answer any questions you might have. My mother has passed away after about 5 months on hospice. I am not saying that will be your experience. I did move my mother to a different NH where I felt the care was better. I had not felt the care was bad in the previous NH until a variety of unfortunate occurrences happened.
In the back of your mind should be "is this a medical malpractice case against the NH?".
Make sure that lots of pictures are taken.
Get mom's prior medical records from hospital documenting that the bedsore did/didn't exist upon admission.
Frankly, I would call a Medi-Mal lawyer this AM.
One of our posters used to work for a Medi-Mal attorney, hopefully she'll have some advice.
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Your poor mom. I hope she recovers fast.
What finally helped (somewhat) was working out an agreement with the SW and Unit Director (who was an RN) that I would email them once a week with questions and concerns and that they'd get back to me in a timely manner. We agreed from the get-go that I would be the point of contact for medical questions. My SIL and Brother were the most frequent visitors, but we knew that we needed the administration to have only one point of contact for medical information and directives. That was me.
We came to this agreement after a really upsetting phone call from one of the nurses, telling me that mom had a collapsed lung (she didn't).
It was the last straw. I asked for a care meeting, took the day off and asked them why I shouldn't report them to the Joint Commission on NH Accreditation.
They cleaned up their act after that .
I realized, along the way, that while their communication sucked, mom's care was quite good.
That does not seem to be the case here.
Have you left messages and asked the would care doc/nurse to call you?
Is one of you Health Care POA?
If it was denied after 6 weeks, did you appeal the denial? Was it due to mom not progressing or not cooperating?
Her "private insurance" by which I assume you mean Medicare Supplement (she's not on Medicare Advantage, is she?) would only come into play after day 20 of Straight Medicare part A paying in full.
As I mentioned, Ohio is a state that allows Miller (also called Pooled) income trusts. If mom's INCOME (not assets) are over the Medicaid amount, she can create a trust and the excess income in the trust reverts to the state after her death. This gets her under the income cap.
If mom has countable ASSETS (house and car don't count; depending on which state, retirement accounts may also be exempt) like a Brokerage account, Savings, CDs, etc, those generally need to be spent down until she is eligible for Medicaid.
Does one of you have POA for financials? Health Care?
If you do, use some money to visit her Elder Law attorney and get some guidance.
But I SO agree with MD; if she's got E.Coli in the wound, she needs to be gotten to the hospital asap; the bedsore itself CAN be a sign of neglect; E.Coli in the bedsore means they aren't cleaning her properly. Clear neglect.
Sepsis (a blood infection from a wound like this, or from a UTI) can kill. And quickly. With few symptoms, even in a GOOD facility. My mom was in a very vigilant place; she STILL nearly died of sepis due to a UTI that got out of control in a few hours, and yes, we had someone visiting every day. We just aren't trained to see the signs.
I went last night and got my first look at her pressure ulcer. It is unbelievable and today I'm going to go there and have her admitted into the hospital.
Thank you for your helpful info.
Medicaid is means tested. Have you seen an Elder Law attorney about setting up a pooled income trust?
Is Medicare paying for rehab?
My biggest complaint is the lack of communication from the facility. I have asked my sister who has a bit more time to at least check with other facilities to see if we're closer to getting her in there. We (my sisters and I) are meeting to discuss these things. I am ready to take her to the hospital to get her out if that is what we have to do. Although I didn't mention that my mother has some childhood trauma from growing up in an orphanage that is showing up now and she is very fearful of moving again and of "telling" on anyone at times. This is very concerning but it gets her so upset to discuss it that it is very difficult.
1. Have you considered calling the Ombudsman?
2 How far away is mom's NH from where you all live?
3 You need to be talking to the DON and/or SW, not the aides.
I am 20 miles from the NH as are my sisters.
Does she live close to anyone who can see her every day, even if it is for 10 minutes? If not, move her to somewhere closer and more convenient and go and visit everyday to see what is happening.
The falling: She should be getting PT who can help her strengthen her muscles (mainly the abs) The problem is that there are a lot of PTs who will only treat patients to what they think is appropriate for a person's age. They don't try to get them walking again. The way I got my Mom to walk again was to get her out of the "hospital" and get a PT who does house visits or in-office PT. If you do in-office PT, be aware that you cannot go back to house visit PT. Then I did the exercises with her every day. You don't say whether she is now in a wheelchair or using a walker. I would suspect she should be able to get around in a wheelchair and that with help, she can get in/out of the wheelchair. If she cannot do that, she is either drugged too heavily or her medical care is inadequate.
The forgetfulness: I suspect she is in a lot of pain, plus the infections that are raging in her system. When a person is in pain, it is hard to get anything done and even harder to concentrate on anything. When my Mom has a UTI, her legs forget how to walk. After getting a pill for the UTI, within a day, she can walk again (the most amazing thing that I have seen repeated over and over.) If her drugs are inappropriate, she may be living in a fog.
The doctor: I would look for a geriatric doctor and take your Mom to that doctor. It is time to get a fresh diagnosis and a fresh care plan.
Her surroundings: Get her out of that nursing home. It sounds like they are not doing what you are expecting them to do. To have constant infections is unacceptable. It doesn't matter if they are understaffed or not. That is THEIR problem, not yours.
Wearing of the diaper: It sounds like your Mom is a severe fall risk at this time. She might not have enough muscle strength to get up out of bed and go to the bathroom with help....or maybe not enough strength to call the nurses so that they can help her go to the bathroom. Wearing the diaper is a good option at this time, however, it sounds like they are just not caring for her like she needs to be cared for....again more the reason to get her out of the current place where she is. (Do check whether she can press the button to call for help. My Mom cannot press the button hard enough, which means that she cannot get help to go to the toilet, when she needs to....this is a big issue when she is in a hospital as they don't have pull cords in our hospitals.)
Did she live independently of any of you up to all these events? If so, she might not be able to return to full independence. Start looking into assisted living. In my state, some of the ALs have floors that have Skilled Nursing Care/Rehab Hospital. Then when the resident can, the person goes back into their Assisted Living area. Also look into caregivers.
I'm so sorry this is happening to you. I think you need to find another rehab hospital/care home and visit more often (be more active in her care plan) or take her home and one of you needs to supervise her care 24x7. She needs you to advocate for her right now and until her health stabilizes.
P.S. I'm assuming that someone is taking care of her financial obligations....
Cover909
The night crew telling her to pee in the diaper at night, either want to horse around or are swamped with what the day crew did or did not do.
As you've discovered the "better" homes are filled up and have waiting lists. These homes can and many do charge higher rates because of this.
Out of curiosity if you know, did the bed she is/was in have bed rails and we're they "locked"?; a really sweet nurse locked one of the ones of the bed I'm in, mentioning the same about falling out and she could get in trouble.
https://www.agingcare.com/discussions/if-you-are-going-to-become-a-caregiver-480769.htm?orderby=oldest
Please find another facility for your mom. She may be at her end of life but, she doesn't deserve to die in misery because of this dump of a nursing home.
May The Lord give you all strength and wisdom to deal with this awful situation.
Cover909
Were tests run when she was hospitalized to rule out a stroke causing her problems. You know, you have a right to transfer her to another NH. You also can call 911 and have her taken to the hospital for that bed sore. From there, you can have her taken to another NH.
Cover909
Cover909
Mayo Clinic website is your friend . Consider having her taken to the hospital for evaluation of the bedsore.
Is mom being seen by a wound care nurse? Demand one
Get a care meeting scheduled ASAP and take the morning off from work.
Make sure all her therapists, DON, SW and dietitian are present or on the call.
Ask how they are going to prevent falls (lowered bed?)
Ask how they are addressing bedsore? Alternate pressure air mattress?
How is she progressing in therapy?
Do they think she will be able to return to living alone?
What level of care does she need?
Do they believe she has dementia? (Ask for a psych eval).
Make sure they have tested her for a UTI --these can cause psychological and behavioral symptoms.