(Awkward question I know.) My 95-year-old father is in MC facility under hospice care & is bedridden. He is slowly deteriorating as expected, but seems to be comfortable. He has gotten very skinny. I'm concerned that he is not being turned every 2 hours. It takes 2 people to turn & position him & my gut feeling is that, since he is being monitored by hospice, the staff of the MC do not think he needs as much attention from them. On multiple occasions when I visit & ask about it I am assured that he is being turned. However he is in the same position each time I visit. I know that may be coincidental & that he may have been turned appropriately before I got there. However, I have a sitter with him at night & she told me that she has difficulty getting anyone to help her. I have discussed this with the executive director & the nursing director at least twice & both have reassured me that the staff will help. However he has developed a skin breakdown area on his lower back, according to the sitter.
I am going to tell the hospice nurse about this so he can monitor the area. I know that this could have happened anyway, but I want to limit the damage as much as possible. In the meantime, I want the executive director & nursing director to emphasize to the staff how important it is that he be turned appropriately & hold them accountable if he isn't. Also I will photograph the area next time I'm there.
Am I dreaming? Do I need a doctor's order? I know the directors can't be there day & night, but there's got to be a way. I've purchased wedge & extra regular pillows with which to prop him. It takes 5 minutes to turn & position him, if he hasn't been incontinent.
I hesitate to get firm with them because they may retaliate. I have twice asked the directors to tell me when they can no longer provide the level of care he needs & I've been assured that they can manage. I have contemplated moving him to a different place, but in my area all the long term care facilities are sketchy & I'm sure are having staffing problems as is everyone. So would it be any different?
I guess I need some guidance on how to write an email that is firm, but non-threatening, if such a thing is possible so that they will take this seriously. I know I can't tell them how to run their "shop", but I want to do all I can to hold off the ravages of being bedridden. Thoughts?
It is not unusual to have emergencies where those Staff members are helping out another resident, thus turning your Dad is put on the back burner until the emergency is through.
I remember visiting my Mom later in the evening at her facility, and it was like herding cats trying to get the residents back into their rooms for night time. As soon as the residents are settled in, a few would wander back out in their pj's into the mail hallway. I remember overhearing one nurse say "Lord, give me strength".
This is why I chose a hospice organization that worked frequently in my mom's MC. They all worked well as a team, and the staff was very receptive to the nurse's orders.
Your dad absolutely should have the pressure mattress mentioned by Grandma1954. (I'm surprised that he doesn't already.) Get the hospice folks to order it ASAP. The fact that he's getting pressure sores isn't really all that surprising, and the spot where he's getting it is the main place where they tend to occur. His skin is breaking down, and he doesn't have any cushion on his body now. There may not be much to prevent it happening in one place or another.
In my years of life, I know I am not in control; even though I’ve accomplished much. But if difficult circumstances arise I bring it to God early in my morning and tell him my concerns, As I continue to walk in love, (for God loves all people at all times), and I figure He likes that of me. Then I wait and see ( this is also sometimes difficult). Patience is a virtue, and a good practice, it keeps us from mistakes.
I know how difficult it feels not to be able to do more. But just doing your best in love, will bring about a peaceable journey for you, bringing your light into the workers presence may even trigger them to see you understand their problems as well.
Nothing will ever be perfect in this life, but we can show love in a difficult situation, and perhaps in this you will find your direction. He (God) listens and responds.
My mom is in AL and will probably go to MC (if that is the best plan). I put in Blink Camera’s that runs off the wifi of the facility. I didn’t ask, I put them in. They are movement activated. I turned off the LED so the surveillance is not obvious (that red light is distracting). The facility eventually put a sign on the outside of her door stating Surveillance. This camera has been helpful to me. She has a caregiver from 2-6 that helps her shower, go to pt and to dinner. I check the recordings every morning to see how often she moves in the night. Your dad would be a great candidate for cameras. Since he lives alone, there is not an issue of privacy lost for a roommate.
It was a game changer for me because I knew what was going on when it was going on.
I would also talk to Hospice and express your concerns. ALSO, you may need to change Hospice providers. The facility my mom is at has 2 they do business with and one is better. I used that as I searched to see if there were better ones than the 2 they mentioned to me. My thoughts for you:
1. I would put in the cameras (I use Blink but they may have better ones). They have a 30 day free saved recordings and the yearly rate is $30.00 for the year. I can hear what is being said and the recordings are saved for 60 days.
2. I would talk to Hospice on what they can do to facilitate the required care. Get a air pressure mattress.
3. I would look to see if there is another hospice and interview them to determine if they have better care. I would not tell them I already have hospice, since they may not want to have conflict with another provider.
4. I would, after the above 3 things are done, if needed, draft a letter for the director of nursing (that is the person in charge of evaluations and care) with a cc to the directors. I would fax it to ensure it is received as well as email it. This correspondence is only sent if your issues with them is proven with the surveillance. I set up 3 camera because I wanted to get all the angles and if one becomes off line, the others can pick up the slack. That has happened and I was grateful for the other camera. My mom has 3 rooms but I only have them in the 2 rooms she uses.
My Dad had 3 shifts of caregivers when he lived at home and it was costing him $20k per month, yes per month. Cost can vary from area to area. And that was just one person each shift. If Dad would need to be turn over two hours, as the Original Poster's would need, what would that caregiver do?
Chances are the grown daughter is a senior herself, like I was. There are limitations.
Better for him to stay in Memory Care where he has a village to help out.
I worked my way through college as a nurses side at nursing homes. It was a terrible job. Nurses did not change linens, take care of bedsores or turn patients. That was the nurse's aides job. We were always understaffed and pressured to do tasks that were related to housekeeping rather than patient care. One nursing home had us crawling under the beds to wash the bedsprings! I understand that covid has created a shortage in medical staff in general.
I have incurable cancer and am in palliative care. Due to fatigue, I spend a lot of time sleeping. I am very aware that bedsores are a possibility for me. I am sorry you are having to struggle with this. It should not be that hard to make and follow a schedule to turn a patient and prevent pressure sores.
You can the photos to yourself but also have them “just in case” you need documentation. I would first verbally mention an issue to the staff, next time I would write up one of those “if you see something” notes (take photo of the note) and hand it to the unit again. Third time, I would level up to supervisor along with both incident photo and note photo. It worked for awhile till a change of staff. They were receptive to verbal but reacted harshly to documentation and pressed to have my mother moved. (I didn’t even show them the photos) I had to invoke hospice for the extra care to give my mom a little more time.
It is a fine line you have to walk: keeping peace with the staff to maintain the security of the facility BUT avoid harm to your LO in a time where there are limited (if any?) options.
Having cameras in resident's rooms is illegal in my state so that's out. I'm going to request the alternating pressure mattress from hospice.
After a lengthy discussion about my concerns, the hospice RN is delivering a barrier cream today. I like the idea of marking the disposable brief & will follow up some how.
I know that working in MC is a challenge & I'm not sure I could do it. I'm always pleasant to the staff & thank them for all they do. I have the sitter at night so that he will at least get turned & positioned during that time. And I'm going to request from either dad's primary care or hospice for an official order to have him turned appropriately.
If skin breakdown is inevitable, I want to make sure I've done everything I can to limit it. Only then can I get some peace.
In reality, during end of life, pressure sores MAY HAPPEN in some instances; they can be impossible to avoid entirely depending upon how long the person is bedridden and what lengths are gone to to avoid them. Stay on top of the staff as best you can, then make sure dad is being given enough comfort meds so that he's suffering no pain. Also make sure you realize HOW the patient is 'repositioned' in the bed first, so that you know if they are or are not actually DOING it! And, if dad has any issues preventing him from being turned on one side or another. The hospice nurse is the best one to speak to about the entire matter; ask for his or her input on how it should be done, etc.
Best of luck.
Re the mattress issue, I tried one of those adjustable air mattresses for a while but ultimately had the most success buying a Twin size Serta mattress cushion at Kohls. It also helped with heel pressure.
Take detailed notes and document your conversations with notes that consistently show the date, time and the person you spoke with. E-mail is a great way to create a legal record of your communications with staff. Confirm every important conversation with supervisory or management staff by email, ie “Per our conversation this afternoon I am confirming our mutual understanding that it is medically necessary and imperative that my father is re-positioned at a minimum of every two hours and has wet pants changed to prevent skin ulcers. It is also our mutual understanding that this medical concern is being appropriately communicated to and addressed by your staff. Please advise me if you are aware of any issues in addressing this concern.”
Take photos of your Dad’s skin as often as you can with the date set on the camera and bring their attention to whatever breakdown is occurring under their watch. Your Dad has enough to deal with. There is no excuse for the facility neglecting to provide this basic medical care. Make it clear that you are paying attention and expect their care and compassion concerning your father - never mind the fact that they are likely being paid thousands with the expectation of providing competent care in return.
You are not dreaming - you are standing up for the rights of a patient who is not able to stand up for himself. I think the doctor’s order idea is good too if your doctor will help you with that. It would be an official medical record of care ordered. Failure to follow that could land them in real legal trouble if things break bad. Don’t let them try to build a case that he is terminal and already had bedsores not caused by their lack of care unless that is true. I would not hesitate to hold their feet to the fire on this. Don’t be afraid to let them see you take notes and document- document- document. I hope your Dad gets the care he needs.
You have every right to tell them how to "run their shop" because they are getting paid to provide proper care to your father. He isn't in their facility for free nor are they caring for him free oout of the goodness of their hearts. They are making money off of him every minute of the day. Put a camera in his room and see how many times a day they are turning him.
A nursing home or MC will never admit to a bedridden resident needing more care than they can provide. A bedridden dementia patient is easy. It's the ones who can still get around that are hard. They'd love it if every bed in the MC was occupied by a bedridden invalid.
Talk to the director of the facility he's in and bring it to their attention that he's starting to get a pressure sore. Then ask them if they would better be instructed by a personal injury law firm specializing in nursing home abuse and neglect on the importance of repositioning bedridden patients and proper skin care.
They will improve the care your father receives.