August 29, 2012
Running a long-term care facility can be very complex. There are so many regulations governing these facilities that a person is designated to help keep the place on track. Regular reports have to be filled out by the director of nursing and the administrator, plans of care for each patient, usually done by resident care managers. Ordering medication is usually done by the nurses or medication aids. To keep costs down, medications ordered by the physician that is available over the counter (otc) are ordered from supply companies instead of individually from the pharmacy. Usually a person was designated to go over the supplies. Some places I worked would post a paper that the nurses would write down items they were low on in the OTC category.
One place I worked had the sign-up sheet, but it frustrated me that nurses only placed an item on the sheet after opening the last bottle. There were two medication carts that required a bottle in each. If the other cart were almost out of the same item, often the new supply would arrive after it was out of the item as well. I started to look over the cupboard of OTC meds and write in meds that had 1-2 left. That many could easily be gone when the replacement stock came (or not, depending) One day, the Director of Nursing (DON) was gone for a few days and supplies were getting low, so I took it on myself to fill out the fax form and fax it in. I confessed my sin as soon as the DON returned and she grinned and said you may as well do all the ordering, so then I was checking on Attends supplies as well as wound care supplies.
I worked night shift there, so had a little bit of extra time and looked to fill it. I would do the ‘return for credit’ forms for discontinued pharmacy medications. If an ordered medication had not come in, I got on the phone and called the pharmacy to trouble-shoot, since the other nurses only kept faxing order after order instead of looking for the problem. I was on first name basis with all the night pharmacists. I also made most of the calls to the VA, making appointments, reordering medications etc, since it was a pain to cut through all the red tape and I seem to have a knack with red tape and nobody else seemed to want to bother. It was irritating how little initiative was taken. We once got a special patient in that required special formula for a J-tube. Formulas for the usual stomach tubes aren’t right for the jejunum, halfway through the small intestine. I found and ordered a box of the right stuff and went off on my weekend. I came back to find the box of formula out in the middle of the hallway, unopened. I was livid since I’d told the nurses it would come while I was gone. The patient was receiving stomach formula, which isn’t terrible, but not the best.
Noticing that frequently prescription meds weren’t ordered until the last one was used, risking a gap in time without them, I started to pull the reorder tabs. I’d go through each cart and when meds were down to the last week of supply, I’d pull the tab and place it on the reorder form. Sometimes I’d have another form for those two weeks ahead and file it to fax a week later. This worked good until one particularly large order didn’t arrive. I was off on my weekend and when I came back, things were in a quandary. They were out of several medications and the nurses kept faxing reorders. The pharmacy would fax back that they’d already sent the order and the next shift, a nurse would fax another reorder. NOBODY thought to pick up a phone and talk to the pharmacy.
I sifted through all the cupboards and other possible cubby holes looking for a lost order, but couldn’t find anything, so picked up the phone after evening shift left. I told the rep on the phone that I had faxed the order for all of the missing meds myself and had looked everywhere for them. I also firmly insisted that it was large order and it would be a disaster if we couldn’t solve this. The rep said she’d check around and call me back. Fifteen minutes later, she called and told me that they had located the order. What had happened was that courier delivering the meds that night was brand new and didn’t know to stop at our facility or look for something for us. The box was found in the far back of the delivery vehicle where it had been overlooked for several nights. It was sent promptly by special courier.
I guess one could say I’m good at trouble shooting.
Wednesday, August 29, 2012
Thursday, February 16, 2012
Trying to Organize the Nursing Assistants Time
2-15-2012
Nursing homes have a bad rap. Sometimes it’s even deserved. You’ll get the occasional lazy nursing assistant and nurses who don’t care if the aids are doing their job. I think that’s terrible.
The first time I ran into problems with a group of aids, I worked night shift. The aids spent the night partying down in the break room, screaming with laughter. More than one call light came on from people complaining about the noise. A couple of times during the shift, they’d head out and spend 15-30 minutes on the floor, changing a few resident’s bedding and diapers, the last run spent making sure that everybody looked good for day shift.
Once I felt comfortable with the authority, I started to gradually steer the aids back to actually working. First I decreed that that rounds should be made every two hours, 10:00, 12, 02 and 04, which I had been taught at a place that got near perfect inspections. They argued. Their ringleader, “Suzy” stated that the next round should start two hours after the previous round ENDED. I told her that each person should be checked and changed every two hours and if the round takes an hour and if they waited two hours after that, it would be three hours before said resident would be changed and the aids weren’t being paid to sit around for two hours it would be neglect.
They ran to the Director of Nursing Services (DNS) and asked if they had to do rounds every two hours. She said yes, they did.
Next, I required them to turn people in bed each round who couldn’t turn on their own. I explained that this was important for preventing bedsores. I routinely ran down the halls making notes on how each resident was positioned so I could see if they were turned after the next round.
The aids ran to the DNS to complain they were being required to turn the residents. The DNS said that they were supposed to.
One by one they quit except for the ringleader, Suzy. She educated the new aids about how mean I was and how they had the right to sit around all night. Resentment continued. Screams of laughter continued to come from the break room, complaints were made by residents so I asked them to please talk a little softer, that residents were complaining.
They ran to the DNS and complained that I’d told them they couldn’t talk. At all. Despite the ridiculousness of this, (how can they do the job without talking?) I was written up as a concession to their constant complaints.
Eventually, the troublemakers quit and I had my crew, most of whom were faithful. They were an odd bunch that I called the misfits. If the work gets done, I don’t mind personality problems and do quite good balancing complaints of that nature. I have rarely ever had a patient develop full-blown bedsores where I worked the night shift, at least new ones that weren’t there when I started.
I worked one other place where the aids did much the same thing on evening shift. I guess previous nurses had tried to roust them before and were fired for being so hard on those poor, poor mistreated nurses aids. I was told to be kind since they’d had such a hard time, but when I tried to get them to use their time wisely, get vitals done and pass water at the beginning of the shift when it was slow, they acted like I was crazy. I answered lights while they had their Koffee-Klatches down the hall. After being asked repeatedly to do some work, they started to hide out in patient rooms to yak. I’d track them down and break them up, but the attitude continued. Again there was an instigator, reminding the others that I had no right to tell them what to do. Word got around that I was “mean”.
There came two new patients, both in the same room and both with looney-toone daughters. One daughter was vile, spitting filth and angry at all times, always finding fault. The other talked in the royal third person and kept cornering me to put her mom on the bedpan. I could have said “not my job”, a lot of nurses would have, but I could tell she was going to be difficult and tried hard to please. In the end, she wrote a long list of complaints about me, most of which concerned about how mean I was to the aids though she’d only seen one interaction of a minute or so and I’d been perfectly nice. I lost that round with the nurse’s aids.
Most groups of aids I’ve worked with are trying their best by their residents. They get fond of the patients and I’ve seen a few bring something special to eat for a resident who’s not eating. At one facility, the nursing assistants were just great, responsive to the residents and for the most part, working efficiently. But I noticed one problem…. the man they put to bed last wanted to be first. “Frank” finished his dinner quickly and would slowly make his way to his room. He could just make it to a standing position, but then would get stuck, unable to turn around and lay on the bed. Because he was so unsteady, he had a chair alarm that sounded when he tried to stand and a staff member would rush and urge Frank to sit down, we’d get to him soon.
I noticed, however, that the aids were being rather rigid in their bedtime routine. They would start at the end of one hall and go room to room, working their way down the hall around the corner to the end of the next. Frank was last by that system. An aid would come running when Frank set off his alarm and tell him he had to wait. Half the time, I was stuck doing the running. It made no sense to me to waste all that time running so I started laying him down on top of his bed while he waited for his aid, which irritated them into at least putting Frank to bed first.
But this got me to thinking about organizing bedtime routines and so I mandated the following: The first residents to lay down would be the loud and demanding ones, including Frank who kept setting off his alarm. The next group would be those who were tired and hurting followed by the ones who didn’t care when they lay down. This would not be a static setup, residents would move to another place in the line up when needed. I told the aids that I knew it didn’t seem fair that the noisy residents were placed first, but many of them also were ones who hurt a lot. Plus, keeping the floor quiet was less stressful on everyone, including the residents. I received more than one compliment from visitors stating that this was quietest nursing home they’d visited.
Working in a long term care facility is not easy, but sometimes thinking outside the box helps… ;-)
Nursing homes have a bad rap. Sometimes it’s even deserved. You’ll get the occasional lazy nursing assistant and nurses who don’t care if the aids are doing their job. I think that’s terrible.
The first time I ran into problems with a group of aids, I worked night shift. The aids spent the night partying down in the break room, screaming with laughter. More than one call light came on from people complaining about the noise. A couple of times during the shift, they’d head out and spend 15-30 minutes on the floor, changing a few resident’s bedding and diapers, the last run spent making sure that everybody looked good for day shift.
Once I felt comfortable with the authority, I started to gradually steer the aids back to actually working. First I decreed that that rounds should be made every two hours, 10:00, 12, 02 and 04, which I had been taught at a place that got near perfect inspections. They argued. Their ringleader, “Suzy” stated that the next round should start two hours after the previous round ENDED. I told her that each person should be checked and changed every two hours and if the round takes an hour and if they waited two hours after that, it would be three hours before said resident would be changed and the aids weren’t being paid to sit around for two hours it would be neglect.
They ran to the Director of Nursing Services (DNS) and asked if they had to do rounds every two hours. She said yes, they did.
Next, I required them to turn people in bed each round who couldn’t turn on their own. I explained that this was important for preventing bedsores. I routinely ran down the halls making notes on how each resident was positioned so I could see if they were turned after the next round.
The aids ran to the DNS to complain they were being required to turn the residents. The DNS said that they were supposed to.
One by one they quit except for the ringleader, Suzy. She educated the new aids about how mean I was and how they had the right to sit around all night. Resentment continued. Screams of laughter continued to come from the break room, complaints were made by residents so I asked them to please talk a little softer, that residents were complaining.
They ran to the DNS and complained that I’d told them they couldn’t talk. At all. Despite the ridiculousness of this, (how can they do the job without talking?) I was written up as a concession to their constant complaints.
Eventually, the troublemakers quit and I had my crew, most of whom were faithful. They were an odd bunch that I called the misfits. If the work gets done, I don’t mind personality problems and do quite good balancing complaints of that nature. I have rarely ever had a patient develop full-blown bedsores where I worked the night shift, at least new ones that weren’t there when I started.
I worked one other place where the aids did much the same thing on evening shift. I guess previous nurses had tried to roust them before and were fired for being so hard on those poor, poor mistreated nurses aids. I was told to be kind since they’d had such a hard time, but when I tried to get them to use their time wisely, get vitals done and pass water at the beginning of the shift when it was slow, they acted like I was crazy. I answered lights while they had their Koffee-Klatches down the hall. After being asked repeatedly to do some work, they started to hide out in patient rooms to yak. I’d track them down and break them up, but the attitude continued. Again there was an instigator, reminding the others that I had no right to tell them what to do. Word got around that I was “mean”.
There came two new patients, both in the same room and both with looney-toone daughters. One daughter was vile, spitting filth and angry at all times, always finding fault. The other talked in the royal third person and kept cornering me to put her mom on the bedpan. I could have said “not my job”, a lot of nurses would have, but I could tell she was going to be difficult and tried hard to please. In the end, she wrote a long list of complaints about me, most of which concerned about how mean I was to the aids though she’d only seen one interaction of a minute or so and I’d been perfectly nice. I lost that round with the nurse’s aids.
Most groups of aids I’ve worked with are trying their best by their residents. They get fond of the patients and I’ve seen a few bring something special to eat for a resident who’s not eating. At one facility, the nursing assistants were just great, responsive to the residents and for the most part, working efficiently. But I noticed one problem…. the man they put to bed last wanted to be first. “Frank” finished his dinner quickly and would slowly make his way to his room. He could just make it to a standing position, but then would get stuck, unable to turn around and lay on the bed. Because he was so unsteady, he had a chair alarm that sounded when he tried to stand and a staff member would rush and urge Frank to sit down, we’d get to him soon.
I noticed, however, that the aids were being rather rigid in their bedtime routine. They would start at the end of one hall and go room to room, working their way down the hall around the corner to the end of the next. Frank was last by that system. An aid would come running when Frank set off his alarm and tell him he had to wait. Half the time, I was stuck doing the running. It made no sense to me to waste all that time running so I started laying him down on top of his bed while he waited for his aid, which irritated them into at least putting Frank to bed first.
But this got me to thinking about organizing bedtime routines and so I mandated the following: The first residents to lay down would be the loud and demanding ones, including Frank who kept setting off his alarm. The next group would be those who were tired and hurting followed by the ones who didn’t care when they lay down. This would not be a static setup, residents would move to another place in the line up when needed. I told the aids that I knew it didn’t seem fair that the noisy residents were placed first, but many of them also were ones who hurt a lot. Plus, keeping the floor quiet was less stressful on everyone, including the residents. I received more than one compliment from visitors stating that this was quietest nursing home they’d visited.
Working in a long term care facility is not easy, but sometimes thinking outside the box helps… ;-)
Sunday, January 8, 2012
Assaults in Nursing Homes
1-7-12
When someone mentions assaults in nursing homes, one thinks of staff attacking a poor, helpless resident. Maybe it’s pinching an annoying woman or giving a kick to bad-mouthed man. What most people don’t realize is that staff are more often hurt by residents than the other way around.
I’ve worked in nursing homes for almost 20 years and I’ve rarely seen staff deliberately harm patients (at least physically), but I’ve seen residents get frustrated and try to hurt their caretaker. All of them, of course, have dementia to a severe degree, which doesn’t make it hurt less. Most of the time, they are too weak to do much harm. The favorite action seems to be to grab the arm and twist. That usually doesn’t hurt. If they twist enough, all you have to do is lean in the direction of the twist to reduce torque on the arm. Sometimes they take both hands and twist your arm in different directions, like wringing a dishrag. That can be tougher on you, but even if it’s enough to hurt, it’s a simple thing to reach over and pry a thumb loose and the rest of the hand comes off. It doesn’t harm or even hurt the resident when you do that. The worst is when they grab your hair and pull. You can count on losing air with that. One resident seemed to like to grab the hand, separate out the pinky and twist it. One aid got her finger broken with that. They usually do these things when upset at having wet clothes changed or to get up to go to dinner. Usually they don’t believe they’re wet or that it’s time for dinner, etc.
My worst assault with a resident was a man who still had some strength and could walk and get around. I was coming back from the dining room to get something from the nurse’s station when I found “Chuck” pushing “Tom” around in his chair. Tom was a double amputee and was already frightened of Chuck who was his roommate. Chuck got an angry look over his face when Tom yelled in fear and brought up his right hand to do a kind of karate chop on Tom’s left neck. By then I’d broken into a run and as I arrived I put my body in front of Chuck, between him and Tom’s wheelchair. I’ve found that in talking to an agitated resident, it’s best to look right in their eyes, so I kept my eyes on Chuck’s face and started talking as I gently pushed Tom’s chair away. After I was sure Chuck wasn’t going to immediately punch me or something, I stepped back a bit and glanced around to see if Tom was severely injured. He was wheeling himself away, so I turned back to Chuck and tried to coax him back to his room.
Chuck had problems keeping his blood oxygen up, but refused to keep his oxygen on, couldn’t remember to keep it with him. When his oxygen levels dropped, he frequently got combative and agitated and generally improved when his oxygen tubing was replaced. That’s why I tried to get him to his room. I didn’t want to leave him alone and no one else was around except residents returning from lunch. About halfway there, he stopped and grabbed my right arm and twisted it to my right. His grip was stronger than any I had experienced and I couldn’t break his grip my usual ways so I had to lean right to lessen the torque and keep him from breaking my arm. I kept trying to loosen his fingers when he suddenly grabbed a big bunch of hair and pulled. I then grabbed that hand to keep him from pulling it out and then was stuck for something to do. I’d worked a lot of night shifts so it was second nature to me to remain quiet no matter what since usually there was a way out. But now I was stuck. So I deliberately started to yell for help, trying not to sound like a resident with a habit of always screaming that was there. After a couple of yells, he turned loose of me and stepped back looking confused, like, ‘Why is she screaming?’. An aid came along and helped me get him to his room and put oxygen on him.
My hair fell out as I tried to fix it up and left a bald spot on my left top forward part of my head. Chuck was sent out to the hospital and from there to somewhere else for difficult people with dementia, which surprised me. The last place I’d worked kept everybody regardless of what they did except one who tried to assault the administrator. HE got sent out!
Most of the time agitatable dementia patients can be treated with anti-psychotic meds or antidepressants. Since in the early part of the twentieth century when patients were routinely sedated for the convenience of the staff, state laws have forbidden such things. Many inspectors of nursing homes get down on use of these meds, but I hardly think preventing assaults is a convenience. Also, an agitated person is clearly not happy, but fearful and confused. Assaults are a result of the delusional resident fearing harm. I’ve seen patients go from getting angry all the time to cheerful and start to participate in social activities. How can that be bad for them? Today’s medications are much less sedating than those available in the forties and fifties.
I totally agree that abuse of the elderly is unacceptable and people who do this deserve what they get. I once found a mute resident left in her bed during dinner while her aid was in the dining room feeding people, clearly not going to get this woman up for dinner. I also remembered that this resident was missing from dinner the night before. “Mary” was helpless, unable to complain and I was very angry. I immediately went to the supervisor to complain and the aid was fired. I don’t know if her license was suspended, I hope it was. In most places, there is usually someone who cares about the resident and who will stand up for them.
When someone mentions assaults in nursing homes, one thinks of staff attacking a poor, helpless resident. Maybe it’s pinching an annoying woman or giving a kick to bad-mouthed man. What most people don’t realize is that staff are more often hurt by residents than the other way around.
I’ve worked in nursing homes for almost 20 years and I’ve rarely seen staff deliberately harm patients (at least physically), but I’ve seen residents get frustrated and try to hurt their caretaker. All of them, of course, have dementia to a severe degree, which doesn’t make it hurt less. Most of the time, they are too weak to do much harm. The favorite action seems to be to grab the arm and twist. That usually doesn’t hurt. If they twist enough, all you have to do is lean in the direction of the twist to reduce torque on the arm. Sometimes they take both hands and twist your arm in different directions, like wringing a dishrag. That can be tougher on you, but even if it’s enough to hurt, it’s a simple thing to reach over and pry a thumb loose and the rest of the hand comes off. It doesn’t harm or even hurt the resident when you do that. The worst is when they grab your hair and pull. You can count on losing air with that. One resident seemed to like to grab the hand, separate out the pinky and twist it. One aid got her finger broken with that. They usually do these things when upset at having wet clothes changed or to get up to go to dinner. Usually they don’t believe they’re wet or that it’s time for dinner, etc.
My worst assault with a resident was a man who still had some strength and could walk and get around. I was coming back from the dining room to get something from the nurse’s station when I found “Chuck” pushing “Tom” around in his chair. Tom was a double amputee and was already frightened of Chuck who was his roommate. Chuck got an angry look over his face when Tom yelled in fear and brought up his right hand to do a kind of karate chop on Tom’s left neck. By then I’d broken into a run and as I arrived I put my body in front of Chuck, between him and Tom’s wheelchair. I’ve found that in talking to an agitated resident, it’s best to look right in their eyes, so I kept my eyes on Chuck’s face and started talking as I gently pushed Tom’s chair away. After I was sure Chuck wasn’t going to immediately punch me or something, I stepped back a bit and glanced around to see if Tom was severely injured. He was wheeling himself away, so I turned back to Chuck and tried to coax him back to his room.
Chuck had problems keeping his blood oxygen up, but refused to keep his oxygen on, couldn’t remember to keep it with him. When his oxygen levels dropped, he frequently got combative and agitated and generally improved when his oxygen tubing was replaced. That’s why I tried to get him to his room. I didn’t want to leave him alone and no one else was around except residents returning from lunch. About halfway there, he stopped and grabbed my right arm and twisted it to my right. His grip was stronger than any I had experienced and I couldn’t break his grip my usual ways so I had to lean right to lessen the torque and keep him from breaking my arm. I kept trying to loosen his fingers when he suddenly grabbed a big bunch of hair and pulled. I then grabbed that hand to keep him from pulling it out and then was stuck for something to do. I’d worked a lot of night shifts so it was second nature to me to remain quiet no matter what since usually there was a way out. But now I was stuck. So I deliberately started to yell for help, trying not to sound like a resident with a habit of always screaming that was there. After a couple of yells, he turned loose of me and stepped back looking confused, like, ‘Why is she screaming?’. An aid came along and helped me get him to his room and put oxygen on him.
My hair fell out as I tried to fix it up and left a bald spot on my left top forward part of my head. Chuck was sent out to the hospital and from there to somewhere else for difficult people with dementia, which surprised me. The last place I’d worked kept everybody regardless of what they did except one who tried to assault the administrator. HE got sent out!
Most of the time agitatable dementia patients can be treated with anti-psychotic meds or antidepressants. Since in the early part of the twentieth century when patients were routinely sedated for the convenience of the staff, state laws have forbidden such things. Many inspectors of nursing homes get down on use of these meds, but I hardly think preventing assaults is a convenience. Also, an agitated person is clearly not happy, but fearful and confused. Assaults are a result of the delusional resident fearing harm. I’ve seen patients go from getting angry all the time to cheerful and start to participate in social activities. How can that be bad for them? Today’s medications are much less sedating than those available in the forties and fifties.
I totally agree that abuse of the elderly is unacceptable and people who do this deserve what they get. I once found a mute resident left in her bed during dinner while her aid was in the dining room feeding people, clearly not going to get this woman up for dinner. I also remembered that this resident was missing from dinner the night before. “Mary” was helpless, unable to complain and I was very angry. I immediately went to the supervisor to complain and the aid was fired. I don’t know if her license was suspended, I hope it was. In most places, there is usually someone who cares about the resident and who will stand up for them.
Thursday, January 5, 2012
Frivolous Lawsuits?
12-9-11
I was sitting back, studying for my Advanced Life Saving course, keeping an eye partially on the television when one of those ads for lawyers that try to round up clients that have tried this or that medication came on. I hate those ads. I hate the way Americans have become ‘sue-happy’, feeling entitled to blame someone when things don’t go as planned, making the nearest deep pocket pay. Many seem to view it as winning the lottery. What happened to accepting that bad things happen and sometimes things go wrong when people mean well. That would seem to apply to the various drugs. I like to think that most drug companies really want to help people as well as make money. When someone takes a new medication, he should realize that all of them have side effects and some of those side effects won’t show up for years.
I’ve been involved with a couple of lawsuits of nursing homes that I had worked at. The first was where a woman had fallen out of bed. It had happened directly as a result of her preference for hanging her head over the side of the bed, secondarily because states have begun to discourage the use of side rails, calling them restraints. The second lawsuit was a man who had died of pressure sores developed because of his refusal to lie down once in a while to take the weight off his bottom.
For what reason to sue about mom falling out of bed? There was no evidence that she suffered or that the fall was the direct cause of death. After all, “Mary” wasn’t in a nursing home because of screaming good health. And accidents do happen. When people sue for injury and death, part of the recovery is for future earnings or loss of help with the children. That was not at stake here nor was pain and suffering. If anybody needed suing, it was the state supervisory body that began cracking down on using guard rails. If she’d had a guard rail up, she wouldn’t have fallen. Now nursing homes are forced to put these people on very low beds, basically a mattress on the floor, which is just as restraining as guard rails for people unable to stand up and winds up making it hard for people who have to get these people up, dressed and into wheelchairs. I foresee workman’s comp claims going up due to this.
The other lawsuit was a man who refused to allow us to lay him down for rest periods or even at night to sleep. He developed pressure sores as a result of this. He knew good and well this was coming as I repeatedly told him and even wrote it down in big print on the occasion that he acted like he couldn’t hear. I may have goofed in joking that we needed to lay him down or his family might sue if he got sores. I’m thinking that may have given him an idea, because he gave a sly smile when he refused to lay down. There were occasions when he was so tired he’d allow us to lay him down and I made sure that my aids kept the promise to get him up when he asked. Other nurses would keep him in bed when he allowed the lay down because it would be so long before he’d go to bed again. But that made him worse, making him not trust the nurses, so I carefully nurtured the trust so he’d let us put him in bed at least to treat the sores, change dressings etc. and sometimes he’d be so tired, he stayed there a little longer.
Despite our best efforts, he died largely from those pressure sores and his family sued. There’s a lawyer here locally who despises nursing homes and believes the worst of them. I defended the facility vociferously, hoped the facility wouldn’t settle, but they did. It was totally unfair and encourages everybody with dollar signs in their eyes to sue. Maybe if losers in lawsuits had to pay all the costs, people would stand up for themselves and not settle and suers would think carefully before suing. But as it is, it’s cheaper to settle than go to court, so more and more people are suing about the dumbest things and even staging incidents in order to sue.
This is discouraging to the people who work in nursing homes and do their best for the people under their care and I think it does a disservice to those people who have been genuinely neglected and abused. I tell people who ask that not every home is bad and most get better or worse from time to time depending on the turnover of staff. I recommend that the best thing is to check your family member over every week and drop in on mealtimes to see how they are eating. Being nice to the staff ensures that they will think more highly of your family member and will be more cooperative with your wishes. Also, they won’t duck when they see you coming, LOL.
But that doesn’t mean you shouldn’t be firm if you find something you think is wrong. Check on your resident’s pain levels and make sure they get adequate relief. I think most people in wheelchairs have some pain, since lack of activity can lead to spasms and contracting of joints and pain has been reported as being undertreated. People in nursing homes are not going to hold a job, drive or care for children again, so addiction to pain medications is not an issue, but bowel movements might be. That can be treated with fiber and laxatives. The most important thing is quality of life. If they are continually anxious, they should be allowed anti-anxiety medications if the more acceptable anti-depressants don’t help enough. The state regulates those as well in an inconsistent way, with some inspectors getting down on tranquilizer use and others cracking down on anti-psychotics according to their individual pet peeve. Each place I’ve worked at has been freaky about different things depending on their experience with inspectors, but as family members, you can insist on something being done about those things, as long as they don’t make your resident too sleepy to eat and participate in activities. More modern medication has a lower sleepiness index than older meds.
Anyway, careful watch over your resident will ensure against problems and the resident comfort is more important than looking out for something to sue after the fact.
I was sitting back, studying for my Advanced Life Saving course, keeping an eye partially on the television when one of those ads for lawyers that try to round up clients that have tried this or that medication came on. I hate those ads. I hate the way Americans have become ‘sue-happy’, feeling entitled to blame someone when things don’t go as planned, making the nearest deep pocket pay. Many seem to view it as winning the lottery. What happened to accepting that bad things happen and sometimes things go wrong when people mean well. That would seem to apply to the various drugs. I like to think that most drug companies really want to help people as well as make money. When someone takes a new medication, he should realize that all of them have side effects and some of those side effects won’t show up for years.
I’ve been involved with a couple of lawsuits of nursing homes that I had worked at. The first was where a woman had fallen out of bed. It had happened directly as a result of her preference for hanging her head over the side of the bed, secondarily because states have begun to discourage the use of side rails, calling them restraints. The second lawsuit was a man who had died of pressure sores developed because of his refusal to lie down once in a while to take the weight off his bottom.
For what reason to sue about mom falling out of bed? There was no evidence that she suffered or that the fall was the direct cause of death. After all, “Mary” wasn’t in a nursing home because of screaming good health. And accidents do happen. When people sue for injury and death, part of the recovery is for future earnings or loss of help with the children. That was not at stake here nor was pain and suffering. If anybody needed suing, it was the state supervisory body that began cracking down on using guard rails. If she’d had a guard rail up, she wouldn’t have fallen. Now nursing homes are forced to put these people on very low beds, basically a mattress on the floor, which is just as restraining as guard rails for people unable to stand up and winds up making it hard for people who have to get these people up, dressed and into wheelchairs. I foresee workman’s comp claims going up due to this.
The other lawsuit was a man who refused to allow us to lay him down for rest periods or even at night to sleep. He developed pressure sores as a result of this. He knew good and well this was coming as I repeatedly told him and even wrote it down in big print on the occasion that he acted like he couldn’t hear. I may have goofed in joking that we needed to lay him down or his family might sue if he got sores. I’m thinking that may have given him an idea, because he gave a sly smile when he refused to lay down. There were occasions when he was so tired he’d allow us to lay him down and I made sure that my aids kept the promise to get him up when he asked. Other nurses would keep him in bed when he allowed the lay down because it would be so long before he’d go to bed again. But that made him worse, making him not trust the nurses, so I carefully nurtured the trust so he’d let us put him in bed at least to treat the sores, change dressings etc. and sometimes he’d be so tired, he stayed there a little longer.
Despite our best efforts, he died largely from those pressure sores and his family sued. There’s a lawyer here locally who despises nursing homes and believes the worst of them. I defended the facility vociferously, hoped the facility wouldn’t settle, but they did. It was totally unfair and encourages everybody with dollar signs in their eyes to sue. Maybe if losers in lawsuits had to pay all the costs, people would stand up for themselves and not settle and suers would think carefully before suing. But as it is, it’s cheaper to settle than go to court, so more and more people are suing about the dumbest things and even staging incidents in order to sue.
This is discouraging to the people who work in nursing homes and do their best for the people under their care and I think it does a disservice to those people who have been genuinely neglected and abused. I tell people who ask that not every home is bad and most get better or worse from time to time depending on the turnover of staff. I recommend that the best thing is to check your family member over every week and drop in on mealtimes to see how they are eating. Being nice to the staff ensures that they will think more highly of your family member and will be more cooperative with your wishes. Also, they won’t duck when they see you coming, LOL.
But that doesn’t mean you shouldn’t be firm if you find something you think is wrong. Check on your resident’s pain levels and make sure they get adequate relief. I think most people in wheelchairs have some pain, since lack of activity can lead to spasms and contracting of joints and pain has been reported as being undertreated. People in nursing homes are not going to hold a job, drive or care for children again, so addiction to pain medications is not an issue, but bowel movements might be. That can be treated with fiber and laxatives. The most important thing is quality of life. If they are continually anxious, they should be allowed anti-anxiety medications if the more acceptable anti-depressants don’t help enough. The state regulates those as well in an inconsistent way, with some inspectors getting down on tranquilizer use and others cracking down on anti-psychotics according to their individual pet peeve. Each place I’ve worked at has been freaky about different things depending on their experience with inspectors, but as family members, you can insist on something being done about those things, as long as they don’t make your resident too sleepy to eat and participate in activities. More modern medication has a lower sleepiness index than older meds.
Anyway, careful watch over your resident will ensure against problems and the resident comfort is more important than looking out for something to sue after the fact.
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