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.
Sunday, January 8, 2012
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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