Okay, my father has the beginning of what seems to be bed sores. The staff in the nursing home will turn blue in the face and tell us they are not. Being not a physician I went on line to see a picture of bed sores, well it's a bed sore problem for my father.
What in fact should be our next steps? We have requested a wound nurse. I have 3-5 times. I have never heard back from them. They recommended a dermatologist but it is in a basement of a building with no elevator. My father is confined to a wheelchair. What should we do next? We are thinking about a hospital visit? Please tell us what to do next in regarding this manner. This is so wrong, in so many ways.
There must be a dermatologist somewhere in your community where there is access. I'd have this diagnosed by someone not involved with the nursing home. Then, if it is a bedsore and they won't admit it, you can take it to your ombudsman at www.ltcombudsman.org. Type in the Zip code of the nursing home for your contact. This is your representative.
Good luck,
Carol
You can go and find and buy air cushions for him to sit on and then you go and secure it to his wheelchair & any other chair in his room with velcro. Michaels craft stores has adhesive Velcro precut that works great for this. If he is really heavy, you may have to replace these very often too. This will not be a covered expense by Medicare, Medicaid or other insurance either. You private pay for this and install them. Also you can get a flowing "air-matress" installed on his bed. Now Medicare & Medicaid will pay for these if medically necessary. My mom is totally bedfast in a NH and on hospice. The hospice group ordered this the first day they came on too. But I imagine that dad is not at this point of his care, so if you want this, then it's up to family to private pay for this. The NH will have the name of a provider that brings in private pay equipment routinely at the facility.
Now the doctor can order that a dermaplast or other specialized bandage be placed on the area daily. I'd speak about having this done. This is pretty routinely done. Also the doctor can order that he get turned every 2 hours or so when he is lying in bed. Now these sort of orders are sticky in that if dad is still good on his ADL's, then he is expected to be able to shift his weight and do some things to prevent the bedsore on his own. If he is the obstinate type who just won't do simple things for himself and can, the NH is in a tough spot as to just what all they can do. When you have his next care plan meeting @ the NH, you need to discuss all this in detail so that everybody is on the same page as to what is happening, what is covered under Medicare & Medicaid and what is expected of him and nursing staff in all this. Everybody needs to work together on all this, if you are coming across as telling them they have to do everything, it is not going to work in your or dad's benefit. Understand? Good luck.
You and your father have rights. The staff at the nursing home have responsibilities. It is not your responsibility to diagnose your father or to come in and provide medical care for him or to be there to turn him every two hours.
The coverage for supplies and equipment varies; some plans cover these things including medicare and medicaid depending on diagnosis. don't rule out options before checking it out.
These broad responses about things on this blog are not helpful. It often sounds as though patients and families have no power or rights and that is just simply not the case - though it can be very frustrating don't give in to the nursing home line that they are simply understaffed, overworked and that your parent is a problem patient. Its nonsense. There are laws that regulate their actions and responses and in particular mandatory bed sore prevention and treatment.
Pressure sores are much easier to prevent than they are to heal, besides which, once the skin is broken down it is an open invitation for infections to enter.
If they argue with you till the are blue in the face, then you have to argue right back until you are purple in the face!
Make them do what needs to be done and never take 'no' for an answer.
I used to have a mini-sound recorder [H2] in my pocket for visits, especially when a clinician or physician was present.
As it was, whenever I drew attention to a problem, it was immediately seen to.
When a member of the nursing staff came into my wife's room and threw a pillow around in anger for something that had happened elsewhere, I ordered her from the room and had her unassigned to my wife. The floor sister was quite co-operative.
On another occasion, a PT was yarking my wife's legs out of bed the day after her knee replacement, ignoring my wife cries of pain. I ordered her from the room saying, "If you do not get out, I will throw you out!" I am not usually so irritated, but when someone does something that causes a patient in pain to have even more pain, then whatever it is they are doing has to stop, stat.
As I have said before, the cared for is more important than the carer. Not everyone agrees with that, but that is my philosophy. The helpless have to be helped, and that is why we are caregivers.
Carers under stress can attend support groups where others in similar situations will share their experiences and, hopefully, good advice on how to cope with difficult loved ones.
Texarkana has this spot on in being assertive but not aggressive.
If you go the nuclear route of contacting an attorney or being demanding and telling them what they "have" to do, the NH may well send you a "30 Day Notice". In the notice (which is sent to the state and their insurers), it will be brief and say something like Mr. Smith needs a higher or more specialized level of care than we can provide at this time and so Mr Smith will need to move to another facility within 30 days. If you get a 30 Day Notice, you will need to find another facility for him. They could extend the days (Medicare & Medicaid have safeguards on this) but really you will have to find another NH. So you will have to find a specialized facility that deals with wound care. This may not be easy to find.
You can take him to see an outside MD. I took by mom to see her private practice opthamologist & her old podiatrist even through she is in a NH for the first couple of years. The NH did require that they faxed over a short report that was included in mom's file @ the NH. (I could not bring the report over, had to come from the doctors office directly) This may be a good way to approach this to determine just what is happening with dad's situation from an objective third party. You can request a care plan meeting after dad sees the dermatologist too. They usually are every 90 days (at least they are for TX NH) but you can request in writing to the DON (director of nursing) for it a care plan meeting to be done the week after the dermatologist visit (so they get the dermatologists report & review it). The care plan meeting is really a good opportunity for everybody to voice their concerns. In addition to nursing, dietary & activities & social worker will be at the meeting or on CC line. For us, dietary has been especially great as they have tweaked mom's foods for her being bedfast this last year and getting items with prebiotics so that her elimination is better. What if dad is straining for bowel movements and that is causing the pressure? then dietary changes could make a difference. Really it needs to be a team approach to care. Good luck.
I was pretty confused when my mother went to a nursing home, and trusted that the facility doctor would do the trick. Turns out it took absolutely weeks to get a low sodium diet for her, even though her hand swelled like inflated plastic gloves.
I have also worked in a nursing home (a long time ago) and more recently in other areas of residential care. There is a strong pecking order about who can tell the doctor what. (pretty much nobody). I also wonder how often the doctor actually examines the patient, and not just their chart.
My dad's doctor is happy to look at pictures of his behind on a cell phone photo, which can also be emailed.
Reestablish with an outside doctor who specializes in elderly non ambulatory adults.
1. Back
2. Bladder
3. Bowels
4. Bed [pressure sores]
These are always priorities and no member of staff should need telling to attend to them at all times because they are the primary causes of patient discomfort, infection, confusion, and concomitant infection often leading to death.
TAKE PHOTOS OF THEM NOW. KEEP A LOG. MEASURE THEM. RECORD YOUR CONVERSATIONS WITH THE STAFF ABOUT THE BEDSORES. ASK WHY HE ISN'T BEING TURNED, CHANGED, AND CLEANED AS HE NEEDS TO BE.
PHOTOS, RECORD CONVERSATIONS, MEASURE THEM WITH A RULER OR WHATEVER. Tailbone area is usually where they get it. You can get them anywhere there is pressure. Dad probably needs one of those air matresses to help relieve pressure point.
Complain to the ombudsman, your city councillors, your reps senators, Governor, and even Barack. Get someone moving in the right direction.
Stand unafraid and never surrender until his needs are met