Tuesday, June 25, 2013

Julia: Part I Cease & Desist: Undue Influence and Abuse of Our Family

Before making your care provider decision, anyone considering entrusting their loved one to even volunteer care by someone they think they know or have seen in a place, like their Church, where they feel "safe", please read our story of misplaced trust and how we’re still picking up the pieces of the havoc wrecked on our lives.

WHY, JULIA?  Why do my daughter and I believe you have financially and emotionally abused my now almost 99 year old mother and our immediate family since about January 2010 (when she was 95 and had shared our home since she was 57 years of age; almost four decades of continuously living together), while my husband was critically and chronically ill in a hospital bed in our home, since his untimely death in January 2011 and that you are still continuing your actions as I write?

Perhaps, if you stopped refusing to meet, as you have since early 2011, to sit down with us, with an impartial person like our Pastor, as we’ve suggested, we’d have answers to that question and the following…..

WHY, JULIA? Why did you, as we believe, knowingly and willfully make a false report to the State of Missouri Elder Abuse Hot line stating I was financially and emotionally abusing my Mom when all the email communications we exchanged from February 2010 through June 2010 showed no concern on your part except to gather more information on Mom and our family?  

Missouri Law protects the reporter and, in my opinion, punishes the wrongfully accused not allowing any information to be released about the report including being told there was a report made or the “accused” is a “person of interest”. This was true in 2010 and appears to still be a part of the Missouri Statute. It's time, State Legislators to correct this injustice.

Writer's Note: 1-26-15. Noticed a few days ago additions to Missouri State Statues requiring "imminent danger" for the Elder to be investigated. Did not find any definitions. Did not find any references to Guidelines, Systems of Procedures for the DHSS or the Adult Protective Worker and the effect of this "change" is 2017.

Missouri Law did not provide specific systems and procedures to follow for the DHSS worker assigned to “investigate” the complaint. There were no policies in place mandating specific protocols ensuring a timely investigation including direct contact with the accused be made to investigate all allegations. To this day, I've never received notification I was accused of anything, by anyone, at anytime yet my world has been shattered, broken apart and financially damaged by actions there is no doubt you were responsible for doing.

Missouri DHSS guidelines for hiring entry level people given the responsibility for making Medicaid decisions don't even require a college degree. These "workers" aren't required to have a degree in Social Work, undergraduate or graduate or to be a LCW. They can have a GED and a few years working with the general public (fast food or retail gets a State job determining the lives of individuals and families?). One year of work at the DHSS and a few internal courses and they can become an Adult Protective Worker.

A month after my Mom entered a Skilled Nursing Center, supposedly at her request for "permanent placement" while we were told it was for "respite", I received a form letter from the Missouri DHSS asking me to appear as a "person of interest" with no mention of for what purpose, about what matter or concerning anyone in particular.

Writer's Note: 1-26-15. I've discovered in recent months that Medicare provides specific lengths of time for "Respite" and that Respite is for the "family' and not for the "Senior". 

DECEIT AND DECEPTION ON THE PART OF THE DHSS. Without investigating, without any interview of me, my daughter or my husband, who was alive at the time and living in the "same environment" and in a much more weakened and "vulnerable state" and also a Senior under Missouri Law, I was told Respite would be good for Mom as we'd asked for additional Adult Day Care time and the APW suggested this as an alternative.
It’s an interesting story how my daughter and I discovered all these facts and more – to be told in another entry.

Whatever happened to Individual Rights, the Right to Know Your Accuser and Innocent Until Proven Guilty? It'll be three years this November I was falsely accused and unjustly sentenced to live without my Mom being a part of our family as she had been for almost forty years.

She's been diagnosed with Lewy Body Dementia; it's in very advanced stages; it had been going on while you, Julia, kept telling me there was "absolutely nothing" wrong with my Mom mentally even though she was exhibiting classic (as we now know) LBD symptoms of hallucinations, delusions, difficulty with her gait/walking and other symptoms.

Everyone should visit the website of the Lewy Body Dementia Association to understand this Dementia. People with the disease can appear to function quite well; someone, however, working with men and women on a regular basis with Dementia and Alzheimer's as Julia did, would see these "guideposts". A Registered Nurse trained in one of the top Nursing Schools in the US as Julia was and specializing in caring for this group should definitely see the Dementia.

I’ve gone through training since this happened within the State of Missouri on Elder Abuse through becoming elected to a position on a Board of Directors for an organization providing services for Seniors to improve their quality of life. This began the journey of discovering who the real abuser was and continues to be. It's you, Julia.

WHY, JULIA?  Why did you violate the oath you took as a Registered Nurse? I believe it’s referred to as the Florence Nightingale Pledge.
My life was turned upside down. My character and integrity were assaulted.We suffered irreparable financial loss. Yet through working for extending providing a better life for other Seniors, I’ve found a beginning closure and made lemonade out of one of life’s lemons.

WHY, JULIA? Has your only response to my asking why you made the call to the Missouri Elder Abuse Hot line been, “You can’t prove it?”

WHY, JULIA?  Why deny making the call reporting what is looked upon as a crime? Or, if it was a “mistake”, acknowledging the mistake, if indeed it was one?

I know you've been a highly competitive and capable tennis player since college (possibly even before) and that you are very good at evaluating your opponent and playing to their weakness while advancing your game.

Human life is not a game, Julia; Seniors are not to be used like tennis balls.

Tuesday, June 11, 2013

Care Plan Meeting Misevaluation Leads to Another Emergency Room Visit

Misevaluation by her facility Nurse Manager at a recent Care Plan Meeting.

At our last Care Plan Meeting, NM said Mom was being "aggressive" and she wanted us to put Mom on anti psychotics; also Mom had significant weight gain and NM wanted to put her on a diuretic.

Mom has adverse reactions to almost all drugs and especially antipsychotics. Mom has a preexisting medical condition negating the use of antipsychotics along with a previous reaction to an antipsychotic. Both conditions should be in Mom's medical record and easily accessible to anyone considering recommending medications. But we haven't found them in her records and cannot convince the facility to enter these into her record; should have been from previous medical records given to facility when she transferred.

For the facility, however, drugs are a way of ease in managing their patients and require less continuing care and therefore lower cost.

When asked for specific dates/times/references for Mom's "aggressive" behaviour, no records were provided and no information was available.

There was a list of Mom's weight fluctuations but there was also a failure to note any reference to previous Urinary Tract Infections, retention of water and digested materials from impaction, as having had an effect causing the weight gain.

Both of these factors are significant signposts of a Urinary Tract Infection and should be charted and also separately noted for easy reference.

Records are kept but notations do not allow correlations to be drawn.

Medical care in a Skilled Nursing Facility often relies on accurate and timely observations of personnel AND positive and correct response all up and down the chain of command, especially with the Nurse Manager (often an LPN; she/he is responsible for an entire floor or section of patients and is directly responsible to the facility's Director of Nursing, usually).

We cannot seem to communicate with Mom's medical caregivers at her facility on various medical challenges with Mom from UTI's to LBD.

They refuse to accept and include a diagnosis of possible Lewy Body Dementia because of the word "possible" yet that is the full medical description. 

They do not see LBD as being a disease with constant fluctuations and want to treat it like Alzheimer's believing each progression should be constant, consistent and permanent. This is NOT LBD!

Read the following information about Lewy Body Dementia from the Lewy Body Dementia Association to understand the scope and challenges of LBD.
Within the info is general info on aggressive behavior and anti psychotic drugs as well as a general overall description of LBD SYMPTOMS AND DIAGNOSTIC CRITERIA.

Care Planning resulting in overlooking a medical condition leads to complications requiring the family to transport Mom to the ER -- yet again -- for a medical condition that should have been easily seen by the Skilled Nursing Center.

A few days went by and another "incident" occurred.

I received a phone call Mom was being very difficult, wouldn't get off the toilet and being verbally abusive to staff.

The Nurse Manager was able to put Mom on a cell phone. Mom didn't talk "with" me; it was a one way monologue with Mom saying she was going to sit there until the ambulance came to take her to the Hospital. Yes, she was expressing anger and frustration and some of her language was offensive but I could tell she was frustrated.

Mom was asking for medical evaluation in the only way she knew how and the Staff, especially the Nurse Manager, didn't seem to have the time to listen to what she was trying to tell them. The Aide and NM simply wanted her to get off the toilet so they could put her back in her wheelchair and "be done" with her.

Mom's reaction was similar to a small child's who wasn't being listened to and understood. She stood her ground and finally called in the "calvary" by saying she wouldn't get off the toilet until the ambulance came to take her to the hospital.

This is actually a violation of Resident's Rights in a Skilled Nursing Facility in Missouri, denying a resident the right to seek medical attention outside a facility.

Substantiated by the recent State Investigation of the facility, NM and other staff responsible for resident care often do not listen to the patients and follow State Regulations requiring Patient's Rights for medical services outside the facility. This isn't an isolated incident, it happens all the time in Skilled Nursing Centers where almost all are understaffed.

UTI's are very frequent in the older population, especially the very elderly. Combine this with any form of Dementia and you have a challenge. Meeting the challenge is easy when you're informed and understand Dementia and especially Lewy Body Dementia.

READ ABOUT common areas everyone should understand about Lewy Body Dementia and especially information giving insight to the person challenged. 

Skilled Nursing Centers and Living Centers of all types should be places where family can trust their loved ones are in professional and caring hands and not have to intervene and ensure State Rules and Regulations are followed.

Once again daughter and I changed our plans, rescheduled our complete day to get to the facility early afternoon after receiving the call from the NM my Mom would not get off the toilet and was very "angry". 

I knew we'd be running her to the ER; it was Saturday and staff was cut back and by nighttime, a skeleton crew would mean Mom would get very little help including the frequent toileting her diarrhea and incontinence she was experiencing would require.

Mom's communicative abilities are exceptionally impaired at times but she, like so many of our elderly, are often "childlike" in that they sense, they feel, a problem within their bodies but they do not have the language or the mental abilities to explain what is happening.

Verbal skills that have declined as Mom's have with her Dementia often affect clear and concise communication (what we generally ask for and expect in adults) and should be addressed with more training of professionals and family members who serve as Care Givers.

With LB and other forms of Dementia, the person often cannot clearly explain the pain they're experiencing and may even talk about pain in a location other than where it's focused.

Dementia is a brain challenge. Just like various forms of Cancer targeting different areas of the body, Dementias have common yet different actions and cause differing reactions in abilities and progressions of the disease.

Today, we do not link together these various mental degenerative and individually titled "diseases" but I believe some day we will see the brain as being an organ as affected in its medical conditions as any other part of the human body:  heart, lungs, kidney, etc.

Perhaps in the future a Neurologist or other specific "Brain" Specialist will be as common for physical exams as today's specialists in heart, bone, etc.