Friday, August 17, 2018

Wounds and Sores No Regulations Federal or States

Mom suffered many wounds and sores in her facility from abrasions to openings large enough to require stitches. 

They were overlooked, mismanaged and caused many additional medical costs, pain and suffering.  

Mom had inadequate monitoring of medications -- A MAJOR PROBLEM IN LONG TERM CARE FACILITIES WHERE DOCTORS ARE "ON STAFF".

Computer programs are often old versions that do not  provide anything more than basic "accounting" of medications administered.

These "recordings" are often done by staff who move from one to another and then "enter" the distribution after administering to several patients -- often questionable as to time administered, dosage, etc. 

Recordings of services provided are often not entered until the "provider" can find the time between being called to one and then another and another and only being the single staff person available or perhaps one of two to serve as many as 20 individuals needing assistance and all in varying stages of capability and need for personal assistance.

Doctors are admitted to practicing at the facility and as such are "employed" by the facility and subject to release by the facility. 

While many will tell you is difficult to find Doctors willing to go into a facility, I believe if an accurate invesitigation was done of the number of "patients" seen by a Doctor during one visit to a facility of one hour was recorded we would find less than 5 minutes was spent with each one

I've observed Doctors moving from person to person, in an open environment of a general gathering place like the hall, or an area where food was served or patients were "parked" for hours on end. No gloves, no change of gloves, no washing or sanitizing of hands.

Not only does this violate a person's right to HIPPA privacy it also violates their right to dignity, self determination and privacy as I've witnessed Dr's using stethascopes under garments they lift or lower and other examination procedures in full view of residents, staff and visitors.


QUESTION:  If this is done in sight of a "visitor"? What might be done when one is not present?

Today, reading more Rules and Regulations for the State of Missouri and reviewing sites giving advice on preparing for the “annual” visit by the Department of Health and Senior Services reviewing Long Term Care Facilities,I was shocked to read the following:

“Neither state nor federal regulations require a facility to keep/provide a report” on pressure sores/wounds.

Here’s our personal list of a few wounds and sores that we believe warrant specific reports generated with or without attention by a Doctor or by an outside Medical Facility:

Mom fell, she suffered a “wound”, a cut; facility looked at it and determined no problem; we took her to the ER and the Dr on duty assessed a need for 5 staples. There was no entry in her record about this “wound” from the fall.

Mom was subjected to having a rough towel used to remove hardened fecal material on her anal area with a rough, scrubbing procedure. This caused bleeding of the Hemhorroids and sores on the exterior part of her anal area. Her screams could be heard all across the floor; I know, I was there.

We noticed small sores on her legs caused by flaking of skin and rubbing of her legs against something. We were told there were no “sores”. Taking Mom to a wound specialist who’d seen her before she was given specific medication for infection and specific instructions for wound care – which was not followed by the facility.

Mom had pressure sores from sitting in a wheelchair for long periods of time; she had pressure sores from not being moved and staying in one position for long periods of time.

Time has passed. Mom passed in 2014. Procedures have not changed. When are we going to speak up about this abuse of our least capable population of human beings? 

Our mothers and fathers, sisters and brothers, relatives, friends and even people we've never met are being treated as though they were less than human and even lower than some animals we keep in captivity or in shelters.

Monday, August 13, 2018

Look Before You Leap: Visit, Shop Around Long Term Care

Even if you have no intention of "going into" a Long Term Care Facility.....SHOP AROUND AS THOUGH YOU NEEDED IT NOW.... or someone you care about is already in imminent need.

Why?  Simple.  We shop for everything else in life but almost all of us don't think we "need" to shop for something we "don't need at the moment". 

How many college visits did you make with your kids? How many people did you date before deciding this was "the one"? Belong to an organization, a club or even making a choice where to eat or meet -- most of us put more into those choices than we do "a place to live" when living means more extensive medical care and supervision.

You need to visit more than once and walk the facility, all areas, check out the on line information from the DHSS including Annual Reports. 

Know where you/your loved one wants to go if it's the choice that needs to be made. IF YOU DON'T, you'll settle for someone telling you where to go and what's available and won't have any ability to choose, you'll just have to "go" where you're told "has space".

Google/Search the web for comments from people who have loved ones there and you won't always find it where you think it will be.  Look for Blogs about families with loved ones in LTC, Assisted Living or Independent Living. 

Visit every facility within a twenty five mile radius of where you want to reside or place a loved one.

Why that distance? Easier to get to for you in times of need and just to visit more frequently because it's closer.

Do not eliminate any facility because it appears to be high priced or very inexpensive. 

You'll get ideas and see the possibilities to look for at those that are in your budget or category of care range.

Just as you'd shop for a home or apartment -- make a list of what inclusions and features you want to have.

Is there an outside area that residents can use BY THEMSELVES and without having to be "admitted". 

Even if they have mental challenges or wander, an enclosed patio with sturdy chairs, of adequate height and with arms for pushing the body up and easing down, are important.

Put yourself in "their" place. 

Have them use their cane or walker and walk with you from point to point to see their abilities and challenges.

Remember! Their movement will usually become less and less and they will probably advance to other forms of self movement that are more limiting as time passes.

Get into a wheelchair and see from their perspective how far it actually is to get to the dining room, the main area where family and friends visit and even from one room to another on a floor to visit a new "friend". 

Attend a meeting of the Resident Council and the Family Council. They are two separate organizations.

These should be open to the general public although membership is generally exclusive to residents in the one and to family members/friends of residents, in the other.

Talk with residents about what they did today, yesterday and even a few days ago.  

What does the facility do to transport residents to outside activities and for excursions (shopping, etc)?  
Who goes? How are they selected? What's the cost?

Walk with your nose leading the way. 
If there's a smell of urine or other waste products, human or food or whatever, it's not "natural" and "to be expected. 

It's a housekeeping necessity and if this isn't taken care of, what else that might cause infections and other medical problems could there be?

What do you need to ensure you're given immediate access to records (if you have Power of Attorney; and if you don't, someone definitely needs this and Medical Power of Attorney).

Most people spend as little time as possible seeing these as the last place they ever want to live. I understand. Mom always told me that. If  you've read our story, you know Mom was manipulated and controlled by someone using Undue Influence at a time when her Lewy Body Dementia was starting to become more and more extensive and she was "mallable". 

Your life is busy. You don't need one more thing to do. I get it. 

It's your life. It's your choice.....or it should be.

Thursday, August 9, 2018

Learning From My Cat's Dementia

Caregivers can learn a lot from their aging pets as they move towards their end of days. 

This entry was started in late 2013, Mom and our cat were both approaching their "end of days". We saw obvious signs in our cat's behaviours and her obvious changes; with Mom, we saw changes and felt her time with us was growing less and less.

OBSERVATIONS:  Cat has lost a great deal of weight and has gone from being "choosy" regarding what she eats to also including where she eats what she chooses to eat.

For humans, one of the "signs" of "end of life" in the elderly is their "choosing" to eat less and less and then refusing food.

Various studies have concluded that medications can change the way we humans smell and taste; medications that affect the body and the brain. 

Perhaps we're not seeing the correlation between the brain that's being affected by disease and the medications elderly people are often given for a myriad of reasons -- including "mood" improvement, especially in Long Term Care Facilities.

Cat is not on any meds but notice she tries to smell more what she eats and may turn away even when given various choices: canned food, fresh food, it doesn't matter.

Our senses are important from birth onward. The newborn "roots" and uses the sense of smell to locate food and to recognize caregivers.

Watching our cat and Mom, I see these "basic instincts" becoming more important as the brain seems not to process everyday common activities as it once did.

Cat's ability to chew also seems to be affected and she's been surviving on the "gravy" we've found in some canned food and the "liquids" we produce from cooking fish or chicken along with a very small amount of the actual solid materials.

Taste for one type of food may produce eating and then again it might cause her to turn away. Is it the sense of smell or taste or both?

In Long Term Care facilities, Dental Hygiene is often non existent or at such a low level as to cause complications never experienced before by the individual while living with family members or on their own.

THRUSH -- take a look at this report by government resources

WONDERING.  Why facilities don't have more food choices they offer and keep track of what items seem to be more "accepted" by residents on an individual basis? 

Why aren't LTC's trying like I am for my cat and did for my children and my Mom when she lived with us, to watch closely their Nutrition and ensure they received the necessary amount of nourishment to promote health and well being?

Reality Check:  Staff that's hired from a service, constant turnover, two few staff for number of residents -- problems are rampant but it takes highly observant family members to eliminate this chronic problem.

INTERESTING COMMENT:  I was once told Mom lived as long as she did because she was a "determined person". Guess what we provided for almost forty years for her mental and physical well being including healthcare that intervened when necessary and didn't wait until the complications (like so many of her Urinary Track Infections at the facilities causing severe challenges) didn't have any positive effect?

And, it was our constant vigilance and action while she lived in the Long Term Care Facilities that added to her life despite the lack of facility oversight and care.

In the facility Mom was in for the last two years, the access to recording information concerning residents appeared to be limited to wall mounted units in the hallways and those appeared to be used by Aides to record what they did. 

The Aide, who moved from one to another to another, had to make/take the time to record after performing a service and she/he could often be seen making notes on more than one resident at a time. THAT'S DANGEROUS.

The Nurses (LPN's) used laptop computers at the "main desk" or at "medication stands located near the main desk" where they pulled up information on individual residents OR they wrote on pieces of paper that then had to be filed and, of course, couldn't really be accessed and referred to easily AND each person's hand writing or printing might be very difficult to interpret. 

ANOTHER OBSERVATION:  Cat eats in different areas and what she refuses in one, she may accept in another. Facilities, at least Mom's did, often move residents from a "main dining area" where they've eaten for a long time to a "special dining area" but there is often one person to feed three people at one time or two will sit waiting for as long as it takes to feed the one before "getting their turn". BY THAT TIME, MANY REFUSE, HAVE FALLEN ASLEEP OR ARE DISINTERESTED.  

Cat likes to be near me and will accept some foods when they're placed near my chair as I work on the computer or even "in bed" in a box she's chosen to lay in near the back door where the Sun warms her very lightweight body. In Mom's facility, residents "share" tables but there's no "moderator", no "promoter" sharing time and place with them who has been trained to lead conversation, share current affairs or involve residents in "the real world" and keep their minds active and involved.

Cat has always been small; she was the littlest in the litter we were told; but she was active and quick and very agile before her Dementia really took effect -- a lot like Mom's abilities to move, be active and accomplish tasks.

Cat reminds me, as Mom did, of a regression physically backwards in time to being a small kitten/child. Animals, however, are born being more capable of moving and fending for themselves while humans go through many stages of being totally dependent to developing skillsets and abilities.

Overheard a woman visiting her husband saying to the receptionist how THEY'RE going to have to give him something because he's just so unpredictable and she can't stand to visit him when he's one way one minute and another the next.

HOW SELF CENTERED WE BECOME, THOSE OF US WHO CAN WALK AWAY AND WHO CAN MEASURE "OUR" TIME AND OUR LIVES as needing not to be "disturbed" by another's needs and wants expressed in a way we do not feel is "acceptable" to us. 

I can only wonder what kind of relationship, what type of marriage these two had. Maybe she's "making up for" the poor ways she was treated; maybe she was always the one who did't listen, wouldn't listen.

LONG TERM CARE needs to focus on all three words, ephasising the CARE. Too few provide real compassion and concern. Too many walk away or simply find other things to do rather than watch, listen and provide caregiving.