Alone.
It wasn’t the first time I had seen this particular
picture. However it was the first time I was capable of following the outcome. And
it wasn’t the first time I that I lost my job because I chose to do the right
thing.
In the last ten years, I’ve worked in forty-four
nursing homes spread across five states. I feel as if I’m attempting to
find my way out of the catacombs, forever looking for light and air. I don’t
feel like that because of the patients, for they are what make it bearable to
work in a skilled nursing facility.
No. I feel like I’m forever in a lost city made up of
people who were once vibrant and vital to life and living, but are now fed a steady
diet of Little House on the Prairie and
Bonanza re-runs all day everyday.
They are told what they can do; when they can and cannot get in and out of bed
or eat meals, get a bath, or even when or
if they can go to the bathroom or have their diaper changed. And most are
told that they will go to therapy a certain amount of time each day, at least
as long Medicare A or B, or Medicaid monies hold out. In other words, besides
breathing or having private thoughts, they no longer have any control over
their lives.
In my very humble and personal opinion, once we
passed a law that allowed for innocent babies to be killed in utero because they were
inconvenient, it has become very acceptable to “put away” our elderly in places
where they go to die.
It’s like the frog in the pot of boiling water. At
what point did the frog go from being warm to uncomfortably warm to miserable
to pain to feeling nothing? We live in a society of many who feel nothing, even
those who are put in place to ensure that elder abuse and neglect don’t happen,
or if it does, there are ways to help them.
I am here to tell you that there is no help for at
least one patient, whose story is told below, and at least two other patients
that I have reported have severe problems with wounds, one in another facility. I’ve was told, “No. We
aren’t going to address any patients in another facility other than the single incident.” Period. End of
discussion.
I am nauseated to report the following story.
I found the bed askew when I pulled the curtain away
from his bed. Someone had pushed it out of its tidy place and hadn’t bothered
to put it back. He lay surrounded by more than a half-a-dozen pillows. Some had
been placed in an attempt to take the pressure off of his back, particularly
his buttocks; others were under and between his legs. There was a nasal cannula
in place delivering the vital O2 required to keep him breathing.
The bedside table was filthy with dried food. It took
more than a couple of attempts to roll the rusty wheels away from the edge of
the bed in order to reach the patient, also surrounded by raised bedrails on
either side. When asked how he felt, the patient responded, “My right leg hurts
a little.” I then begin pulling away a single pillow at a time, although it was
very obvious he was most uncomfortable.
His legs were drawn towards his chest the way his
hands were curled towards his heart. In my mind’s eye, I suppose at this stage
of life, it was his heart, or what was in it, that mattered. Although his eyes
were already dead, he was gracious and spoke kindly.
The CNA told me that the wound had gotten bad because
the patient didn’t want to “get out of the recliner” in order to get into bed because
he said “he couldn’t breathe” while on his back.
The CNA serving as the wound care nurse (CMS rules
and regulations require that a wound care nurse be an RN), rolled the patient
on his side in order to change the bandage on the Stage IV wound. I had been
asked to evaluate the wound, a wound that only three months prior had been the
size of my little finger. I had also been told that no other physical therapist
had been willing to look at his wound, or any wound, which is really
interesting after reading the corporation’s definition of Physical Therapy per
their website:
“Physical
Therapy focuses on problems with loss of movement, strength, motion, balance,
and skin breakdown to accelerate recovery, prevent impairments, and minimize
wounds and contractures. Our therapists work aggressively on healing advanced
state decubitus ulcers (bed sores) utilizing state-of-the-art wound care
protocols and pressure relief techniques to restore skin integrity.”
The bandage itself was about 10” x 10” which covered
a wound that was approximately 3.5” in diameter, covered by a piece of grey
foam that had been folded over itself several times.
The CNA brought with her hydrogen peroxide and saline
to clean the wound. I stood beside the CNA as she removed the entire bandage
and I smelled the wound before I could see it. Once I could see, I believed the
foul odor to be feces only to realize that the grayish-green substance was
oozing from the wound itself.
The patient was literally rotting.
When I asked the CNA how long the wound had not been
getting better, she replied, “I’ve been documenting it getting worse for at
least 60 days.” The patient was on hospice and had only been in the nursing
home for three months.
The wound was far past anything I could do to help.
Without touching the wound, I documented the
following:
“This wound
is out of my scope of practice. The patient needs to be referred to MD for
further assessment and possible indications for surgical debridement, IV
antibiotics, and hyperbaric therapy.”
Unknown to me until weeks later, the patient was
transferred out of the nursing home within six hours. They took the patient
(under the cover of darkness) across state lines, performed radical surgery
that included, but was not limited to, removal of the sacrum (tailbone), a colostomy, along with surgical debridement of two other wounds.
I visited this patient on three occasions. The first
time he was receiving blood, not because of a low hematocrit (per his nurse)
but because he was “leaking blood from ‘somewhere.’” I personally witnessed
consistent blood pressure readings of 90-something over 50-something and lower.
Prior to the second visit I was informed that his blood pressure had dropped
into the 70-something over forty-something range during the night. The third
visit I saw a family member while the patient received hyperbaric treatment.
The fourth visit in five days was the day the patient expired.
The patient was cremated and buried before the
State/Local representative for elder abuse began investigations on a report that I made ten days prior.
The point of writing and publishing such a story as
this?
It's not just the elderly at risk. We are all only a bad accident or severe stroke away
from being in a position where we cannot care for ourselves and/or there are no
caregivers who can. and we all know someone who is in a nursing home or under the
care of an entity like hospice, home health, or are in some type of rehab
program. The sickening thing about this particular situation is that over fifteen corporations are somehow in "bed together" and are profiting from the neglect and
abuse noted above.
I have contacted over two dozen entities in the Alabama
and Mississippi state governments in an attempt to help right the wrongs done
to the patient who is already dead by helping those that I am aware need help
today, and I’m sure others who I don’t know about. I’ve been informed that
there are no pictures and not enough documentation to support that any wrong
has happened.
Whether or not there is documentation to not support
the above or that it disappeared just like his body did with cremation, does
not warrant the lack of investigation regarding the ones who are still alive
and dying slow deaths due to severe wounds that come from neglect.
Write your senators and
congressman in Mississippi and Alabama, along with the Centers for Medicare and
Medicaid Services and the government offices listed below. Please beg them to do something about this situation. It
could be your loved one.
It could be you.
Office of the Governor, Stacy Lewis, email: stacey.lewis@governor.alabama.gov
Alabama Governmental Affairs, Henry Davis, email: henry.davis@medicaid.alabama.gov or phone number: 334-242-5005
Alabama Department of Senior Services, Nell Morrison: 334-242-5743
Alabama Ombudsman, Virginia Bell: 334-242-5753 or 334-328-4121 or email: virginia.bell@adss.alabama.gov
Commissioner of Medicaid, Stephanie Azar: 334-242-7100 or email: stephanie.azar@medicaid.alabama.gov
Mississippi Governor, Phil Bryant's, office: 601-359-3150
Mississippi: Elder Abuse, Nursing Home Neglect, Senior Exploitation: 800-852-8341
Mississippi Elder Abuse: 800-222-8000
Mississippi Medicaid Fraud Investigation: 800-852-8341
Centers for Medicare and Medicaid Services: 800-447-8477
