Monday, October 31, 2016

The Lost Cities and Rotting Bones


 His flesh and his bones rotted while he lay in the corner of the nursing home.

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.



http://www.alabamaageline.gov/elder-abuse

Governor of Alabama, Robert Bentley's, Montgomery office: 334-242-7100 
Governor's Chief of Staff, John Bargineer: 334-242-7100

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


2 comments:

Unknown said...

Thank you for this. i'll do what I can, this situation must be addressed.

Sarah Beaugez said...

I say thanks for all you may be capable of helping.