Fall from a lift and mom's high tolerance to pain leave me worried

Mom's had another incident at the nursing home that will leave me worrying for a couple of weeks.   The aides use something called a "sit to stand lift" to move her from chair to toilet.  Apparently, she lost her grip and she slid out of the lift; the aid saw it coming and caught her and "sat her on the floor".  They said there's no bruising, no broken arms or legs and no pain so she seems fine. My fear now is that something more is wrong but the signs will be so subtle that it will go ignored or unnoticed until she's in excruciating pain; that's what happened last year about this time.
 
I worry that Mom will have pain but won't feel it.  Since her broken sacrum was diagnosed in February 2011, Mom's been on pain medication that works on her nerves (those little things that transmit pain to the brain) and she wears a pain patch.  To make it more complex, I believe that she has an increased tolerance to pain after a stroke during my birth.  I've seen her burn her hand canning and not realize it until her fingers are full of big blisters.  At that time she was un-phased and just kept working; she said "It doesn't hurt, it can't be that bad."

She "seemed fine" after the "assist to the floor" last January yet she ended up dead in the MRI machine.  I told the nurse who called to tell all the aides to look for "crankiness", impatience or asking the aides if it's time yet for another pain pill.  These are all signs that she's having more pain that SHE or the aide's realize.  I noticed it in her over the holidays - before the "assist to the floor", a month before her pain became excruciating.  Mom's normally in good spirits and doesn't complain; but at Christmas she was disgusted and griped constantly about everything - gifts, visitors, her shoes, her clothes, the aides, my hair, the beautician.  I realize now this was her pain talking.  We might have saved her from the MRI fiasco, the delerium of the narcotics and the bedridden period she required to "heal".  ( I don't believe her sacrum will ever "heal" but that's another post..)


I'm frustrated because I've expressed concern about this "sit-to-stand" lift for a few months.  It's a lift that uses straps under her arms to raise her up from a chair onto this small platform where she "stands" - holding on - while the lift is rolled right up to the toilet.  There she's lowered on to the commode to do her business.  The process is reversed to get her back to her chair.  

The straps that go under her arms are too loose and lift her from the shoulders than the behind.  I've told them she could suffer a dislocated shoulder; it falls on deaf ears.  She is also very weak in the hands and unable to grip the handles properly so I worry that she'll let go - which she did yesterday - and just fold up and fall out of the lift.  The aides and nurses don't seem to worry - when it comes to this stuff they are REACTIVE not PROACTIVE.  To do anything differently would require 2 aides not 1 - translation: the lift works for a one time price; another aide = another body at work costs too much.  I suppose they rationalize it by saying that they want the patient to do as much for themselves as possible. 

I know they are operating to make a profit but it often seems to be at the expense of my Mom's well being. 

Here are a couple of photos that illustrate the lift.  The one on the second is the type used with mom - the hand holds are black knobs.

sit-to-stand lifts risks, subtle signs of pain in elderly, use of lifts in nursing homes.

Isolation is over but I find other problems at the nursing home

I finally got in a good visit with Mom.  I traveled 7 hours to her home town and got to see her daily for three days. On my first visit, after I hugged her like crazy, I took a good long look around.  I looked at the bedding, her clothes, her shoes, her drawers in the night stand - everything, anything...  What I found was disturbing and encouraging.  All of her clothes and shoes where there, her bedding was clean. ... however.... in the bottom drawer of her nightstand I found a bed pan.   This is the normal storage for bedpans in Mom's nursing home; they use them, rinse and wash them and store each in a thick plastic bag.  This one was not in a bag and was smeared with something brown.... it's a bed pan, that can only mean one thing.... EEEEEeeeUUUU uuuuu!!!!

So, I asked floor nurse - not the aid - to come to look at "something disturbing".
Me: pointing to the open drawer: "Is that a bed pan?"
Nurse: glancing down, hands on hips: "Yes, it is. We always keep them in the bottom drawer."
Me: pointing to the  bed pan and the smear, "What do you suppose that brown substance might be?"
Nurse: suddenly paying close attention,  "Oh! that's not acceptable!"
Me:  bending over and pointing, "And, those, are those the same bandages you use on Mom's stasis ulcers?"
Nurse: "I'll have someone clean it up right away."

...and she did.  The nurse threw the bedpan in the trash and soon housekeeping came to clean the drawer with a bleach solution.  I am left wondering how long a dirty bed pan had been in the drawer and if the nurse putting on Mom's bandages would have used them or thrown them away.  Someone put a dirty bed pan in the drawer- it could have been the night before or days before.  Someone might have been using a dirty bed pan for days. Someone changes mom's bandages daily and should have seen it and done something. It's always "someone else" whenever I find this type of stuff at the nursing home.  

Every visit I find something terribly disturbing.  It does not leave me confident that Mom's getting good care.  This nursing home is ranked fairly well compared to others across the state, I can only imagine how crappy - no pun intended - that must be. 

MRSA puts mom "in exile" and it demonstrates holes in the rules

Confined to a wheelchair now, my mom has begun to get stasis ulcers on her lower legs. These are oozing gross wounds that open up on her chins.  Apparently these are ulcers are common for people who have limited motion in their lower extremities (legs and feet).  My niece, the 25-year career nurse - tells me its caused by poor circulation of blood and lymph fluids.  The skin tissue in the legs doesn't get nutrients from blood flow so it begins to breakdown.   Mom insists it only hurts when they apply salve but the tissue around these sores is often so swollen, red and angry looking that I can't imagine it doesn't hurt.  Since June, I've been concerned about a large on her left calf that would not heal.  Over the past 4 months it's improved then become worse and improved again several times.  In early September a nurse called to tell me it tested positive for MRSA and Mom would be put into "isolation" to prevent infecting anyone else.

I was very upset because she had the wound for so long and they hadn't tested it for any virus or bacteria. I asked if there was more they could do - different medication, vitamins, better diet...I got no answers.  They watched the wound closely for changes that indicate MRSA and finally in early September they "swabbed" the wound and ran tests. The nurse told me they look for discharges of pus and blood and a particular odor that indicates staph might be infecting a wound; once they see it, they test for staph infection. 

After the positive MRSA test, they had to put mom into isolation - no room mate, visitors must wear gowns and gloves, a bed side commode but that as long as the wound was covered, she could go to meals in the dining room.   I felt good that she'd have someone to visit with now and then. I also asked if she could have a larger TV until her isolation was over.  I got no answers even after leaving several messages. 

When I was able to visit 2 weeks later, I learned that Mom had NOT been to meals and that she'd been stuck in her room, alone most of the time.   "...being in exile, like Napoleon", she said. I was so angry.  If I'd know she was NOT going to meals, I'd have sent flowers every few days.  I'd have written letters - something, ANYTHING to help lift her spirits.  I tried to talk with the nurse on duty and she gave me a different story - that Mom HAD been to meals, that visitors didn't need gowns or gloves to protect them from infection.. Two hours later aides brought meals to mom in her room but before entering they put on paper gowns and gloves!..  I asked about the inconsistency but could not get a straight answer from the aides or nurses.  Now I have to call and complain because of these inconsistencies.  It makes me so frustrated!  How hard is it to train people to know what to do?  Infections like MRSA, colds, stomach bugs - are pervasive once they get a hold in nursing homes so all of their staff need to treat the patients the SAME way.  Families and visitors need to follow consistent - and best practice - methods to prevent spreading or getting illnesses.  I want to know that the staff does the RIGHT things to keep things from spreading - to my own mom, to themselves, visitors or other patients. 

I hate that Mom had to be "isolated". All of her clothing, towels, bedding and dining plates and utensils had to be bagged in special red biohazard bags before leaving her room.  The nurse tells me that they tried to "enrich" her activities with extra visits from their staff but it's not the same as family or friends.  Given the inconsistent messages from their own nurses and other crap that goes on, I doubt they do much "enrichment".   My family was quite freaked out and didn't want to visit; they feared mom was exhaling the virus and that they'd become infected.  I went anyway because I read enough about MRSA to understand that it was most likely caught quickly and thus a local infection - meaning it was only in the tissue on her leg and not spread throughout her system.  I also spoke with the nurse before my visit and learned that the sores on her legs were nearly completely healed.  I didn't intend to touch her wounds, bandages or the like so I knew that chances of being infected were very, very small.  Visiting my Mom after she'd been isolated for two weeks out weighed my concerns about getting any virus. 


This is the definition of MRSA from wikipedia:
Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans. It may also be called multidrug-resistant Staphylococcus aureus or oxacillin-resistant Staphylococcus aureus (ORSA).


More on stasis or venous ulcers at wikipedia: http://en.wikipedia.org/wiki/Venous_ulcer

How could my mom get MRSA?  Mom has MRSA, can i get it? Dad has MRSA can I get it.  What should nursing homes do about MRSA?

Mom falls and I get no calls... guess what hit the fan..

Last week was pretty rough - in 2 calls, I learned that Mom's in a lot of pain; had 2 falls and no one's called to tell me what's going on.  I had to "put the bitch on" and demand that I get calls from now on.   I learned of these falls on Feb 8 when the transportation coordinator told me that Mom's doctor made an appointment for her the next day at 330pm.  "Why?" I ask.. "well, he just wants to check up on her.." is the vague reply.  Her regular check up is not until the end of February so I asked to speak with the nurse.  The nurse was also vague with details.  It was like playing 20 questions.  The nurse told me mom had an "assist to the floor" - it's basically where an aide has a hold of my mom but she still ends up on the floor.  The fact that she ended up on the floor is not the reason for the doctor visit.   The nurse finally said that she requested the doctors visit because Mom's "just not herself".   "What does that mean?"  I'm ticked now because I have to push for these details..  She tells me that Mom's had back pain, that she's not felt well enough to go to the dining room, that she's asking for pain pills in the morning before she gets up.

This is very distressing because  my mom has a high tolerance for pain.  She's not a baby, she's not a whiner; she doesn't do this for attention.  She's hurting and they've let it go on for nearly a month!  I called my sister in law to see if she or my brother could meet mom at the doctor and learned that Mom had 2 falls not 1.  The first was about Jan 10 and the second - the one the nurse told me about - was Jan 21.  Apparently the brakes on Mom's wheel chair failed and it rolled away from her as an aide was helping her to sit down - they both ended up on the floor.   It happened again two weeks later.  My brother went up to investigate and pointed out the bad brakes - they're fixed now but at what cost to my mom?   Sister in Law also told me that Mom has a bad bruise and open wound near her armpit  - no doubt a skin tear where the aide had a hold of my mom.  None of these details - requesting pain medication, refusing to go to meals, the would, the 2nd fall -were in the fax that the nursing home sent to the doctor.  I had to write a letter and fax it to him to ensure he gets the details.  I also feel it's necessary to point out to him that she's asking for pain medications - which she'd normally not do. I asked that he order an MRI or CAT scan - something to figure out if anything was broken or misaligned during these "assists to the floor".  ARGH!!

I have to visit the nursing home next week to discuss their failure to call me.  I was very pointed - nearly yelling -  when I spoke to the nurse - "CALL ME,  I HAVE MOM'S POWER OF ATTORNEY, I PAY THE BILLS.  MY LOCAL FAMILY DOES NOT COMMUNICATE WITH ME. YOU MUST CALL ME."  She wrote it on a post it and promised to put it in the file.   A lot of good that will do - post it's fall off, the glue goes bad.   She promised to tape it in place.  Right.  I'm not convinced.  I believe they'll blow it off - they'll blow ME off.   It really makes me distrust them and the kind of care they're giving to my mom.   I feel powerless to do anything - I need them to be good to my Mom.  I need them to keep her there or her doctor will insist she find another physician.  It's an awful situation and Mom suffers for all of it.  Hopefully, I can make it a little better during my visit next week.

There's a special place for those who steal from nursing home residents!

Hell has a special place for those creeps who steal from nursing home residents!!!  And, trust me - it will be FULL!!

I already wrote about Mom's brand new go-with-everything pants in brown and navy - but I have two new examples to gripe about.  Mom's roomate is a sickly little gal who is getting sicker all the time.  She is a dwarf and has suffered from physical problems and constant pain all her life. She has no family and has very few personal possessions so when something goes missing she is especially distressed and hurt.  She has no way to go looking for it and no money to replace it.   One of her favorite things was a quilt made JUST for her by a friend of her long-dead mother.  It was white with embroidered red roses and red bands between the white fields of flowers.   She went out of town for a biopsy and it was gone from her bed when she returned.  The aides gave her their standard answer, "It must be in the wash.."  Any dope would know you don't "wash" a handmade RED quilt!!!   Three days later it was still missing and she was quite upset.  She cried and cried.  I felt so very bad since there was nothing I could do.    She has NOTHING! - nothing to her name -  just this one thing that made her feel loved and remembered and it's gone.   She also told me that she is missing a few dollars but that is all secondary to her quilt. 

Another resident  - who is on medicaide and receives $40 per month for "personal" needs - told me through tears how her DVDs disappeared while she was away for an appointment.   She had saved and gone without things for months and months to buy a few movies to watch on a borrowed DVD player and now it's all gone.  Someone had to have known when she was out and gone in to her room to take them.   They knew just where to look, only the DVDs were missing, nothing else was disturbed.   If I had the money, I'd buy replacements for her AND a locking cabinet for her closet so her things would STAY PUT. 

I am flabbergasted that anyone could be so very LOW DOWN and  evil that they'd steal from such vulnerable people.   Often nursing home residents have nothing; their homes are sold off, furniture given or donated away and friends and pets long gone.  Some don't have enough room to hang a photo or put  a chair near their bed.  To take things from them is the WORST sin possible. 

Lost clothes at nursing home a COSTLY pain!

Last month I noticed that two pair of Mom's pants were missing.  I alerted the staff and called social services with the brand names, size and color.  Today (3 weeks later) I called to check on it - the pants have been declared officially lost.

This REALLY ticks me off so BAD!   They can't loose the cheap sweatpants Mom wears most of the time. They have to loose the nearly BRAND NEW nice soft slacks that I bought for her last fall.    She had them at the assisted living facility but only wore them for a few special events.  I waited to take them to the nursing home because I wanted to see how she settled in..  I took them there one month ago, a week later they were MIA. I took 3 pair to her - light blue, dark blue and brown.  The dark blue and brown pair disappeared in one week.  ONE WEEK!!!  This makes me quiet suspicious.  I doubt she even had a chance to wear them.    They were a size 14, soft on the inside and out with pockets for her tissues.   They would be a good basic item in anyone's closet - obviously they are a good basic in someone else's now!!!  

The nursing home apologized of course and said they'd reimburse me replacement cost.  But replacing them is probably impossible.   First, it's middle of summer, so I can't replace these until late August or September when the fall merchandise comes in.  Second, the fabric - soft on the inside and velvety soft on the outside will be hard to find.  AND - third - pockets! Elastic waist pants with POCKETS are hard to find.  GRRRRR.... I am SO SOO MAD!!!

The social service rep that called me said "unfortunately, this happens more often than we'd like..." My reply - THEN FIX THE PROCESS!!!  Obviously something is not working so analyze it and FIX IT!!!   How much are they spending on replacement clothes?  How many angry families are out there like me? What if a family can't afford to replace the clothes?    After our conversation, I could tell I made the gal angry - I told her I was ticked but ticked at the situation NOT at her.    It didn't seem to matter.   I always get the same answer - "You could write a letter to our executive administrator.."   The Director already hates me because I gave them hell for leaving mom in an uncomfortable wheelchair for two months!!!    She hated that I was right about the pad in the chair being all wrong and letting mom slip all over.  She'll really hate me now that I all but told social services that I think someone stole mom's pants.  I should have kept my mouth shut but it's just too suspicious to me!!!  

New pad & old chair ...but now the Exec Director hates me...

A family counsel meeting between the staff at the nursing home, Mom, me and my brother went well overall - until the Executive Director joined in....  The social services staff at Mom's nursing home regularly requests meetings like this to discuss the residents' needs, wishes and to understand what's possible as far as care, comfort and support.   It's a good thing to do but often when bad news is involved emotions get heated.  I admit that I was hot headed over this pad situation but I was calmer and it was addressed to my satisfaction before the meeting.  At the family conference I realized that they were all worried about criticism directed at the therapists and didn't understand the significance of the pad in the wheelchair.   

We started the conversation by discussing Mom's health issues and asking her what would make her comfortable.  She had a small list - her chair (a rocker/recliner that no longer reclines), her 28" flat screen TV and less "man-handling" when she's getting help to the bathroom.     The TV can't go into her current room, the "recliner" was a no-no until we explained that it no longer reclined and she didn't have the strength to do it anyway.  The "man-handling" will be an on going issue that retraining aides will help but we all have to watch closely for rushed and rough treatment.   We discussed re-arranging furniture in Mom's shared room to accommodate the chair, bed and wheelchair... all easy fixes.   Mom, being her thoughtful self, said she didn't want to make adjustments if it upset Judy her room mate.  Mom is worried that Judy is in constant pain and said "she has it worse than me."   Mom fails to realize her weaknesses and limits but remains thoughtful of someone who's just as limited.  Judy is a dwarf with severe arthritis in her joints and hands.  She goes to dialysis regularly and seems to have some developmental disabilities too.   I am proud that Mom wants to  consider her wishes but will continue to push for Mom's comfort.   We agreed to try different ways to arrange the room to meet Mom's wishes.

We were all happy about the progress of things until I brought up the wheelchair....They were ready for this - they immediately said, "We'll have to get our Executive Director for that!" then ran down the hall to get her.   She is a large imposing woman, probably near 6 feet tall, wide shoulders and a booming voice.  She entered, quickly made the usual niceties and immediately began talking about how she'll "defend" her therapists, that mom refused treatment, that they did all they could....   I let her finish and then stood up, raised my hands in the "halt" position and said, "Stop, I'm not complaining about your therapists.  I believe the did all they could for her, I know Mom will refuse therapy and won't exercise, her arthritis limits that.  My issue ( I really emphasized this word - IS-SHOE) is that my Mom has spent TWO MONTHS in pain! For TWO MONTHS barely able to move, unable to right herself in a wheel chair because the pad was absolutely wrong and the wheelchair just a little too big. She was sitting like this (I demonstrated by sliding down on my tail bone and sticking my arms in the air) ON HER TAILBONE which caused pain in her lower back. Her shoulders rested on the back of the chair.  This pushed her arms up to the point that she could not reach the wheels to move herself around.    I noticed this immediately! I spent two days watching her and helping her before I said anything because I wanted to be certain of the cause.   If I had not brought the other wheelchair to demonstrate the fit, no one would have listened to me."  I remember speal this because I practiced it over and over before I went to this meeting.  I  was READY.  I continued, "She has suffered because of a simple pad, A PAD!! that was easily changed but no one took the time to consider.  It's a minor tweak but made a huge difference." I added something about everyone blaming it on her bad posture and failing to look beyond that to find a way so that Mom was able to right herself. 

At this point the nursing director chimed in, "She's right.  I've watched Elvina during the meeting and she is able to push herself back in the wheelchair now. Her posture is better." At that statement the Executive Director softened and began to discuss things WITH  us not AT us.  It all ended positively with an appointment for me to take Mom's chair in at 11am the next day.  She left but I could tell she was steaming on the inside. I believe they WANT us to think they care about Mom's comfort but only time will tell.  I will continue to visit daily for another week.   I am also more resolved to move closer to my Mom so I can see her on a more regular basis.  I can't go more than 4 weeks with out a visit.  Once I'm working again, I will try to hire someone to check on her every couple of days.

I have a greater fear that the Executive Director hates me now and will make Mom suffer for it.   She might transfer that "she's a pain in the ass" attitude to my Mom.    I will not be made to feel guilty because I find ways to make Mom comfortable and enable her to do as much as she can.   I will not feel bad about making the people who are getting paid to care for her do these things too.   I realize they have many people to tend to and need some repeatable methods to save time. I realize they can't remember every little detail about every single person but I CAN and DO expect them to apply some common sense.
wheelchair pads, how do you communicate with nursing homes