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Sunday, August 21, 2005

Dear Meg,

I just want to thank you for deciding to go to battle for the residents of the nursing home. It makes me wonder, where are those peoples' families? How can they allow their loved ones to live under such conditions? I would hope you would notify the media to come in and do an investigative report on the conditions and treatment there. Something has to change! Your vivid account was horrific!

First of all, let me thank you for your concern and for taking the time to reply. One of the problems in the nursing home business is that the "squeaky wheel gets the oil"whether it needs it or not. When a family member does complain, especially if they are chronic complainers (not that I blame them!), the entire staff is aware of them and they make sure that, at least on days that the family visits, that those particular residents are well taken care of, often to the detriment of other residents who may be in more dire need of attention and care. What these familys don't realize is that when they are not around, the staff tends to avoid their loved one out of fear that they may do something wrong. They fear that they may lose their job so, the families are actually making matters worse for their loved one with all of that excessive complaining. Also, if the resident is unable to tell the family what is happening, all too often, the staff actually takes the family's behavior out on the resident.

(In all fairness, I must say that there are many dedicated staff members who truly love their work and do all that they can for their residents. Unfortunately, these people are few and far between.)

Now, for the truly sad answer to your question...the majority of families simply don't care enough to pay attention and there are actually an alarming number of residents who rarely, IF EVER, have any visitors. There are some who do drop in for a minute or two, but I sometimes wonder if those visits don't do more harm than good. Yesterday I overheard a man telling his father that he had to leave 5 minutes after he arrived because his wife thought she was "coming down with a cold." I hurt for the resident when I heard that. To make matters worse, the son spent most of the visit chatting with a staff member.

I've brought clothing and toiletry items to residents who have no one. I remember one gentleman who had no family that I had ever seen. The County was listed as his "responsible party". One day I found him walking down the hall in his socks. I looked for his shoes but he had NONE! I pointed it out to the charge nurse whose solution to the problem was to take his socks off so that he didn't didn't slip and fall. I bought him a pair of shoes and a pair of slippers. I cannot count the times, over the years, that I have brought things like pillows, underwear, afghans and even clothing to residents who either had no family or no family that cared enough to bring the needed items. Of course, I am not the only one who would do such things. As I said, there are many staff members with endless compassion and huge hearts who would also bring necessary items to the less fortunate residents.

What really makes me ill are the family members who rarely visit and then when they do, they spend the entire visit complaining about everything that they can think of in an attempt to transfer their guilt onto anyone else other than themselves. Far too often, staff members are busy tending to the ridiculous complaints of these people. Some examples, "Mother has always had her nails done weekly!" or "Father didn't get his newspaper delivered today, I demand that you find out what happened to his paper!" While the staff is busy tending to the minor complaints of these people, another resident down the hall may be lying in urine and/or feces. Not wanting to be reported, the staff will cater to the nut people and ignore the poor resident down the hall who has no one to complain for them and cannot speak for themselves.

Yes, what I saw yesterday was indeed horrific. But I promise you, that is the tip of the iceberg. Years ago, I was called to check the reddened knee of a resident who could not speak. When I lifted her lower leg, it bent at the middle of the shin. Upon further assessment, I found that both of her legs were broken and NO ONE had a clue as to how it happenecouldn't couldn't tell us so we never did get to the bottom of that incident. My guess is that she had her legs in between the side rails and some cruel jack ass or some careless nit wit slammed the side rails down on her legs.

I fired one CNA in the hall after learning that she had covered the mouth of a resident who was lying in bed, and then she pushed her head into the pillow and shook her by the face in an attempt to shut her up. The woecholaliacholalia, a condition in which a patient cannot help repeating syllables over and over again. The resident said, "No, no, no, no, no...." and it irritated the staff member.

There was another CNA in the room at the time and she witnessed the incident. Luckily, a woman who worked in the laundry observed the entire episode. After she reported it to me, she was harassed by the unit NURSE(!) as well as the other CNA's that worked on that unit until she was so intimidated that she quit.

And get this, I was written up for firing the two CNA's in the hall. (The second CNA refused to tell me what had happened and that made her as guilty as the offending CNA.) I was so upset by the entire incident that I immediately fired them both in the hall Admittedly, that is not the proper way to fire people, but I was ACRIMONIUS! I should have controlled myself better but seriously, what decent human being could blame me? But, blame me they did, and I was severely reprimanded. It was the only time that I have ever been written up and that write-up was placed in my personnel record. To be honest, I didn't care one little bit and, given the same set of circumstances, I would probably do it again.

Another dreadful incident occurred when I was working as the Assistant Director of Nursing at a nursing home here in Marietta. I found a woman sitting in her wheelchair, (once again, they were all lined up along the sides of the hall) and she was full of blood. She had two avulsions on the same finger. (An avulsion is an injury where the skin is actually gouged and a hole is left) I asked the CNA who was caring for the woman that day if she knew what had happened. She told me that she was clipping the ladies' fingernails and "missed". First of all, she should have reported the initial injury to the charge nurse immediately. Second of all, how in the hell does that happen by accident TWICE? I remain convinced that the CNA did it on purpose. I was a new employee and as such, I reported it to the Director of Nursing rather than handling it myself. She did nothing. Later on that day as I was documenting what I had found in the resident's chart, I sort of mumbled to myself, "I should have written her up for that." Well, the Director of Nursing was right next to me and she almost shouted at me, "If I thought that she needed to be written up, I would have done it!" I was in no way accusing her of anything, I was just angry at myself for not dealing with the CNA myself instead of reporting it to my superior. I certainly was in a position to have done so. This particular resident was combative and not a very pleasant woman but she was confused and I'm quite sure that she would have been horrified at her behavior if she had been in her right mind. But, it didn't matter one iota how annoying she was, she was entrusted to our care and she most certainly didn't deserve to be abused. Anyway, the next day my Director called me into her office and terminated me because, "You and I have different views on how to run a nursing home." She was, most assuredly, correct.

On another occasion, a very alert resident was abused by a CNA, one that had an excellent reputation, ( She was actually considered one of the best CNA's in the facility!). The CNA told the lady that she would have to go to the dining room to eat her lunch. The resident responded that she wanted to eat in her room and said, "You can't make me go to the dining room!" The "excellent" CNA made a fist and shook it in the ladies" face saying, "You will do exactly as I say or you'll be sorry!" The resident responded, "I can report you!" Then the CNA then took the ladies' thumb and bent it back, holding it like that long enough to hurt her and to scare the hell out of the poor woman. Later, when I noticed that she had been crying, it took quite a bit of convincing and reassurance to get the truth out of her when I asked her what happened. She was terrified of potential retribution from the CNA. I reported this to the State and you'll be happy to know that the GBI investigated the episode and the CNA was prosecuted although I never did find out what sentence she received. But, she did lose her certification and will never be able to work with patients again.

Some lesser problems, but problems nonetheless, include things like residents being dressed in Christmas sweatshirts in July (Can you imagine a confused resident thinking that they were even MORE confused seeing that?), employees that don't speak English being hired to care for confused residents, and the dreaded "thickened liquids".

If a patient has a tough time swallowing or a history of choking, they will usually have an order to have their liquids thickened. The order is written for the liquids to be either "honey thickened" or "nectar thickened". The problem is that I have rarely, if ever, seen the liquids thickened to the consistency of nectar or honey. What I have seen is a lot of liquids that are the consistency of semi-soft Jell-O or even thicker.

Imagine drinking a glass of gritty water, milk or juice that would be better served with a spoon! FAR too much of that gritty thickening agent is stirred into every liquid that the patient is served. Naturally, they rarely drink the crap and the elderly can quickly dehydrate. I have made my son and daughter promise that should I ever be in a condition where I require thickened liquids, that they will sign a paper releasing any facility from liability should I suffer any ill effects of drinking "normal" liquids.

Also, I have seen nurses crush time-released medications such as morphine. What happens is a pill that is supposed to last for 12 hours is given in such a manner that the patient receives a HUGE does of the morphine which could cause an overdose at worst and at best, they are left to suffer in pain for the 11 hours that they must wait after the large does wears off and the next does is given. The excuse that the nurses give is, "The patient can't swallow the pill whole so I have to crush it." Well, a smart nurse should do one of two things. Firstly, you can get the order changed so that you can deliver the medicine rectally (almost any medication that can be given orally can also be given rectally). Secondly, the nurse could simply call the doctor and tell him or her that the pill is not appropriate for that particular patient and they can order something else. Something like a pain patch (another form of time-released medication that is absorbed though the skin and lasts for 3 days.) would be ideal for such a patient. No matter how many times I explained that concept and no matter how many signs I posted in the medication rooms, they continued to crush the damn time-released pills! Such combinations of stupidity and laziness are far too common.

Speaking of pain medications, you wouldn't believe how many nurses don't believe in giving pain medication. I attended a pain relief seminar years ago and I forget the exact percentages, but, at that time, only 30 something % of doctors ordered adequate pain medications and 20 something % of nurses actually give the pain medication that is ordered. If you took 100 patients and did the math using 35% for the doctors and 25% for the nurses, about 35 of them would have had adequate pain relief ordered and of that 35, only 8 or 9 of them would receive the medication. That's 8 or 9 people out of 100 who receive adequate pain relief!!!!! Why would a nurse withhold pain medication if they have an order from a doctor? There are as many stupid reasons as there are stupid nurses. The way they are so stingy with that stuff, you'd think it was their own personal stash!!!! Anybody over the age of 40 knows all about the aches and pains of growing older, can you imagine how much these arthritic, decrepit old people must hurt? In nursing school, we are taught that the definition of pain is "whatever what the patient says it is". Even if you think that the patient might be overreacting to their pain or even exaggerating the level of their pain, why not err on the side of the patient? The nurse is covered if they carry out the doctors' orders.

When I was working as the Assistant Director of Nursing, I would come in on Monday mornings and find an inordinate number of residents "impacted". That means that their stool was very hard and right there, waiting to come out but the residents were unable to relieve themselves. So, I would have to actually dig it out of them to provide relief. (Not a pleasant experience for anyone concerned.) This particular facility was staffed by far too many agency nurses (They were too cheap to offer a decent wage and therefore couldn't attract many decent charge nurses.). After finding so many residents impacted week after week, I started monitoring the levels in the bottles of a drug called Lactulose (a liquid laxative usually kept in the bottom drawer of a medication cart). I eventually figured out that the agency nurses, as well as some of our own staff, would give only the drugs that were in the"bingo cards". The drugs in the other sections of the medication cart were just not given at all. Apparently, they were too lazy to bend over and get it out of the drawer. (I don't mean to demean agency nurses, many of them are excellent.)

As the ADON, I would often stop by work unannounced in the middle of the night only to find staff sleeping while call lights would be going off up and down the halls. As anyone in this business can tell you, most falls occur on the night shift because these people get so sick of waiting for someone to answer their call lights that they climb over the side rails of their beds, in the dark, and then they fall as they are trying to toilet themselves. In my opinion, the number of broken hips that I have seen under such circumstances is criminal.

Also, at the end of every month, somebody has the job of checking the monthly MAR's and TAR's (Medication Administration Records and Treatment Administration Records). This is where the nurses initial when the meds or treatments were given or performed. If there are holes in them where the medication orders or treatment orders were not properly carried out, nurses were assigned to go and fill in all of the holes with their own initials, whether they had given the medication or not. The only requirement is that the nurse doing the initialling had to have been on the clock on the dates he or she was initialing. Nobody really cared if the orders had been carried out, but God forbid the State should audit these records and find orders that have been left undone.

Whenever the State comes for the annual inspections of these facilities, everybody works like fools for a week or more to make it appear as though everything is being done properly. After the inspections, things go back to normal. I have seen this happen at EVERY SINGLE FACILITY THAT I HAVE WORKED AT!!!!

If there is anyone out there who has the time, as I have suggested before, it would be a lovely gesture to stop by a local nursing home and visit with some residents who have no visitors. Take your kids with you, they would benefit as much as, if not more than, the residents. There is little as gratifying as a visit with these treasures. Many local churches come to these places and make nice little things for the residents, visit with them and they even come caroling room to room during the Christmas season. If your church doesn't have such a group, it would be the height of generosity of spirit to start one. It certainly doesn't have to be a church group, like the song says, "where two are gathered in His name, there is love"

Also, most of these facilities would love to have children trick or treat on Halloween. The residents truly enjoy seeing the children in their costumes and it is certainly a safe place for the kids to celebrate Halloween. The holidays are a great time to visit these places as those are the times when the lonely residents feel the loneliest. But there's certainly no bad time to visit!

If there is anyone out there who has clothing that they would like to donate to a local nursing home, just call the facility's social worker and ask if you can do so. Also, books and games are great as well. You could even email me and I would be happy to assist you. I would love to return to the place that I visited yesterday and bring them some sorely needed items. If you would like to donate cash, I would be happy to send you receipts for anything that I would purchase for these people. As a matter of fact, if there is anyone out there who could assist me in starting such a charitable organization, I would love to hear from you as well. Someone who knows the legalities of the accounting end would be great, I can do the rest. And, with the resident's permission, I could even send you pictures. As a matter of fact, I just thought of a great idea. I could begin an organization for the elderly like those that have you "adopt" a poor child in foreign country only you could "adopt" a Grandparent! That idea just struck me like a huge brainstorm and I certainly have the time and the great desire to do it. If there is enough interest in something like that, I would absolutely LOVE to do it! So, please, if you think that you would be interested, email me at Meg.Kelso@gmail.com .

Lastly, to answer the question about getting the media involved, I am most certainly going to report that facility to the State tomorrow but I would have to ask some questions about confidentiality before I reported them to the media. Perhaps the State regulatory agency that I am calling tomorrow will advise me regarding that.

I am so hyped about this...we could do some wonderful things for some of our most treasured assets...our elderly. We owe them so very much and I can't imagine a more deserving group of people. Remember my friend who survived the Bataan Death March? He once told me that living in that nursing home was worse than the march...we are a rich enough and kind enough country to change that, don't you think?

Meg


Send comments to: Meg.Kelso@gmail.com

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