My 87 year old mother fell and broke her hip. She had been living in a memory care unit, due to dementia. Physically she was is very good shape, walking and using the restroom independently, feeding herself but needed assistance with bathing and dressing appropriately. After the hip surgery she went to a skilled care facility so she could get rehab. While there she contracted C-diff and a heel ulcer. Due to these two complications, her rehab has been very limited. They don't want her to walk on the heel until it heals so she is only working on transfers and some ROM type exercises. The antibiotics for the C-diff and the infected heel ulcer have affected her appetite and she is not eating well. Her 100 paid Medicare days will be up in about 4 wks and she is making little progress. If the skilled care facility at all liable for the complications she acquired while under their care? I feel like she would be doing a lot better if she had not had these complications.
Skin breakdown can be a result of warfarin use. It can also mean poor circulation to the extremities caused by blockages or heart failure.
Adding poor appetite and weight loss to that mix makes me suspect she is not going to make her goals. She may even be a Hospice candidate. A facility is duly responsible for her care, but if a patient is terminal, there is nothing they can do to stop the end signs. End signs include repeated infections as the immune system fails, skin breakdown, appetite loss, weight loss and bloodwork showing liver and kidneys failing.
My mom, before she passed, was always in bed and rarely got out of bed. Subsequently she developed pressure sores on her heels from lying in the same position. That broke my heart, as while I knew pressure ulcers are preventable I knew because my mom was simply refusing to move around more that presented a challenge as the staff can't force her out of bed. At that point I knew my mother was losing the will to live, that she was tired. Could I have blamed it on the staff? Were they the only party at fault? Not really. My mother was 89, had broke her hip at 86 and was never the same after the hip surgery and anesthesia.
Regarding C.diff there could be several reasons she developed this; recurrent episodes of antibiotics (c.diff is an opportunist infection), poor hygiene, dirty commodes and bathrooms. Most often it's from too many antibiotics that reek havoc on the digestive system.
So many other factors that can cause skin breakdown - poor nutrition, circulation, immobility. How was she after the surgery? Did she get up and walk post op? Did she receive physical therapy in the hospital prior to transfer to rehab? Was she bedridden before? I mean was she active or just got out of bed to perform hygiene and go to the bathroom?
There are no guarantees in nursing homes. The patient and/or POA sign a consent that covers them from being held liable from things they can't prevent-i.e. C.diff. Nursing homes work hard to prevent pressure sores as well, as each pressure sore in a Medicare nursing home has to be reported because if Medicare on their audits finds a nursing home has too many occurances of pressure ulcers it decreases their Quality score and jeopardizes their funding and their license to provide care under Medicare.
How are they treating those heel sores now? Have you talked to the Nursing Director about your concerns? Usually that is step one in the complaint process.
Can you prove they are understaffed? Unfortunately many nursing homes are but many are not. Are their staff trained properly in pressure ulcer formation & how to prevent them?
At 87 after coming off a hip repair and anesthesia, do you have realistic goals for her recovery? How do you know she just isn't refusing rehab? Have you been with her when they come to take her to therapy? I'd be curious to know if she wants to go or if she has to be talked into it.
Unfortunately it is what it is with nursing home staffing. Or who knows, you could be listening to staff complain about how understaffed they are, when in fact they are not but perceived to be by those employees.
You'd have a hard time proving negligence. Elderly people have lowered immunity systems which preclude them to developing infections.
In the case of my mother, I knew that she could be stubborn and not get out of bed and lie in one position all day, so I couldn't entirely blame them. It was several circumstances I couldn't control. And btw I couldn't believe how fast she developed that heel ulcer either, but now I know from home health nursing that by the time skin breakdown actually occurs, there has been some period of time that the extremity was already dependent from immobility. By the time the pressure ulcer can be seen there has been deep tissue injury forming underneath the area. Is the ulcer on the leg which was the surgical repair? If so then yes it could very well be your mom refusing to move due to pain or just refusing period as she maybe doesn't understand what happened, or her circulation is compromised, on blood thinners like lovenox injections or warfarin, amongst other things.
It's very tough going through this and unfortunately it could be the beginning of the end for your mother, sorry to say. I knew my mom was going downhill and I didn't put unrealistic expectations on her recovery. Quality of life is very important at the end. It's hard not to be subjective when you are going through this and takes time to be objective in evaluating the whole picture. I wish you well.
They are absolutely responsible! The thing I've seen in AZ is the facilities, group homes,etc are so understaffed and that causes the negligence!!
And you're right. Your mom would be doing better without these complications but a fall is very traumatic in an elderly person. Surgery is more traumatic especially when someone has dementia. There's no way to know if being in a nursing home exacerbated your mom's conditions.
Stay involved in her care, continue to be a presence at the nursing home, encourage the staff and management to call you with any questions or concerns. And always take any questions and/or concerns you may have to the nursing supervisor.