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I've been taking care of my grandfather for about two years now at home because we were denied Medicaid. He was taken to the hospital about an hour ago because he wasn't breathing right. He has skin tears on his arms from lifting him in and out of the bed and he has bed sores from the pressure of him laying in bed. All of his skin tears and wounds are cleaned and dressed. My question is, can I get in trouble for this? When the ambulance came the guy asked me what are all the bruises on his arms and I said their not bruises but skin tears. Now i'm nervous.

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I've noticed how thin and fragile my mother-in-law's skin has become as she's gotten older (88) and she's always got a bruise of some sort on her arms. I think just barely bumping her arm she can get what looks like a bruise, but of course it doesn't hurt because it's her fragile skin that is so easily hurt. Doctors and nurses at the hospital see old people all the time, so I wouldn't worry about the bruising thing. The bed sores is another problem though. While it isn't necessarily because you're mean or cruel to your grandpa, it is because he needs to be turned often to relieve the pressure on his backside, and he needs ointments etc for that. While he's at the hospital, why not talk to the staff there? Ask them to show you what the correct way is to lift him, and what you should be doing for the sores. You don't say whether your grandfather is dying or not, but think about hospice coming in and helping you if that's the case. Ask someone at the hospital about these things. You need help.
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I suggest you get a belt that is intended for lifting patients. We nurses use them so we won't tear skin on arms. You need to document all his tears with photos, but if his skin is this fragile, subject to infection and maybe septicemia (infection in the blood), then get the doctor to order home health care and Medicare should pay for this. He cannot assist in his own care, therefore making him eligible for Medicare assistance. One has to spend all assets in order to get on Medicaid so ask them what you need to do to get their assistance. Bed sores are a result of not turning a patient frequently as much as every two hours. If you cannot manage turning use a body pillow to prop him up on one side, then change to the other side with the pillow. Keep trying to get the doctor to order him into a nursing home. Fragile skin like you described is very dangerous.
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Why was he denied for Medicaid?

He has Medicare? I'm assuming he does, so if he is in the hospital for 3 or more days, I'd suggest that you try to have him discharged to a NH for "rehab". Talk with the social worker @ the hospital about this. Make sure it is a NH with a rehab unit and the NH takes Medicaid and also does admissions as "Medicaid Pending". If he is hospitalized for a full 3 days, then MediCARE will pay for 21 or more days in the NH as a post hospitalization "rehab". You can use this period of time to get whatever done so that he qualifies for Medicaid and stays at the NH. I say this as it sounds like his needs are really beyond what you are able to do and without issues (the skin tears and bedsores). This will also show that you are aware of his fragile skin situation, in case there is questioning on abuse. Good luck.
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Use safety precautions. Do you have a gait belt? Use that, it will help a LOT. Also, have a bed pad under him when in bed or in the chair, and you can use THAT and a gait belt to lift him, NOT his arms, etc. There is a lot that can be done to keep them safe... also do skin care like keeping skin clean and dry, moisturized, etc. (I worked for many years as a charge nurse in nursing homes.)
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If someone has that tender of skin... they should NEVER be lifted BY their arms, etc.
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Having been a caregiver for 3 family members,I found what worked for them involving bed sores.Along with rolling them on their side,and keeping their skin dry and moisturized,I used a sheepskin pad.I actually purchased it at a pet supply shop,comes in a roll and can be cut to fit a bed.It allows air to circulate,and is soft.I had purchased them before,to keep my dogs from getting pressure sores on their elbows,when laying on the floor.Also,some medical supply co,carry an inflatable pad for the beds,it is electric and fills and deflates with an electric pump under the bed.
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If he still gets denied Medicaid, you also can use the Medicare paid for time in NH rehab to get the house retrofitted with a lift or something else to make it easier for you and better for him. If he was denied because of not being medically necessary for skilled nursing, the time in the hospital will provide the fat medical file needed for that part of the Medicaid review - you know often when the elder is living at home, they just don't have the documentation needed to show the true need for skilled nursing that Medicaid requires. If the denial was about his having too much in assets or income that is whole other hurdle to go through and do a spend-down if you truly find that his caregiving needs are beyond you and his being living in your or his home.
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My Mom barely has to bump her arms & she's got a tear - her doctors are all well aware of this - it is from long-term use of prednisone for her rheumatoid arthritis. Due to Coumadin therapy she also bruises very easily - very literally from the slightest bump also. Your grandfather's primary doctor can order home health aids to come in - he doesn't have to have medicaid for this program as long as he has medicare. Call and explain your situation to his primary doctor and allow them to transfer him to a SNF from the hospital for care for as long as Medicare will pay.
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Pressure sores - maybe in the hospital they will give you Mepilex - ask for it - it's a wonderful removeable slightly padded but aerated dressings you can put on a clean sore, remove, replace it as long as all is sterile-clean, and its even good as a preventative, as it keeps the skin moist. In my homecare work, I found the 2 hour goals to turn patient, to be predictable but not relieable, for most patients refused such frequent turns, particularly during the night. The 2 hours might work well in a hospital, but at home, it seems counterproductive to wake and argue over turning. Better, in my experience, to be sure they are not lying on the sores in the first place, put them on their side, and turn them every 4-5 hours is a good start. And yes sheepskin pads - also, if he might get sores from sitting up in bed, I also found the pads put out by Wondergel, are really excellet at providing firm yet soft, flexible support that also is aerated so it stays cool. Care needs depend on the stage of the wound - whether it's open or not, how red, how fragile - if it's not open, some light massage with a drop of moisturizer, could work, but ask the hospital. There's some gel advertized for sore prevention too. Bbedsores are very serious, can quickly, grow inside, not outside the skin, and become fatal, so you will need to really pay attention and find a care plan that explicitly targets gradual remedy for these. I find too often, caregivers are given single instructions when a series of adjustments, dressings and movement can help. They are told to turn the pt every 2 hours, and probably in a hospital or institution, this is the most frequent treatment. But at home, the caregiver finds the pt refuses to be turned and arguing in the middle of the night seems counterproductive, and so care can be inadequate. We used a variety of ways with removing and replacing the Mepilex dressing each time the pt used the bathroom, we cleaned sore 2x day with saline, let dry, then replaced Mepilex - and used the Mepilex dressing as a prevention (expensive but worth it, as it keeps skin moist - it can be cut to size) - make sure you ask MDs and hospital and home RNs, and take notes. And good luck - you get used to paying attention, but I agree with others here, if it's getting to be too much, take this as a good opportunity to get others involved - especially if the bedsores are open at all, or developed, you have to do so.
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Hi Miss 37, about your grndfather there are ways to lift him never lift him through his arm ask a nurse what is the best way to lift him. And the bed sore the best way to avoid it is making sure he is turn every 2 hours. Find ways to postion him. I'm sure you are trying your best, just ask for help in the hospital in what can you do to better his quality of life.
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My mom's doctor prescribed a pad for her bed from the local pharmacy that Medicare paid for.-, and the pharmacy installed. It had a motor attached that would pump up and inflate one side and then the other so she never had a bedsore. And every time she had to go into the hospital, I was given cream and instructions on how to get the redness off her bottom, so she never had pressure sores. And use lots of pillows to get heels off the bed, a draw sheet to help roll him over, more pillows to keep him in that position. Ask the nurses for help. Good luck.
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You need to have a nurse show you how to treat bedsores and the doctor needs to give you meds for it. A bedridden person must be turned every half hour. A registered nurse (paid for by Medicare) showed me how to disinfect the sores, cut out gangrene, pack it, and bandage. I also suggest you get a bedpad- the kind with peaks- and use it and top it off with one of those cotton "sheepskin" pads. This will help reduce bedsores. You haven't done anything wrong but it is nice that they do check for elder abuse.
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My heart goes out to you. This has to be so difficult. You need help, Medicare should be helping you. You should be able to get hospice, or at home health care. I am not an expert, but when my Mother became disabled I called a home health care center and they did the paper work?
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Yes, the air/bubble mattress tops are often used to prevent bedsores - they cost a couple of hundred dollars roughly, but Medicare does pay for them, if the MD or RN's from the hospital prescribe them - so that's a really good option - it changes the pressure regularly. The care of the wounds is very different depending on how much they have developed - with prevention and small wounds being more manageable with care, than more intense as terrim described. Glad you're having all this checked out, best of luck!
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Ask if you can have a physical therapy or occupational therapy evaluation in the home to teach you proper body mechanics and methods for transferring and turning your grandfather. You can purchase arm and leg protectors which are like leggings to provide protection to his arms. If he can't afford use some fluffy socks and cut the feet off and slide in his arms and legs to protect the areas.
Keep skin dry, turn him every. 2 hours to avoid bedsores while in bed. Ask for a prescription from the doctor for an air mattress and wheelchair cushion. Finally good nutrition to heal skin . Ensure, yogurt fruit smoothies, vitamin c, vitamin d, zinc which all promote healing. Foods high in protein. If he can't eat meats, puréed meats, cheese, milk products, yogurt, non fat dry milk added to soups and stews will increase protein, carnation instant breakfast smoothies, cottage cheese, etc. be sure he gets plenty of fluids.

For skin care in peri area. Keep him clean and dry. Apply zinc oxide to skin as a protection several times daily. For skin tears monitor for bleeding, or change in drainage. If foul smelling or yellow or greenish, call md for evaluation and possible infection. I use tegaderm dressings to keep skin tear lean and protected. Available in local pharmacies. Non prescription. Good luck. And no I don't think you need worry, the paramedic is a mandated reporter and must ask about bruises for his own protection well.
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Not lean but clean. . Sorry for typos! :)
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You are doing the best you can so good luck. Have to say that there is a product that addresses the lifting/safety issues plus the bedsores. Allows a person to "help themselves" in bed transfers and repositioning in bed (for comfort and to reduce bedsore pressure) as long as the person has some upper body strength Google Friendly Beds
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I wouldn't worry about it. My 91 1/2 year old dad did bruise easily and he suffered from skin tears. However, I began giving him vitamin supplements 2 months ago (a good Men's Multi-vitamin along with some natural memory supplements), and his memory is improving along with his skin that is looking better by each day. Also, we do not eat red meat or chicken (just cooked wild salmon with skin on it, dad likes tartar sauce, so I use fat free yogurt with a little bit of mayo, powdered ranch dressing, and relish.) Since January (when I brought dad home with me), he is looking and doing 100% better! Also, I feed dad whole grains (no white flour), smoothies with fruit, etc., and he LOVES it! (He has gained 40+ since I brought him home from the ALF that has an Alzheimer’s and Dementia ward that should be SHUT DOWN because they cannot take care of patients.) Remember, home care for your disabled loved one is far more superior in care compared to any “elderly homes” that are out there!
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Authentic Australian medical sheepskin is quite effective in preventing bedsores. It is pretty expensive, but worth every penny if you can keep bedsores from developing. I have used these personally and they are very comfortable (cool in summer, warm in winter). If incontinence is an issue, there are urine-resistant sheepskins available. Medical sheepskins must be washed in specially-formulated detergent. I hope this is helpful information and wish your family all the best.
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