My mom has been physically injured twice within a week. I have used all options. Do I report to state authorities? Many other issues.

Funny, I was thinking about this question today. My husband, who is 88, is at home. All of his life he worked outside with no shirt on, and since he retired, he works in the yard with no shirt on. His skin is so thin. He didn't open the car door enough the other day and just bumping against it tore the skin on his shoulder a lot. Then he stumbled over the dog yesterday and fell against the wall. He has a skinned place 3 inches long and about 1 inch wide. The skin just peels back if you look at it. I thought, "I hope he doesn't have to go to a doctor until that heals. They might think was abusing him". He complains that his skin is like it is not attached to his body. I just remind him that he played in the sun all of his life, now he has to pay. His mom told him to wear shirts when he worked. The skin on my arms from midway down from my elbow and my hands are almost as bad as his, I wore blouses, but would turn the cuffs up.

As a mandated reporter, you don't have the luxury of letting it go. If you can file an anonymous report that includes other patients' experiences that would be fantastic. Since this is happening to your mom, you can bet it is happening to others as well. The less reports the better the home looks to the state, until someone dies because of neglect.

I had to report and it was not an easy decision. The home became very angry, but care changed for the better until I could get her out and into another home that was far better.

We should not have to be there every day just to make sure our loved ones are cared for properly, but sadly that it almost the universal requirement.

Does your facility allow cameras? Not all states allow it. In my state it is allowed with certain stipulations. The camera can only be on the resident that is being surveilled. It cannot be pointing towards a roommate. Place a camera in there. Will put your mind at ease.

Cetude,

Nothing is ideal. Institutions or home care. There isn’t perfection anywhere.

It’s the same with anything. A child can attend a public school that can be a great school or an inferior school or a very expensive private school that can be great or not so great. We can’t generalize.

A person would be stupid to think the more expensive private school is problem free. The kids in private schools have drugs in school too. The difference? Their kids have more money to buy more expensive drugs. Sorry, if this upsets anyone but I have seen it over and over.

In one of our private schools one of the teachers smoked pot and sold it to the kids. Yes, he did this for years before he was caught. He sold high quality pot because the kids could afford it with their allowances.

Same with churches. There are no perfect churches because there are no perfect people.

When my mom was in a nursing home for rehab there were issues. There is a shortage of staff. I would hear them talking about working double shifts.

Having said that, the rehab with occupational and physical therapy was exactly what mom needed. When problems came up I addressed the serious ones and let the little things go. I see no point in knit picking. Why? As I said, no one is perfect. I don’t expect anyone to be and I grew up with a perfectionist mom. It is unnerving to be around perfectionist.

I motivated my children but I never ever wanted them to feel ‘less than’ like I was made to feel, and doing my very best was never enough. I had more blue ribbons, awards, good report cards, perfect attendance, etc. and it was NEVER enough for my mom.

Mom was the type that if I had something 99 percent right, she would point out the one percent that was wrong.

So. we should respect all staff in facilities who are doing their best, show appreciation and only address serious issues. At least that’s how I feel.

Let me tell you I could easily live in some of our assisted living facilities. They are lovely! Our nursing homes needs improvement but it’s all we have available and better than nothing.

Rather than complain, do something to contribute though. Volunteer! When mom was in rehab facility I saw fantastic volunteers, from violinists and guitarists to gospel singers.

I also met a really sweet woman who volunteered to feed an ALZ patient whose family did not live nearby. One day she asked the woman, “Do you know who I am?” The woman replied, “No, I can’t say that I do, but I know you belong to me. You come to see me and feed me.” I thought that was so special!

Yes, it can be depressing. I went daily and the same women would be saying, “Help me! I want to go home.” It scared me at first and made me cry until I realized they would be screaming, “Help me!” no matter where they were.

The ladies that were lucid and could communicate would ask me to visit with them when they saw me leaving my mom’s room. I would. They told me about their deceased husbands and their children, etc. it was sweet. It only took a short visit with them, maybe 20 minutes to bring them a bit of joy. I brought the residents not on a restricted diet a few cookies or individual ice creams just like I brought to mom. They loved it!

It’s true that addicts have adopted the serenity prayer but it really applies to all of us. It’s a great prayer, “change what we can and accept what we can’t.” Great message for all of us.

As far as I know, the department of health as well as other regulatory agencies set the minimum staffing ratios in facilities for care. Facilities can be cited as well as fined for being out of compliance for adequate staffing. In my career as a geriatric social worker, I have seen and experienced both good and not so good facilities. What was interesting to me was that some of the older facilities had the better care. I wonder if it was because they paid for staff rather than having chandeliers in the dining room. Let's face it everyone's home is different so it follows that nursing homes may be different. I once sat in a meeting with a resident's husband and the ombudsmen over a dispute regarding his wife's laundry. While the ombudsmen recognized the husband's concerns, he also pointed out that no one's home is perfect(lost socks, burnt dinners were his example),it follows that a facility caring for a larger number of persons wouldn't be perfect either. Our elders need us to advocate for good care when they can no longer advocate for themselves. What my husband and I looked for when his mother needed skilled rehab was an odor free, clean facilityvas well as residents,activities, kind caring staff interaction with residents, and a good therapy department. To evaluate we used meducare.gov and the state department of health website. Theses two websites provide the facility's report card on performance. Medicare.gov also has a checklist for touring nursing homes which can be printed and used for when family is taking a tour. Placing someone is a difficult but I feel it is a personal decision for each family and should be exempt from other's judgment.

Rovana,

Seriously ? I'll say it again; people took their parents in when the parents grew old and needed them. The elderly parents (for their best years) gave up their freedom and personal pursuits for at least 18-20+ years to diaper, feed, clothe, suffer the pains of growth, rejection, financially support etc. etc. - all that sacrifice and devotion. And you say that it's hard for you to give back a fraction of that care towards the end of their lives . . . LOL
No, it is not true that people, in the past, just got sick and died in an instant - perhaps in a few instances- but YES Rovana - People took their elderly parents into their homes and took care of them until they died because they LOVED them and were grateful for what their parents had done for them.
Some still do.

Civilized, honest people who have their priorities straight make sure their parents are well taken care of and are involved in their loved ones care - WHETHER they need to involve skilled nursing professionals, or not.

You will be i that same position, some day. I guess you will have had your time and you will gracefully fall into the hands of strangers, you will be content to watch your children walk away and leave you. Guess that's just how it is, Right?

Cetude Agree with you. I have seen with my own eyes how rude staff treat the residents. For the most part, they do not show any love or kindness to them. The staff is just there for a paycheck and they do not care. It's sad.

This is happening every where . Where is the law? where is the regulation?Reporting never works. Because admin employs workers for cheap price, and those undocumented and untrained etc This is a cruel world with uncivilised behaviour . Young workers have no respect for elders...
Many places do not have security cameras Jesus!
Always excuses such as no staff, meal break etc... other times on phone texting and chatting !!

For those who are attacking Cetude: I really don't understand WHY you would accuse her of causing concern - sounds like you feel a conviction OF YOUR OWN based on your reactions.
She's right - most nursing homes are inadequately staffed and the level of care is nothing you would want a beloved parent to have to endure. I know from experience.
There are cultures which would not dream of having to place their loved ones in the hands of strangers.
There were eras in this country when elderly parents were taken care of by their adult children - it was common sense.
Apparently, the values and standards of this nation - which is appallingly evident - caters to the young and healthy and chooses to shove the infirm and aged citizens into institutions far removed from sight.
To put this matter in a more personal perspective - some day you will grow unpopular with society because of your waning ability to contribute and because of your increasing needs. They will begin to treat you as a burden and disregard all which you have worked for and lived for, the precious soul whom you are will be tossed into the dubious hands of strangers.
Becoming clear ?............................

Nurse to patient ratios in nursing homes are far from safe. Please do not glorify institutionalized care when so many injuries, wounds and deaths are caused by nursing homes that keep lawyers very busy.

These numbers reflect these two ratios: 
Resident: patient to nurse ratio 
Resident: Patient to CNA ratio
The numbers were insane:
32:1 nurse and 16:1 CNA- Ohio
44:1 nurse and 44:2 CNA- Tennessee
50:2 nurse and 15:3 CNA- New York
66:2 nurse and 66:4 CNA- Illinois
50:1 nurse and 30:1 CNA- Georgia
60:1 nurse and 60:3-4 CNA- Nebraska

Nurses Say Staffing Ratios In Long Term Care Facilities Are Unsafe Read: https://nurse.org/articles/nurse-staffing-unsafe-long-care-facilities/

***************************************

Read this: " A 2014 report by the OIG found that 22% of Medicare beneficiaries in SNFs experienced an adverse event during their stay, half of which were preventable. More than half of the patients who experienced an adverse event at a SNF required hospitalization. A separate OIG report found an even higher incidence of adverse events at rehabilitation facilities. Among these are hazards that are well documented in older patients, such as medication errors, health care–associated infections, delirium, falls, and pressure ulcers. "

https://psnet.ahrq.gov/primer/long-term-care-and-patient-safety

OP has not responded since the 10th.

At the very least it should have been documented in her file, patient tore skin due to excessive scratching, what was done for wound care and follow up required. Or incident report #, with follow up care required. Sweep it under the rug, no one will know. If something like this is going unreported and treated, what about larger issues? Not only with mom but also other residents who don't have any one to be their voice and watch over them. When was the last time you were able to view her whole file? May be a good practice to start quarterly or more often as needs arise. Can't slip something in there post dated if you have already documented contents of her file.

I am sorry you are having to deal with this especially with your siblings are not cooperating..
 I don't know if this has been suggested but take photos and I would even go as far as recording responses from the staff with your phone so the state can hear there replies to your inquiry. They need to be held accountable if they are neglecting her or are the reason for her injuries.. No one should have to put up with neglect and injuries, otherwise she might need to be moved to another facility but that might be even more drama and hard on her.

Cetude, I'm sorry to learn that your experiences were so negative, but I've seen just the opposite in a variety of facilities.  Certainly there were some that were better than others, but I've never seen anyone pull a PEG tube out, and based on how a doctor handled removal when it was no longer needed, I think it would take a lot of painful tugging for a non medical staff to get a PEG tube out.

As to staffing, there are state mandated standards.   I don't recall if it was something like a 1:11 ratio or more or less, but that was a question I learned to ask before placement (after a bad experience at one hospital related rehab facility).

I'm sorry to learn that you've experienced poor and frustrating care, but there are some very good facilities available.   After several rehabs, I found a top notch religious affiliated place for my father.

Cetude, your one CNA to a hall full of people is not accurate.

Every single facility that I toured and the ones that my dad were in had 2 at night and 3 during the day. Sometimes 2 if someone called in, but there was also a nurse and other staff in and out.

I am not attacking you or your personal experience, but you yourself have told us that you cared solo for your mom in her home. This doesn't make you an expert on facility care or what they look like now. Please refrain from being a expert opinion on something you have not experienced. It is hard enough to make the decision to have a loved one go into a facility. Not everyone can forego having a life of their own to serve our parent until their deaths. Not all of us want to forego a life to live for our parents, so please don't make others feel wrong because they choose differently than you did. We each have to make the best choices for our personal situations. No one is right and no one is wrong, it is situational.

I'm sorry I offended some people saying how nursing homes are. So I want to clarify my original post. When you decide to put a loved one in a nursing home there are things you need to know. Institutionalized care is just that--a single CNA to a hall full of very needy patients, each requiring tons of time. The "system" prefers nursing homes because it is cheaper than home health for patients with complex needs. The average nursing home patient costs about $80,000+ a year for their care. It would be over triple that with around the clock home health.

CNAs have it very hard, and it is backbreaking work. It is the typical way nursing homes are staffed--one CNA to a hall. If your loved one has to be fed, chances are they will not get adequate nutrition. It takes *infinite* patience to feed one person, and if family is not there to help feed the patient they will go without. Before mom's PEG tube was put in--it took me one and a half (1-1/2) hours to feed mom a single meal giving her liquids a teaspoon at a time. No CNA has that kind of time. the LPN that passes meds has to give medications to tons of patients and they need to know if the meds need crushed and put in apple sauce, which ones whole, and which ones have PEG tubes. The PEG tube should be only a LAST resort when you really have no other choice--they will die of dehydration without it

PEG tubes are *not* cared for properly, not flushed the way they should which means they get clotted, and even get pulled out by the CNA while turning the patient and it gets caught on the sheets. The CNA will simply claim the patient pulled it when it was staff that did it by accident. Mom never bothered her PEG tube, and I used a tube top purchased from Amazon to keep it from getting caught and pulled. The tube top was very comfortable for her, and looked more like a dress. If not cared for properly, they can also get infected. So the more helpless the person, the more likely they will get neglected--*not* deliberately but simply CNAs do not have that kind of time to spend on one patient. PEG tubes also have hazards--if they are not sitting up while fed they will choke and aspirate so they require constant supervision while tube feedings and fluids are administered. You just can't leave them there by themselves -- they may slump over and choke to death on aspiration. For my mom I did daily dressing changes, hovered over mom while tube feedings were happening, established a bowel schedule (Sundays, Tuesdays, and Thursdays), used lactulose to induce bowel movements, and flushed the tube well after meds and or feedings were done. I also was able to tell if mom was assimilating the food and fluids by drawing back what was in there. Mom normally had ZERO residual. All was well. When mom had 60 ml residual I called my brother and told him mom was dying--that residual told me a lot, and how much she urinated. Mom used to urinate a great deal. When she urinated little that was a big change and that told me her kidneys were shutting down. Long before symptoms were apparent.

If they are bed ridden they need a specialty bed, and be turned. You also have to use a hoyer lift and sit them on a chair every single day--you just can't leave them in bed. It is bad for their skin, breathing, etc. Daily inspection of paper-thin skin is essential.

YES all of this is very very complicated. That was because mom's condition was that delicate. Even a nursing home can't manage this sort of complexity, so the complications arise.

I also had to monitor mom's blood sugars and insulin. I preferred insulin because I could manage her sugars very well. To the end mom's sugars were always stellar.

I had a good friend who was in a nursing home for rehab after his surgery. He preferred to stay in bed although he eventually regained the ability to stand. He developed blood clots and died..right in the nursing home. I visited most days and pushed him to stand up on his own and refused, so got clots

Report this UNACCEPTABLE abuse.

YES !! ! Report it ! That's crazy that the nurse thinks she can get away with such blatant neglect. Also, if you are concerned about retribution from the nursing home staff - consult an attorney and have them accompany you when you speak to these people - so THEY know that someone with legal authority is aware of the situation, as well.
This happened to my Mom and I DID experience retribution. If I had POA and could have involved an attorney - I doubt that the staff would have pulled what they did.
This is your Mom's life and she is precious. This is where she has to live now - she should be safe, clean and cared for on all fronts - at least. This nursing facility is being paid handsomely by the government to take care of our elder loved ones, they need to monitor their employees.

My aunt is in a 6 pack, close to home. I drop in anytime I want, not announced. The Ladies do their best, I know. They are nice good people, and so is Art. Accidents happen, and deadly ones... But I need to forgive, and forgive myself, and everyone, and heal..
Last week, oops, time flies... Christmas Day, I went to see her. Her arm was poorly bandaged. She scraped it, and Rose taped it with whatever she had. I took off the CVS, and bought all sorts of first aid stuff. Art finally showed up, and the next day, her arm was nicely patched. I called her hospice, and they sent down a wonderful person to analyze the wound. Her response is: The older the person is, and the more fidgety she gets, she will scratch and pick at the sore...Yup, chalk it up to dementia, and the way we go.. the body starts to wear down, or the skin can..I ran into a corner of the house, looked at my daughter, and told her : tommorrow, I will have a bruise there." She says I am bruising way too easily...
I hope you can get the truth out. If it was an accident, they should tell you exactly what happened... Thinking someone new doesn't know how to manipulate patients around without hurting them. Ask other residents or look at them and see if they have some kind of issues.

Don't know if this is good for older people: Arnicare... It is supposed help stop the bruising...

I can understand all the complexities that go with running a complex organization and all of the personnel issues that can arise. There's a lot of training and certification involved too. I'm perfectly fine letting an organization straighten these things out - BUT NOT AT MY MOTHERS EXPENSE.
Listen to your own voice and do the right thing. Don't put yourself in the position of regret. Your siblings in my view don't have much of a say, if they want a say maybe they should be closer.

Anytime a resident is injured in a nursing home the staff are required to fill out an incident report. This report will explain what happened and what actions were taken. Normally, after a physical injury staff will monitor the resident's vital's once every shift for three days. These results should be in the resident's medical chart. What most people don't realize is that the "Incident Report" is not part of the resident's medical chart, therefore it is not accessible to the family. An "Incident Report" is primarily a tracking tool used by facilities to look for patterns. What they look for is things like are injuries primarily happening on the same shift or, are the same staff members involved in the incidents.

Whenever there is a change with a resident the responsible party is to be notified within 24 hours. This is not a matter of good policy it is the required by the Federal Regulations that govern long-term care facilities. You should have been notified of these injuries within 24 hours of the occurrence, if you were not you need to speak to the Director of Nursing and asked her why you were not notified within the time frame set by the Federal Regulations.

If you are concerned about the number of injuries your loved one is getting in the home and the staff are not addressing your concerns you have two options.

1. You can call your local Long Term Care Ombudsman Program. The Ombudsman are the Federally Mandated Advocates for residents in long-term care communities. They can come in and do an investigation and work with the home to make sure this does not happen again. The Ombudsman are experts in State and Federal law and can often time resolve issue without going directly to the State authorities.

2. You can call the Elder Abuse and Neglect Hotline and make a report. The State can do an investigation and possibly cite the community if they find the did not follow the proper protocol .

If your siblings are worried about you calling the State then start with the Ombudsman. I was an Ombudsman for over 17 years and handled many situations like this. The nursing home would much rather deal with an Ombudsman coming in and investigating this than the State. The Ombudsman can not cite a home for not following the proper procedures but can require the home to make the proper corrections. As an Ombudsman if I went into a home over a problem like this and the home did not correct the problem I would call the State myself. When I called the State and reported the incident and that I tried to resolve the situation but the home refused to make the corrections the State would usually send an investigator right away. The State knows if they home did not respond to the Ombudsman it is time for them to step in.

The last thing I would share with you is that families often worry that retaliation will happen if they report a home to the State. I can not promise you this won't happen but it does not happen nearly as often as people fear it will. There are also very strict regulations that protect residents from any retaliation from staff. The fear of retaliation is the biggest factor that keeps families/residents from reporting problems in communities.

Yespecially, Right Away!

I think you really have answered your own question. As a mandated reporter, you are REQUIRED to report abuse. I am sure you would report abuse if you saw another patient abused, please do so for your mother.

I was thinking about your problem. I am 85 and hubby is 88. Our skin tears just looking at it. Especially where the sun hit it all of our lives, like hands and arms. As you know, if she is on Blood thinners that will make it look really bruised and bad too. That said, what other posters said about looking in to it is a great thing. You never know.

My best advice is to contact an attorney and also look for a new place for your Mom. If you are private pay, you will not have a hard time finding another place. Document the injuries. Take pictures. Speak to the administrator of the NH. If no one will document, file a police report. I’ve been there. It is shameful. You will not feel peaceful until to take action. If your siblings don’t agree, that’s unfortunate. If you are the one who handles the matters, you should do what you think is best.

you bet you should................
how dare anyone hurt someone who is hired and paid to help and keep people safe in their care.
I too, had this happen with my dad. I was there every day, left 9pm every night and it still happened more than once.
I felt not only anger over it but I felt responsible to do it for any other person who could be abused also, and was afraid to complain.
I reported every thing every time something occurred. and I also had a police report made just in case it would be needed at a later date.
they can not throw you out because you filed a complaint with the agencies that investigate complaints of this kind. Take a look at all of the people in the nursing home. Could you feel ok with yourself knowing that this is happening and or could happen to any one of them and not do your best to try and stop it.
I know I couldn't. That is why I filed my complaints.
after filing m y complaints no one went near my dad at all. they were all to scared to. they did there job and got the hell away from him. that's just what I wanted.
most of these people are seniors whos health is declining and they have the right to live out the time they have left as care free, abuse free and happy as possible

Yes, I would report it to the authorites. The reporting is anonymous so there be no fear of reprisals. A resident cannot be discharged from a facility because an incident was reported. I would report to the ombudsmen as well as the department of health. Additionally, I would speak to the administrator of the facility and the director of nursing. If the facility is a part of a larger corporation, I would make them awareness well. This needs to be done not only to protect your mother but other residents who have no one to speak for them. There also needs to be interventions in place so she doesn't reinjure her hands.

Yes.
Put yourself in her shoes.
What would you want someone to do for you?
Have you consider in home care ?
Your home but someone to come do what your mom needs on a daily basis ?

I’m sorry about OP’s choice of words, and also from some responders. “Mom has been physically injured”, “report elder abuse”, “covering up” and “how these injuries supposedly happened”. Old people’s skin is so fragile, and the chances are that mother did it to herself. Yes it should be documented, and someone (you? them?) should be trying to work out how it happened. The second is more important right now, to stop it happening again. Being so angry may not help anyone.

Look for another facility asap. As a mandated reporter you MUST report no question! REPORT IT. If this is happening to your mother there is no telling how many others are suffering as well. Good luck.