Hold on to your hats, 'cause I'm going to rant.

And before I get started let me say if any of you "people" in administration and the upper eschelon of nursing staff at my father's nursing home are lurking out there, this message is directly aimed at you. You've driven us to the point where we will do everything in our power to report every mistake you make to any authority that is willing to listen. PLUS we will tell everyone we meet that is in the position of deciding on a nursing home for their LO to avoid you like the plague.

If I thought it was worth the time and effort I would sue you for everything you are worth, then buy the place and make the Administrator, the Physician's ASSistant, the Doctor and the D. of Nursing clean the toilets and floors with a toothbrush. But I digress...

I thought it bad enough that the NH allowed 4 helpless residents to be beaten by a psychotic, combative patient before they removed him from the ward. But that was back in November and you know how time goes. We do our best to make things right, prevent this from happening ever again and we move on, because we have to. The state is busy "investigating" the matter, because I adamantly insisted they do so. We'll see what the report says, if they ever get it done.

So much for the stress, both physical and mental that my father went through on top of the beating. So much for the same stress that my husband and I went through, the loss of work time, the sleepless nights etc., etc. Heck, we knew that after Dad went into the NH it wouldn't be that much easier. But we didn't expect to have him beaten.

So, he recovers as best he can given his condition and we are grateful to God that he is still with us.

Then, the next fiasco happens. The you-know-what hits the fan once again. This time is comes in the form of a highly contagious virus which ran rampant through the nursing home.

I understand these things happen given the nature of viruses and the ease with which they are spread from patient to patient. It is suspected it was a norovirus; which causes a severe case of gastrointestinal upset (vomiting and diarrhea). Dehydration can occur rapidly as you can imagine.

Well, it did. My father went approx. 5 days without holding anything down. He would occasionally take a sip of water. It was clear he was dangerously dehydrated when he went completely delusional, talking "out of his mind".
And the PA and Dr. said he wasn't bad enough to warrant IV fluids.
Nevermind that several nurses and CNAs came down with the same thing. Two of the nurses were hospitalized and received IV fluids. They are normal healthy individuals in their 40s.

Most of the residents on Dad's ward are in their 80s.
I demanded he be put on IV fluids and offered to stay with him while they were being administered. I demanded blood work be done to check electrolytes, etc.

Blood work was not done for two days after request. They never gave him IV fluids.

By the grace of God he has survived once again, however it has taken him down several notches so to speak. It is unbelieveable.

I was told by a CNA that 4 people on that ward died during the weak. Yes they were all "old" but they couldn't fight the illness.

This is disgusting. And I am more disgusted at myself that I didn't just call an ambulance and have him taken to a hospital - I am a complete idiot.

But I thought that they would do the right thing and accomodate since they have the capability of rehyrating people in this facility.

I have had it with this place. And to have to move him to another place will be a nightmare but I may end up doing it just so he can live out his final days in whatever peace there is to be had in his world of Alzheimer's...

Semper Fi -

I'm really glad to see a fairly recent post from you. You may have thought I have forgotten your existence. Not true! As a matter of fact, i have thought of you recently and wondered how you are, how your dad is, and whatever happened with the problems in your dad's NH. While I see that the problems continue - and Im very sorry for that (though not surprised given everything I've seen going on in various NHs over the years)- I'm happy to know that you're still kicking butt and taking names.

Debbie and I are doing alright. She still has plenty of health issues and new challenges are always coming up, but we continue to go out to flea markets and have as much fun as we can afford.

Take care of yourself, and I'll look in here every now and then to see if there is news from you. I wish you well with the ongoing battle and hope your father stays strong.

gs,
Thank you for the link.
I've searched for a dedicated site such as this for a long, long time; it is sorely needed.

Folks considering NHs for their LOs (or even for themselves) need access to frank, uncensored evaluations, not just that provided through the Medicare NH evalutaion site - or by word of mouth from neighbors or friends. Or by state evaluations of deficiencies, or records of complaints received during the year which are so often written in such a way as to downplay their severity.
Those are good places to start, but often fail to paint as real a picture as one can get short of actually living in the facility.

Having said that, I have no doubt that NH administrators/staff lurk behind the scenes of this new site - just as I've said they probably do with Eldercare and other related forums and blogs (call me paranoid if need be!). And because of this, I will use caution in my evaluation. I cannot risk any more retaliation against my father than already takes place because of our requests for investigations and our often futile insistence that the NH keep him safe.
Nonetheless, I thank you for pointing me in its direction!

This current thread which I started back in 2005 is actually a continuation of this
initial postI made in 2004 when the first - and most severe - patient-on-patient incident occurred.

I've made it 100% clear from the beginning that I do not hold the the initiator(s) of the attacks (for lack of a better term) responsible, but the administration of the nursing home itself. They are solely responsible for their resident's care. That's what they are paid to do, and maintaining dignity and assuring safety is part of the responsibility.

It stands to reason though, that my first concern expressed on this forum would be for my father - or any other patient who is non-ambulatory, and a receipient of such attacks - as opposed to the ambulatory patient who initiates the 'unwanted contact'.

My intent is to continue documenting my father's journey from HIS/OUR perspective. By doing so, I will automatically include what I've discovered can and should be done to improve the quality of life for BOTH the victim and the perpetrator of the attack. But most urgent is the need to keep people safe, which includes from others.

It is not my intent to be cruel or callous towards the latter; please forgive me if you perceive my words as such.

Since the inital attack nearly three years ago, I've been compiling the scant information available on the internet and elsewhere about this severely under-reported type of abuse/neglect which occurs in long-term care facilities.
Here is one of the most recent articles I found:
Nursing home residents at risk for peer abuse

I've also renewed contact with a former boss (the best I ever had ) from decades ago who is still active in Alzheimer's research (he is an MD/PhD who also had clinical duties in an Alzheimer's dementia ward at a V.A. Hospital where I worked as his lab assistant).
Here is an abstract of one of his most recent papers in which he and his colleagues describe the Effects of continuous activity programming on behavioral symptoms of dementia
(I have a personal copy of the paper, but not a link to a full copy on the web).

I've had a chance to dialogue via email with he and his colleaguewho helped developed the continuous activity program for dementia patients. I'm convinced this concept is desperately needed in all dementia units for EVERY patient. And if it were implemented would probably reduce incidents of 'peer abuse' to virtually zero.

We owe it to our loved ones to be ever vigilent and demand changes in the NH 'status quo' which, at least where my father resides, isn't working.

Enough for now. I've gone on too long...
All of you are in my prayers.

Welcome, GS and thanks for that link! Unfortunately, I couldn't find ANY links to nursing homes for my state, so I assume this is a NEW listing service and only basic ratings are available for free but comprehensive reports are available for a fee?

Are you affiliated with the Caregrade site? If so, you should place your advertisement in the classified advertising area of the site.

This message has been edited. Last edited by: Moms_Buddy,

Unfortunately there is so much of this, although I do believe it is getting better than it used to be years ago. I think the internet is helping as it is much easier to report problems these days and to investigate potential new places. You may want to visit a site called

www.caregrade.com.
This is a site designed exactly what you are looking for. You can write a review for the NH and also research other options.

Good luck

Thank you Torp Backatcha baby yes she does have hallucinations although as of last weeks progress report of sorts we found out why none of these medications for AD were not working she has been diagnosed with other Psychosis's ones that I believed a while back she had been suffering from for a number of years now they have her on a Psychotropic drug that seem to be working Ill get a better idea at the end of this week just how well they are doing. Shes still doing the wandering though evidently they can not keep up with her but in order to place her we need to see how well these drugs are going to work for her on the combative issue since alot of these NH's dont want to take on someone like this. Hah and I do? With no help?! Ok so Im still a lil smart butt but you get my point

{{{{hugs for you BG }}}}}}

Our family went through this with my step-grandmother. It broke our hearts to see this tiny, gentle woman behave like this. Is your MIL having hallucinations? The doctors believed that fear as the result of the hallucinations were causing the "fight or flight" instinct to take over. To her, the threats were real. She was also running away and hiding; they once found her under a bed in another room.

Oh BG, I'm so sorry I didn't know she had gotten worse and the NH alternative was at hand.
My dear friend, anything I can do to help, you got it. PM me if you need to. What a scary time for you!

Thank you Dochka for the site, unfortunately Im not borrowing trouble here what I saw today and experienced with my MIL is something that gives me great deal of pause she tried taking a swing at me and tried on the nurse 3 different times all the while trying to get up out of the chair screaming and carrying on...they just called again and have to give her yet another medication to try and quell her combativeness.

Dear BG,
Do not borrow trouble, girl! Wait and see what happens.
In my research for semper fi I found out a law was enacted by the National Health Institute in 2004 to protect our elders in long term care facilities. However, it seems we must be vigilant and act as advocates for them to the end (to avoid any and all hardships).

Here's a site for you, darlin':
http://www.memberofthefamily.net/

We and many others can all benefit by taking action and supporting each other!

I am sick to my stomach on this Semper Fi and now I find myself at the opposite end of your situation, my MIL is the combative one....
I never thought Id see this in her and now Im heartbroken and scared to death of what may happen since she is still ambulatory herself and is to the point I can no longer care for her within the home....
What the hell can we do to ensure peoples safety in these places?
Im at a loss....

Hi again, this topic really gets me so upset, can you tell? Anyway here is another site to go for help:
http://www.ltcombudsman.org/static_pages/ombudsmen.cfm

http://www.nursing-home-abuse-resource.com/nursing_home_abuse/signs.html

This message has been edited. Last edited by: DOCHKA,

I'm sorry for all your trouble! What a sad situation. But oh so maddening in my opinion.
If the "State" is "supposedly" investigating, then a nice, calm letter or e-mail to a State Senator explaining your situation will put a big fire under their butt and get them moving.
If you "nicely" mention you are so fed up that you may talk to the "press", you'll get action for sure!
You are your Dad's advocate! Stand up for his and your rights to decent healthcare you deserve.
You don't have to be nasty about it, but nice reminders to people in high places that we are not going to be victims to incompetence really helps! Good Luck!

Here is a site to find your state's reps:
http://www.loc.gov/rr/news/stategov/stategov.html

This message has been edited. Last edited by: DOCHKA,

Semper Fi, so GOOD to hear from you and so sorry to hear that things have not improved for your dad and you. Wish I could offer a suggestion... something more than just my best wishes that things change SOON...

Just a quick update...and to answer my own question originally posted in my thread title.

No, it never ends...

Same nursing home. No, I haven't transfered Dad from this one because of waiting lists and other homes don't have private rooms on their dementia wards.

Not that that seems to matter.

We're now up to at least six 'admitted to' "incidents" of patient-on-patient abuse.

No, I don't blame the CNAs. Never did.
I still hold the administration 100% accountable for not providing staffing to monitor their ambulatory dementia patients.

And not, it's not OK that other patients hit, punch, shove or slap my Dad - ANYTIME!
There are NO EXCUSES to this kind of abuse.

The state still claims after each time they investigate (and yes, I make CERTAIN I demand an investigation):
"No evidence to substantiate the claim".

Can't take pictures of the bruises, cuts, etc. Dad gets from these incidents because the state won't consider them as evidence.

No lawyers give a hoot what's going on, because they can't make money off of this claim. He's still alive, afterall...

And, the Dementia Unit staff doesn't like it when my Dad YELLS REALLY LOUD when someone slaps, hits, punches, etc. him.

Oh gee...too bad he can still use the only thing he has going for him to protect himself - a loud, booming voice screaming for help!

So, just an update...

Nothing changes. No matter how much effort you put in to protect them, to demand changes, to notify the state, etc. etc. etc.

Doesn't matter.

He (they) are old.
They have dementia.
According to the staff, "This is what they do."

DISGUSTING.

On a different note, hope all is going as well as can be expected given everyone's situation.

God bless you all through your journey with your LO's.

Rane, thank you so much for validating what many of us feel, and the experiences we've had, with NHs. Your link to the nurse's site has already been very helpful to me. I appreciate it.

About a decade ago, I worked in a NH handling their medical supplies. Though my job did not involve any direct patient contact, and I could have gone about my day ignoring the residents,I could no more have done that than fly. I refused to be deaf , dumb and blind. I made stops every day to take a moment to chat with one resident, get a blanket for another, get a sip of water for someone else.

Wish I could say all the nurses and aides there had the same attitude. This particular NH had a bad reputation, and it showed. Getting a behind-the-scenes look was horrifying, and certainly contributed to my extreme aversion to placing my parents (which, unfortunately, I eventually had to do anyway - sometimes one's choices-no matter how necessary- aren't easy, are they?).There were people who tried to change the tide in that place. Several of us, including the administrator, DON, her assistant DON, one nurse, and a few others, were fairly new to the NH and did our best to make changes in it's operation. Sad to say, we were met with so much resistance that ALL the aforementioned people ended up deciding to leave the facility at the same time. We actually had a get-together to express our frustrations after we resigned en masse. The owners of the NH had made it exceedingly clear that they were not going to make any changes if it involved spending any money. We were hog-tied, and some of us faced the possibility of facing serious consequences if we stayed. Speaking for myself, I was told to indiscriminately charge any patient I could get away with for any inventory that wasn't accounted for (and with their ridiculous system, that was a lot). My suggestion for a new system fell on deaf ears, and I refused to follow their illegal tactics. The only nurse I trusted in that place left after she was forced to cover an entire wing by herself one shift - a wing she was not familiar with- that housed about 100 patients. She was terrified that any number of mishaps could occur, and she was scared both for the residents' well-being and for her professional career. That was her last night there.

Seems like it comes back to money every way I look at it. Money for staffing, for training, for food, for decent supplies, for everything that could make an elderly person's life kinder and gentler. The people who run these places - too often - are more interested in their bottom line. The results - some of the things I saw - are just horrifying.

I,too, believe there are NHs out there that aren't like that. Some are good. But for those that aren't, there needs to be a GREAT deal more accountability! Inspections are a joke. What will it take before the powers-that-be decide that the elderly deserve the same human rights we all do?

Dear Mom's Buddy,

I can't tell you how much it meant to get that huge pat on the back! Thanks so very much An effective change in the nursing homes can only be made when the families and healthcare workers join together. We're all very much in this together, as we are all being abused.
As I've stated, the nursing home administrators, and corporate workers (that I've interacted with), have no medical background. Their ignorance - and arrogance - is truly stunning.

The stories you were describing made me ache with sadness - and rage. It's true that only the most tragic tales get told in the media regarding our countries nursing homes. Even though I'm very bitter about the neglect that I've personally witnessed, and promptly reported, I still hold on to the hope that there must be a few long-term-care facilities in existence that have adequate, and caring, staffing. As it stands now, and until we all start screaming (much louder) to our state representatives, this just isn't going to happen.

First of all, there isn't, and never really was, a nursing shortage. Those of us in healthcare have known this all along. It's true that there weren't as many nursing students for a few years, however, there have always been enough nurses and CNA's. In my area, the nursing schools are full. I am unable to be admitted to the RN program until 2007 - and only if I act fast.
The following article will explain more about the lies that have been fed to the general population, and why, regarding the alleged "nursing shortage."

http://www.hireamericancitizens.org/nusing000.html

Regarding the above article:
I have often had to help a nurse, or CNA, recently recruited from another country spell a word as simple as "arm" while she/he was writing an incident report, etc.
Not only do many of these foreign workers lack a grasp of the English language, medical or otherwise; but cultural differences and beliefs crop up also which make it doubly hard for everyone involved -- especially the residents/patients. Regarding this issue, I have no desire to be "politically correct," as it is yet another potentially dangerous situation caused by corporate greed.
I do want to add, though, that I've also met some of the very best caretakers, and friends, who are from out of the country.

The long-term-care industry is pretty much a confusing mess, no matter how you slice it.

Before I sign off - I want to give anyone interested another website address - to offer more insight - where nurses discuss the issues they're having with long-term-care. Please, bear in mind, that this is a forum for them to vent and give support to each other -- not to be judged. These are very dedicated people who are trying hard to give optimum care to those in their charge. Besides having to navigate their own way through the political crap that goes on, corporate and otherwise, some are also working and taking care of elderly parents themselves -- as the current average age of a nurse is forty-something.

This forum is also a wealth of information on just about anything related to nursing homes -- infection control, etc.

http://allnurses.com/forums/forumdisplay.php?f=22

Peace to all of you,

Rane

Rane, bless you for telling the other side to the story!! It hurts my heart that, as in so MANY professions, the GOOD guys get tarred with the same brush as the BAD guys!! It is no wonder that there are nursing shortages and crises EVERYWHERE - what pros put up with is MEGA and therein lies the problem - the good ones get burned out and leave, and the bad ones learn to not give a crap and go with the flow...

Our area's daily newspsper recently ran a lengthy 5 part series on Nursing Home care in our state and it was shocking!! Of course, they DID trot out every sensational story and never any of the good stuff, but in our case, the homes are so unregulated and unmanaged that they receive no punishment or minor slaps on the wrists ($800 fine for allowing someone to get eaten up by fire ants... no fine for allowing a person in a Posey to hang themself because they were not checked on for over 4 hours...but they did have to attend a refresher class... ) when an injury or death occurs because of neglect or negligence.

Thanks for YOUR dedication and I hope there are LOTS of unsung heroes like you out there because we can't all avoid using nursing homes!!! Your point of view is quite refreshing and I hope you'll stop in often and weigh-in from that perspective - it helps immensely to know ALL SIDES of an issue when fighting the good fight!!

May,

as a cna in a nuring home, fight, fight, fight. Make yourself well known to the administrator, the social worker, the nurses, and the cna's. The cna's are probably doing the best they can with what they are given. I once tried to report a very abusive cna, and none of the bosses would listen, I then called the state who told me that unless the abuse had caused a death, they had no time for it. So be there, call, drop in. Forget about inspections, they are a joke. Be there, be verbal, and leave no question unasked. It is very true, in this case, that "the squeaky wheel gets the grease.".

Dear May,

Thank you so much for responding. You're absolutely correct: "pitch a tent." The administrators definitely take notice of those families who are the most outspoken. And yes, we know (approximately) when "the state" is coming.
When the floors are still being polished late into the night (keeping the residents agitated), and we suddenly have an abundance of supplies, you know they're on the way. As I have primarily worked night shift, I've gotten to witness more than my share of these last minute shenanigans.

My intentions of posting my feelings regarding what I've seen as a healthcare worker, are not designed to compound the guilt and fear that some of you (myself included) are feeling so intensely.
I do not want to be an alarmist, however, I feel that choosing to keep quiet would be a grave disservice to those who can no longer speak for themselves. Those residents who can "speak" are frequently (at times, justifiably) afraid to do so. Their terror of speaking out is not so much due to a fear of being physically harmed, but rather of having the nurses lay a (major) guilt trip on them, which I've seen happen time and again: "Look what you've done, you caused so-and-so to be suspended." That sort of thing. And, since it is company policy to automatically (no questions asked) suspend a nurse, or CNA, when any sort of accusation is made, no matter how small - or ridiculous; "suspensions" (without pay) are the order of the day. Before you say "good work" on taking immediate disciplinary action, let me clarify that the corporations arbitrarily do this to the nursing staff as a way of scapegoating. As a way of saying, "See, we really do care." No...I'm afraid they don't.
The more serious infractions - such as gaps, or "holes" in patient charting are covered up. This is probably why the RN freaked out when (I don't recall who posted this story) they tried to view their parent's records. Which, by the way, you have every right to do, if you happen to be the DPOA. Otherwise, this could mean a 25k fine (for the nursing home) for a privacy violation. Good old HIPPA. And God bless them too, while I'm at it.

Please forgive me, I've had way too much coffee this morning and am starting to feel really snarky as a result. This subject doesn't exactly lend itself to improving my mood either.

Maybe when the shock wears off of having to place my father-in-law in a nursing home, then I can get down to the real business of "feeling my feelings." Right now, I just can't do it.

Again, my love an support to you, May, and to everyone else who is facing this tremendous challenge.

-Rane