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My Dad has been in his nursing home for 3 years. He is in a wheelchair and cannot move much. He has been participating in activities when I visit him and seems relatively happy. He has had a lot of the same staff for years. I got a call yesterday morning that he fell from the built in (on tracks) hoyer lift on the way to the shower. They sent him to the hospital. He fractured his pelvis and hit his head, but won’t need surgery. This morning the nurse at the hospital asked if I was aware of a pressure sore he had. I was not. I saw a picture of it, it looked pretty bad to me. She said it looked like it had been there a while and not from his fall. It’s about the size of a palm with no fingers and it’s a wound, not just a red spot. He can’t really adjust himself in his wheelchair or on a bed, so I just want to ask if anyone has experience with this? This sore plus the fall has got me so worried about his care where I was not before. I would appreciate your input/experience.Thank you!

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Oh man super tough I’m so sorry for your dad I’m glad that’s he’s alright . Sounds like an emergency care plan meeting needs to happen with you and the director of nursing , social worker from the nursing home , and the unit manager from the unit that your father resides on. It is MANDATORY that these nursing homes check skin once a week for wounds and rashes and document it (this may change from state to state) so I definitely understand your concern that would alarm anyone . I would also definitely recommend contacting your ombudsman to have them there with you too in that meeting so that you can have some support and that extra layer of authority because the nursing home will have X amount of days to write a resolution report to them on the matter . Hugs to you my friend 💛


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maria
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Carlacs May 2023
Great info, thank you so much for your reply.
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I can't say whether the fall was due to neglect or just a tragic accident, but IMO the pressure sore is definitely neglect. Pressure ulcers are like icebergs, if the mark you see is palm sized then the damage you can't see is significantly greater than that; they can't have failed to notice a sore this size.
My mom's NH let me know when they first noticed a small red mark on her backside during diaper changes and they kept her mostly in bed until it healed. I also invested in the ROHO seat cushion that was recommended by an OT since she did spend all her waking hours in her wheelchair. No more sores, not even stage 1.
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Carlacs May 2023
Thank you for the info and your reply!
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Neglect [or strictly speaking negligence]. Trust me, it isn't often I don't want to ask a lot of questions first; but a fall from [a sling attached to] a Hoyer lift is a Never event. Somebody screwed up. Ask for a detailed incident report (in writing).

The pressure sore may or may not be: where is it, how deep is it, is this actually a pressure sore or is it an abrasion or a moisture lesion or...

How is he? Hope he's comfortable now. Is he able to tell you anything about what happened?
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Carlacs May 2023
He seemed to know what happened yesterday but forgot today. They have been giving him a lot of pain medication and he’s tired, but comfortable. All he said was he fell about 4 feet and the lady that was helping him was a nice lady. Thanks for your response.
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Yes, you are correct to be quite concerned. I cannot see a reason that this pressure sore was missed, and they are deadly. Your father is now dealing with a severe injury as the pelvis is terribly painful injury and slow to heal, without any way but time to fix it. It can cause other problems as well.

I would call on an ombudsman. A pressure sore is reportable for almost any nursing home. Too many of them and state licensure is threatened. They CAN happen quickly and especially so with someone wheelchair bound.

I am so sorry you are dealing with this. It is reportable. You Dad is going, I think, to require good SNF placement now for at least a while.
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Carlacs May 2023
Thank you so much for your reply.
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The aids bathing him should know enough to bring the sore to an RNs attention. You want a Nurse that has experience in woundcare to watch it and bandage it. Dad now should have an air mattress on his bed and a roho cushion in his wheelchair and you don't pay for these. His Medicare may cover them. If not, IMO, they allowed this sore to get to this point, they pay for whats needed to heal it and keep from not coming back.
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Carlacs May 2023
Thank you for the information and your reply.
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You should find out the stage of the sore and if it has been treated with dressing changes and if it has been seen by a wound specialist. You could ask him about pain involved.

It likely is neglect especially combined with the fall. It is wrong you were not informed about the sore. They are very hard to heal in the elderly.

He should have a special mattress and he should have his positions adjusted. He may very well need constant pain medication.

I would consider consulting a lawyer who specializes in elder care abuse. They will know if you have a case and will not charge any fees upfront. If you proceed with a case you should find a different and better SN facility for your father.
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Carlacs May 2023
Thank you so much for your reply.
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Gee when I got My Mom from the rehab ( NH ) They said " She was Independent " She was there for about 2 Months . She could Not walk , she was incontinent with C- Fids ( Diarrhea ) and she Had a Open Bedsore that was Black the size of a baseball on her tail Bone . I was alone with her and Lifting her in and Out of Wheelchairs for 2 weeks . They told me " The VNA Nurse would be coming " That did Not Happen for 2 weeks . No One would help me - Not her friends , relatives or my sister . In 2 Months she just went downhill - couldn't swallow water or keep her head On the Pillow . The Doctor would not tell me what was going On . By the time the VNA Nurse arrived we both decided to call 911 . And Once I got to the Hospital The Nurse said " She needs 24 Hour care - here are the lawyers to talk to . " I found Out from friends they had terrible experiences with this Rehab . I was in such a state of shock . I Hope you get some good answers here .
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Carlacs May 2023
How awful!!! I am sorry your mom (mad you) went through that! Thanks for sharing that and for the information.
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You Can also go on YELP and see if they have any Fines and also through Propublicas website - They List what complaints were Lodged to Medicare and I saw a Pattern with some of these SNF . Other people Have Listed Elder abuse attorneys which work similar to personal injury lawyers . Personally I stay away from Lawyers It is ridiculously stressful
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Riverdale May 2023
Also stressful to have your mother dropped by a new aid not following protocol and having both her femurs broken.
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There are doctors who specialize in wound care. Ask for one to evaluate your dad.
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Carlacs May 2023
Thank you!
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You’ve received great replies and information. I’m chiming in to say how sorry I am this happened as it never should have at all. You definitely should have been informed from the start about the pressure sore and a plan formed to address it. The Hoyer fall also shouldn’t have happened. My mom spent four years in a nursing home, completely unable to move herself or assist in moves at all, and there was never a sore or skin breakdown at all. It takes a vigilant staff to ensure good skin care. I hope your father can get good care from a wound care team and you’ll be successful in finding a better place for him to live
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NeedHelpWithMom Jun 2023
Did your mom have one of those rotating air mattresses?

When I toured places for mom to enter rehab. The head nurse told me that those mattresses worked well in preventing sores from occurring.
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Wow! What a tragedy. I am so sorry this happened to your dad.

Where is his pressure sore located? Is it visible due to being in an obvious place? If it is, then I would suspect negligence on the staff’s behalf.

The reason I ask is because my mom had a pressure sore that was really low on her bottom in a spot that wasn’t visible by seeing her backside. Who knows how long she had it before she told me about it. She sat in her recliner all day.

I bathed her on a regular basis and didn’t know that she had a sore because it was in a spot where it wasn’t visible. She washed her private areas herself so there wasn’t any way I would have discovered it.

When her doctor was about to retire, she said to me, “Honey, when you look for a new doctor, find a woman.” I said, “Okay, mom.” and didn’t think too much about it.

Then she says, “I have a sore that hurts and I would rather show it to a woman than a man.”

When I asked her how long she had it, she replied, “Oh, a long time, years.” I was very upset that she hadn’t told me.

She was extremely modest. It surprised me that she asked for a woman doctor because she had four children, all delivered by a man!

The sore was so bad that a nurse who specialized in wound care had to treat it. The nurse also instructed mom to use a special pillow for sitting in her recliner.

I am not familiar with hoyer lifts and how they work. Your dad took quite a tumble. I would absolutely want to get the entire story of what happened.

Best wishes to you and your father. I hope that he recovers as quickly as possible.

I think it would be a good idea to look into alternative options for his care. Between the sore and the fall I would be extremely concerned about his well being.

One has to wonder how often these things occur in general and certainly if it has happened before in his facility.
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I am so sorry this has happened to your Dad.

I know to err is human but there are protocols, procedures, regulations & charters designed specifically for the age care sector. Towards best care is the goal. To remove harm, minimise risk, ensure safety being the basic foundations of this.

Bedsores can & do happen despite all attempts to prevent - despite regular skin checks & the best air mattress & specialty cushions. BUT. They get reported, monitored & treated.

Things have gone wrong here.

Skin checks should be done.
Pressure areas monitored.
Any wound reported, to family, RN, Doctor. Wounds to be dressed & kept clean.

Hoyer lifts must be checked & deemed safe to use. Any faulty equipment reported & taken out of circulation. Staff must be trained to use, or working as a team under direct direction of a trained staff member.

I would want a meeting with the Facilty Manager. A chance to ask what happened & why. Instead of a blame session, I would attempt to stay neutral to find out the facts. An honest Management team will have some sort of negative event disclosure model of care. Tell you honestly what happened. Then what they are doing to prevent this happening again. To your Dad & others. Eg More staff training, equipment checks, more thorough skin checks.

If Management attempt to coverup or hide from full disclosure, get heavier. Legal weight heavy if you need.
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Carlacs Jun 2023
Thank you so much for your reply!
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