Nursing Home Neglect?

What is the name of your state? Texas

My Grandmother is 84 years old. Last September, she was moved out of a retirement center (no type of nursing care provided) due to health issues. She was not watching her diet or exercise, which caused a flare up of her congestive heart failure and type 2 diabetes.

She spent the next year living with my parents at their home. There, she was put on a regulated diet and excercise program. This enabled her to be taken off 5 medications, and she became very healthy, with only 2 trips to the hospital during that time.

She decided she wanted a bit of independence and moved into an assited living facility (with nursing care) about 2 1/2 months ago. This place appeared to be great for her, as they advertise a "diabetic diet", and they adminsiter her medications everyday. This is the extent of their assistance.

Here is the problem. Since she has been there, she has made about 5 trips to the hospital. All of them have been diagnosed as related to the congestive heart failure, high sodium, too much water in the body, diabetes, blood too thin, kidney problems, etc.

She has since been put back on the medications she was able to stop taking at my parents house. We have found out that everyday, the assited living center is offering her pies, cake, cookies, etc. Only half the time does a worker go "oh wait, you are not supposed to have that". And of course, she eats it when they "forget". She SHOULD be responsible enough to not eat those things which are forbidden by her doctor, but that is like putting a cookie or a prune in front of a 4 year old. Which one would they take? The center advertises they will give her a diabetic diet. It was one of the main reasons she went there. So THEY should be responsible too!

Also, right before the 1st time at the hospital, we found out that she was out of medications for several days and the staff did not do anything about it. One other (that we caught) medication was dosed incorrectly, they did not give her enough blood thinner (Warfarin)....they did not follow the doctors orders. When we went to the hospital, her symptoms were a direct result of the medication woes.

The abundance of sweets has continued in the meantime (although she has been there 2 1/2 months---you would think they would know by now).
She went to the doctor a few weeks ago and was given a diuretic to get the water off her body, which was prescriber because she had edema (swelling). This is a direct correlation to her diet (sodium, sugar, etc). This is to be taken ONLY with potassium, or it can cause your kidney's to shut down, etc. WELL, the staff have not been giving the potassium to her, and had a very flippant attitude when confronted.

2 days ago, she was taken to the hospital for severe edema and she could not urinate. When the nurse/doctor examined her, she had an incredible amount of fluid in her body. Her stomach appeared that there was a 15 pound bowling ball under her shirt. They also said that she was being given TOO MUCH blood thinner (Warafin). Again, the staff at the facility is dosing her incorrectly. This was the original medicine dosed wrong, and now this is the 3rd time we have caught them. Also, we asked the retirement center for a print out of the medications they have given her the past few weeks and the print out they provided had a different birthday and room number on it----but my grandmother's name. (possible miss dose this whole time??) She is still in the hospital as I write this, as they are trying to regulate the problems before the thin blood and edema cause too much strain on her heart (She has had an angioplasty and a stint prior)

So, my question is-----my grandmother's health has obviously deteriorated since she has been there. This can all be documented and proven. Is there any basis for a lawsuit against this retirement center? I need to ensure that they do not continue to exhibit the ignorance that they have with my grandmother. I have a hunch she is not the first person whose health has been affected as a direct result of their actions.
Any advice?

Thanks!
Kim

[JETX]

"Is there any basis for a lawsuit against this retirement center?"
*** Not at this time. However, I would suggest that you or her family get PROACTIVE in this and take the issues to the administration. Make it clear to them that they have a problem and you expect it to be resolved. You should follow this up in writing.

You may also wish to contact the Texas DHS at:
[url]http://www.dhs.state.tx.us/nhconsumer.html[/url]

[ellencee]

kstockton
An assisted living facility is not staffed by medical professionals and the responsibility for many aspects of care (including medications) remains with the individual and, or the responsible family member.

There may be some area of facility responsibility that has been breached, but without the policies and procedures and the licensing information that states level of care allowed and provided, I can not even make an educated guess as to whether or not any liability exists.

Most assisted living facilities can only assist the person in taking the medication but the person remains responsibile for knowing if what they are taking is or isn't correct. If it is not correct, then the person is responsible for not taking it. If your grandmother can not tell if her medications are correct, then she no longer meets the requirements for assisted living; she is dependent. She can remain in an assisted living facility if Home Health provides skilled nursing for her.

I'm not sure why she's on Wafarin and not receiving skilled nursing services, anyway.

I recommend that you find out what's going on with the medications and that you talk with her and with her permission, talk to her physician about ordering Home Health skilled nursing services for monitoring of her meds, her clotting times, and her CHF.

If her condition continues to be in jeapordy after the addition of Home Health services, it may be time to consider a skilled nursing facility.

If your grandmother is still competent, it is up to her if she eats cakes or pies or anything else. It is also up to her if she wants to go to a skilled facility or wants Home Health services.

You can search the Texas assisted living facility licensing information and determine if the facility is providing care in accordance with the level of care that they are allowed to provide.
Assisted living facilty information may be located in the Department Health and Human Services information or in the Department of Social Services information. I have no idea which department is appropriate for Texas.

EC

Assisted living facilities, like nursing home, are staffed with low pay often inadequate employees.
It will do no good to "talk to" adminstration or anyone else at the facility.
Move your mother to a better place. Your yellow pages may be able to help you find an ombudsmnan or section of your State Health Department who can help you find a suitable nursing home.
Lawsuits against such facilities are rarely productive.

[JETX]

"Lawsuits against such facilities are rarely productive."
*** As are posts made by JackSchroder!

THank you for your replies. I do appreciate it.

This particular facility does have nurses on staff, and they are the ones who give her medicines. They also are responsible for taking the medicine out of the bottle and giving it to her as prescribed. This is something that she pays for in addition to the base amount for rent, food, etc.

This facility has a point system where you get a certain number of free points for services. Once you reach the maximum points (she has just by having them do her laundry), then it costs money. This facility is a "step up" facility, meaning it is also a nursing home for dependant care---which she is right in the middle.
This facility also advertises their diabetic diet, and serve the residents personally----all the while being informed of their condition.

With that said, it is hard for me to believe that they are not somehow liable for causing her 5 trips to the ER in 2 months, and bungling her medicines and food. Heck, they aren't even sure who she is, judging by the print out they provided us that has the wrong birthdate on it.

I will consult the DHS.

Thank You

[ellencee]

kstockton
I read the standards for assisted living facilities in Texas. As I do not have the terms and provisions of care as contracted between your grandmother and the facility, I remain unable to give you more than a very general opinion.

Whether a med tech or a licensed nurse (LPN or RN) is assisting in medication administration, the facility bears a responsibility for administering medications appropriately. However, if a medication error occurred, it is doubtful that it caused the CHF, the kidney failure, or anything other than exacerbating the symptoms of CHF.

Your grandmother had a history of all of these problems prior to moving in with your parents. Your grandmother requested to return to assisted independent living, out from under the well-meaning intentions to control her medications, improve her physical status through exercise, and control her diet by controlling what foods were made available to her. In other words, your grandmother was a competent woman who wanted her freedom to not exercise, to eat what she wanted to eat, and to live her life on her terms, and made that decision knowing that she had improved while living with your parents.

Even in the presence of one or more medication errors, I am doubtful that it can be proven that she would not have suffered the physical complications that you described; therefore, I doubt that a valid claim of negligence exists as far as being a viable medmal suit. It is a significant issue that needs to be addressed with the facility and reported to the licensing agency for the facility. I encourage you or someone else to take those steps as soon as possible.

Although your grandmother may need increased care and supervision of her physical needs and regimens, I encourage you to think of the quality of life that your grandmother will have if she loses all control over her life. She is 84 years old and in failing health and she, more than anyone, is aware of that. If she chooses to return to assisted living, please support her in this decision and encourage your parents to support her decision. If she returns to assisted living, Home Health services remain an option for increasing medical care while maintaining freedom. Home Health services should qualify for Medicare payment due to her medications and her physical/health problems.

An elder care attorney in your area will be able to give you specific answers to your questions.

Best wishes,
EC

Thank you for your response.

We have already spoken with the administrator and have had several errors since that time.
I did some research yesterday with the TX Dept. of Health and have now filed a complaint with them regarding this particular center and errors which have occured.
It is just so hard for us, because the medicines which they made error with, are the very ones that impairative to her well being and CAN kill if not administered properly. Not giving them properly can also INJURE, as she is still in the hospital after several days (trying to get water off her heart, lower her blood pressure, blood sugar), due to the improper dosing of medicine (verified by the nursing staff)


Thanks again for your advice!
Kim

I would add one more item:

If the facility is privately accredited as well as state licensed, they will advertise their accreditation somewhere, or you can ask. In many states, certain types of residential facilities are "deemed licensed" in the the state does not directly inspect the facilities (other than general public health inspections, fire inspections, and so forth). As long as they are accredited, they remain licensed. Very often the accrediting organization will have much higher standards than the state licensing regulations provide for.
Based on personal experience, accreditation organizations do NOT resolve individual complaints, but they DO take complaints seriously in terms of monitoring facilities they accredit. People are often not aware of the role of accrediting agencies (if you file a complaint with DHS, there might be a process by which DHS reports complaints to the accrediting agency if that is how the facility is licensed, but don't count on it).

Re: the sweets, by the way, the resident has the RIGHT to eat them, but that is not the same as the facility making a point of putting them in front of her, failing to make sure it is convenient and appealing for her to have more appropriate snacks and desserts, and so on. It would not be acceptable for staff to simply say, "No, you can't have that" but the care coordinator, administrator, or social worker at the facility can work on a way to respect her individual rights and support appropriate diet. Also, does she have a regular physician who can make care plan recommendations? Does the facility hold care conferences and inform you ahead of time when they are to be held? Have grandma and family worked out things like health care power of attorney?

As a former certified nursing assistant (which paid for my college) I saw that the best care went to the residents who were most liked by staff and administration and/or had families who were most involved. The more frequent visits the better, and vary the times. Don't just come for afternoon coffee, for example. Try to forge friendships with staff. Lots of times poor or mediocre care isn't intentional, and although good care should be a given, you are dealing with real people in the real world. There are ALWAYS going to be staff who are careless or uncaring, and there are also ALWAYS going to be staff who will go out of their way to protect your family member's individual rights and her quality of life.

By the way, I agree with everything other posters have had to say.

[nailtech]

Kstockton,

Might I suggest this link in helping you, I have had some friends here and it is a wonderful/responsible place to stay for assisted living..

I tried to PM you and email you but it was disabled...

there is a couple in your area...

copy and paste this link in a browser...

[url]http://www.hearthstoneassisted.com/community_tx.html#Irving[/url]

hope this helps, I wasnt trying to advertise for them.. just no way of emailing this to her privately...

I really wouldnt worry about the law suit... just moving her would be best...

I am amazed this problem is still producing whys and wherefors. Please, move your mother to a better facility. You say you "talked" to administration and no changes resulted. Accreditation organizations do nothing to help patients in a facility. The Licesning Agency for Texas may do little more. This is the real world. No one will help your mother. It is up to you.

to jack.