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Nursing home care

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Chass

Junior Member
What is the name of your state? Florida

My father was hospitalized for Congestive Heart Failure "CHF" and a pulmonary embolism back on Jan. 14, 2008 which started with a blood clot in his leg.

On Jan 18, 2008 he was sent to a nursing home/rehab center for twenty days for physical therapy. His stay was extended due to another hopitaliztion for dehydration and low blood pressure while in their care. He was due to come home on Friday Feb. 22, 08.

This whole time he has been complaining about his left foot hurting. He became wheel chair bound due to the tenderness and severe pain in his foot. He walked with the aid of a cane before this.

On February 18, 2008 he called me complaining that he couldn't sleep or eat for the severe throbbing pain in his foot.

When he complained at the facility they rubbed cream on his foot or put tinactin on it or gave him a pain pill.

On Feb. 18 2008 I decided to take him outside the facility to see another Doctor. This doctor prescribed antibiotics for my dad and to double up on his diuretics. The nursing home staff made it known they didn't like the fact that I took my father to an outside physician stating my father had a resident physician at the facility. I gave them the orders from the outside physician and they seemed to oblige.

We assumed my father was on diuretics as he has a history of congestive heart failure. We found out on Feb. 19, 2008 upon visiting my dad's pulmonary specialist that he wasn't on diuretics or his cumidin at this time. The pulmonary specialist wrote orders for the cumidin and diuretics and ordered they be administered ASAP as he was at high risk for CHF and another pulmonary embolism.


On the morning of Thursday Feb. 21, I called the doctor i took my father to outside the facility as he told me if my father's foot didn't improve to call him. I did and was advised to take my father to the ER.

My father had another scheduled doctor's appointment that day I decided to keep than take him to the ER. Upon mentioning my fathers foot and looking at it the doctor recommended I take my father to the ER where he was re-hospitalized for another pulmonary embolism as well as cellulitis.

In my opinion this is inexcusable. Not only did the resident physician not have my father on the proper medications they neglected his complaints and seriousness of his foot problem. I'm not sure of the chain of command here but someone should be held responsible.

When my father first arrived at the facility, I asked the Director of nursing who was going to tend to my Father's foot, she assured me a podiatrist was going to see him. "myself wondering why it hadn't been tended to" but me not being a doctor thought everything that should be done was being done. It took three weeks for the poditrist to see my father.

Now over a month later/two hospital admissions and over 20 days in the rehab facility my father is back in the hospital and they are saying amputation of his foot may be an option.

I don't understand how this could happen!

The mishandling of my father's health needs nearly cost him his life and may cost him his left foot :(

My father is 91 years old and was relatively independant up until his hospitalization.

In reading this board I see it is very hard to prove negligence in these cases and I know doctor's are human and make mistakes but my father had been complaining of his foot hurting for over a month.

This is my first experience with a facility like this and it is truly sad if this is an example of our nursing home care.

Any and all input will be appreciated!
 


lya

Senior Member
Your father's claim of medical malpractice (negligence) will not be easy to prove because the impaired circulation in his foot is due to old age and old veins, not negligence.

Cellulitis may not have been the cause of his foot pain, not the whole time he complained of pain. Some of the pain was most likely due to poor circulation. Poor circulation led to the cellulitis.

Your father's discharge orders, which are the ones for the initial admission to the NH/rehab center, should be reviewed to verify that his orders were implemented in the NH/rehab center. If Coumadin was ordered, scheduled bloodwork should also have been ordered.

I have no idea of your father's hydration status, but most elderly people do not get enough to drink. They don't recognize thirst and limited mobility keeps them from getting something to drink at frequent intervals. Giving a diuretic to an elderly person is not always a good idea, regardless of a history of CHF.

Diuretics only work in the presence of adequate hydration and an effective pump (heart) to circulate the blood through effective kidneys. Chances are, a diurectic was not going to help but would potentially worsen his circulatory problems by reducing circulating volume and predisposing him to clots and the effects of dehydration.

I don't know who was negligent, if any person. The recent physician who gave your father diurectics may be the one who was negligent. The nursing home may have been negligent in not following admission orders or no person may have been negligent.

A review of your father's records should begin with the hospital's discharge orders and progress through his daily records and orders at the NH.

Your father must appoint you as his POA and/or healthcare proxy or must hire an attorney to represent him. At this point, you have no right to review your father's records, unless you are his POA or guardian.

Remember that your father has had a greater length of life than is expected and his body is shutting down, as it should and as it will. No amount of medical care can reverse the process or keep the process from continuing.

Your father does not need you to be in an emotional state of seeking to blame others; he needs you to be there for him, with him, giving him permission and understanding as he makes his way out of this life.
 
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Chass

Junior Member
Thank you for taking the time to reply only I am emotional!

Regardless of my father's age I don't feel his medical needs were met! It is not unheard of people living up into their hundreds now a days functioning reasonably well. I see no reason why my father can't be one of them with proper care.

No one said anything about my father's body shutting down. He was admitted to the NH for rehab. He was re-hospitalized the day before he was due to get out.

If he was at the end stage of life wouldn't hospice be mentioned? It was never mentioned to me. I do have POA and my father lives with me.

Upon my father's recent hospitalization there was no mention of him being at the end stage of life only amputation of his leg may be needed due to a serious infection which may have entered his bone and they are treating him not sending him home to die.

Had the NH taken my father's complaints seriously and had him diagnosed in a timely manner my father wouldn't be in this predicament. He had been complaining for over a month. The redness and swelling was getting worse and there were no clinical tests, X-ray's done before his recent hospitalization.

At least the doctor I took my father too on Feb. 19 of this month saw the risk of infection and prescribed an antibiotic. This was not done by the resident physician at the NH.

I will do as you suggest and get all my father's hospital records.
 

tranquility

Senior Member
It is not unheard of people living up into their hundreds now a days functioning reasonably well. I see no reason why my father can't be one of them with proper care.
My father was hospitalized for Congestive Heart Failure "CHF" and a pulmonary embolism back on Jan. 14, 2008 which started with a blood clot in his leg.
Those seem like a few reasons why ten more years for a 91 year old is unlikely. Now, I'm not a big fan of lya's legal knowledge, but (in my entirely amateur but reasonably well informed state) the medical knowledge posted seems pretty darn good over a long period of time. From my job in dealing with estates and trusts and because of some personal issues right now, I think a lot about end-of-life issues. It seems to me it's time to start considering such things.

It's clear that the truly elderly are treated differently from the younger in the aggressiveness of treatment. Is that so wrong? Does you dad really want all kinds of fancy proceedures and aggressive drugs (with the risks of side effects) or, is it time to consider making him comfortable? From my understanding, CHF is not a quick in and out fix kind of thing but is generally a complex series of events and life choice risks which come together to create the problem. There is not a pill to take care of it and everything else is going to be more difficult because the basic system of the body is not operating as well as it should. Be his advocate, not his gladiator.
 

Chass

Junior Member
Maybe I'm in complete denial here but if one has the will to live shouldn't we give them that choice?!

I asked my father this very question a few weeks ago and he told me he wanted to live.

Or should we just lock them up in a NH and give up on them?!

Now if it comes to amputation. That is entirely his choice and I will be behind him 100% whatever his decision is.

How did the subject change from improper care in a NH to his body shutting down? This is something I have NOT been told by any of his doctors or the NH.

Or is it normal to keep this kind of information a secret?
 

tranquility

Senior Member
The topic changed because a person with medical experience wrote:
Remember that your father has had a greater length of life than is expected and his body is shutting down, as it should and as it will. No amount of medical care can reverse the process or keep the process from continuing.
and because of that it becomes very hard to prove malpractice. As was also written:
Your father's claim of medical malpractice (negligence) will not be easy to prove because the impaired circulation in his foot is due to old age and old veins, not negligence.
No one is here to tell you not to treat. That is something which must be determined by all the parties involved. It's just that when you have a thread about nursing home care in the medical and health care malpractice section and ask for "any and all input" you should expect that not only is the malpractice issue be addressed, but the life issues related to that.
 

Chass

Junior Member
Thank you tranquility your right!

When I came here I had no idea my dad may be in the dying process as I was never told and I'm not a doctor or in the medical field.

I would have thought I would have been told if he was in the dying process?!

I didn't mean any disrespect in my other posts I had no idea this might be the case.

But the pain I've witnessed my father go through due to his foot has been heartbreaking:(
 

las365

Senior Member
Chass, it is sad but true that, especially in the "lawsuit abuse" climate we live in today and the laws in many states capping awards for non-economic damages in medical malpractice cases, a malpractice case is very hard to pursue when the bulk of damages incurred are non-economic (pain and suffering, loss of a limb). Lya articulated exactly what the defense would be in a case like your father's ("He's old, this was inevitable no matter what the care was.").

I am not a lawyer. The firm I work for handles medical malpractice cases. We would be wary of taking this case because of the lack of substantial economic damages (lost wages, loss of earning capacity in particular) and the very high cost of pursuing a medical malpractice case. On the other hand, the medical expenses incurred as a result of the negligence (if there was negligence) are probably pretty substantial; however, they are probably being covered by Medicare or health insurance, and so there would be a lien on the recovery, if any, for repayment of that.

What I am saying is that you have an issue that I believe is exteremly important: the standard of care your father is entitled to and whether or not he received that care. You could approach it by encouraging your father to file a medical malpractice case, which would take years to pursue and have no guarantee of success.

You could also, in addition to or instead of that, make a stink! File complaints with the appropriate state and/or Federal agencies that regulate the medical and operating licenses of the practitioners and facilities involved. Go to your local media and try to interest them in doing an "expose" to publicize the problem. Talk to your local and state officials to encourage investigation into how the elderly are treated in nursing homes in your area. You may actually be able to make a difference for other people. :)
 

Chass

Junior Member
What I am saying is that you have an issue that I believe is exteremly important: the standard of care your father is entitled to and whether or not he received that care. You could approach it by encouraging your father to file a medical malpractice case, which would take years to pursue and have no guarantee of success.

You could also, in addition to or instead of that, make a stink! File complaints with the appropriate state and/or Federal agencies that regulate the medical and operating licenses of the practitioners and facilities involved. Go to your local media and try to interest them in doing an "expose" to publicize the problem. Talk to your local and state officials to encourage investigation into how the elderly are treated in nursing homes in your area. You may actually be able to make a difference for other people. :)


Thank you Las365 for your input!

A stink I will raise because I think the NH neglected my father's foot. Even if he was in the dying process he deserved to be treated and not over looked as it appears he was.

I WILL get to the bottom of this.

Thanks again!!
 

ecmst12

Senior Member
I think you are misunderstanding the point. The point is not that your father is in the process of actively dying. The point is that every human being begins the "process of dying" as soon as they are born, but your father is closer to the end of that process because of his age. Things do not work as well in a 91 year old body as they do in a younger body. Minor issues to a younger person can become serious very quickly in an old, fragile body. And that means there MAY NOT have been any negligence leading up to his current condition. Or there may have been negligence. Only a complete review of his records could tell.
 

Chass

Junior Member
I think you are misunderstanding the point. The point is not that your father is in the process of actively dying. The point is that every human being begins the "process of dying" as soon as they are born, but your father is closer to the end of that process because of his age. Things do not work as well in a 91 year old body as they do in a younger body. Minor issues to a younger person can become serious very quickly in an old, fragile body. And that means there MAY NOT have been any negligence leading up to his current condition. Or there may have been negligence. Only a complete review of his records could tell.

I understand and a thorough review of his medical records will be reviewed. Thank you!
 

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