The Nursing Home – the Good, the Bad and the Ugly
By Patricia Walter – daughter of Katherine Boyle August 2007
My Mom had made a wonderful recovery during the last four months of her stay at Heartland of Marietta, aka HCR Manor Care. Heartland had a great staff. My Mom had finally decided it was time to start PT and live her life again, even if it was as a resident of a nursing home.
She was eight-five years old and had been independent her whole life until February 2006. She lived alone and took care of herself with a little help from her only daughter. She had her groceries and prescriptions delivered to her door and all her washing was sent out to the laundry. Doctor’s visits were accomplished with the help of the local O’Neil Senior Center Van or her daughter. Life was still pretty good for Katherine.
She had experienced many falls in the last few years fracturing her hip, wrist and ribs along many other assorted bumps and bruises. She had survived cancer of the uterus and several smaller strokes. Katherine was a survivor. She learned that skill during the first fourteen years of her life in an orphanage, the Jones Home, in Cleveland Ohio. Her parents had come to America from Czechoslovakia during the early 1920’s. Katherine was born on April 23, 1923. Her Mother became ill and her father had a drinking problem. They were not able care for Katherine, her sister and her brothers. All of the children were placed in the Jones Home Orphanage. Her two brothers left as soon as possible and her sister was adopted by a family. Katherine remained until she was fourteen years old when a foster family took her into their home.
Mom did not find her memories of the Jones Home to be warm and fuzzy. She remembers being locked in closets for misbehaving, having Castor oil forced down her throat and even getting hit with rulers from time to time. She was a real fighter from the very beginning and learned how to become a survivor. That survivor mindset followed her all through her life.
The survivor mindset saved my Mom after a fall on February 25, 2007. She had been in her bathroom changing clothes and somehow fell. Her apartment was warm and cozy, but she had spilled water on the tile floor in the bathroom. She fell face down on the cold, wet floor. I had called her about 3:30 in the afternoon and did not call again until about 8:30 at night. She laid on the floor for, perhaps, all that time. We will never know because she does not remember the fall. When she did not answer her phone, I sent my husband over to check on her.
I received the call you never want to get – my husband saying my Mom is unconscious, on the floor. He was not even sure she was still alive. “Call the Emergency Squad.” I shouted out the order and jumped in my car to get to my Mom’s apartment before the squad arrived.
She looked dead and was very, very cold. The squad told us her internal temperature had dropped to eight-five degrees and her heartbeat was only thirty beats per minute. She had suffered severe hyperthermia by laying on the wet, cold tile floor.
The emergency room was not sure they could save her. They gave her warm IV’s, put a special heated blanket device on her and started additional treatments and medicines. She stayed in the Emergency Room all night. She was then moved to a regular room in the hospital, but quickly had a breathing attack and just oxygen was not solving the problem. She was place on a ventilator. She was eventually weaned from the ventilator and able to breathe on her own. She was still very weak and sick. She would need care around the clock. The hospital asked what nursing home we wanted to send her to?
Visiting nursing homes and reading everything that I could about them on the internet was very difficult. I choose what I thought was the best of the four in our area. I personally did not like the records of two and the third had a waiting list a mile long. So Heartland of Marietta was our choice.
Mom was not very happy in the early days of her stay. In fact, some of the staff mentioned how “bitchy” she was when she first arrived several months later at a family meeting. She was always afraid of being back into a situation like the orphanage. She had now returned to her “roots” being back in a controlled environment where she had little or no control. She was panicked and very upset. The staff at Heartland were as kind and understanding as possible. It is always difficult dealing with uncooperative residents.
Slowly, Mom adapted to her new home. She was completely dependent on the staff. During her early days at the nursing home, she could not even hold a spoon long enough to get it to her mouth. She was very, very weak. She remained in bed for quite a few weeks. She refused to do any physical therapy or to socialize in any manner. She ate her meals in her room.
Finally one day, I talked to my Mom and told her she would never get out of bed unless she started to exercise and build her muscles. I promised to be there whenever she took her PT to make sure everything would be OK. For some reason, at the time and moment it all made sense to my Mom and she started PT.
I was there for the first few days while she learned how to get out of bed and for her first visit to the PT room. She did all her exercises with the determination that she was going to get better and start walking again, even if she had to use a walker.
She lifted weights, did exercises and finally was able to walk up to 140 feet on her walker unassisted. She would have the aides help her into her wheelchair and started to explore the whole nursing home. She had not been out of her room for several months. She was meeting other residents and getting ready for a car trip to see the rest of the world once again.
I had attended a family meeting about my Mom on June 20, 2007 where the staff was very happy about her progress. She was walking on a walker, moving around the nursing home in her wheel chair and eating anything she wanted. They felt that perhaps in a few months my Mom would be ready to leave the nursing home and go to assisted living.
Unfortunately, I am sure that every nursing home has a few less than desirable aides and employees. Aides are not the highest paid employees in the facility, but aides are the backbone of any nursing home. They do all the hands-on-work with the residents.
I spent a lot of time in the nursing home, sometimes I visited three times a day. I took Mom food and just wanted to make sure things were OK. She finally became strong enough to use a phone. She was able to dial my number and tell me if there was a problem.
There were a number of incidents when she called me for help. Simple things like when she did not get her soup for lunch or dinner. She would call me when she needed to go to the bathroom and an aide would not answer her call bell for a long time. Her room would sometimes get very cold because the aide would turn the heat off and then forget to turn it back on. There were often small problems. Mom would call me, I would call the front desk and all would be well again. Fortunately, my Mom was mentally competent and able to use a phone. There were many people at the nursing home that could not call anyone for help. They just lay in their beds waiting for help whenever it came.
I imagine that every nursing home has their share of young aides that just don’t understand what it is like to be almost completely helpless in a bed. Many of the residents can hardly see, hear or even talk in a normal voice. They are as helpless as babies. They are old, wrinkled hulks of aged bodies, but every wrinkled body has a human being inside with feelings, memories, wants and needs. They are people and deserve to be treated with kindness and respect.
The lack of caring on the part of some aides and nurses become the “bad” in a nursing home. They approach the job like changing the oil in a car. Just get the job done and move on. But unlike machines, patients have feelings. Again, I think that most of the staff are very caring, but the handful that are not, can make life for a helpless patient extremely difficult and upsetting.
The fall happened Friday evening about 8:30 on June 22, 2007. I have been told “accidents happen” at nursing homes by the director at Heartland. I imagine that they do, but I have also seen aides not paying attention to a patient while working with them too. The aides are talking to each other, thinking about their boyfriends or families. Many aides seem to be young and most obviously don’t understand what it is like to be very old, unsteady and requiring help for almost every move a person needs to make.
My Mom called my about 9 am and told me that she had fallen. She explained that she asked to be taken to the bathroom. She was very mentally coherent and understood what was happening around her. She knew she was very unstable and always wanted help when getting in and out of bed. The PT at Heartland told me personally that no order had ever been issued that stated my Mom was to transfer from the bed to wheel chair by herself. I have also been told that Heartland has a gait belt rule that the cotton belt is to be used during transfers.
That evening my Mom was getting ready to stand up to be seated in her wheel chair. The PT’s had trained my Mom to hold her hands out to them for support. My Mom stood up and held her hands out – but the aide did not provide support or help. My Mom fell very hard on the tiled, concrete floor. She landed on her bottom with a very hard thud using only her hands to soften the fall. She was stunned and her wrist immediately began hurting.
My Mom mentioned that the pill nurse in the hall saw the fall and would write a report about the incident. The nursing home x-rayed my Mom’s wrist the next day. The fall really hurt my Mom’s back, arms, neck, wrists and head. She complained of her head aching and her neck and back hurting.
By Sunday morning my Mom started to vomit and be nauseated. The vomiting and nausea continued for seven days. The nursing home did provide medicine and shots, but they did not prevent the nausea.
By Wednesday, June 27, 2007, I talked with the head nurse and insisted my Mom be taken to the hospital. Mom was a little over 100 pounds, old and frail. She could not stay healthy and strong if she could not eat. Her lack of weight had been an issue with the nursing home staff since she had arrived. Reluctantly, the nurse contacted the doctor and approved the hospital visit. An ambulance took her to the Emergency Room.
The doctor ordered tests and they gave Mom shots for nausea while she was there. After all the testing, the doctor felt Mom had a hiatal hernia that was causing the problem. She sent Mom back with orders for Sucralfate for the hernia. As soon as Mom arrived back at the nursing home, she started to vomit again.
The vomiting continued until Sunday morning when I had a heated discussion with the head nurse demanding my Mom be sent back to the hospital. Finally the nurse said the doctor approve the hospital visit to “appease the family and resident!” I hardly think that appeasing a family had anything to do with the fact that an eighty-five year old, weak lady had been laying in her nursing home bed vomiting for seven days after a fall.
My Mom spent all day in the ER and then was transferred to PICU. By Tuesday morning the doctors told me her only chance of survival was to be put on a ventilator since the vomiting had allowed her to aspirate matter into her lungs causing pneumonia.
It was deja-vou from February. Mom on the ventilator breathing for her while she lay unconscious. I could not believe it was happening again because of a fall at the nursing home where she was to be taken care of. After six days on a ventilator, the doctors were able to wean Mom off. She was on oxygen only, breathing by herself, but very weak.
Tuesday morning, July 10, was the morning my Mom officially died. Her heart stopped and her breathing stopped. The hospital called us to come as quickly as possible and they would try to hold her until we got there. She was already back on a ventilator by the time we arrived. The doctor had given her a shot to start her heart and try to keep her alive so we could see her before it stopped again.
We sat with her, held her hand, cried, hugged and watched the heart monitor, waiting for the erratic displayed graph to stop. Her heart kept beating, sometimes strong – sometimes weak. Her blood pressure was extremely low. My Mom had always been a survivor and at this point in her life, she was still fighting to live. After awhile, the doctor said “I have to treat her” and they started medicines to control all the functions that they could.
Mom survived the ordeal. At one point she had ten IV bags attached to her. Since her blood pressure was so low she could not be sedated very strongly. So she had enough morphine to make her comfortable, but she was awake. She managed to survive laying awake with a ventilator tube down her throat for seven more days. The doctors were not taking any more chances. Tests had shown she had blood clots in her legs and the doctors think that small pieces broke off and went into her lung blood vessels which stopped her breathing and heart.
Meanwhile, her stomach was backing up with material from her bowels. The doctors think she had an adhesion in her intestine from a previous surgery and it had become almost completely blocked. I personally feel the fall caused damage to that area of the intestine. She required a major surgery to remove the blockage, but was not strong enough for it. A temporary colostomy was performed to allow her stomach and intestines to work better.
Twenty days after arriving in the ER, Mom was sent back to Heartland Nursing Home. She knew the staff and really liked most of the people that worked there. It had become home for her. They had helped her regain her life back, got her up and walking on her walker and feeling alive again.
However, it only took one aide at the nursing home to take away all of the good progress she had made. It took one fall to cause the nausea, the damage to her intestine and the ensuing pneumonia and colostomy.
I placed a complaint with the local ombudsman and also the Ohio Department of Health. The ugly is not only the aide not properly assisting my Mom and allowing her to fall, but the way the management of Heartland handles the complaint.
It was explained to me that the aide was wrong to not using a gait belt, but she was not responsible for my Mom’
s fall. I was told they asked my Mom if she was transferring from her bed to the wheelchair. The first time she answered the question she said yes she was transferring. But then to make sure they understood the situation, they asked her the same question again at a later time. I don’t think it is fair to expect an eighty-five year old woman that has just taken a severe fall to completely understand the situation and the technical jargon of a nursing home.
My Mom told me very clearly that she asked to go to the bathroom and was getting out of bed and into the wheel chair to do so. The aide said my Mom changed her mind so she began doing other things and no longer paid attention to my Mom. Old people don’t jump in and out of bed much. Normally my Mom got out for PT and to go to the bathroom. She always expected to be assisted. I was at the nursing home twice a day for several months and then once a day after that. I always saw my Mom being assisted. She was always afraid of falling because the aides would not hold on to her.
So fancy jargon about “transfering from bed to wheel chair” might not mean a lot to an old person, but give me your hands to help me get up, does have meaning. My Mom held her hands out to the aide for assistance and there were no hands to grab. The aide had turned away to do other chores.
The official reports of the incident indicate my Mom decided not to transfer from her bed to the wheel chair and the aide moved away to do other chores. The accident was her fault. This story is the official report from my Mom and myself telling what happened that evening. A story about how one fall can happen because an aide is not using a gait belt and aiding a patient – how sixteen days on a ventilator can result from a fall in a nursing home.