Saturday, February 15, 2014

A Trip by Ambulance

She crawled down the hallway to get to the living room
That dreaded call from across the street came in around nine on Saturday night. Mom relayed right away that Louise fell in her room and couldn't get up. She crawled into the living room and called out to my mother, who couldn't hear her from the other end of the house.

Louise couldn't get back into her wheelchair, yet, refused to go to the hospital insisting that she was fine. In her bedroom, I asked her to demonstrate that she could transfer from the bed to the wheelchair and back. She was able to do that, so I went home. I live across the street.

By Sunday morning, Louise was too sore to get out of bed. I dialed 911 and she was taken by ambulance to the hospital where she was admitted. She had a painful injury to her left ankle that had fusion surgery in 2007, and her left knee was bruised. They found she also had a urinary tract infection. After she arrived in the emergency room, a bruise appeared on her chin following the line of the cervical collar that had been placed on her during the ride.

Louise is a non typical 93 year old female who lives at home with her 88 year old sister. She dresses herself, prepares daily noon meals of sandwiches and washes dishes by pulling herself up to stand at the sink. She routinely maintains her own personal hygiene, showering and shampooing unassisted, performs toilet transfers, makes her own bed and takes care of her cat.

Feb. 11, Tuesday 4 pm - Patient was transported by ambulance from Lake Point Medical Center to a Skilled Nursing Facility arriving around 5 pm. Assigned to room 505 B.

Upon arrival at GH, patient was evaluated by Gladys and Rose, Nurse Techs who removed her street clothes and put her in a hospital gown for the initial assessment of her condition. Personal clothing (including nightgown) was available at the time of arrival provided by Niece who accompanied the ambulance. Clothing was placed in patient's dresser and closet. Dinner was provided. Patient fed herself and had a good appetite completing most of the meal. Bedside commode was positioned next to bed. Staff was briefed on patient's personal history prior to injury.

Feb. 12, Wednesday 10:30 am - Upon my arrival, Patient was found in bed still dressed in a hospital gown. After a discussion with the Nursing Supervisor, patient was helped to the bedside commode where she was seated with the door to the room left open in full view of hall traffic. Upon direct questioning as to the course of treatment and reason for remaining in bed, patient was seen by Occupational Therapy representative, Sara, who immediately responded by assisting in getting the patient dressed in street clothes and taking Patient to the Exercise room for evaluation. :)

Feb. 13, Thursday 11:45 am - Patient was located in the dining room following Occupational Therapy where her relatives (Niece, Sister and Friend) joined her for lunch of soup, Chicken Tetrazzini and pineapple cake. Patient's appetite was good and she fed herself without assistance. Visitors remained until 2 pm. :)
4:30 pm Niece received a frantic call from the nursing staff at the request of patient who was agitated to the point of tears asking that I return to GH. She was already in bed and had been dressed in a diaper (not pull-ups) and was extremely distressed by this action of the staff as she is able to use the toilet if assisted in making the transfer. :(

Feb. 14, Friday 10:00 am - Valentine's Day. Patient was located in the Occupational Therapy area with electrodes attached to her left ankle. She had refused her breakfast, yet when offered, drank a large glass of milk fetched from the kitchen. Kitchen staff was very accommodating even offering a banana. Patient had been showered and her hair had been shampooed. :)
3:00 pm Family members returned to find patient in distress, searching the closet for additional "pull-up" underwear. Staff informed family that patient was not to put on disposable underwear unassisted. (Grabbed them out of my hand and put them back in the drawer.) Patient was extremely tired and tearful, having difficulty in expressing her concerns. Visitors departed approximately 4:30 pm with patient stating she would eat the evening meal in her room.

Feb. 15, Saturday 11:45 am - Patient was located in the "Small Dining Room" seated at a table with patients who lack the skills to feed themselves or communicate verbally. Patient was in tears and visibly shaken by this development. Her hair was in disarray and uncombed. I moved her to the "Large Dining Room" where the patient fed herself unassisted after recovering her composure. She explained that someone had "fed her dinner" the previous evening in her room. Patient stated that the staff did not make eye contact during the meal, instead concentrated on a device held in the staff member's lap while distractedly shoveling food into the patient's mouth. Later, she rang and asked that the room lights be turned off along with the TV. Lights were turned off and TV was left blaring all night. :(

Following lunch, I asked a tech to assist in helping patient to the bathroom where staff member continued a conversation on her cell phone during the transfer from wheel chair to the commode. Patient was dropped from 6 inches above toilet where she landed on the seat and was left in my care. Tech did not return to assist patient back to wheel chair. I assisted with the transfer back to her wheel chair and in performing personal hygiene needs: hair combing, teeth brushing and washing of dentures not done earlier in the morning. :(
4:45 pm Patient was assisted in reaching the phone after 6 rings. She was tearful and tired and said, "Sometimes I don't even want to go on."
7:00 pm Patient answered the phone and seemed somewhat calmer, had been showered and was dressed for and comfortably in bed.

I called to report my concerns to the nurse on duty (Beth) who was compassionate and understanding and listened to my account about lack of respect and dignity being demonstrated by the recent developments. Monday I will make a report to the Facility Administrator. There is a distinct difference in the weekday staff and the weekend staff who operate with little administrative supervision.


  1. Hello Peg. This is a disheartening development. You report the services offered from the home and it reminds me of another 'terrible' place I had opportunity to visit many years ago. Your beautiful aunt deserves much more respect and compassionate care. It is such a shock when I arrive face to face with such a disinterested attitude that can be found almost everywhere these days.

    You have done a wonderful job as a daughter and niece and deserve much praise for your efforts.

    1. Hi Mike. I've been worried about you as I haven't seen you on line too much lately. Hoping that all is going okay with you and your family. There have been several repeat incidents at the "Home"; some good and others, not so much. It seems like they would take into account the fact that someone who is visually impaired would be better suited in a familiar configuration to what they are used to for transfers to and from the wheelchair. It makes me feel like such a jerk when I have to point out the obvious issues, like not having a raised toilet device that has arms and other things of that nature. I certainly am over protective of my dear loved ones, admittedly so.
      Thank you for your very kind words about the caregiving efforts that take place here. Jim has been tremendously supportive and kind to them for many years now. Louise moved over from Fort Worth in 2005 and we've seen them through this stuff before. It always amazes me.
      Hope to see you on the Hub soon and thanks again for your thoughtful comments.

  2. Oh Peg,

    This is an outrage and a nightmare. This is when I am absolutely ashamed to be associated with the healthcare profession.

    I have encountered burned out, tired, frustrated, even abusive staff. As a staff nurse I have reported/ relieved them. As a charge nurse, I have counseled/ disciplined them. As an administrator, I have re-sensitized/ terminated them.

    None of these behaviors makes it any better for the sweet family member and the loved ones who witness the cruel/ neglectful behavior. Thinking of the Golden Rule, my eyes are filled with tears at the thought of anyone treating my dear Momma like that and that is how much I love your sweet ladies. Please keep your beautiful strength and apologize to your Auntie from Maria on behalf of all of those ignorant tell each of those staff about me and tell them to be very very ashamed of themselves. And tell them to put those damn cell phones away...tell that administrator in any true facility, there should be a prohibitive policy. You should put your concerns in writing with a copy to their accrediting agency. They have an obligation to tell you who that is.

    Each and every one of those staff need to see some serious "street time" with documentation in their file. They are fortunate you do not lodge a case of neglect.

    Love you and thinking of you, Maria

    1. Dear Sweet Maria,
      Your words have warmed my heart and I know you have seen this neglectful behavior in the medical world for many years. As a patient advocate, I have seen such neglect and malpractice that it makes me frightened for those who have no one to look over them during a hospitalization or nursing home stay. There are plenty of them at the facility who are subject to being ignored and disrespected. It breaks my heart each time I visit.
      I try to remain positive in my comments to the staff and in my requests on behalf of my family, and for the most part, I can usually find a loving, caring person who will listen and try to facilitate change. Each shift change seems to bring some of each kind of caregiver: those who care and those who simply punch a time card.
      I found out they are not using cell phones. Instead, they have a documentation system to record the activities in which they are engaged. Rather than serve as a record of accomplishment, they seem to facilitate less personal interaction with the patient as they are constantly talking into their earpiece rather than focusing on what they are doing.
      Anyhow, I appreciate so much your thoughtful and meaningful comments about the ladies and their well-being. I will pass along your kind words.
      Love you so much,

  3. Hello Peg - I just stopped by to see what was going on in your neck of the woods. I am guessing that everything is wonderful. Hope all is well with you and yours.

    1. Hello Mck - I've been trying to make myself write but it's been . . . I hope you are doing well and I am going to post soon and will definitely get over to read your latest. Today is the day.