I remember reading in annarbor.com/news about a case of neglect of a nursing home resident in Michigan that left an indelible mark on me. I had witnessed much poor and sometimes disgusting care meted out to elderly residents over the years [always robustly intervening; always being disliked by nurses who had become ‘managers’, thus, no longer nurses], but there was something about a patient infested with maggots that left a particular mark.
A nursing assistant found maggots in the genital area of a 66-year-old woman who had a urinary catheter at 5:59 a.m. on Aug. 13, 2011. A nursing home incident report said the patient “was offered a shower, which she refused, so she was ‘immediately’ given a bed bath by staff.”
However, in interviews with a state inspector on Aug. 30 and 31, a nursing assistant and the charge nurse said the woman did not get a shower because the nursing home did not have enough staff. Both the nursing assistant and the charge nurse told the state inspector the nurse used saline solution to rinse the area. But not all of the maggots came off, the assistant said.
Two nursing assistants told state inspectors that they had seen flies in wounds on the woman’s legs about two weeks before the maggots were discovered. One of them reported telling the unit manager and the director of nursing “she’s gonna get maggots.” The aide reported being instructed to document that the woman refused showers. The state report quotes the aide saying, “They let her lay there and they didn’t change her wounds (dressings) and they didn’t want to argue with her.”
A nurse manager came to the facility around noon to give the resident a shower the day the maggots were discovered. She told the inspector she saw “one or two maggots, but I think there were more.” She also said a “clinical corporate person” wanted her to document the discovery on the incident report as debridement. “They wouldn’t let me put maggots down on the incident report,” she said.
Another nursing assistant reported observing a nurse manager removing maggots from the woman’s genital area three days after the discovery of the maggots.
The woman was sent to the hospital on Aug. 28 and diagnosed with septic shock secondary to a urinary tract infection, chronic skin ulcers and kidney stones. Later tests and examinations revealed she had a broken hip likely due to bone thinning and extensive skin changes due to poor hygiene and refusing to be turned.
The woman told the state inspector that she was embarrassed by the maggot incident. She said she had told staff at the nursing home about seeing flies in her room and in the hall but no one did anything. She also said she told staff her catheter needed cleaning, but “they wouldn’t wash my catheter. There were times it was weeks before they cleaned my catheter.”
In its plan of correction, the nursing home stated the resident is now offered daily bed baths and her doctor and a family member will be notified if she refuses. Regular catheter care is also provided.
While the poor care that allowed the maggot infestation is perhaps the most shocking of the violations detailed in the September report, the state regards it as less serious than others cited. Violations are ranked on a scale for severity and scope, providing a measure of how many residents were affected and how many times a violation has occurred. Grades are given, with A being the least serious and L being the worst.
The discovery of maggots in the patient’s genital area ranked as a D, while the failure to provide a sanitary environment and failure to maintain the records were ranked Fs. The failure to monitor the fluid intake and output of a resident and failure to supervise residents in wheelchairs ranked as Gs.
A follow-up visit from the state in October found all problems at the nursing home cited in the September inspection had been corrected, a state official said Thursday. However, another inspection on Oct. 27 found several new violations, although none as serious as several of those in the September report.
Angil Tarach-Ritchey, a registered nurse who runs her own private-duty nursing company in the Ann Arbor area and who has worked in elder care and advocacy for more than 30 years, is not convinced.
“This isn’t a problem that just happened and this isn’t a problem that’s going to go away,” she said. “How the care is provided in a facility stems from the ownership and administration.”
LENIN’S SCALE OF NURSING HOME VIOLATIONS
A TELLING RELATIVES LIES ABOUT THE STANDARD OF CARE
B BEING UNFRIENDLY TO RELATIVES
C NOT REPLACING FOUL SMELLING CHAIRS AND CARPETS
D NOT ORGANISING TRIPS OUTSIDE OF THE HOME
E EXPECTING EVERYONE TO EAT THE SAME TYPE OF FOOD
F ONLY BUYING THE CHEAPEST BOG-STANDARD FOOD [USUALLY CHEAP MINCE MEAT BY THE BUCKETLOAD]
G NOT TAKING RELATIVES’ COMPLAINTS SERIOUSLY – NOT GIVING TELEPHONE ACCESS TO HEAD OFFICE MANAGEMENT
H EMPLOYING TOO FEW STAFF [SHOULD BE MINIMUM RATIO OF 1:5 DURING THE DAY]
I NOT CHECKING FOREIGN WORKERS CERTIFICATES – THE NMC DO NOT DO THIS PROPERLY – NOT KEEPING PROPER RECORDS
J EMPLOYING ILLEGAL IMMIGRANTS AT BELOW THE MINIMUM WAGE
K TOLERATING UNCARING, LAZY, AND INCOMPETENT STAFF
L BEING COMPLICIT TO ABUSE OF ANY KIND; PUTTING PROFITS BEFORE PEOPLE
TAKE THE HIJKL’S INTO PUBLIC OWNERSHIP
PLACE ALL CARE HOMES UNDER THE CONTROL OF THEIR REGIONAL HOSPITAL
STAFF TO ROTATE BETWEEN CARE HOMES AND HOSPITAL
PUT AUDIO-CAMERA DEVISES IN ALL CARE HOMES
SCRAP THE CQC, ENABLE RELATIVES AND ADVOCACY GROUPS TO EVALUATE THE CARE HOME
PROSECUTE ALL SERIOUS ABUSE
SACK UNCARING, LAZY, AND INCOMPETENT STAFF – PROHIBIT THEM FROM WORKING WITH THE ELDERLY
lenin nightingale 2015