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Any experience with making a formal complaint to the Ombudsman while the patient still lives at the facility? My loved one was bedridden on a feeding tube and was suddenly sent to the hospital for severe dehydration. The doctors at the hospital said he couldn't have been getting his flushes of about 8 ounces every 4 hours because he was down roughly 7 liters of fluid. His bloodwork showed an imbalance in his sodium. The nursing home adamantly insists he has been given excellent care and received all his feedings and water as directed. The hospital refused to address the issue with the nursing home and sent him back there. I tried to get him sent elsewhere but no one would take him. The dehydration was caught from a routine blood test. He was also lethargic. The doctors said if it went any longer his brain would have swollen. Does anyone know any medical reason that could cause severe dehydration? I'm afraid this is going to happen again and next time the outcome could be brain swelling and death. Also I am afraid that if I report them they might refuse to take him back next time he goes to the hospital for any reason. They could also retaliate with giving him less care. I can't sleep nights worrying.

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Yes. report it.
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There are rights that you have as a person that brings abuse to light. You can get hold of a company called, FATE 916-481-8558
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My sister was neglected, poor hygiene, staff ordered extra meds not on her chart and did not run by me-POA. Food was horrid, sis lost 30 pounds-20 in one month. I asked for weight check info was told her admitting weight. Aide standing next to me when I asked agreed this was not correct. They did not give sis her bath, did not give me any believable info about sis multiple falls, or other injuries. Sis got a raging case of scabies from this place/staff and did nothing about it before it covered her body. This place was horrid. I could not bring her home, my own family member was in a health crisis at the same time. I spent 6 months looking for a new place. Because sis had been combative-very few will accept in the first place and staff member wrote in the chart I had screamed at her-not true ever-we kept getting rejected over and over for other options elsewhere which I knew there had to be some reason I was not aware of or given the opportunity to clarify or refute. I have filed a complaint with the state after sis was moved-due to covid not sure they are doing much about the complaint. Nursing manger lied to me and others too about giving care I know did not happen. I was terrified of retaliation as sis would not be able to tell me who or when stuff could have happened-i feel certain retaliation would have happened-maybe not physical but certainly could have with held meds, food, water, clean clothes etc I would have no way to prove it. This place was horrible inspite of a good reputation. An ombudsman contacted me after and said they are only able to verify policies etc are in place as required. They can not apply any legal actions or fines to the place or people that mistreated or neglected the resident. I am glad we got out in the nick of time I hate to think about the way the residents are living now that family can not check on them in person-un announced etc. other post suggest you contact the facility director-one occasion director did admit her team dropped the ball when they did not provide an immediate clean up when someone defecated on the couch and floor in my sister's room. The upper management is nearly invisible to find out who owns the property who is the CEO etc. They want to be hidden for a reason. I only found out after we moved when the guy was on TV boasting about the fabulous job they were doing to stop covid-really I seriously doubt that-they are simply not reporting the numbers, family is out of the loop since they can not see their person when they become ill.
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bkburden Nov 2020
We have got to stand up for our loved ones, because if we don't no one else will. They have absolutely no right to treat people the way they do. The law states they must have standard of care. From what you wrote, she did not. They need to be reported ASAP.
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Report to the State Nursing Home board.
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I haven't been online for awhile and am just now seeing your question. The answer is "YES" they can refuse to readmit after transferring your loved one to the hospital. I speak from personal experience. I have a lot of experience filing formal complaints. My mother's NH retaliated against me, not her, which resulted in her being sent to the hospital and then dumped by the NH. They refused readmittance in the midst of this pandemic.

The retaliation was against me for filing multiple complaints not only with the local ombudsman, but with state agencies. My complaints resulted in multiple "tags" for the nursing home and frequent visits from the State to ensure not only the safety of my mother, but the safety of other residents. They did receive lower ratings by CMS -- granted I was not the only one filing complaints.

The nightmare I had to go thru as a result of her "eviction" was horrendous. I escalated to state congressional leaders to every person/agency I could think of to help her with no avail. The fact that NHs can do this is criminal, even worse to do so in the midst of a pandemic. Looking back, I regret the way I voiced my complaint regarding neglect issues, but I don't regret filing the complaints and escalating the multiple incidents. It saved her life.

What is tragic is that I had to choose the worse of the worst NHs to place her after they dumped her at the hospital. Very few NHs were accepting new admits at the time. I had to send her to a place with horrible ratings and several neglect lawsuits. Even worse I could not tour the facility, had to move her to a place without knowing what it looked like inside, whether it was clean and whether it smelled. It is a dilapidated building, with severe staff shortages (one CNA and one LPN for 30-35 residents), where I have learned there is a high usage of agency staff, where the exchange of care information is poor, where meds are often not given, and where the phone goes unanswered for hours -- even after a recent Covid outbreak where my nerves were off the chart.

I will summarize by saying, you can contact the Ombudsman, but do it gently, and not often, and try to limit the number of complaints you file with your state agencies. If you do, be prepared for the possibility of the NH retaliating by shipping your loved one off to the hospital and then refusing readmittance. It is my experience that the ombudsman is a negotiator and serves as a liaision between family members, residents, and nursing homes. They are powerless in preventing nursing home evictions despite what they tell you. It is a well known fact that nursing homes discharge residents involuntarily, and you have little or no recourse. Ombudsman also cannot stop staff from retailiating (by refusing to provide care or neglecting your loved one). Staff behavior is covert, and they will deny it if challenged, especially now in the midst of this pandemic.

In my state ombudsman cannot visit nursing homes except for severe cases of neglect, and even then, they are in and out quickly. They have little if any line of vision into what is now occurring in nursing homes and the amount of support they can provide is limited.

Hindsight says I should have moved my mother long before the Covid outbreak and at the first stage of reporting multiple issues of neglect. The problems with long term care occurred long before the pandemic. My heart goes out to you.
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haileybug Oct 2020
I am sorry the way your mother has been treated.
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For your own piece of mind speak to the director of nursing and social worker. Let them handle it.
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Keepyourheadup1 Jan 2021
I love when this works out but she described a nightmarish place. Morale non-existent. Let us know.
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Please don't hesitate to contact the Ombudsman. It's in your LO's best interest.
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I have worked with physicians in many areas during my nursing career. Far too often, I have heard some of them pronounce in absolute terms that a situation could only have come about in a particular way. That is so often not true when we're dealing with the human body. Dehydration can result from infection, high blood sugar, diarrhea, fever--to name a few causes.

Physicians and nurses (among others) are mandated to report to the appropriate agency if they have reason to believe an elder was abused or neglected. Did any of them report the nursing home.

When I worked for a regulatory agency, I received a report from a hospital social worker that a nursing home resident was so severely dehydrated that the diagnosing physician was actually shaking from the upset he felt at the patient's condition on admission. Yet, neither he nor any of the physicians who treated her in the hospital included dehydration as a diagnosis in her medical record.

All this to say, there is not always an easy explanation for a person's condition. In addition, tube feedings do not always provide a benefit as the body sometimes cannot utilize the nutrients.
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Keepyourheadup1 Jan 2021
Thank you, the peg tube lifestyle is inhumane and regulated by guidelines in NH by Health and Human Services. They should be providing Speech therapy to teach to swallow again introducing to eating by mouth. Many doctors write and approve soft foods by mouth. Hospitals allow family to give soft foods by mouth. Inhumane they cook and feed others all around people who cannot be given food by mouth and feed others all around them three times or more a day. They smell the food and see others eating by mouth. The State will remove your relative from home if you feed them by mouth and they have a peg tube, even if youve been told and have documentation documenting that you can feed them soft foods by mouth. While on a diabetic portion controllef prescribed oral soft foods Nutrition laden diet along with the peg tube for hydration, some bolus feedings, and for medication, and juicing vegetables and reccoking meals adding vegies my relative went from morbid obesity size 6x to a 1x in one year. I myself using the diabetic nutrition plan along with juicing vegetables and fruit and recooking to add vegetables to dishes went from a twelve to a size 3 in one year. She was never dehydrated and had routine lab work a few times and a week before the State took her from her home and had not been dehydrated or anything else in lab work. They put her in a complete pump feeding, and barred me from the NH. But I received the pharmaceutical reports monthly in the mail and saw dehydration treatment and mind changing drugs with permanent side effects as well on the report. The feeding formula by itself was not in and of itself sufficient for the best optimum results, no far from it. However, bolus peg tube feeding was great for hydration my relative hated to drink water all her life, great for medication, and meals in the go. This needs to be revised by a congresstional hearing it legislation which I have not found.
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If someone has POA then stay in touch with the DON as to discrepancy between hospital and their records (Im sure they were fudged if they didn't give properly). The intake is very low could it be your LO has CHF and therefore fluids are limited? Ask physician how to avoid this in the future.
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Keepyourheadup1 Jan 2021
Whats CHF, please.
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demand the paperwork when they supposedly did what they said they were doing when they were supposed to.. It's all supposed to be logged, if they refuse hire a lawyer to help you get your hands on those logs...
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Imho, yes, report this to the Ombudsman.
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Your aging loved one can be tricky. I worked in senior care for the last 16 years. Caring for senior is my privelage and passion. To answer your question, there are several reasons why your loved one could be struggling with dehydration. The administrator can be your best starting point. I can attest to the fact that most people who gravitate to senior care are as in love with your family member as you are.
First: in my experience as an administrator it is not likely that the ordered amount of water isn't given when ordered. The process is probably performed at 8a, 12p, 4p and 8a when the traditional medication pass takes place.
The very first thing I see is that 8 ounces every 4 hours is only half of the amount of water that a senior needs on a daily basis. The average senior should consume 8 ounces of water 8 times per day. Regardless of mobility. Seniors typically take quite a few medications, many of which may be designed to keep fluid build up from happening. These will be your cardiac medications, Lasix for edema, etc. If your loved ones is only taking half of the fluid intake and coupled with medications that encourage fluid loss - the result can be dehydration in a matter of days. The good news is the fix is simple. You can call her physician, or leave a message with the facility administrator to communicate the issue to the facility physician. (I always communicate every detail with my families as their single point of contact) The doctor may want to add the water a little at a time if cardiac issues or edema is present. Be sure the order clearly sets the exact amount of fluids to be given every 4 hours. Do not agree to have more than the 4 ounces given - champion having the fluids given every four hours so that your loved one is being continually replenished and doesn't go more than 8 hours (sleep time) between fluid intake. Ask if a routine lab draw is advised to assess for dehydration. Probably not, but won't hurt to ask as a second layer of defense. It may be time to discuss hospice care, which gives you all kinds of backup! Weekly nurse assessments, extra eyes via a bath aid, pays for certain medications and supplies like incontinence products and bed pads. Your loved one doesn't need to be actively dying to qualify, and it is covered in full by Medicare. No extra expense to you. Those are, of course, highly personal decisions for you and your loved ones doctor to discuss.

Other things to keep an eye on is the temperature in the room being comfortable but not so warm that your family member is losing fluid from sweating or being too hot. I can bet your loved one likes to be toasty but maybe it's a bit too toasty.

Reven medication list with the physician to ensure that there isn't some weird combination of medications that is causing dehydration. Sometimes simply changing the time of day a medication is given works wonders!

I encourage my families to communicate every issue, question or concern with me. As the administrator, my license makes me personally accountable for every life entrusted to me. It also makes it easier on the family and easier on me. The family doesn't have to chase down multiple people to communicate with every department head for various things. The administrator ultimately supervises every department and being in the know gives you a second set of eyes when you're not there! And an administrator who has seen how worried you are, is a powerful ally!

The nurse may not have questioned the decreased intake if cardiac issues or edema. Fluid restrictions are common in those instances.

Hope this helps! Let us know how it goes! Good luck and god bless you for being the caregiver! There's a special place in heaven for you guys!

Laura
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Keepyourheadup1 Jan 2021
Yes, I found there to be a lot of dynamics. Great info.
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Grounds for Lawsuit. This is quite serious. Neglect is against the law. Personally, I would bring LO home for hospice care. I wouldn't wait for potential death due to further Neglect. I'm sorry your loved one (and you) are going through this.
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Remember what Dorthy said, “There is no place like home.” Making the complaint might punish the facility, but will it solve your problem? If your LO is a hospice candidate bring him to your home for care.
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Keepyourheadup1 Jan 2021
The county senior service supplied additional home health at no cost up to three times a week. Go to your local municipality websites depatmont for seniors online.
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Make a report. If your facts are accurate and verifiable the Ombudsman will take care of the problem. All nursing homes and assisted living facilities are not the evil empire and welcome reports on how they can improve.
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I feel so bad for you, NovaAndrews. You're in a mine field. Plunge through! I've walked in your shoes--just a couple of months ago. Our facilities in this country are horrid, no matter the level. Be it independent living, assisted living, memory care, nursing homes, rehab. And they're all in bed with the hospitals and vice versa. It's a reciprocal nightmare!, i.e., "You send us some patients......and we'll send you some. But we won't tell what we know on each other". I think they've all thrived on Covid because nobody can get in to see what's happening......or NOT happening! They DO retaliate, make no mistake about it. The emergency room will declare the patient dehydrated and by golly, you can call the nursing home after the patient returns and ask them what the ER said and they'll lie and say, "He's fine. No, he's not dehydrated. Never really was".....not knowing you've obtained a copy of the records and you already know the answer and he IS dehydrated. They'll blow up AT YOU when they find you've got a copy. They don't want you seeing that. But they don't back down. They'll put blocks on their phone and e-mail so you can't contact them. And you can't go in and face off with them because of Covid. They're protected. This goes on in Florida for sure and I've given myself a headache just sitting here re-living it all.

As for contacting the Ombudsman, what do you have to lose? I wish I'd done it! I feel guilty because I didn't. I didn't truly know that was an option. You're already walking in a mine field, so what the heck? Give it everything you've got. I don't think the care could be any worse than what you've described. Get your LO's records first as ammunition, if you haven't already. You don't need a reason. You can do that in one day simply by going to the hospital and asking. Encephalopathy (brain swelling) is serious, no cure, and will cause the patient to act out and become combative, among other things. Patient will get thrown out for bad behavior because they have "brain snaps". When you move him (and you WILL find a place--just keep looking--and I know it's a pain), new facility administrator might possibly tell you, "Previous facility has already called and said the family is the problem, not the patient". Baloney. Because you stood up for negligence and maltreatment of your LO? I feel for you. I truly do. It's a tough situation for YOU and your LO. I wish you the very best. Keep the faith!
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haileybug Sep 2020
sister46

On point
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Report it. Sodium is a critical issue that can result in seizures, brain damage and death. Document everything with email and/or calendar events. Tell the ombudsman your fear of retaliation and preference of another facility if you feel that strongly about it.
Talk to the dr who treats him at the facility and request regular monitoring for his fluid levels. In addition to sodium, there can be potassium and magnesium balances that can also be quite serious. The follow up by requesting copies of medicines and tests to ensure they are paying closer attention.
Even after telling a facility to check my mom for 4 days, they didn't do it. By 4th day we had a real nasty conversation and they did the test in the am. They got results back before noon with timestamp and notes of STAT to get her to emergency room due to critical level. Lab even had a note on the report that they called and talked to nurse so-and-so to give the info PLUS faxed it to facility. In spite of all that, they waited until after 7pm to call an ambulance. The ER doctor said they could not believe she had not had any seizures and was still awake. Of course, there may have been seizures we were never told about and not documented in the rehab records. We also found out that the same night they sent her to ER, they packed up all of her belongings and put them in a closet for us to pick up. Will always wonder if they assumed she was going to pass based on what the lab result was.
The reason for her dehydration was sedating her, even after being told to stop with the narcotics (she gets severely constipated, major fall risk, and cannot communicate when taking narcotics). They slapped a diaper on her upon arrival and kept her knocked out. A cup was for her to get her own fluids - which didn't happen (cup always the same) and food trays not being eaten because she could not stay awake long enough to eat or see the tray was there. Pretty much she was out of sight, out of mind, and getting very little care and not asking for any care or help. Eases the workload on the staff. Records showed her doing therapy for several hours each day - observation by visitors showed her slumped in a wheelchair sitting in the PT room.
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LauraCoulter Sep 2020
I'm super heartbroken you had a bad experience. Many of us care deeply and give more to our families and residents than we do to ourself. I worked 7 days a week for the first 5 years of my career. Partly because I loved it so much, but partly because if I promised to check something, do something or follow up on something - there wasn't a chance in heck that I didn't have that answer or information when I saw my families next. Also, it made it easier and more relaxed to meet with families on their off time.
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64 oz of fluid daily is the minimal amount for an elderly person per 24 hr so 48 oz (8 oz x 6 = 48 oz) daily amount is far short of minimal daily requirement. Perhaps you should make the PCP who orders this aware of this as the care home isn't into that. So no wonder the resident is dehydrated. Besides that some slipups in care may also exist; I have come upon night workers who charted they gave the feedings but bedside evidence was not consistant, Counting the empty cans in the waste basket if able and little things like that may be the proof you need
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Dehydration is a common problem in the elderly and there are lots and lots of factors involved, uncertainties, and medical factors, neglect being one of the least likely. It can be and often is very difficult to manage. The "doctors at the hospital said" this, or that, doesn't mean much; other than the doctors at the hospital probably shouldn't have said it, or at least in the manner that you say in your post. I'm not a doctor; my mom dealt with this for years with lots of the symptoms and complexities mentioned in the various responses to your post, her care was carefully monitored by family, and there was no neglect.
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1nephew Sep 2020
Your mother and her family were lucky. Your reply suggests that if the family of the writer was monitoring there would be no neglect. Why offer false assurances when you nothing about the situation?

Between me, my sister and the private aides we hired, we still could not prevent all the neglect my mother was subject to in a nursing home for the last two years of her life. We weren't there 24/7, but damn close to it, and we inevitably discovered disturbing lack of care issues. Even when we were there!!! It was a constant struggle. I had to complain before they finally had the stock person keep an adequate supply of large diapers. I would go around to other units and take what my mother needed! Her private aide would arrive in the a.m. to find her soaking wet; an aide had doubled up at midnight so she could skip the 6am change. They'd often run out of eye drops or forget to give them. They'd place a tray in her room she could barely reach, with the wrong food and milk she couldn't drink and sweetened juice she shouldn't drink...Pain from a bedsore that we had to insist they treat. It was a nightmare. Outside providers would tell me that it was like this all over. I didn't want to believe it, but the numbers infected and dead in nursing homes in my state and nationwide (and Canada and elsewhere) due to covid 19 bears it out. She had severe arthritis in a shoulder and they were constantly handling her in ways that caused great pain. Care plan? Joke. They'd get temps in who had not even been briefed. We would take my mother to specialists (ortho surgeon who gave her a cortisone shot, urologist who had remedies for incontinence, foot doctor to finally get fitted for orthotics, etc. ) THE ONLY REASON my mother was not consigned to sheer h*ll is because she had two devoted daughters who do not have families and are self employed with scheduling flexibility, and because we could afford to pay CNAs to do what we could not do.

We owe it to our loved ones to pay attention to red flags, and there is no bigger one, in my opinion, than an outside provider or hospital that says someone is in a seriously compromised condition.
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Administrators will tell you whatever suits their purpose, true or not. Never depend upon a nursing home to follow doctors' orders or even to do their jobs well. The workers are mostly uneducated, low paid, and with too many patients to care (and I use that word loosely) for. They know they are expendable and there is no future in it so they become calloused or simply just don't care. Many of us don't have the physical or monetary means to care for a loved one at home so we are stuck with this unworkable system. That said, all you can do is find the best (again, word used loosely) of the worst nursing homes around, and stay on top of things every single day. Visit every day you can, unannounced, check the dates on juice boxes, cleanliness of the room and linens, odors, bathrooms, IVs, etc. and always check the med records - know what meds they are being given, when, and WHY. Stay in touch with the doctor. Take photos. Show up at feeding times to see what they are being given to eat and if anyone is feeding or supervising. Talk to some of the residents, hear what they are saying. Many people are being duped into thinking a place is nice, but that's never entirely true. After I complained about dehydration, the nursing home insisted it was not true. I have photos of the same juice boxes that were there for over a week on my dad's table, spoiled. He was so weak he was unable to even lift them to drink, but the nursing home said they did their job. They left food but he was not able to lift a spoon, oh well, nobody had time to feed him, and they'd take it away later. But they seemed so nice.....
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sunshine45 Sep 2020
AKA - Haileybug

BAM …. On point
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I had to report neglect and poor care on the part of one night caregiver while my dad was in MC facility. The guy got uglier with Dad and I went and raised holy h*ll. He was fired! We can’t put up with nonsense that’s detrimental to our LO.
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my2cents Sep 2020
In a rehab, the employee marked each med as being given, however on 2 or 3 occasions where I was present, the correct quantity of pills was not in the cup. Two pills should have been sodium (due to an emergency run from rehab to hospital after sodium was critically low). She replied that my mom doesn't like to take sodium, so she didn't put both in the cup. I knew that none of the pills in the cup was sodium and went to the cart with her because she was going to show me 'proof' that she gave at least one sodium. That's how I found out it was a manually entered system - so if employee marked each drug and number of pills, it would show up as correct meds given. HOWEVER, it didn't mean those meds made it into the cup. . . which they did not. I reported it and the employee barged into the room wanting to know why I got her in trouble. Duh - you are not dispensing what you check off. The woman kept her job in spite of her scary aggressive manner with visitors and patients. She continued to be nasty and nastier with my mom. My mom was supposed to stay another 2 weeks at the time of reporting the medicine issue. I returned to my home over 200 miles away and got a call saying my mom would be released the next day because she had improved so much.
About the only thing I could do was post reviews listing all of the incidents I observed for my mom and a couple other patients. So yes, they can ditch the patient who is bringing attention to problems that they are very aware exist.
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As a long term care ombudsman for many years I see several issues. Firstly, the facility must accommodate the clinical needs of the resident. The 'accommodation of needs' is a critical element and they must do this under CMS/Medicare/ Medicaid or transfer the person to a facility that can accommodate those needs. Secondly, there can be no retaliation ever over an issue raised with a LTC ombudsman. I constantly verify as do my colleagues and I have only ever had one instance and that resulted in the dismissal to the aide involved. There is zero tolerance for retaliation. If I find a resident who is not getting the care that is appropriate to their needs I consult with my contact person who then makes the changes necessary. I follow up to ensure changes happen and the resident can call me if there are any issues between my follow-ups. I urge you to contact the ombudsman.
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Screennamed Oct 2020
Alan you're not describing reality
They CAN AND DO RETALIATE,
Remember, laws only apply
when standing in front of a judge,
SNFs do as they want to restrict costs, and to cover mistakes;
Retaliation happens daily,
in ways you're not familiar with?
Utilization of the word MUST indicates you're inexperienced with 2020 nursing home tactics.

Facilities by-pass "MUST," by claiming they're providing services, when they're not, they will claim to be doing X When in reality they aren't even doing Y.

Nursing home problems aren't solved by an Ombudsman;
unfortunately an eviction case can be created to counter an Ombuds interference.
In 5 minutes or less, an eviction case can be started by pretending a resident is a danger to others.Remember, any resident can and will be evicted, with a few fabricated records + fabricated complaints.
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I'm in New York but you might be able to do this in other States - call the Department of Health and file a complaint. They will keep it anonymous if you ask them to and will probably do an inspection without focusing just on your LO (also minimizing the chance that the NH will know it was you). They will let you know what they find after they do their inspection. If they don't find anything, at least you might have some peace of mind knowing it was checked out. I understand the concern about retaliation - it's too bad but it happens sometimes. Good luck.
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Wishing you luck on this, its sad that some NH don't provide the care they should, even though they are short staffed sometimes, that is no excuse.  Keep records of everything you have been told, get copies of the hospital/doctors reports.  Please speak up, you might also be saving someone else.  They, the NH of course will deny everything, possibly have someone on their staff that isn't doing their job and must be reported.  I know my experience is trival, but I saw one of the nurses or aide walking down the hall coughing around people without covering her face......now how good is that with people of compromised conditions.  I reported her to the main nurse and I hadn't seen her(that cougher) any longer.  She also just didn't seem compassionate enough.  I hate to get someone fired but IF they are not doing what they have been hired to do, they have to learn the hard way.  Again, please report so it hopefully won't happen again. Also, keep records of dates, etc.....everything.
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"The doctors at the hospital said he couldn't have been getting his flushes of about 8 ounces every 4 hours because he was down roughly 7 liters of fluid."

The doctors know.

Yes, I would call the Ombudsman. Do not worry about any retaliation.

This is just too big a risk to not say anything.

Someone needs to know about this. Don't be afraid to report it.
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AlvaDeer Sep 2020
In this old Nurse's experience the doctors often DON'T know, Hailey. It is my experience, when they haven't ordered the proper testing of electrolytes (Sodium, Potassium, et al) to protect against the very things OP mentioned, that they will "pass the buck". Just saying. They honestly aren't gods. We cannot know here who did or did not do things.
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Dehydration is common and life threatening in the elderly. Causes: not taking in enough fluids to balance what your body loses in urine, feces, and sweat. Common causes are large GI losses like diarrhea, and diabetes (elevated blood sugar can result in large volumes of iron in a short time). This can happen “overnight” in frail elderly. So it can be simply the case that over a weekend, when staffing is at its lowest that a patient has lots of diarrhea and misses one or two water flushes and then he is “doing well, sleeping really good” to the untrained direct care giver... “but last light he had tons of diarrhea.” It is easily diagnosed and fixed. The MD would consult with their staff dietician and change the type of tube feeds and add fiber. He may add Imodium. And they would monitor the intake and output results. Before each weekend a nurse would assess his fluid status by giving the pt a good look/bedside assessment as a preventative measure. Nursing homes should be pros at bowel and bladder issues. As they are so costly (time and linens) and greatly impact quality of life. Somebody dropped the ball. This is usually how the first diagnosis occurs. You should meet with the case manager and director of nursing to talk this out then send them a certified letter that summarizes the meeting and keep your records. They will get the message and follow your LO more closely. It is my feeling that the Nurses tell the MD what is needed and then the MD orders it. The Nurses run the show. All it would take is an agency fill in due to short staffing over a weekend to result in a dehydration hospitalization on a Monday or Tuesday. M - F the “regular staff” that have worked with your LO would notice the symptoms, see the change- lethargy increased confusion low BP etc. Good Luck. It is a common problem and an easy fix.
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Cece55 Sep 2020
Urine loss not iron loss (spell check got me)
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It's a nursing home.. what else is new. This is most likely dehydration. Sodium levels very high but you also have to look at the BUN, creatinine, and other lab levels. CAUSES are due to not enough fluids--it could ALSO be due to vomiting, diarrhea, diuretics, or aldosteronism (rare). See what the hospital says and go from there. Get with social services and put your loved one in another nursing home. The hospitals should be able to rule out aldosteronism just from blood test.

If there is prolonged dehydration, there can be kidney damage, down to kidney failure so yes there is damage.

BUT let the hospital diagnose the CAUSE first before jumping to conclusions.

If you are complaining, why not take your loved one to your home and care for him. All nursing homes are awful. I'm very thankful I never put my mom in one. I cared for her to the end--15 years--and she died very comfortably and her skin was in excellent condition.
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wolflover451 Sep 2020
I didn't like your response saying "ALL nursing homes are awful".  Actually there are some very good NH and don't lump them all into "bad" ones.  My father was in a very good one.  they called me even if he had a bruise on his finger.  And NOT all people are capable of taking care of their loved ones at home for various reasons.  I am glad that YOU were capable of that job, but some aren't and they shouldn't be made to feel otherwise.
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2 reasons I can think of as an RN: he may have a hormone problem that causes inappropriate excretion of urine or his kidneys are not working correctly . Ask his facility to weigh him daily at the same time of the day in same type of clothes, better yet make get a doctor's order. If his weight goes down consistently, be concerned and call his doctor.
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cetude Sep 2020
Sounds like dehydration to me.
If you are talking about syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH), the sodium levels should be low. aldosteronism is possible...but that's rare.
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You can file a complaint with the state anonymously. They will send in an investigator who will talk to everyone involved in your loved ones care and read their chart to see what is being recorded. After their investigation they will get back to you with their findings.
I had to do this with my mother in law. She had been living with us and was sent to the nursing home after surgery. They were refusing to acknowledge her dementia and paranoia. (She is not a pleasant person to care for) After a second trip to the hospital, I received documention from the doctor that cared for her of her mental status. The investigator arrived at the nursing home shortly after mom returned from the hospital. Only then did they admit to her mental status and that she would not be coming home.
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