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My mom was admitted to SNF for therapy to recover from upper leg bone break surgery. In just 7 days she developed a STAGE 4 wound. She could not participate in therapy because of the wound so they gave me 2 options:
1. Take her home
2. Admit her as a long-term resident.
Because of the severity and level of care this wound needs I'm not able to care for her at home. She also would have hospice care to help but she is now bedridden and in adult diapers so 24-hour care is the only option I believe. Any suggestions how to provide care at home other than by myself? (Family is not available)

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You would need to hire round the clock, either through an agency or privately.
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She got a wound in Rehab? What caused it. Did she show pressure signs (redness) at the time of admitting? If this wound was caused by Rehab not recognizing it, thats on them. Don't think a wound gets this bad overnight. If she had it coming in then the Hospital should have acknowledged it. When someone is admitted to a facility pressure points, pressure sores and any wounds need to be documented. If there is a sign of any of these things, an air mattress should have been ordered and the areas checked all the time.

If you place her in SN the cost will come out of Moms pocket. Medicare will not pay if she is not given therapy. If Mom has no money then Medicaid would be applied for. You could bring her home with the requirement that a woundcare nurse see her. If she gets "in home" care medicare pays for it and you get an aide. But its not 24/7 care.
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MsAtin16 May 2022
Joann29, thank you for asking about the wound. Yes, when she left the hospital she did have a red area around her tail bone that was documented by one nurse who I seen care by covering with bandage and turning her on side. The next night she was transported to SNF. However, it was not documented at discharge from hospital and documented as unstageable wound at admission to SNF. The stage 4 wound diagnosis was actually 11 days later after ER visit and transfered to another facility where the wound doctor debrided the wound. The size of the red area was 2.6 diameter and when she went back to ER it was 6.8 diameter, discoloured black, red, scaly and yellow/ white discharge in a couple of areas all around it.

It was 7 days after she was in 1st SNF, that by accident, I seen when I walked in as an aide was changing her. I heard her Hollar as I walked backed to her room and rushed to see. Pulled back the curtain and freaked out. I have been scared for my mom's care because she wasn't a pleasant compliant as some would expect. It was hard for me to hold years back and not lash back at times of her sharp tongue. I just want her home. But I'm afraid she'll just wind up back in the ER if I try to care for her my self. I have no other family that's in good health them selves to help. Hospice is great but they aren't consistent with same nurses. That would just eat at my mom. I couldn't do that to her. Well gotta go. TORNADO WARNING ALARMS ARE GOING OFF HERE IN OKLAHOMA! TTYL
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This wound needs to be addressed. IMO it should have not gone this far. Hopefully AlVA, RN, will see this post.

You can put Mom on Hospice and demand that a wound care nurse be brought in to care for the wound. Mom is to be under no discomfort when on Hospice. IMO, someone is at fault her for properly not caring for it.
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I know you want to take her home but my dad had a sore on the back of his right leg and they did wound care twice a week on it. I thought it was just like putting medicine on it and retapping it but no they take like a knife thing and cut off the dead skin (debreivement) that’s what they call it. Unfortunately unless you can pay out of pocket for 24/7 care or any in home care I think your best option is ltc or Al. Trust me there is no way I could have taken care of my dad. 24/7 care is hard and exhausting physically and mentally. I was doing 7/5 care for both parents for at least 2 months until my mom recovered. I was so exhausted mentally and physically. We did get va assistance which they came twice a week for 4 hours each time and that was a big help, because once mom recovered she could do more for both of them and the help from va made things easier on her too. I think but not totally sure you can get some help from Medicare everything was just confusing so I don’t remember how Medicare works for in home care. We really only had the va for in home care. I do know Medicare will send pt ot bath aide and a nurse and if the nurse request it they will send wound care. Sorry I probably went over the answer you were wanting. Just my two cents worth
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Countrymouse May 2022
Debridement. Makes my head swim just thinking about it :(
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Unless the SNF was shockingly bad, the fact that your mother developed this wound post operatively when in a fully equipped facility indicates that her skin must have been pretty dam' vulnerable (or already injured) to start with. And how did she come to sustain the fracture?

You would need:
daily visits (possibly more than one) from wound care specialist nurses
a maximum package of care - this is usually 4 visits per day, morning, lunch, afternoon, evening; two aides if your mother can't mobilise or change position independently.
a profiling bed
a variable pressure air mattress
a slide sheet
possibly a hoist (you'll need to get advice from an Occupational Therapist in any case)
lots of continence care supplies
lots of skin integrity supplies
a SSKIN (risk assessment and care plan combined) checklist
quite a lot of other things - this is just a rough sketch

Has there been a formal Assessment of Needs?
Has your mother been able to express her preference?
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It takes strict attention to positioning, shifting position and using pillows, etc to prevent pressure areas. Skilled home care will be covered by Medicare for a period of time, so you get a nurse, a HHA, and maybe some PT/OT. So maybe 3 or 4 visits in a week, not always consistent providers. It is very hard to meet her needs at home without hired caregivers who are skilled at caring for a bed bound patient. Hard at a SNF as well. A patient with this sort of wound needs more than an assisted living can provide.
Without knowing more about her medical history and general condition prior to her arrival at hospital and then to SNFs, hospice care at the SNF might be the way to ensure she is comfortable and receives some individualized attention. Hospice care focus will be on comfort, not on healing that wound. Hospice can keep the wound covered and drainage contained. Hospice can also medicate her in advance of wound care, to decrease her discomfort.
Hard to heal a stage 4 wound, and debridement is very painful and may make wound worse.
Think about asking the SNF about getting an order for hospice evaluation and then you can specify what hospice you want to use. Often a SNF has a 'favorite' hospice...start with them.
Or just call a local hospice and ask to talk to an outreach worker about the situation. Don't get talked into a hospice evaluation, though. You have the right to choose, and if this particular agency seems too pushy, thank them for the information and say goodbye.
Good luck. You can see how a fall often triggers the downward spiral for frail elders.
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