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This is from sitting in the wheelchair all day and she's been there for 11 yrs now. This is my primary complaint on the nursing home. This came up fast!

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terryjack....I've not heard of skin integrity till now, but will mention it at the next care plan meeting. I have put my ononymous opinions in to the healthcare administration and intend on contacting the ombudsman program as well. The last doctor I spoke with came to the nursing home and I got little to no feedback from her on my opinion, but do accompany mom to as many doctor visits as I can outside the nursing home. I have considered another nursing home, but fear they will reject her due to this wound. If I see another wound like this, I may press that further. She has a severely altered speech that limits my understanding of her and she cannot write well anymore, so I sign everything for her. I do not need the POA for many reasons. She seems fine with the facility and is liked by staff and other residents. She's had a severe mental decline over the years and is a severe diabetic as well. She does resist meds at times, but most of the time she gives in. I'll help the staff with her as much as I can. Thank you for your concerns.
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Is maintaining skin integrity written into your mom's care plan? You can call the agency that monitors facilities, you can contact them or you can contact your local long term care ombudsman.
Facilities are to do everything they can to prevent sores from developing. You should also speak with her physician. You can always transfer her to another facility if she desires. Does she complain about the care she is receiving? Is she capable of making complex decisions, are you her POA? Does she like the facility, staff and activities? Is she resistant to care? No matter, she should receive care that prevents sores from developing and physical decline. Your LTC ombudsman can guide you regarding your mother's rights and what the facility is responsible for. Good luck
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We've been advised by doctors to add Ensure or Boost or a similar supplement for failure to thrive, but sometimes it's just too much for someone to drink in addition to meals.

But it looks as if you're really "on top" of the situation, for which I'm very pleased, for you.

Best wishes for success with this new plan, and for a peaceful sojourn for your mother.
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To Clarify my situation...my mother is 73, and weighs 99 pounds. In December she was 113. Hospice is looking in on her for the second time with a failure to thrive diagnosis. She IS now getting the wound care she needs including turning, Wound-Vac therapy, and Infectious disease doctor visits. She's more bedbound now than ever just in the last two months. She was NOT in the wheelchair for 11yrs, but for only the last 5yrs since she quit walking. Believe me! I am documenting my notes and some photo's and looking at her records. I am visiting every other day for now. She does have a NEW foam pad on her wheelchair, which I haven't seen her in at all since being re-admitted to nursing home from hospital two weeks ago. I've seen caring nurses and lazy CNA's.......but do make my complaints. My goal is definitly to cure and prevent. I can't be there every day, but for now every other day. I am overwhelmed, but do love my mother more every day and am just doing what I hope she would have done for me. Thank you All for the legal advice as well.
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This is medical malpractice not personal injury. There is a big difference in these types of attorneys. However I would start with Pam's advice before bringing an attorney in.
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Ferris, just a comment/correction on the issue of the practice area of any attorney the OP might consult... Personal injury (PI) attorneys generally handle auto negligence cases, slips and falls, dog bites, and sometimes products liability cases as well.

Practice areas of law are highly specialized, like medicine.

A medical malpractice attorney would be the appropriate type of attorney to consult. Some of them, including one for which I worked, hired a former nurse to be on staff to review medical records. Good ones maintain lists of potential doctors to consult, by specialty, for their various cases.

The standards of proof are different as well, as medmal requires proof that deviation from standard care of practice has occurred. Proofs in personal injury cases aren't that technical, and used to also include the concept of contributory negligence as an offset to damages.

Although a PI attorney could take the case, his/her approach wouldn't likely be as thorough or sophisticated as that of a medmal attorney.

But your points on documentation are good and sound advice, as well as the instructions for regular movement. Those are very good suggestions.

Just wanted to offer some perspective on the legal practice area issue.

I've read a lot of your posts and find them very informative, especially when you provide insight into IRS practices!
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At this stage of infection, nothing will help but immediate medical intervention. Think opening so foul smelling and to the bone kind of infection...
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Further thoughts...does she have a foam pad, gel pad or cutout pad in her wheelchair?
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I agree, decubi (pressure sores) do not appear overnight, but with diminished fat at the sacrum, they can appear much sooner. But, sitting in a wheelchair for 11 years without much care being taken does require your attention. Get a personal injury attorney, document your mother's sore with photos, keep records of how often you ask about her condition at the nursing home, and either remove her to another facility or get her on a bed being changed from side to side every 2 hours. That is standard care for nursing bed sores. Get a copy of the doctor's progress notes, as well as the nursing home, and if this continues she could get septicemia which is bacteria in the blood stream (usually fatal). Hurry, no time to waste!
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Involving an attorney could go both ways. As Pam notes, communication could be hampered and the staff would be on guard and likely document everything more extensively than they did. And their own counsel would likely become involved as I'm sure they're required to provide notification of potential legal liabilities once an attorney contacts them.

But an attorney could also scare them. They'd be more cautious in the future...probably.

On the other hand, what is the goal? Presumably it's to get the pressure ulcer cured and keep your mother safe in the future.

If you feel you can comfortably handle this with the staff go for it. If you feel you need extra "juice", contact an elder law attorney who specializes in medical malpractice.

But you can save your money by attempting to handle the issue yourself, and demonstrate that not only are you concerned about the lack of care which allowed this to happen, that you're willing to work with the staff to resolve the issue and avoid it in the future. Sometimes that creates a new level of communication - it did for us.
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Thank you all for the feedback....It HAS encouraged me on my decision. Hugs to you all!
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The point Pam is making is that once you retain a lawyer, there is no going back and talking to staff about how to correct the problem so that it doesn't happen again. You probably want to work through the care and healing process, make sure that precautions are in place to prevent it happening again. If their attitude is "there's really not much we can do about this, your mom's old" or if it happens again I would consider action
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Ouch. Not all lawyers act with profit as their only goal! A good lawyer would help you analyze your situation in the way that Pam did, helping you see the pros and cons of pursuing legal action, and that sometimes an alternative approach is best. But otherwise...What Pam said. :)
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What Pam said!
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Pressure sore's do not come to stage IV overnight, they take time. Frequently diabetes and obesity are contributing factors, and if the patient does not self report, they are unnoticed. If there was risk, there should have been MD orders for body checks. See the head of Nursing ASAP. Ask to go over the care logs. Ask for an ombudsman. Calling in the lawyers will cut off all conversation and the NH may even tell you to find other accommodations. Get the problem fixed. Lawyers don't fix problems like this, they complicate them into a three ring circus with profit as the goal.
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