- Bowel Program including Dig Stim was NOT done. WHY?He was on a succesful bowel program for 2 years
Problems with negligence of not doing following through with the standard protocol:
- Increase toxic load from a full bowel increase irritability of the patient
- A full bowel will hold urine in the bladder. That is counter productive to having a surgically installed supra pubic catheter which is to help drain the bladder of urine that would otherwise be stagnet and lead to urinay tract infections. UTI cause irritabilty!
- Not having a regular morning bowel program causes "inconviences" and over stressing the budget.
David may or may not have a BM after he is up in his wheelcahir. He does no have the strenth to get on to a toilet or comode. Yes, he wears an adult diaper. How big a load do you think one adult diaper can hold? It is embarrasing. To ignore normal body funtions and force him to have _it happen is demeaning for any adult to poop their pants.
- Feces smell.
- Feces from shoulder to toes is an unsanitary mess!
Caroleene was "trained' by nurse Mary. Caroleene NEVER ever successfully did the bowel program.
( We have isssues with Mary not knowing how to hook up a urinary bag then lie about it. I also have issues with her comining in ot our home with out knocking nor announcing her self. I was in the Living room one AM to see her wandering around our home. Her responce to me asking who see was and what she was doing here was, 'I thought you were sleeping. I didn't want to wake you up."
From what I observed of Mary, I did not think she was going to transition to the home care setting.)
Why was Nurse Mary in our home? Betty was David's nurse.
It is my understanding that this company's policy does not allow CNA's to give gylercine suppositories. There fore the RN's were coming in as they ''had time.' "You don't understand. We are very busy. We have to come in when WE have the time."
RN's shoved a supposity in his rectum and walk out the door reguardless of whether or not any one would be there to clean it up. I may or may not be. No staff ever confered with me if I would be able to wipe his bottom and dispose of the feces.
- This poor communication and poor managment.
We may or may not have a choice as to when, where or how to clean him up post BM in the wheel chair.
It is too taxing to put him in and out of bed extra times; but _hit is squished all over the chair and his clothes, anyway.
There is an option to lay the back his chair. He is forced to precariously turn to his side while soiled chucks and dirty diaper are removed. Would you like me to make a video to get you all to understand how difficult a task this is? We have told Ms Caroleene many, many times since October 2014. Accidents in the chair ARE an avoidable mistake!
Then I ,Mom, have to wash adult clothes out by hand and let then soak until I have the funds to do extra laudry. Currently our laundry room is on the 3rd floor. ( Don't be suggesting David get Housekeeping to help do laundry.)
When we go over budget on laundry that mean I don't pay a bill or I don't eat. In April and May the extra wastage of laundry from BM and excessive use of wash clothes and towels cost me over $60 over my budget.
Many times David has no choice but to sit in *__IT that will casue skin break down.
We may be out on an appointment; I am not home; or I am too injured to even care for my self let alone spend 20 to 60 minutes dealing with pooh!
- Sitting in a wheel chair or being stuck in bed leads to increased potential of skin break down, decreased pertsalis decreasedlung funciton...shall I go on?
- Add having to sit in BM siemotionally difficult.
- David does have skin break down. Has this been reported by CNA's? What was the agency's written plan of action to protect his skin? I suggest there was NO plan ofaction with the excuse that you were "short staffed and this case was to be temporay. " I have found what the law says about not doing the care; neglect.
- Not getting on the CDASS program has been the problem of the Helen Rocky Mountain Options for Long Term Care lack of getting her work done in a timely manner. She set this up with your agency. David never forced you to agree to his case.
- PT evaluated David's needs. Standing in the standing frame allows gravity to help with bowel movements.
- The standing frame use is an intrical part of his over all health. I, Mom, am no longer capable of safely getting him in thestnader all by myself.
- WHy was David not put in the stander?
- Check the times logged in and logged out. David needs 2 hours but was grateful for 90 minutes on the schedule so I did not have to strain myself to get him in and out of bed. (BTW after my shoulder injury February 23, 2015 - he had to stay in his chair all weekend or stay in bed as he only had a CNA 5 days a week for 90 minutes in teh morning.)
I have concerns as the length of time has not been adequte for ROM. Recently David informed me numerous times that Caroleene has stated in response to his complaints, "I'm not strong enough."
My concern is if this CNA can not do the ROM with out hurting her self or David OR she can not do the job that will do David any good, WHY was the supervisor NOT informed so the CNA could replaced?
Or, is there too much distraction from all the voice messages being left on CNA's phone during that a time sheis suppoese ot being doing ROM? From the lack of follow thorugh it looks liek she is rushing ot leave early druing her scheduled visit.
To clarifyOn the day swhen I am not out fro my appointments I had beenhearing her phone either rign or numbersou voice mails every day aroudn 10 AM It appaered to meshe was disteracted tho did not answer the phone most times. David informed me the voice mail sounds continuedeven when I was not home.
3. Scheduling Staff is not matching skills.
When asked why CNA'S" did not have the skills to compentently do the careplan these are only 3 of the replies from staff:
"CNA's come in with their certificates in hand."
"You have to understand they need to be taught."
"you have to undersatnd we are short staffed."
As an RN for over 30 years whose strong point was teaching, I DO understand about teaching. Is the company implying that they were intending to pay me or not to train their staff when I was too sick ot care for my self?
- Schedule: David was grateful for the help he got. He was told Caroleene could not come until 9:30 am. He worked with it. It was a problem since not being ready to go in the morning until 11:00 interfered with optimal time window he could be transported by Metro Transit to appointment s or in gernal getting out if the weather permitted.
- David has had DR orders for him ot get out of the house daily due to his oldest diagnosis that existed prior to the MS diagnois. He has been almost a prisoner in his own home. It not easy for him to get out whenhis day starts so late; 11 AM
- I had scheduled 2 business events way back in December. I paid for the non-refundable vendor booths. David was calling teh agency to check if someone was scheduled or not. At the last minute Sherrie informs David she had no one that has been out already to work so would send someone new.
- I said NO.
- I do not want a new person wandering around our home with out being oriented. I need to trust they would not hurt him nor would steal or not follow the careplan. (Irene was disasater. " You won't let Irene come out, so who else do I have to send?") May 16 I got up at 5 am to get David ready to go with me. We got picked up by Metro transit at 6:45 AM. I was exhausted by the time I got my table set up. I sent David home at Noon by Metro para transit van. At least I knew that I would not have to pack up and go home early because someone hurt him or used 1/2 bottle of foaming face wash on his bottom.Yes, someone apparently did. EO face wash cost $22 for a full bottle. Can't peopel rea labels?
- "One day" when David had an eaelry morning dr appointmetn. The scheduler called to tell him that no one would come until 11 am to get him out of bed. Think about it. He would not be ready for the day until after NOON. Then the pm staff would come to put him in bed at 5:00 or 5:30. This incident made him upset and told Sherrie why it upset him. He said, " Any pshycriast will tell you it is not healthy to saty in bead all ady (parapahrased.) Since you are the schedular if I deteriorate in any way based on___I will hold you personally responsible." __She hung up.
- 2 hours later Nurse Sharon and Robert knocked on the door unannounced to deliver termination papers. Sharon said that Helen had been informed 2 hours before. Sharon was obivisouly upset. This was the first time she had met David and I in person. She was apparently was not aware that I have a degree in nursing: some of the statements and lack of knowledge on issues of infection control, bolwel program and more from CNA's and other staff do not go over well with me. I can't help but wonder how many other clients are being intimated by similar statements meant to hush the clients when they express concerns. Does the law really allow agencies to ABANDOM care with the excuses, "We can no longer meet your needs."
What was done to EVEN try to meet David's basic bodiy function needs?
Helen did call later much later. She stated that the agency staff "complained they were afraid because David was taping/ recording them doing thir work". (Or something to that effect.)
Who made up this lie?
If David were to record the CNA'S. keep in mind the Federal Wire Taping Laws and nanny cams. I see this kind of lie as harrasemnt that is unsetlteling to his already delicate condition. Keep in mind DAvid had blood in his urine and was just completeing the dose of antibiotic for a UTI. Who causedit BYW?
Lack of knowledge of good infection control is chronic among CNA's in this area. This agency and other agencies who have been to our home have NEVER addressed the problem as I see fit. In return those in charge (with the exception of Beth) get defensive and lash back.
In my experience I did a lot of hand washing teaching where I worked. There are ways to help staff improve on infection control. Such as observing the CNA in that home setting by RN in an papropirate way to teach."Blaming" or "denying" the client's concerns is NOT accepetable as a solution.
1) Psudomonus x2 this year.
2) David had puss filled sores all over his body. The popped fairly fast. ( I do have some photos.)
Who reported it? Do you know why those happened?
May 12, I thinkaDAvid had an appointment with dr Alex. I was not informed of a sore on his leg that was there BEFRE the dr appoitnt. That night a CNA had undressed David when I walked into his room to see a large puss pocket the size of an orange seed on his inner left thigh. At that time David told me Caro commented it was a spider bite. David thought it was an in-grown hair but can't see that well.
Mid week the week before I had noted that David had dozens puss filled sores on his back. I questioned it as maybe we needed to put a towel behind your back in case it was sweat I would watch it tho' I was not currently geting David in and out of bed.
Tuesday Am I called Min at dr Al's office to reprot the sore on his left leg AND the fact that he had little sores all over. I quetione staph tho we don't know wihtout a culture. Some where the order for a culture was not placed into Beth's box......
I have lots of photos inlcuding how the leg bag was not starped right.. I question why CNA's feel they have the training to dismiss open wounds or are carelessa bout how the leg bag will or will not drain right???
Later when I peiced together some evidence I realizied that someone used the CNA hand soap in his bath water. (Ireane had used up over & worth of doTERRA foaming handwash on pooping rags I told her to just leave me to do...What does the careplan say about David sensitivities? Is there even a PM careplan? Or have these new CNA's been even given an AM careplan?
NO SOAP! Skin is SEnSATIVE!
Who reported his signs and symtpoms to the RN?
Why did nurse Betty never come out to get a urine culture? David was miserable. He was worse than cranky! Who can blame him?
February 23 about a month afeer we moved, (Jauanry 17)I had no choice but take ua to the doctors. I am not allowed to drive. I took the city bus. I was an awful day with snow drifts piled up every where and ice in the streets .Mind you , the RN could have taken a UA in most of the previous week.
I had to cross West bound on Academy on foot to catch the next bus. A car made an illegal left turn as I was finishing crossing with my Pedistrain light. It caused me to fall on ice sustaining more that a just serious shoulder injury.
Urgent CARE doc said I could NOT use my arm at ALL for 3 days. As of May 25 my arm is still not healed.
Gratefully, the agency sent out "ONLY for 3 days. THAT IS ALL!"
What? No plan for emergency?...
I then got bronchitis. Apparently it is OK for CNA to come to work with bronchitis how many times with out another CNA to back her up? (Oh, short staffed, I know. So, we are grateful)
My body fell like a row of dominoes. I was taken by ambualnce x3 to ER after the fall. I have had ex-rays, CAT scans, EKG's and cardiac echograms. I see a chriopractors twice a week and I do phyical therapy for my shoulder -sitll not healed. Now I'm completing a 3 week cardiac monitor.
I'm am still not ok to heavy work.
I don't drive, so I drag home groceries.
What IF some one wastes a whole bottle of hand soap? What IF the AM CNA says nothing about something running out? Is she is distracted and leave un-rinsed dried on food and metamucil on the counters not knowing if I am to be admited ot the hospital or not. (Right, she can't wash dishes.) It seems like it is ok to leave before completing all of the careplan tasks because we don't understand "Our agency is short staffed."
To fuel my upset Caro was being nice and brought in DIAL hand soap. I sent it home. "Thaks but no thanks" Dial is very heavily perfumed. I tried it out to prove what i already knew. The snythetics were very strong for hours. The soap bothered David and myself- We are allergic to this junk in the over the counter soaps. We are careful about what we have in the house. I use essential oils for our over all health.
- I have not said evey thing I have to say about why David and I have discussed that we want an accounting of the tasks the state has been billed for.
- We want an accounting why the bowel program was never done; why the stander was never used and WHY CNA came in slopping handsanitizer and using regular hand soap in David?
Copies of this are scheuled ot be published on http://NoNon-centsNanna.com
Email to __ Home care Agency in Colorado Springs
email to Helen C at Rocky Mountain Options for Long Term Care and supervisiors
email to our state representitive Owen Hill
eamil to Pre-paid legal
email to local and national news
(Typos from Malika Bourne are to be expected.)
Sincerly Malika Bourne mother of David E.
Disabled patients. She described some of the ethical dilemmas that this population deals with and stated that this population has unique ethical concerns.
Colorado Colo. Rev. Stat. § 26-3.1-101 MISTREATMENT: The act or omission which threatens the health, safety, or welfare of an at-risk adult, as such term is defined in subsection (1) of this section, or which exposes the adult to a situation or condition that poses an imminent risk of death, serious bodily injury, or bodily injury to the adult
MISAPPROPRIATION OF RESIDENT/PATIENT PROPERTY (2 elements needed) Deliberate misplacing, exploiting, or wrongful use of a consumer’s/resident’s property Or A pattern of misplacing, exploiting, or wrongful use of a consumer’s/resident’s property And Consumer/Resident consent not given If the allegation is made against the agency staff member, then it is reportable. If the consumer reports misappropriation by a family member to the agency, it would n....
"Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home-care services) or the failure on the part of an in-home service provider to provide necessary care.
Neglect typically means the refusal or failure to provide an elderly person/vulnerable adult with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety"
Multiple sclerosis - discharge
Daily bowel care program
Call your health care provider if you notice:
- Pain in your belly that does not go away
- Blood in your stool
- You are spending a longer amount of time on bowel care
- Your belly is very bloated or distended
Incontinence - care; Dysfunctional bowel - care; Neurogenic bowel - care
Nerves that help your bowels work smoothly can be damaged after a brain or spinal cord injury. People with multiple sclerosis also have problems with their bowels. Symptoms may include:
- Constipation (hard bowel movements)
- Diarrhea (loose bowel movements)
- Loss of bowel control
A daily bowel care program can help you avoid embarrassment. Work with your health care provider.
3. Examples of appropriate "behavioral" intervention for a home health aide might include remembering to alert a client to a transition in tasks in a manner specified by family or behavioral professional, using non clinical calming techniques when client is visibly agitated, distracting client who is escalating or obsessing, taking advise from family or mental health professional and avoiding actions that are known to escalate client (such as disrupting routine, unnecessary rushing, etc).
Note: "unnecesary rushing" : Malika says CNA we have encounter may say, "I'm very fast and very good". to a point that is so, but they tend ot rush patients to do the task so they can get in and out and be paid for the "incident" But that quick job does not meet all of the patients needs that state alocated for specific tasks such as a bowel program. Many aids are rushing the clients so they can do "incidents" with mulitple clients with mulitple agencies during the same time period. The law should be clarified to stop this practice.
FYI: essetial oils are considered over the counter comestic and food supliment NOT medications.
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES OTHER TYPES OF CARE 7 HOME HEALTHCARE SERVICES A Payment rates for the home health services are established as follows
D. Physically Disabled or Blind Adult - includes all clients who meet the level of care screening guidelines for SNF or ICF care, and who are age 18 through 64.
Clients who are developmentally disabled or mentally ill, as defined in 8.401.18, shall not be included in the Physically Disabled or Blind target group, unless the person's need for long term care services is primarily due to physical impairments not caused by any diagnosis included in the definition of developmental disability or mental illness at 8.401.18, as determined by Utilization Review Contractor from the medical evidence.
17 Services in Home and Community Based Services programs established in accordance with federal waivers shall be provided to clients in accordance with the Utilization Review
Law clarificaiton of who can do bowel program and who will be trained for CNA care in home
Infection control standards
Plan of correction (A) An HCA shall submit to the department a written plan of correction detailing measures that will be taken by the agency to correct deficiencies found as a result of inspections and shall be submitted in the formand manner required by the department.
6.4 Consumer rights (A) Assurance of rights (1) The HCA shall establish and implement written policies and procedures regarding the rights of consumers and the implementation of these rights. A complete statement of these rights, including the right to file a complaint with the department, shall be distributed to all employees and contracted personnel upon hire. (2) At a minimum, the HCA’s policies and procedures shall specify that: (a) The consumer or authorized representative has the right to be informed of the consumer’s rights through an effective means of communication. (b) The consumer has the right to be assured that the HCA shall not condition the provision of care or otherwise discriminate against a consumer based upon personal, cultural or ethnic preference, disabilities or whether the consumer has an advance directive. (c) The HCA shall protect and promote the exercise of these rights.
Exercise of rights and respect for property and person (1) The rights of the consumer may be exercised by the consumer or authorized representative without fear of retribution or retaliation.
(2) The consumer has the right to have his or her person and property treated with respect. The consumer has the right to be free from neglect, financial exploitation, verbal, physical and psychological abuse including humiliation, intimidation orpunishment. Was David punished with terminaiton because he called them on not doing the job?
(3) The consumer or authorized representative, upon request to the HCA, has the right to be informed of the full name, licensure status, staff position and employer of all persons with whom the consumer has contact and who is supplying, staffing or supervising care or services. The consumer has the right to be served by agency staff that is properly trained and competent to perform their duties.
(4) The consumer has the right to live free from involuntary confinement, and to be free from physical or chemical restraints as defined in 6 CCR 1011-1, Chapter II, Part 8. (5) The consumer or authorized representative has the right to express complaints verbally or in writing about services or care that is or is not furnished, or about the lack of respect for the consumer’s person or p...
5 Admissions (A) Agencies shall only accept consumers for care or services on the basis of a reasonable assurance that the needs of the consumer can be met adequately by the agency in the individual’s temporary or permanent home or place of residence. (1) There shall be initial documentation of the agreed upon days and times of services to be provided based upon the consumer’s needs that is updated at least annually. (B) If an agency receives a referral of a consumer who requires care or services that are not available at the time of referral, the agency shall advise the consumer’s primary care provider, if applicable, and the consumer or authorized representative of that fact. (1) The agency shall only admit the consumer if the primary care provider and the consumer or consumer’s repres
Discharge planning (A) There shall be a specific plan for discharge in the consumer record and there shall be ongoing discharge planning with the consumer. (B) If no improvement or no discharge is expected, the agency shall document in the consumer record this assessment. (C) The HCA shall assist each consumer or authorized representative to find an appropriate placement with another agency if the consumer continues to require care and/or services upon discharge. The HCA shall document due diligence in ensuring continuity of care upon discharge as necessary to protect the consumer’s safety and welfare.
10 Agency reporting requirements (A) Each HCA shall comply with the occurrence reporting requirements set forth in 6 CCR 1011, Chapter II, section 3.2.
(B) The agency shall investigate each reportable occurrence and institute appropriate measures to prevent similar future occurrences. (1) Documentation regarding the investigation, including the appropriate measures to be instituted, shall be made available to the department, upon request. (2) A report with the investigation findings shall be available for review by the department within five (5) working days of the occurrence.
(C) Nothing in this section 6.10 shall be construed to limit or modify any statutory or commonlaw right, privilege, confidentiality or immunity. (D) An HCA shall notify the department before it initiates discharge of any consumer who requires and desires continuing paid care or services where there are no known transfer arrangements to protect the consumer’s health, safety or welfare.
(1) Emergency discharges necessary to protect the safety and welfare of staff shall be reported to the department within 48 hours of the occurrence.
6.20 Consumer record content (A) All HCAs shall have a complete and accurate record for each consumer assessed, cared for, treated or served. The record shall contain sufficient information to identify the consumer; support the diagnosis or condition; justify the care, treatment, and/or services delivered; and promote continuity of care internally and externally, where applicable.
(1) Such records shall contain consumer-specific information as appropriate to the care, treatment or services provided including but not limited to: (a) Records of communications with the consumer or authorized representative regarding care, treatment and services, including documentation of phone calls and e-mails, and (b) Referrals to and names of known home care agen...
Code of Colorado Regulations 40 (e) If nurse aide services are provided to a consumer who is receiving inhome care by a health professional, the supervising health care professional, in accordance with the professional’s scope of practice and state and federal law, shall make an on-site supervisory visit to the consumer’s home no less frequently than every two (2) weeks to supervise the nurse aide.
Direct observation of care being provided by the nurse aide shall occur at least every 60 days. More frequent direct supervision shall occur if there are adverse changes in the consumer’s condition, complaints received associated with the provision of care by an aide, supervision requested by the nurse aide or consumer for specific issues or other matters concerning the provisions of care by the nurse aide.
(f) If nurse aide services are provided to a consumer who is not receiving inhome care by a health professional, a supervisory visit with the nurse aide present at the consumer’s home shall occur no less frequently than every 60 days. More frequent direct supervision shall occur if there are adverse changes in the consumer’s condition, complaints received associated with the provision of care by an aide, supervision requested by the nurse aide or consumer for specific issues, or other matters concerning the provisions of care by the nurse aide. 7.16 Nurse aide training and orientation
(A) The HCA shall ensure that skills learned or tested elsewhere can be transferred successfully to the care of the consumer in his/her place of residence. This review of skills could be done when the nurse installs an aide into a new consumer care situation, during a supervisory visit or as part of the annual performance review. A mannequin may not be used for this evaluation. (B) If the HCA’s admission policies and the case-mix of HCA consumers demand that the aide care for individuals whose personal care and basic nursing or therapy needs require more complex training than the minimum required in the regulation, the HCA shall document how these additional skills are taught and validated. (C) The HCA shall establish a process for standardized, step-by-step observation and evaluation of nurse aide competency in the following subject areas prior to the assignment of tasks requiring direct observation of items (3), (9), (10) and (11) of this paragraph (C). (1) Communications skills; (2) Observation, reporting and documentation of consumer status and the care or service furnished; (3) Reading and recording temperature, pulse and respiration; (4) Basic infection control procedures; (5) Basic elements of body functioning and changes in body function that shall be reported to an aide’s supervisor; (6) Maintenance of a clean, safe, and healthy environment; (7) Recognizing emergencies and knowledge of emergency procedures;