Caregiver was Incompetent?

I have a lot to say about experiences at facilities. Not all are negative and it really depends on the character of the individual providing the care that makes or breaks the experience. The one thing I cannot say or emphasize enough to anyone guiding the care of a loved one is that it is an eyes on responsibility. I don’t mean eyes on every few weeks or eyes on during a nice Sunday visit that is predictable and expected by the facility. I mean eyes on just about every day at random and unexpected times. Every elderly resident, whether an Alzheimer’s patient or not, but particularly an Alzheimer’s patient, needs an actively involved advocate. In this story, the caregiver was incompetent or deliberately covering up a wound.

Move from Rehab Wing to Long Term Care Wing

Following the plateauing of my mother in the second rehab facility, I was informed that she was being moved to the long term care wing of this particular facility to free up a rehab bed. The rehab facility was an excellent one and, upon first notice, I had no reason to believe that this was a bad move. It was the same facility but a different wing.

On the first day, I went in to visit mom in her new digs and promptly realized that this wing was not the same caliber as the rehab wing, at least in appearance. The rooms were dingy and a bit dark and much smaller so that a double was really quite cramped. Still I was not concerned as this is only the physical appearance of the space and had nothing to do with the level of care that she would receive. So I believed naively.

This facility was going to be a temporary stop anyway until I determined where I wanted mom to live during this next phase and where I could access a bed without a long wait. I knew that assisted living was not adequate at this point because she needed more nursing care and actually much more assistance with dressing etc. She had just transitioned to a wheelchair though could still stand and walk. She was considered a fall risk. The wheelchair was safer for her general moving about and she was happy zipping around the halls in it.

Intuitively I needed to be that actively concerned advocate.

One Sunday afternoon I went in to visit and mom was sitting in her chair midway down the hall. She looked fine but was not smiling as she usually did when she saw me. Alzheimer’s patients can be very variable in mood so I wasn’t terribly concerned. I could usually cheer her up and get her laughing pretty quickly. But as my efforts were failing and she was clearly unhappy, I began to look her over. I went head to toe testing for pain and problems. Nothing. Until I looked closely at her feet and noticed that one ankle was swollen quite a bit. I pulled the sock down and looked at the skin. It wasn’t just swollen in a way that is common. The ankle was swollen and red and hot to the touch. An alarm bell was going off in my head now.

I removed her shoe and sock kneeling in front of her in the middle of the hallway. I was already upset to find the ankle swollen. But as I looked at her foot I noticed a bit of discoloration toward the heel. From my visual angle, I could not see the bottom of the foot but it looked odd. When I raised her leg and foot up so I could look at it closer, I just gasped. Her entire heel was black. It was a huge abscess that covered her heel and it was obvious that the infection had spread to the ankle. I could not believe this! I jumped up and ran down the hall to find the nurse on duty.

The infection appeared serious.

This was a nightmare. This infection looked very menacing and I wondered seriously if she would survive this given what happened to my father. I reached the nurses station and tried to politely but urgently get the nurse’s attention. She listened to me describe what I had found and, when I asked to get immediate attention, she said they would call the doctor in the morning. What! In the morning? She made this assessment without any level of concern in her voice or urgency. She was not reacting in a way that I would expect. This nurse demonstrated apathy. Another caregiver was incompetent. I demanded that she at least look at it. Finally she agreed to look at it but I had to wait until she administered someone else’s evening medications. Fine. I waited anxiously.

Finally, the wound nurse examined her foot.

The nurse finally followed me down the hall to where mom was sitting and knelt down to look at the ankle and foot. She didn’t say anything except that it looks like it could be infected. My reaction was No S*** Sherlock! The nurse said again that they would get a doctor to look at it in the morning. To that I barked back at her that it needs immediate attention and I wasn’t leaving until a doctor looked at it. I was preparing to follow this nurse around all shift until she did something. I made that clear to her. This was extremely upsetting.

Finally after about a half hour, the unit nurse returned to say that the wound nurse was on her way over from the rehab wing. Upon her arrival, she assessed the situation and immediately called the doctor who prescribed immediate antibiotics. The doctor wanted her to elevate it so they got mom into bed for the evening and rigged up a way to keep her foot elevated even when dinner arrived. I was glad to see mom was getting the medical attention that she needed. But I was thoroughly disturbed by the lack of concern and attention that the unit nurse exhibited.

The caregiver was incompetent or something worse?

That night I thought about this situation and I concluded that this didn’t just happen in an hour. I know that infections can spread and worsen rapidly but this had to have been ignored by a caregiver. It had to be ignored or missed by the person who got her dressed and put on her socks that morning. Either her caregiver was incompetent or this was a deliberate or lazy cover-up. I was distraught by the whole situation and realized that I no longer had an ounce of confidence in the level of care that my mother was receiving. I had to get her out of here and I had to find a place that would restore my confidence.

My mother lost her ability to stand and walk, even enough to assist in her own transfer, because a caregiver was incompetent. Her foot needed to be elevated for several weeks which meant she was in bed for a couple weeks. After that I rigged up a way for her to move about in her wheelchair with one foot elevated. I did that. The facility would have continued to leave her in bed. As her advocate, this will torment me for years to come.