Nutrition and Dehydration

[Snappo]

Similar sort of thing just happened at the facility where I work. Resident of dementia wing had a 'fall' (more probably pushed by another resident.) She was picked up, dusted off, nil apparent injuries noted, and left to go about her business. Later that evening, staff noticed that her little finger was bady bruised and bent. RN was called to attend, then she went about her business, leaving the incident in the 'very capable hands' if the RN. A little later still, staff contacted the RN to find out the outcome for hand over. RN stated that the resident 'wouldn't let her look at her finger'...end of story!!! Staff bypassed the RN (for which there will no doubt be a rap over the knuckles), called an ambulance, resident was taken to hospital and was found to have a badly fractured finger. It was attended to, resident returned with an order for PRN pain medication(which she isn't receiving), and that was that. Great stuff...great care....OMG.....

[At Wits End]

Snappo that experience sounds just like what i endured. I think the pressure of 'paper work' in a nursing home falls on squarely on the RN. The paper work has to be done to make it appear all is OK.
So the RNs are little more than a convenient 'prop' for the nursing home owners.
So the RNs comply with the need for paper work to be up to standard to pass accreditation.
But if there was no documentation then identifiable lapses in care would exceed current levels.
If owners could get away with just using carers, and less carers, and no RNs, and no ENs, then those Nursing home owners would be happy.
And based on the staffing levels that is the reality, because much of the important caring work is done by carers. Hence why some crucial medical and care issues can be overlooked. (such as bed sores)

So the RNs make sure the paper work is done.
They have to compromise all the standards they ever learned in their training to be an RN.
The RNs are stressed, with demands at every turn. It is impossible to do their job well. They get burnout but still keep working there. The RN do not want hospital admissions. Golly someone at the hospital might start to ask WHY so many of their clients have dehydration, bed sores, unexplained bruises, malnutrition etc.
In the end the nursing homes with low standards get a bad name. The RN knows it. But tries to soldier on. The RN gets stressed and just gives up trying.
Far easier to blame some one, anyone, the elderly, the family, the carers for the state of affairs.
Much easier not to call the Dr and NOT to call an ambulance. Just let the poor elderly soul die in their bed. Then they can call the family and try to sound sincere.
The RN is in a NO WIN situation. It is lose lose for the poor elderly. It is Lose Lose for the reputation of the home. And Lose Lose for the career of the RN, unless the RN gets out (which many do)
But there is always another RN who thinks they can make things better (they eventually find the level of support and the staffing allowed means that they are doomed to fail too.
what is wrong in all this that OWNERS of these substandard nursing homes get away with murder, because the owners call the shots, even if they are miles away and never visit their homes.
I think some Australian criminals in gaols are better cared for than Vulnerable elderly people cared?? for in Nursing homes. `
The rotting underbelly of some sub-standard nursing homes in Australia and the wicked way they operate in some areas needs to be exposed.

[Sally]

An interesting story in Today's Courier Mail - Sunday Mail Qld:
Patients in Queensland Hospitals Malnourished. NOTE: This also includes Nursing Homes.

Sally

[paulinek]

I find all these posts so difficult to read, emotionally.

Hydration is incredibly important for all elderly people. I read somewhere that as we get older our ability to recognise our own thirst diminishes. It is important to remind our Elders to drink often, especially in the hot weather, even if they are not thirsty.

I do agree about the amazing lack of care regarding hydration. At one point when my mother couldn't have her over the bed table as there was a mattress on the floor to catch her when she fell out of bed, she had no access to a drink. I spoke to Elder Rights Advocacy and they suggested a sipper bottle of water. I said that one of my sisters had suggested one of those camel packs bike riders used attached to the bed so that she could drink water that way. My mother is of the generation that do not drink water. I did not think a plastic bottle with her all day, getting warm and stale was of any use. Who would clean it and make sure it had fresh water in it? Same with the camel pack. I would still have to go in twice a day, more in the 40 degree days we had over summer. This one issue took three months to resolve with the sudden finding of the memory mattress which kept mum in bed and the mattress on the floor was removed. Table over bed reinstated. I still couldn't get anyone to get her a fresh drink from the fridge, wash her sipper cup and put it within her reach. Mum does not like orange juice and apparently it is the only juice provided by the nursing home. The bright orange thickened gunk, sometimes white, in a jug - is never touched. I just put it out in the hallway every day. No one has noticed in 18 months that it has not been touched. That is not good enough. Hydration is critical and it should be monitored in a much better way.

Interestingly, now that the nursing home has heard we are thinking of moving mum, suddenly she has a fresh drink most mornings now when I go in.

[abbie]

[*]The bright orange thickened gunk, sometimes white, in a jug - is never touched. I just put it out in the hallway every day. No one has noticed in 18 months that it has not been touched

This rings all my bells. People just going about the place doing the same old things every day and not having enough wit or not caring enough to notice that drinks are not being taken. This is why we need caring professionals who have pride in their work - and who are paid a decent salary for a job well done.

[paulinek]

Just on nutrition, my mother was transferred to a public hospital earlier this year after suffering a few bouts of suddenly talking gibberish in the middle of a visit and then later on staff were unable to rouse her.
I found out later that a month before her blood test had shown that her haemoglobin was terribly low but nothing was done about it. It was so low when she went to hospital that her brain was starved of oxygen as her blood was not able to carry the oxygen around her body that it needed. She was transfused and went through tests but no reason for the low haemoglobin was found medically (no internal bleeding was discovered to account for the severely low iron level).

I have been told that her haemoglobin will be tested more frequently in future.(!?!) It really makes me wonder about her diet. Is she not getting enough iron in her diet to keep her body healthy? No one of course has mentioned that to me or tried to improve her diet for the future. I think much more emphasis needs to be placed on the quality of the food provided.

[paulinek]

I was looking at a brochure on my mother's nursing home. There is a photo of Margaret Fulton in a kitchen. Do you think that is a joke? Is it false advertising? I just don't understand how they can get away with that.

[paulinek]

The food the other night was so disgusting I took a photo of it. I had a bread roll in my handbag so I put it into the disgusting looking gravy to soften it a little and fed that to my mother instead of her meal. I swear I would not have fed it to my dogs. I cannot believe they can serve up rubbish like that and call it a meal. I am just so upset about it.

[paulinek]

[*]The bright orange thickened gunk, sometimes white, in a jug - is never touched. I just put it out in the hallway every day. No one has noticed in 18 months that it has not been touched

This rings all my bells. People just going about the place doing the same old things every day and not having enough wit or not caring enough to notice that drinks are not being taken. This is why we need caring professionals who have pride in their work - and who are paid a decent salary for a job well done.

The orange gunk jug is still on the fridge across the room. We have one improvement and that is a drinking cup with it now. Mum still won't drink it. A member of staff told her that if they leave it there long enough, she'll drink it.

[paulinek]

I heard on ABC radio this morning something about malnutrition in nursing homes. I went to their website today but could only find the following article which is dated 2008. Will keep trying to find the information.

50pc of nursing home residents malnourished: survey
Posted Thu Oct 30, 2008 7:00pm AEDT

Malnutrition is rife in Australian nursing homes, according to a study showing half of residents are weak from not enough food.

Nursing specialists are calling for an overhaul of nutritional care of vulnerable elderly people on the back of survey results which found just 50.5 per cent are well nourished.

Nutritional assessment of more than 350 high-care residents in eight aged care facilities in Queensland found that 43 per cent were moderately malnourished and 6.5 per cent were severely malnourished.

Older patients and those requiring the most care had the worst rates, the study in the Australasian Journal of Ageing showed.

The research team, lead by Queensland University of Technology, also found that just 18 per cent of the malnourished residents had been seen by a dietician, and only 29 per cent were receiving supplements.

They said the high rates were probably due to responsibility for daily nutritional care, such as assistance with meals, supplements and monitoring of food intake, falling largely onto care staff.

The study also showed that staff awareness of the importance of nutrition on resident outcomes was inconsistent.

Residents' dental health, which influences general health, was also found to be poorly recorded and oral assessments often outdated.

The situation was best improved with increases to staff training and a better focus on dietary intake, the researchers said.

"Most causes of malnutrition (in nursing homes) are modifiable and central to improving this is greater staff awareness, better assessment skills of care staff and adequate overall management of nutritional care," they wrote in the journal.

- AAP

[paulinek]

This report is from the Dietitian's Association - March, 2010 - Press release
Residents in aged care facilities malnourished
Australia’s peak nutrition body is calling on the Government to tackle ‘shocking’ rates of
malnutrition in Australia’s aged care facilities, where around one in two residents is
malnourished1.
In its submission to the Government’s Aged Care Funding Instrument (ACFI) review2, the
Dietitians Association of Australia (DAA) called for routine nutrition screening, and better
support for nursing and other care staff to feed and weigh residents and monitor their food
intake.
DAA’s President Julie Dundon said: ‘We’ve heard so much about obesity but at the other end
of the scale malnutrition is causing unnecessary suffering. Malnourished aged care residents
are at higher risk of falls and fractures, infections like bed ulcers, and medical complications
– all at a huge cost to the tax payer.’
Ms Dundon said unintentional weight loss needed to be picked up early and steps put in place
to improve the nutritional status of these residents.
‘Pharmacists are already funded to regularly review the medicines taken by residents. We’re
suggesting a similar model, where money could be set aside for Accredited Practising
Dietitians (APDs) to coordinate routine nutrition screening and carry out nutrition
assessments3.’
She said the tragedy of malnutrition is likely to get worse as the Australian population ages.
‘As the link between malnutrition and a poorer quality of life and health outcomes is well
known, the Government needs to give serious attention to the nutritional care of older
people,’ said Ms Dundon.
In its submission to the ACFI review DAA also called for:
• Government funding for:
- aged care residents to be able to better access APDs
- facility staff to work with APDs on planning nutrition care
- APDs to work on activities like facility-wide menu assessments, staff training and
quality improvement projects
• Publicly available Government reports on the rates of malnutrition in Australia
• National standards for menu planning in the aged care setting
• Mandatory training of aged care staff in correct techniques for weighing and feeding
residents.