me.
Her dad, age 74, broke his femur. After surgery at a South Austin hospital and several days treatment for ileus, he was transferred to a nursing home ten minutes from my house.
Besides the broken bone, he had several bedsores, one or more of which had necrotic tissue. He arrived on a Thursday evening, assessment was done on Friday, and it wasn't until the following Thursday before a wound care specialist treated his necrotic wounds. (Nursing staff treated him in the meantime.)
He failed to thrive, barely eating, vomiting often. His daughter was told he had dementia. He was very lucid the times I talked to him (the day after he was admitted and the same day he asked to leave, as well as another day), and was well-mannered and compliant. No sign of depression. Later in the week, she was presented with a packet on hospice and preparing for death and dying.
After a week and a half, he told a staff member he wanted to be transferred to another facility. Later that evening a new medicine was prescribed, supposedly to stimulate his appetite, which also had psychiatric effects. (Mirtazapine) After that was started, he got a visit from the director of nursing, he was asked by the director of nursing who asked him in a manner I considered potentially manipulative in the audio recording the daughter made. Asking didn't he like it there, and was he really unhappy there, and did he really want to leave. Of course, being a nice person (and maybe under the influence of the mirtazapine), he said no.
The daughter had an MPOA executed after he'd been there an almost two weeks, but the nursing home failed to honor it. The nursing home throughout his stay would not provide her with information about the medications and course of treatment, because of HIPAA and because mother was next of kin. Daughter came repeatedly, mother never visited (mental health issues), but it was quite awhile before she had the information about her dad. At one point a doctor who covered for the main doctor periodically called her at home and told the daughter he had pneumonia. The next day she asked them to take him to a hospital. They told her he didn't have pneumonia, and asked him if he wanted to go to the hospital. He said no. I texted our town's director of EMS about my concerns. He went over and checked the dad out, couldn't find pneumonia, and the dad said he'd eaten a little and did a little walking with assistance. Dad said he didn't need to go to a hospital.
Five days later they do transfer him to a hospital for pneumonia, the necrotic bedsores, and continued weight loss. The hospital treats him for almost a week–the worst of the bedsores has infected down into the bone—then a week ago they send him to a long-term acute care hospital. The wound care specialist told me there that the wound almost certainly would not be fully healed for SIX MONTHS. And until it healed he couldn't begin rehab.
He's still at the LTAC although they wanted to move him to a nursing home with a skilled nursing bed and wound care specialist. At least one nursing home refused to take him because they can't give him the level of care he needs. He's continued to vomit off and on and getting enough nutrition to heal is a big concern.
I don't see obvious signs of dementia and never have. My dad, who is gone now, had it so the early and even middle stages are not necessarily very obvious. Her dad seems lucid and intelligent, now and then with minor touches of confusion.
The nursing home here did seem to me to use HIPAA to prevent family members from having the info they needed, didn't treat his wound in a timely manner or adequately, and was very slow to get him to a hospital. The timing of the prescription of mirtazapine was suspicious and when it wasn't working they did not wean him off it.
I do not know if they were a nursing home bribed by UnitedHealth, but it would not surprise me to learn they were after what I observed and what the daughter and her dad went through. Of course, he should have been in a nursing home that had skilled nursing beds, and this one didn't. But the daughter had no way of knowing that.
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