Residents Denied Bathing, Resulting in Bed Sores at St. Petersburg Nursing Home
Consulate Health Care of St. Petersburg has been cited after failing to ensure personal hygiene needs for two residents, which resulted in severe emotional distress and two serious bed sores for residents.
The first resident in this citation was assessed as cognitively intact, but did need one or two people to assist them in bathing. This was noted in their care plan, which specified that the resident had a deficit in performing activities of daily living on their own and needed assistance to avoid decline in relation to other medical conditions. The care plan required that staff would either assist the resident in a full bath or shower or give a sponge bath. This information was clear and available to all nursing staff who cared for the resident.
The resident was interviewed as a part of this citation, and she was very distraught with the care she was given by the nursing home staff. She said she should receive bed baths three times each week, but they were “not getting done.” On the days she was scheduled to have a full shower, the staff told her they were too busy. She felt unclean and noticed that she smelled. The resident shared that she has special equipment to wash her hair, but no one wanted to use it to wash her hair. In addition to receiving no help with her hair, the resident was bathed maybe once or twice each week.
She didn’t understand why the staff wouldn’t help her bathe or even use a Hoyer lift to make their role easier. This is a mechanical lift used to help nursing staff transport residents safely. Staff told her they were too busy. The resident said that she had made the Director of Nursing and Administrator aware of the problem, but they had done nothing. “There’s not enough staff here.”
She said she felt ugly and dirty, and then began to cry during the interview.
This resident used to be a nurse. We can assume that she understands the fast-paced nature of patient care and the strain that nursing home staff face when they have a number of residents to care for. Even so, this resident did not deserve to be ignored and made to feel ugly, dirty, and unclean.
The facility had not only failed to care for this resident, but could not provide the investigator with shower sheets that should have documented the needs and care for this resident.
Nursing homes are responsible to care for residents in the ways they cannot care for themselves. This includes distributing medication, conducting physical therapy, providing a healthy diet, and even helping residents complete their activities of daily living. Activities of daily living consist of bathing, brushing teeth, getting dressed, and other daily hygiene and care activities. This is essential not only for the residents’ dignity and quality of life, but is often tied directly to their health and medical conditions.
A second resident suffered in a similar way. He was also assessed as cognitively intact and totally dependent on nursing home staff to help him bathe. The resident should have received three showers each week, but only gets one or two. The staff told him that the Hoyer lift was missing an essential pad, or that there weren’t enough staff to help. As a result of this, he bought his own Hoyer pad.
Residents of nursing homes and their families should not have to provide their own equipment to receive care. This is the responsibility of the nursing home, not the individual who is relying on the facility for care.
The second resident stated that the Director of Nursing knew about the deficiency in care and “she is working on it.”
When asked for shower sheets for this resident, the facility was unable to provide them. The Director of Nursing revealed that this was a recently-discovered issue. Staff were filling out the sheets and then throwing them away, destroying the record needed to track quality of care for each resident. The Director of Nursing said that she had just started an improvement plan to address this the previous week.
The second resident was also reviewed because he had two pressure ulcers, also known as bed sores. This is an injury created by prolonged pressure on a typically bony area of the body, such as the heel of the foot, the shoulder, or rear. Pressure ulcers are staged based on their severity, from pain in the area of the sore to complete deterioration and tissue death down to the bone. These are injuries that must be treated regularly with changes of tissue dressing and more frequent movement to relieve pressure in that area.
This resident’s pressure ulcers were advanced, labeled as Stage 3 ulcers. This means that tissue has been lost, forming a small crater, and subcutaneous fat may be visible. This is the stage before bone is visible due to the pressure ulcer. These two injuries were on his right foot and needed regular wound care. Even though this is a painful, serious injury that needed daily care, the resident said that staff didn’t want to take care of him. He had to specifically request a dressing change or it would not get done. There was no wound care nurse on staff.
The investigator observed nursing home staff change the resident’s dressing, which was done with errors, such as failing to apply iodosorb, which helps wounds actively heal the full wound.
Pressure ulcers should be extremely rare, or even nonexistent. They are the result of poor care and show a nursing home’s disregard for daily care and residents’ quality of life. These two residents needed help with bathing and were denied that basic dignity and care. The second resident sustained an injury that clearly showed low priority for patient care and comfort.
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