Do I report a nursing home for suspected abuse or neglect? Where do I report the abuse?

[Anonymous]

My grandmother died two days ago. Before she died I was in the room with her while they were bathing her, and saw some hideous bed sores on her lower back around her tail bone. The doctor had been in earlier in the day and told me she only had days left to live.

I don't know if this is abuse or neglect, but seems bed sores can be avoided. The nursing home we had her in has a great reputation of caring for the elderly, so this seems unusual.

Where do I report my suspicions of neglect or abuse?

[SaoirseS]

Before you report:

You may have been looking at Kennedy Terminal Ulcers, not bed sores (or pressure ulcers). People usually die from the inside out, but sometimes skin starts rapidly breaking down and dark sores appear pretty rapidly as death approaches. It's not uncommon. Just guessing, but seeing them may have been what prompted the doctor's assessment that she had only days left to live. You might want to contact her attending physician and see if that was the case.

I'm a funeral home operator, I've seen plenty of Kennedy ulcers and bed sores to know the difference. So have most funeral directors and mortuaries, so you might ask the funeral home as well.

If you still suspect neglect or abuse, if you let me know what state I can point you in the right direction.

@SecretsofKB is a nurse and might be able to offer some insight as well.

[SecretsofKB]

Thanks for the tag!

So I'm a nurse in an acute care setting but not in a nursing home facility. But @SaoirseS is definitely on the right track.

The placement you're describing for the ulcer is normally where you'd see the Kennedy ulcer. Did you notice any pressure ulcers or markings at her heels or maybe her shoulder blades? Heels are a very common spot for pressure ulcers in patients that are in bed for long periods of time.

If you didn't notice any ulcers on any other areas, you have a good chance that it is the Kennedy Terminal Ulcer.

So pressure ulcers are a very big concern and no-no in healthcare. In my setting (ICU), we do head-to-toe assessments on patients twice every shift (which is 12 hours for me) and more depending on physician orders. We also turn and reposition patients every 2 hours a least a well as adding pillows or cushioning to avoid ulcers.

The thing is, due to the acuity of my patients, I never have more that 2 assigned to me at a time. So I am able to focus all of my attention on every bit of these 1 or 2 patients. This is NOT the case in any nursing home. Those nurses can have 20-30 if not more patients on their load. Ulcers can and do happen frequently.

In this case, it does seem to be what @SaoirseS suspected though, but I couldn't tell you for sure without looking.

But as she mentioned, if you do truly suspect neglect, reporting should be your next move.

[Asker]

@SecretsofKB thanks to you and @SaoirseS for your replies. After reading them I called both the doctor's office and the funeral home. Doctor had to track down his notes, but both he and the funeral home confirmed they were terminal ulcers, not bed sores. Thanks for saving me from over reacting.

The thing was my dad and brother spoke highly of the nursing home. My grandmother was also pleased with the care she received there, and made a lot of friends with the staff and other patients. The nursing home is, in the area, by reputation among the very best from all reports. But having heard so many horror stories about neglect and elder abuse, when I saw what I saw some alarm bells went off inside my head and I started wondering. I looked up Kennedy Terminal Ulcers and it makes sense now. They're really hideous, but from what I read there's nothing they could have done about them.

Thank you so much again.

[SaoirseS]

@Asker. No problem. Glad it's resolved (or seems to be). I've heard and read the horror stories about some elder care facilities too, so your concerns I think were reasonable. There are a couple in my area that have been on the radar a couple of times. As @SecretsofKB points out, part of the problem is the nurse to patient ratio in nursing homes. They're often stretched pretty thin, and operate on a thin budget as well. Of course some are managed better than others too. In death care we have standing instructions to report anything suspicious or suggestive of neglect or abuse in elderly death cases to our local medical examiner, who will come by and examine remains and make a determination if further inquiry is warranted.

I'm very sorry for your loss. My thoughts are with you, whoever you might be.

[Guy13]

It probably is State level Agency supervision, however, the overarching laws are federal. Department of Human Health and Services. Website searches...

[hahahmm]

National Center on Elder Abuse (NCEA) - https://ncea.acl.gov/

And state police, I guess.

[In_Trance]

check local laws