The Call

Note to reader:  *Some of the links below do not work. I refer you to the "note" that is highlited in  red below.   I am in the process of editing this piece, by researching again.  It may take me some time to complete the task.  I apologize for any inconvenience this may cause.  Many of the links DO work, hopefully if you will find the information that you are looking for.

The following blog entry is lengthy.  I can't really apologize.  It is my Mom's story, and it is also mine and it is my family's.  Perhaps in the end, you will understand more the reason I am writing.  I don't know if you will want to try and digest all of this in one sitting.  I admire you if you do. Look for the links, click on them if you wish.    But it really is okay if you start and stop, read and leave.  I just hope that you come back. 

Did you leave already?


Ohhh, you are still here!  (I'm glad you are)

Well... I'd like to take the time to thank you.  And, I trust you will come away with at least one piece of new information and say that you are glad someone took the time to share. Some things may seem a bit blunt or out of character, if you know me.  As I write this, it has been TWO years and 5 months...  It is time to unpack the events, and I'm ready!    So here we go, continuing with my Mom's story....

On Wednesday nights my husband and I are almost always in church.  I mean my husband being the pastor and all.  It's where we should be.  It's where all faithful believers should want to be.  Ours happens to be 72 miles from our house.  I know you don't mind me asking, but Lord, do we always have to serve you so far away?  Silence.  That's what I thought.

The usual service has my preacher-husband standing behind the pulpit of a small town Baptist church with his Bible, with his notes (sometimes) but never with his cell phone.  That would be me, the one with the phone turned on silent...mostly.  Leather and paper or digital device.  Either way I have the Word with me and I've only glanced a time or two at the screen to be sucked into the Google, Messenger, Email, Social Media World.  Seriously only a time or two...well, maybe when my sweet husband mentions something that makes my eyebrow arch.  Then I HAVE to check the "fact" out.  But you get the picture.  In church.  With phone nearby.

Sometime after the song books were put away (yes, we still sing out of song books and hymnals and someone still walks to the piano),   and the Bibles/Bible apps were opened, I heard the vibrate feature on my phone.  Quick.  Look.  Message.  Do I open it?  In church?  Yes I do.  And I see a message from a daughter urgently telling me to call the nurse at the  Nursing Center.    Has she had another stroke?  Did she have a heart attack?  Did she need something?  What in the world...so I do what any loving daughter would do and because it sounded so urgent...I went outside to call.  The message had been clear..."Call NOW!"  And so I did.  What I heard next was just the beginning of a nightmare, only to  later become  stark reality.  I made the call.

I came trembling back inside, scribbled something on a piece of paper and walked up to the pulpit.  How else do you interrupt a pastor in the middle of teaching?  Eventually I wrote down notes and located official reports, but I did not have that luxury at the beginning.  I hope that none of you reading this have had an experience where news is sudden, doesn't make sense and is totally unthinkable.  But I would bet some of you have.  After all,  unexpected events, injuries and accidents happen all the time...just not to us. No, always to someone else.  And one can never fully prepare for the unexpected.

So, the note said something like " Mom fell... taking her to  ER in ambulance!"

Without missing a beat, my husband let everyone know that we would not be finishing the study.  They had prayer for her, for us, and we gathered our things and were on our way.  The next hour was spent trying to sort through what happened.  I called the nursing home and spoke to the nurse on duty  and she relayed to me that my mother had fallen and hit her head.  The ambulance service was there and they were evaluating her and taking her to the ER.  Little pieces of information were shared and I began calling some of the family.  Conversations only led to more questions and fear.  I fully expected to find a Mom hurting, but  who would be quite upset at the whole ordeal.

Always keep in mind that emergencies take time.  It takes time for ambulances to come from their dispatch locations, it takes time to get initial information and it takes time to evaluate, transport and give a report to the attending ER physician(s).  What sometimes feels like an eternity to the patient or the family,  in reality,  is some pretty fast work, if you ask me. It just doesn't feel that way.   Word to the wise...somewhere in the back of your mind (if something tragic happens to your loved one) write down all the information you can while it is fresh.  Get reports as soon as they become available and keep them in a safe  place.  It is difficult to recall everything weeks, months, years later. So much information is given in an emergency situation, that it's just plain hard to keep it all straight.  Official reports will help you from exaggerating or undervaluing the situation.  They ARE available to you as the patient and to designated folks like those who have medical power of attorney and such.  However, just like a hospital surgery, if you do not have legal right to the information, HIPPA laws will bring you to a stop sign.   So, if you want to read yourself or have designated family members have access on your behalf (ie:  power of attorney)  those things must be in place when everything is fine, before you or your loved one suffers injury.  If you are conscious, you can certainly give verbal consent to medical staff, etc. to discuss matters with specific people.  If you are unconscious....well....there's a problem.  Mom and I had made those provisions some time before this day, so everything was in place for me.   Be aware, however, most often you have to ASK for reports. And quite frankly, you may have to go get them yourself.


Back to the call or I should say calls...

We are still in the truck, flashers on... headed southeast.   The first family there was to be our ex-son in law and we hoped he could tell us more. But more calls only led us to more questions!   So confusing.  He told us over the phone that she was bleeding and they were doing scans, but that they couldn't tell him anything.  (HIPPA laws at work)    It was all so overwhelming.
 "Did she break any bones?  her hip? is she okay?  Did you talk to her?"
The answers trickled in,
"Not sure, but the ER doctor said this was a bad fall. He'll tell you what he finds, are ya'll almost here? Hurry..."
"What happened, do you know?"
"Just that she fell.  I went in there with her in the ER room, she squeezed my hand, but didn't speak, her head is bleeding and they took her back to do a scan or X rays,  and they'll have to tell you what happened."

While, my Mom lay there, already the wheels of government law had begun to turn.

Any nursing home facility in the state of Mississippi must, when residents are injured, report the incident to the State Department of Health and to the State Attorney General's office. Actually the State Health Department gets involved to investigate the incident.   And as a result of that investigation, and possibly others, a report on the state level was compiled and subsequently made public. Medicare.gov has the most concise and complete source of information obtained in their investigations. I will get back to the story in a bit.  But first there are some links that will help you to understand what was going on and they speak for themselves.

The FULL PUBLIC REPORT  may be found at:      Click HERE   OR 

https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.html?ID=255181&SURVEYDATE=09/22/2017&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1#

Note:   You are certainly welcome to read the whole 26 page report, however if you ONLY want to get to the main sections,

*Additional Note as of October 20, 2021 See below

OR

scroll down to p. 15 and also p. 21 - 23 .  (look at the bottom right corners to locate page numbers.  Each violation had to be addressed in the report and that is why much of the report is repetitive.

Asking you to "go here" or "click there" takes you to various public links  may "tax your patience" as my husband has often said from the pulpit. 

The state of Mississippi has changed their access policy toward this particular public record and the link to the public record I made reference to is NO LONGER valid.  Neither can any other source lead a person to the record itself.  If I was to guess, I would guess that anticipated lawsuits related to COVID 19 may have caused the government to re-think their accessibility.  I am not sure.  But the change did coincide with the Pandemic and given all the knowledge of how nursing homes were put in very precarious places at the beginning of the 2019-2020 Covid-19 pandemic, I think I may be right.  However, there is no printed statement to that effect.  I am BEYOND upset at the inability to now link you to any part of the report.  In the future I may copy the appropriate pages for you to read and include them.  I am SO SORRY that I cannot do this today.  As of this date the link below does still work to the Nursing Home ratings.  Hopefully that link will remain useable.  

So continue on......

You may be wondering if there is any way to check out a nursing home yourself and you can.  Here is one link to Medicare's ratings/evaluation and specific information of not only the facility my mother was in, but also others in the state.    Go ahead...check out the link below:.

(You may Click HERE  to view Medicare's updated public ratings of not only my mother's  Nursing Center, but others in Mississippi as well.)  If you can't go now, do bookmark it and revisit the site later.  There is a LOT of information out there and most of it is a wee bit difficult to wade through.  I didn't check this out for other states, but I would bet you could substitute another state there in the search bar if you were interested.

UPDATE:  yes, you can type:
https://healthcarecomps.com/nursing-homes/ms
https://healthcarecomps.com/nursing-homes/al
https://healthcarecomps.com/nursing-homes/la


and/or substitute a state abbreviation on the end to find Medicare's ratings in the state you choose.
Once there you have the option to look for specific nursing facilities in that state by name or zip code.  If they receive medicaid, they will be listed.  There you have access to a medicare rating (the more stars, the better quality care reported); but you may be interested to note the date...it may be 1 - 2 years old since last update.  But  you also have access to contact info, ownership,  a google map, nursing home info (including the number of complaints, incidents and ratings), fire and health reports/deficiencies and much much more.  If you are currently considering a facility for yourself or a loved one, it would be worth the effort to check it out. Do understand that these facilities, by law, are required to make efforts to resolve any issues found by the state inspection departments and what could have been a problem last year, could be totally resolved this year.  Looking for patterns might be more helpful or at least help you ask more informed questions when looking for a quality facility.  It might surprise you highly to see the ratings...so brace yourself.  It just bothers me that these reports are not the first things that appear in your search engines when you open up a nursing home website.  But they are there.  Your welcome :D

I want to stop here and say thank you to those of you who took the extra time to click on the links given and at least scan through the information.  I will also say, some reports reflect only parts of the whole picture.    You have to really dig to find specific information.  I have indeed done a LOT of "footwork" to provide you with the information here, but certainly there's  more available to those even more industrious than I. 

Moving along 

.

In the report you may have read about certain equipment commonly used.  For those of you unfamiliar with them,  I have included the images/information below:

(photo of green Geri-chair (similar to the chair mentioned in the report) with padded seat and back, recline-able, on  four rollers, with removable tray.


Also mentioned in the report is a  VANDER lift.  (Hoyer)
The video below gives a general idea of what is meant by a Hoyer lift and transference.  I realize this is most likely not the exact model used by  my Mom.  And since I personally did not attend a training session, the demo may not be exactly the same as was given to the CNA's  during their training.   But it should give you a good idea of the principle of transference via a lift.


Take a moment to stop here and view the video below...you never know when a loved one or even you may be placed in this position. This should give a clear idea.
(Click on the arrow in the middle of  the video/ image below  and turn on volume to watch/listen to this manufacturer's demo of how to properly use a lift to transfer an adult safely)
I know models vary slightly but the general process remains the same.

Hi!  Welcome back!  

As you could see, or as you already knew, it would be nearly if not completely impossible to "fall" out of the lift when all is in working order and the staff is using safety protocol.  Now with all this said and demonstrated AND the information competing for brain space .... let's get back to the ER where my mother is.

We arrive.  Mom is back from a scan and so, so  pitiful.   

"Mom, I am so sorry you fell!  Where do you hurt? Can you hear me?  What happened?"  

But I was speaking to one who is only moaning and staring.  I kiss her, I hold her hand, I watch as my husband  has prayer with her and gently touches and holds her other hand.  Eyes open, pain evident, but NO cognitive responses.  Vomit slowly seeps out the side of her mouth.  

"HEY,  we need some help in here? "  A nurse promptly appears.

Since information had come in with gaps of understanding of the whole situation (partially from shock, partially because some of it did not make sense to me) I just stood there trying to make the pieces fit together.  The ER doctor, Dr. Hall, MD,  came in with somber face, yet gentle and  compassionate, to let us know that this was a dire situation.  He invites my husband and me to step around the corner while the nurse is gently cleaning Mom up and keeping her somewhat elevated so as to not aspirate.  

My husband and I heard:  "Come see the results of the scan.  Your mother fell from quite a distance apparently directly on her head and has (at this point, I'm only thinking concussion) three brain bleeds, see them here?  And she also has a fractured skull."  (Remember there is no report yet to skim through at this time, only the stark images that stare as much at me as I stare at them.)  

 A WHAT?   

For any of you out there who have experienced traumatic and unexpected news in any medical situation, you know what I'm about to say...I hear the voice, I know he's talking to me, but I'm having a really hard time absorbing the information...all I can do is stare at the images on the screen until slowly the magnitude of the situation begins to take shape....I DO see the three areas he refers to as brain bleeds and then... the unmistakable  fracture line.  A fracture!   Dr. Hall's prognosis is dire, but he remains focused on giving a snippet of positive along side the huge dose of unthinkable. 

 "Sometimes these bleeds resolve themselves.  We'll know more as the night progresses.  She has had a TREMENDOUSLY SERIOUS injury." 

 About the only thing I can think of to ask at that point is if she also has any other broken bones.  He tells me they can order x-rays. They've just come back from a scan of her head, neck and upper chest.   

"Is she in a lot of pain?" I ask.

I realize now that there are questions and then there are absurd questions, but he answered me as gently as he could. 

He just said, "We can control the pain." 

There....mind racing....heart doing the same...and prayer, oh the prayer.  I almost can't think. But think I must, for now the questions directed toward me come.  

I am asked if there is a living will or who has power of attorney to make decisions on behalf of my mother.  

Decisions have to be made and made quickly.   

(I was always confused about this one as I have signed directives before, and even at this very hospital for other visits and procedures, but the answer is actually 'No, we don't have an official, legal directive on file.'  So once again, each situation is read and an answer and initials are required.  You do know that there are about 7 - 9 things you have to sign off on, right?  No, of course, you probably have no need to know these things.  But you need to know....now...when things are going well...you need to know. There are basically two document choices:

1.  Living Wills:  Are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. (But must be on file at the medical facility and/or on your person and/or able to be seen by medical personnel they are only worth something if they can be read...note to self)  

And

2.  Advanced Directives:  A form filled out by you and/or your legal representative at a medical facility to guide choices for doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Here is a link to a sample of an Advanced Directive form used in Mississippi (I did learn that each state has their own requirements)  

                                                     Click HERE to read samples:

I admit my struggle with this.  There is absolutely no question as to what my mother's wishes were on artificial means to keep her alive; as she made that abundantly clear on multiple occasions; but I got stuck on one that addressed nutrition and the other that addressed medications. The form above is a sample of one that is used in Mississippi.   

Scarey, huh?  This is serious stuff.  We never think we need to know, but, yes, we need to know.  

For me, the fear was that I was signing permission to withhold water and food and was giving permission to take her off of all medications. (Reading these things now in the calmness of my sunroom and reading them with a loved one lying only a few feet away and looking at possible death  are two very, very different things.)  Also, you see, my mother's condition was deteriorating and the medical staff needed to know what to do.  If nothing is signed or approved, the medical staff WILL do everything known to the medical field to keep one alive: including but not limited to CPR (which, in an elderly person, most often breaks their ribs).  One by one, I signed permission until all was worked through prayerfully. I will stop here to say, for those who do not know me, I am an only child.  There is no one else to feel the weight of the legality of it all...the final-ness.  Yes, I was and am blessed with an extremely supportive and prayerful husband, three grown daughters and their families.  And that by itself is worthy of all praise and gratitude, but at the end of the day...I...alone had to sign my signature, and that's a very heavy weight to bear.  I honestly felt as though I was signing away my mother to starve to death and withhold all the medicines that she normally takes.  It took a while to process; but basically we did not prolong her life with a feeding tube and we did not have any artificial means added to prolong life.    However,  she was not conscious to eat or drink.  It really felt like a "catch 22".  My confidence in that decision was held fast by my faith in God to lead me to do the right thing and her voice in my head that said, "Brenda Sue, don't you ever let them put one of those feeding tubes in me if I'm dying."  The other directive with the medication was tougher until I asked them to explain and once I realized that they were speaking of medications that would keep her vitals going for a time even when her body was shutting down...I felt peace.  I do understand there are times when one would not hesitate....and then there are other times.

I also need to stop briefly here and speak to feeding tubes.  There are some pretty good reasons to have them in certain situations.  However, if you ever find yourself having to make this decision only on the basis of swallowing problems/fear of aspiration...which often is deadly...If THAT is your only consideration, just know that a feeding tube to the stomach does not eliminate the possibility of the contents of the stomach coming back up to cause aspiration in the lungs.  Aspiration is when you breath in food/liquids  into your airway which wind up in the lungs, causing all sorts of problems. So basically you CAN vomit and breathe that back into your lungs.  Just saying...if aspiration is your ONLY concern.  It can still happen.  Ask questions...weigh all options and their possible outcomes.  Then make your best choice, whatever that is.  

Back to the ER.  We stayed a while and then left the room to go out to where our former son in law was sitting and tried to put pieces together before we began to call family.  We had not been out very long before...  

A nurse came and said, "Mrs. Holland, excuse me...the doctor needs to see you."  

Could there be more?  What else?  Is she gone?  Mind is still on fast track...and getting nowhere.

Mom had an option to make her feel more comfortable by giving her a certain medication.  And I gave permission for its one-time use.  So just because you sign a form, does not mean you are taking away all measures of making your loved one (OR yourself if you sign these measures before) comfortable.  I know each situation is probably VERY different, but just felt you needed to hear that.

And I can't tell you today if it eventually worked or not, I mean, how does a non-medical person measure that?   Vitals tell medical professionals much more that we can see visibly and Mom appeared more restful to me, so I'd like to think "mission accomplished".    That was the other thing..legitimate questions were asked of most every staff member when we were given new information and it seemed like they were never fully addressed.  I'm not saying that nothing was explained; but I am saying that often their explanation only served to open more questions.  In every medical facility there are medical questions and there are paperwork questions a family has.   There are staff members who are very patient and considerate and then there are those who should really rethink their career choices.  For the most part Mom's caregivers diligently cared for her and respected our private time and attempted to answer our questions.  I may explain a couple of snags later, but nowhere in this blog is my sole intention to be vindictive.  But I figure someone out there might benefit from our experiences....the good....the not so good.

At some point in all this, calls were made to our grown children to relay the severity of it all and they came from near and far .   From Hattiesburg...from Louisiana...from Virginia....

~

One more random piece of information to interject here…this may sound silly, but a resident can only be “admitted” to one place at a time.  If you are admitted as a resident in a nursing home, you CANNOT (at the same time) be admitted to a hospital.  And there is, of course, paperwork to address that.  Now, technically that could open up a whole can of worms and questions.  Do you have to clear out the nursing home room if you are discharged from it?  Can you go back when you leave the hospital?  This is an insurance matter.  (Mom also had previous hospital stays where she was treated and released).  So the basic rule of thumb seemed to be unless there is a full house at the nursing home, most of the time you can return to your same room without having to move things out.  But if your stay is lengthy, you may be expected to make other arrangements.  Technically once my Mom was admitted into a hospital she was discharged from the nursing home…and vice-versa. 

~ 

You may have come to the place where you are wanting to ask "exactly what happened in the nursing home?"  So I put  the full report link again here to  p. 15 and also p. 21 - 23.  (I believe if you go to these 3 or 4 pages, all your questions about what happened will be addressed)  So, if you didn't before, but want to now, please go to:  

https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.html?ID=255181&SURVEYDATE=09/22/2017&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1#

Otherwise, skip the repeated link and keep on going.

......But all papers signed, evaluations complete,  it was time to move her out of the ER.  The doctor graciously said he would move her to a room, instead of ICU, where we could be with her.  At that point....we knew the unspoken words.....

.....And then he did speak, “It would surprise me if she made it through the night.”  Confirmation is not always assuring…