Case Study #1 – Lack of respect
Problem: Martha was very upset because an aide gave her a shower and ruined her new hair-do for the second time in a month.
Action: The Ombudsman and Martha met with the Director of Nurses and explained the problem. The Ombudsman suggested that the staff provide her with a shower cap next time. Also, since she had to pay the hairdresser herself, the Ombudsman suggested the facility to cover the costs of her next hair appointment.
Outcome: The facility agreed to cover the costs, and staff was trained to offer the resident a shower cap. Martha was happy with the resolution to the problem.
Case Study #2 – Misuse of resident’s private property
Problem: Phyllis keeps a jar of instant coffee in her room at the residential care home. Other residents come in and ask her for coffee and, not being able to say “no,” she gives them some and then doesn’t have enough for herself.
Action: Residents are not allowed to have food in their rooms. Phyllis and the Ombudsman met with the administrator and agreed to have her coffee kept in the kitchen with her name on the label. Whenever she wants it for herself, she can ask. The issue was brought up at the Resident Council meeting so that everyone knows what the rules are and that they, too, can have some food or drink kept aside for them.
Outcome: Phyllis gets her coffee when she wants and other residents do not hassle her for coffee.
Case Study #3 – Resident restrained illegally
Problem: When the Ombudsman visited a skilled nursing facility, she found Fred confined in his wheelchair with a belt wrapped around him. Fred appeared to be agitated that he could not remove the belt.
Action: The Ombudsman asked Fred if he could unfasten the belt, and he clearly could not. The Nurse said he had to have the belt on so he wouldn’t fall, and said there was a doctor’s order for the restraint for safety. The Ombudsman quoted the regulations that stated that a restraint could not be used unless the resident could personally unfasten the belt. The belt can only be used for a stated length of time while a medication change gets under control, or for mobility purposes, but it cannot be used to restrain a person in the chair. The Nurse did not remove the belt. The Ombudsman filed a complaint with licensing.
Outcome: Licensing made a visit to the nursing home and cited the facility for improper use of a belt. The doctor re-wrote the order for the belt to be used for a specified time (under 90 days) until the resident was stabilized with his new medication.
Case Study #4 – Protection from undue influence by someone outside of the facility
Problem: Jane was admitted to the dementia unit of a skilled nursing facility. Adult Protective Services (APS) had been following her case for a year because of reports that Carol had befriended Jane and was taking financial advantage of her. APS assessed that Jane’s dementia was progressing quickly, but was able to convince her that she needed to get away from the Carol’s influence. Carol found out where Jane had been moved to and immediately started insinuating herself into Jane’s life at the facility. The staff asked the Ombudsman to assess Jane’s feelings about Carol, because they were very uncomfortable with Carol’s behavior in the facility.
Action: The Ombudsman interviewed Jane in private. During the conversation, the Ombudsman was able to gain Jane’s trust. Even though she showed signs of memory loss, it was very clear that she resented Carol’s attempts to control her life, and said “I should never have given her that money. Now that’s all she wants.” The Ombudsman asked Jane if she still wanted Carol to visit, and Jane said “no.”
Outcome: With Jane’s permission, the Ombudsman contacted Carol and told her that Jane did not want her to visit anymore. Carol became extremely angry and threatened the Ombudsman with lawsuits. The Ombudsman explained to Carol that didn’t matter, the fact is that she was not welcome to visit Jane at the facility. In order to resolve the financial issue and upon Jane’s request, the Ombudsman helped facilitate Jane’s conservatorship for finances. With Jane’s money safely managed, Carol disappeared. Jane was moved to a local residential care home that provides specialized care for people with dementia, and is living her life out happily.
Case Study #5 – Resident falls frequently; staff not offering a solution.
Problem: Frank has short term memory problems from early dementia. He has fallen from his bed or wheelchair several times recently. The facility told Frank’s family that he is “non-compliant” and the staff say they keep telling him not to get out of bed, but he doesn’t listen. The facility told him he would have to move.
Action: The Ombudsman and Frank’s family met with the Director of Nurses to form a care plan to address the falls. The Ombudsman suggested that the facility place alarms on both the bed and wheelchair, and lower the bed at night. The Ombudsman also suggested that the resident be encouraged to go to more activities, since he was usually in his room during the day. The discharge order was dropped.
Outcome: The facility agreed to place bed alarms on the wheelchair and bed. They will lower the bed at night and place a fall pad next to the bed so if Frank does fall out of bed, there is less chance for him to be hurt. The activities director met with the resident and discovered that he likes old movies. The activity director will encourage him to come to more activities, and let him pick out the next three movies for “Movie Afternoon.” Frank became more engaged and better supervised, and he hasn’t fallen since the new safeguards have been put in place. The discharge order was dropped.
Case Study #6 – Facility refuses to readmit a resident who was sent to acute care for 4 days.
Problem: Marilyn was transferred from a skilled nursing facility to an acute care hospital for 4 days for minor surgery. The facility refused to readmit her.
Action: The Ombudsman called the facility and spoke with the Administrator. The Administrator didn’t want to readmit Marilyn because she was a “problem resident.” In discussion with the Administrator, it was revealed that the facility did not offer Marilyn or her family an option to hold the bed for 7 days as required. This is a violation of regulations.
Outcome: The facility agreed to readmit Marilyn. The Ombudsman agreed to work with Marilyn and the facility to come up with a care plan that addresses her needs.