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 Pressure Sore/Hospitalization 
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3432
Location: Vermont
Post Pressure Sore/Hospitalization
Hi - my 88 yr. old LBD/PDD dad has a pressure sore on the end of his tailbone, which is getting worse. A visiting nurse is coming in to try to see if they can get it to heal better, or at least not continue to get worse. After a week, it is worse. I talked with the ALF director and she said if he was her parent she'd want him in the hospital, then "rehab". She said at this point she doesn't think the hospital will accept him. If it gets worse (like she thinks it will) then they will take him in the hospital. They are having an air mattress moved in for his hosp. bed now. My questions:
(1) if he goes in the hospital, can they just give him topical antibiotics and something for the pain? (let's face it, he is not going to get "better" and I can only see the future having more pressure sores, and a repeat of what we're dealing with now)
(2) if he goes in the hospital and gets better for now, and he has to go into "rehab", wouldn't it be better just to have him moved permanently to a nursing home, since he is close to being moved into dementia care where he is now? I am anticipating that 3 moves would be a lot worse for him than 2 moves.
Any help, advice, suggestions are most welcome. Thanks friends, Lynn


Fri Feb 26, 2010 7:11 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
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I think it would have to get much worse for a hospital to accept a patient with a bed sore.

I suggest you call an MD and request "home health" for your father. This qualifies as a skilled need. Find a home health agency with good wound care (or bed sore care). (Not all have this expertise.) An RN would go to the ALF and see your father as often as it takes.

Bed sores take many weeks to heal. There's a very specific treatment regimen to clean and treating bed sores.

I'm assuming he's on Medicare or some insurance program with "home health" benefits.


Fri Feb 26, 2010 8:29 pm
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The visiting nurse/home health nurse is already coming there. She's been seeing him for at least a week. It is getting worse. She is the one who requested the air mattress be delivered today.


Fri Feb 26, 2010 8:34 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
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Robin is correct. And a hospital would be a very bad choice, even if they would accept him. He is more likely there to contract an infection, unhappily enough.

Lynn, I've forgotten: Is he currently in an ALF? He can have home health, covered by Medicare, in the ALF. If it's a SNF, the SNF does the nursing, of course. Special dressings and mattresses are important, but most important of all in healing a pressure sore is keeping the pressure OFF. That means not sitting except at meal time and being propped on his side in the bed. Hope it's only a stage 2. The stage 3-4 sometimes take months to heal, and if the person's nutritional and fluid intake is poor, may not heal at all. :(


Fri Feb 26, 2010 9:10 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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He already has a home health care nurse coming into the ALF - she has been coming for a week to a week and a half, and it is getting worse. I don't know what stage they consider it, but the director says it's pretty bad and getting worse.
They have him lying down most of the afternoon to keep the pressure off for more hours.


Fri Feb 26, 2010 9:41 pm
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You wouldn't expect any progress in that length of time. In what way is it worsening? Is it larger? Redder? More exudate? Sometimes they look worse when they start to heal--they may even bleed slightly, which is a good sign because it means the blood flow to the area has been restored. Give it some time. These things are very slow to heal.


Fri Feb 26, 2010 10:05 pm
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Joined: Sat Jan 03, 2009 2:59 pm
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Lynn,
I don't think the best place is a hospital for your father, too much danger of the medications he could end up getting, hospitals really are equipped to handle patients with dementia, and if he gets out of hand they will just want to medicate him. As stated before a nurse with wound care is best, these bed sores take a long time to heal and some can get very bad.
Good Luck and keep us posted on how he is doing!

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Irene Selak


Fri Feb 26, 2010 11:19 pm
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I had a post lost in cyberspace! The home health nurse who has been managing his wound care for about 10 days told the director that it is getting larger. I don't know any other details.
He had about a quarter sized pressure sore on the bottom of one foot that took 6 months to heal, and it wasn't even bad compared to what this sounds like. That just cleared up in Dec., when this other one started. His new air mattress arrived this afternoon.
I'm going to have hospice go over and evaluate him next week. I am so not a medical person, and have had so little medical stuff to ever deal with, I just feel completely out of my element with all this.


Fri Feb 26, 2010 11:43 pm
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I just lost a post in cyberspace too!
I am glad you are having hospice come in and evaluate your Dad, They will help him and keep him out of pain. Bed sores can be painful! Our experience with hospice was nothing but positive, couldn't have done it without them!!

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Irene Selak


Fri Feb 26, 2010 11:52 pm
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How does the initial hospice thing work? Do they need to go to his dr. and the ALF and look at his medical records, talk with his health care pros? Meet with him? Do they need to have a family member present to meet with initially? Is it different in different places?


Sat Feb 27, 2010 8:22 am
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Actually the doctor orders hospice and contacts them, they will go to the
facility where your Dad lives and do an intaken and go from there, will you be able to attend if they tell you when they are coming?

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Irene Selak


Sat Feb 27, 2010 8:41 am
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Tony had a bed sore on his tail bone, actually bleeding a little. Hospice came in. They applied a rubber type bandage, derma something to protect it and lantiseptic, a yellow jell like stuff to help it heal also. It is now healed. Every time they change him they put that lantiseptic on him, they provide this. They also lay him down for a couple of hours in the afternoon. I am vigilant when I give him a shower and pile that lantiseptic on the spot that was open. If he is in an ALF get the nurse to put it in the order to apply lantiseptic EVERY TIME they change hiim. By the way, that lantiseptic has yellow bees wax in it and it STAINS everything and leaves a greasy spot on his pants. Good Luck! Hospice is wonderful.


Sat Feb 27, 2010 10:24 am
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If I know when hospice can be there, either my sister or I will be there with them and him.
I just found out that his pressure sore is about the size of a dime and goes down to the bone. I'll find out if they are using lantiseptic and if they aren't I'll ask them to get it. Thanks for the advice. They are using the derma whatever and a special kind of bandage.
They are making him lie in his bed except for meals and he is having a fit. He is so mad he is banging the backs of his hands on the walls. I have been wondering why the backs of his hands are always very bruised. He told me that he knocks into things and when he falls he's hit his hands. Now I know what is really happening as my sister was there when he did this. Any advice on this one? Lynn


Sat Feb 27, 2010 1:52 pm
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Joined: Sat Jan 03, 2009 2:59 pm
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The only suggestion I have is to see if they will move his bed away from the wall!
I am sorry that your Dad is going through this, the sores that go to the bone are the hardest to heal and I do hope they are seeing to it that he has enough fluids as the skin will break down even more!

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Irene Selak


Sat Feb 27, 2010 2:59 pm
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Joined: Fri Jun 26, 2009 9:39 pm
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Lynn,
Just to reinforce the wound care specialist. We had a large wound that would not heal. After three doctors and two rounds of antibiotics, I asked for a WOUND CARE SPECIALIST to come, not just any home health nurse. She cleared him up in about two weeks. She really knew her stuff. Johnny's was on his foot and I know it's somewhat different, but you might try insisting on a specialist. Now we are on hospice, too, and the lantiseptic is good stuff, though that's not what was used on his wound. It's a good barrier and it is used profusely on his buttocks, so hopefully we can avoid the pressure sores there. I wish you luck.
Judy


Sat Feb 27, 2010 3:37 pm
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