Pikes Peak Center review: nursing home care

My wife has been a patient at the Genesis Pikes peak center nursing home for 2 1/2 years and it's been a constant battle to get her proper care, it appears that this facility is the opposite of everything you advertise on your web site, these are my most recent complaints submitted today.

GRIEVANCE:
Inconsistent, inadequate fluid intake: For many months I have been trying to ensure that my wife receives adequate fluid intake. About 6 months ago at a patient care conference, I suggested that we attach a fluid chart to the back of Laura's wheelchair to monitor and remind the staff to administer fluids, it was agreed that this would be put into her care plan and after few months we finally got the chart but no one explained to the staff what to do with it but I was able to get most of the staff to use it, however, one nurse, Lynn, has been very resentful and resistant to use it. I recently sent e-mails explaining the importance of ensuring hydration, the last one to Diane Armstrong yesterday. We also had the physician write an order to monitor fluids to call their attention to this issue. Considering that Laura was recently hospitalized for dehydration, I would think that there would be some concern for this issue.
This evening after noticing that the fluid chart was still blank I asked what Laura's fluid intake was.
Lynn notified me that she had 400 ml. intake and that they would no longer be monitoring Laura's fluid intake, she had discussed it with the nursing Director and she rescinded the care plan and discontinued the medical order because " monitoring fluids is not part of Genesis policy and we don't do intake and out put at this facility. I gave Laura 1500 ml. fluid with dinner between 5 pm and 7 pm. I don't think that 400 ml from 6am until 5 p.m. is adequate. Laura is non verbal, unable to drink by herself or eat by herself and it requires patience to get her to drink, one needs to leave the straw in her mouth for 30 seconds to get her to drink. This facility is chronically short staffed and there may be multiple CNA's floating in and out of this unit during a shift, not all aware of Laura's needs. Having a nurse who feels it's not her job to monitor fluids and a nursing supervisor who agrees with her is not a safe environment. I can't help but notice that patients that can't care for themselves appear to have a very short life expectancy.
GRIEVANCE: Last Friday there was cigarette smoke in the 900 hall way and I had a difficult time feeding Laura due to her wheezing and shortness of breath. Prior to this unit becoming the designated smoking area Laura's asthma was well controlled. This evening there was the smell of cigarette smoke in the TV room although no smokers were present or nearby.
GRIEVANCE: Positioning in wheelchair. During Laura's hospital stay fir dehydration she was evaluated by speech therapy and the only recommendation that they had was to have her sit up straight to eat. It took 2 years of complaining to get her arm supports to keep her from leaning sideways but she is still sliding forwards in her chair, even after sliding out of her chair, landing with her feet under her causing a fracture dislocation requiring surgery and a week in the hospital.
Apparently the therapist feels that lying back will keep her from falling out of the chair because most people fall out frontwards. Even when she is placed all the way back in the chair, the seat which is attached by straps still slides forwards a few inches, putting her into a reclining position with her head back. If she has not slid too far forwards her head can be kept up with a small pillow or neck support. I would suggest Velcro to keep the seat from slipping forwards.
GRIEVANCE: Laura's roommate, who I have authorized to advocate for Laura when I am not there tells me that Laura was left in her wheelchair in her dark room by her self today and was crying, she did report this to the nurse but feels that the nurse was hostile to her. Also she didn't feel that the CNA was doing an adequate job of feeding Laura lunch, offered her very little food because shje was too busy socializing, and she has told me before of occasions when the nurses were too busy feeding themselves to feed Laura.

Yesterdays e-mail to Dianne and prior email 07/22/2019 regarding these issues:
If he feels that he can not get a good enough exam clinically at the facility or finds something suspicious on the clinical exam then yes.
Also, the fluid chart has not been filled out recently. I know that Lynn resents using the chart because it uses ounces and nurses use milliliters and she puts it in the electronic chart, but the purpose is to raise the awareness of the entire staff to give fluids. When a new nurse or CNA comes on and the chart is blank, they tend to ignore it and are not aware of the need for fluids.
Last Friday the smell of cigarette smoke was in the 900 hall, Laura had difficulty eating dinner due to increased wheezing and shortness of breath. When the rooms on the smokers side of the hall way get overheated they open the windows and doors. I would recommend putting air conditioners in those rooms to discourage them from opening the windows.
I have been trying out cervical pillows to keep Laura's head up, initial positioning when placed into the wheel chair is still very important. In addition to being all the way back, her body and legs need to be facing forwards with her feet flat on the foot rest. I noticed when she was leaning to one side that her legs and body were turned tot he side.
Let me know if and when you schedule a dental exam so that I can attend.
Thank You for your consideration,
Ken Ginsburg

From: Armstrong, Diane
Sent: Tuesday, July 30, 2019 4:15 PM
To: Ken Ginsburg
Subject: Re: [EXTERNAL SENDER] Patient Care Meeting

Do you want me to set up a dental exam under sedation? It would be done in the hospital with Dr McIntyre.

On Mon, Jul 22, 2019 at 1:04 PM Ken Ginsburg wrote:

I will not be attending the meeting this week. My wife requires care every day and I have found that the 15 minutes every 4 months has not been helpful to us. It appears that the purpose of these meetings is
to fulfill your check list rather than address our concerns. Our concerns are only addressed after multiple complaints, it appears that a reactive approach is preferred over a proactive approach.
To fulfill your checklist funeral arrangements are the same, hospital preference is still UC Health, she can continue the no code status from the hospital if it is confirmed that her heart has stopped, keeping in mind that if she is given a food that she is allergic to and has an anaphylactic reaction her pulse may not be palpable, otherwise she is to continue receiving full care.
She should continue regular dental exams and if the dentist feels that she needs to be sedated for the exam then I consent to that. At Laura's last hospitalization and surgery for her ankle fracture her bio-markers for sepsis were elevated and if it was from a tooth infection no one would know.
I would like to be kept informed of Laura's medical and other treatments and any changes in her care.
I was not notified of Laura's Orthopedic follow up appointment. I kept asking the Nurses about it, they told me don't worry someone will call you, but the only call I received was from the home health nurse calling for the Orthopedic Surgeon to see if we needed help. I advised her that as far as I knew no one was taking care of Laura's ankle fracture. She offered to call the facility and let them know of my concerns. Shortly afterwards, when I asked Nurse Laura to make sure that she get an appointment, she was able to find the appointment and advised me that someone would call me to confirm that she was to be transported but the only call I got was
an automated confirmation call from the orthopedic clinic. I still do not know when Laura's next orthopedic appointment is.
My concerns remain the same.
Adequate fluid intake: I have worked hard to educate the regular nursing staff about this and they appear to be doing their best to meet Laura's needs, however, regular staff is not always there and sometimes they're understaffed or to busy taking care of the very vocal demanding patients who can make their needs known. Many times the nurse assumes that the CNA is giving fluids and the CNA assumes that the nurse is giving fluids.
Several months after I suggested we keep a chart on the back of the wheelchair at our last meeting, I flagged you down in the hallway and asked you about this. You got some blank preprinted forms out of the office and put them on the back of the wheelchair. The next day I asked the nurse why they weren't using the forms and she said " Oh, the CNA said those forms are not for us". I have been trying to monitor and educate the staff about this but it's not my job which causes some resentment. Unfortunately, there appears to be no social worker or nursing supervisor available in this unit to monitor the situation on this unit.
Positioning: The side arm rests have solved the leaning to the side issues, however, Laura still slides forwards
in the wheelchair causing her to lean back in the chair with her head extended. At her hospitalization for dehydration prior to this last one she was evaluated by speech therapy in the hospital and their only recommendation was that she sit up straight to eat. When she has not slid forwards on the seat pad, placing a small pillow behind her head keeps her upright. The seat pad is kept in place with an adjustable belt, but even when it is tightened as much as possible, it can still slide forwards several inches and the seat covering itself is slippery which can cause additional slippage.
Cigarette Smoke Exposure: Has improved, now just mild intermittent exposure when the patients on the smoking side open their windows and doors.
I am not able to monitor staffing levels, but when I arrive in the evening and Laura's room smells of urine and I find urine soaked clothes and bedding, I would assume inadequate staff would be the cause. It appears that we get taken care of most of the time in the evenings with the help of CNA's from other units, employees new to the unit have the most difficulty getting help.
I will continue to monitor Laura's situation and let you know of any continuing problems. I am hopeful that Laura will be well taken care of, I really have better things to do than complain about deficiencies in her care.
Thank You for your consideration,
Ken Ginsburg

She is still Laura and I just want her to be treated as a human being rather than as a vegetable.
I really do appreciate the good nurses who are respectful and sensitive to our needs. Since nurse Laura has come to our unit she has been very helpful and respectful, my wife is happy when I get there because she has been treated as a person, her roommate is amazed at how well she feeds her and takes care of her, and the evening nurse Wilma treats us the same way also. Unfortunately, with the rotating shifts they are only there about every other week and we miss them when they're gone.
We are still hoping for a resolution of these issues.
Thank You,
Ken Ginsburg