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Read: Ruth's Story at a nursing home | Lynn's Story with home care

Ruth's Story

Ruth, age 82, has slept with six down pillows since she was in her fifties. Her grown children are unaware of this, and her husband is deceased. Due to some mild arthritis, she is only comfortable and able to sleep if the pillows are positioned in such a way that they support her arms and legs. Following a hip fracture and subsequent hospitalization, Ruth goes to Golden Years Nursing Home for an anticipated five-week rehabilitation stay. She is assigned a room and given one pillow for her bed. Her recent injury, hospital stay and transfer to the nursing home understandably disorient Ruth, who already suffers some mild short-term memory loss. The physician she has just met on admission to the nursing home has diagnosed her with Alzheimer's disease.

The staff interprets her request for six down pillows as "confusion" and charts this in her record. Her family consists of two daughters, one in Texas and one in Illinois. The staff assists her to call them on the phone, but her continued requests for the pillows is both annoying and confusing to them, and Ruth's ability to communicate effectively over the phone is hampered by her moderate hearing loss and growing frustration over her inability to sleep. In an attempt to address Ruth's needs, the staff requests a sleeping pill from the physician. This order is given, and Ruth is started on a sleeping pill. The medication works, and Ruth sleeps well for the first time since admission. However, she sleeps so soundly, that she is incontinent of urine during the night.

The staff applies an adult incontinent brief, believing that they are sparing Ruth from the embarrassment of incontinent episodes. Ruth tries to explain to the staff (who believe her to be somewhat demented) that she can use the bathroom, but they are not responsive to this. Ruth, who is fully ambulatory following several days of rehab for her broken hip, makes repeated attempts to get up the bathroom by herself to show the staff that she simply doesn't require the adult incontinent briefs (which the staff refers to as "diapers"). Her attempts at unassisted ambulation are interpreted by the staff as further evidence of her confusion, and they place an alarm on her bed and a seatbelt in her wheelchair (it is unclear when or why she was given a wheelchair).

So Ruth, who previously lived independently in her own home, is now both chemically and physically restrained, has been given a diagnosis of Alzheimer's disease, wears "diapers" and is essentially wheelchair bound. She is depressed and despondent. Her five-week rehab stay is now anticipated to be permanent placement due to Ruth's "need for 24 hour care and supervision." Why? Because she needed six down pillows and no one was aware of this, or held accountable for acknowledging it. If you believe this can never happen to you or someone you love, be assured a scenario similar to this happens hundreds of times each day in nursing homes throughout the country.

Click here to read a comparison of how Ruth's day would have been different, if she had a care plan.

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