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Decubitus Ulcer
by Sherry Ernst

My father died from decubitus last month at the hands of a nursing home. It was horrible. He had stage IV decubitus that you could stick your fist in. He was almost whisked off to the crematory before I intervened. I traveled to the funeral home. After they pulled him out of the freezer, they brought him into a small private room. I took it upon my self to turn him over and saw three huge bandages. I removed them and was horrified. I almost vomited but the grief won out. The pain he must have endured. There were two holes in his hip that I could have stuck my entire fist in and I could see his bone surrounded by a void where the skin, muscle, and many layers of tissue used to be. No one would have ever known the extent of the neglect he suffered if I had not looked at his backside. My father is not an isolated case but instead I have found that he is the norm. I was planning to take care of him myself at his home after he had his stroke but that is a very long and very sad story. Needless to say I was helpless to his being discarded into a nursing home. I have made it my personal lifetime goal to make Decubitus a household word so that my father will not have died in vain. I am a very motivated person and will carry on the fight until the end of my life. There is a whole world out there, including seniors, that is ignorant because of the lack of preventative advice or information anywhere on decubitus. Our country needs to wake up and smell the coffee. We treat the whales, dolphins and wild horses better than we do our bedridden relatives and friends.

There is NO reason for one single person to develop Stage I, Stage II, or Stage III decubitus to qualify for a preventative bed or other treatment. The rain forests get more attention and pro-action than a bedridden person. You know Decubitus is a flesh-eating-to-the-bone monster. It is ugly and causes excruciating pain and agony. Our nursing homes and Veterans Hospitals are full of Decubitus deaths. If I am aware of this, such a person as you, are aware of this also. Other than all the pharmaceutical companies that stand to lose from lack of sales of their expensive medicines etc., what is standing in the way? Pressure Reducing Support Surfaces Group II and III, are allowed a patient only after the patient has a Stage III (full thickness tissue loss) or Stage IV (deep tissue destruction) pressure ulcer according to Medicare policies. This is inhumane! Why does some elderly person have to go through this torture? It would be so simple for the code to be changed so that a serious stroke victim that has been paralyzed for example with a 99% risk for decubitus, can go right onto a Group III bed. God, let the poor elders at least die without UNNECESSARY pain. There is no DRG (drug related group) for a bedsore. No hospital patient is ever assigned the primary diagnosis of decubitus. Few, if any, are ever recorded as dying from their pressure wounds, yet many do. What doctor is going to put on a death certificate that the patient died from decubitus or sepsis from decubitus that equates to neglect. All the studies and studies of studies are not accurate because of this. Medicare allows payment to hospitals for rental of special decubitus preventing beds in Group II and III only after the wound has developed and reached life- threatening dimensions. Yet even when that stage is reached, few hospitals and doctors will call for the therapy because it will cut into their profits and we both know this. Isn't it true that Congress has designed a cost containment system that insures the debasement of the patient unlucky enough to land in a hospital that gives him or her a bedsore?

The National Pressure Ulcer Advisory Panel (NPUAP) is funded by two large nursing home corporations that are the worst offenders of decubitus in the country. It appears the are hypocrites.

It does not seem possible to imagine a greater insult than to have the hospital or nursing home you depended on for care cause you decubitus. Then the hospital or nursing home insists that you suffer with it until it develops into a horrendous wound before the Support Surface II group that would have prevented the ulcer in the first place is provided. I would be much less expensive to get the right bed in the first place to save the taxpayers huge amounts of money. You know the figures. A Group II and III support in place is less expensive than treating the decubitus ulcer especially with surgery for debridement.

Please forward to me anything that you might know to help me in my battle against the monster Decubitus. It is too late for my father but is isn't too late for the huge senior population that is coming up. We are going to find ourselves in a crisis if something isn't done soon to educate the public so that we can change the inhumane Medicare policies and change the nursing home standards of practice by making them accountable for their neglect.

Our senior population is reaching the highest numbers ever and by the year 2010 it is estimated that we will be in a crisis. There are the terminally ill patients that are not going to recover -- but must lay somewhere on some thing while they are dying. Why can't they have a support group III surface to lay on whether ti be in a nursing home, hospital or home so that they can die without the pain of decubitus. What would you want when you are the patient in that hospital bed when you are dying?

How wonderful to be in the hands of someone that can get you a group III bed because HCF had changed their Medicare reimbursement system on durable medical goods. How horrible it would be to develop a stage III ulcer and have someone come to you with an electrical device to stick in the gaping bloody hole in your backside. These two scenarios are not possible now only the latter with the TENS. I know what the majority of people would want for their mother or father who are in their eighties and bedridden!

I have founded an organization called nodecubitus.com. Our mission is to have the laws changed concerning nursing home neglect and hospital neglecting the United States; our goal is to change the Medicare law concerning preventative care with regard to the high-risk decubitus patient. It is our organization's belief that preventative durable medical goods from the Group II or III support surfaces are necessary to stop the decubitus before it starts in these terminally ill patients that are inevitably going to get decubitus without special treatment and support surfaces.

We, as concerned and compassionate human beings, need to all stand up and shout, "We will no longer stand for the blatant neglect of our elders in the hands of big profit nursing homes." If an animal is abused or a child is abused there are laws mandating the report of the abuse. Not so with our elders who are just as vulnerable as our pets and our children. In Florida it is a law that you will go to jail or get a stiff penalty for harming an alligator. We feel it is high time to acknowledge the seniors and give them the same kind of protection that an alligator has.

Nodecubitus.com plans to educate, pass the word and stir up the dust of indifference that the general population has for the neglect of our elders. When someone neglects or abuses a vulnerable elder then they must be held accountable for their action no matter whom they might be. We need to do something to nursing homes that fail inspections time and time and time again. It's time we shut down nursing home chains that fail government inspections over and over again. They need to start putting some of those big bucks they find to pay their CEO's into the standards of their nursing homes. And if Medicare is made to reimburse them for the proper equipment we might see some change in this deplorable situation. We need to recognize there are not enough nurses to adequately take care of the critically ill and terminally ill patients. This is due to understaffing from the greed of corporations. Florence Nightingale would roll over in her grave if she knew what was going on with the terminally ill and dying patients with regard to decubitus and lack of preventative care. A person sticks their hand on a poison ivy vine and they naturally get the poison ivy rash. Do we need to study and study and restudy that this person will break out in a rash. Do we need millions of dollars of research to study that poison ivy will give you a rash and study the rash till the cows come home? Do we need to study the studies and monitor the rash with millions of dollars more in research? Or, can we just figure out how to avoid the poison ivy in the first place. It doesn't take rocket science to figure out putting a fence high and wide enough around it will keep peoples hand off of it and it doesn't take rocket science to figure out that an appropriate bed surface would help the terminally ill from developing ulcers faster than they can die.

The elders are so vulnerable. Elders are more vulnerable than baby's; at least babies can grow up and sue their perpetrators. Our elders go to their graves silently.

There might be another alternative to nursing homes and that is foster care for the bedridden. We have foster care for children and teens and midwifery for baby's birth. We need the same for our seniors in their final months. We need an organization (by the grace of God I plan on initiating) that has compassionate citizens willing to adopt the bedridden elderly to keep them free of decubitus and make sure they have a loving crossover. If you have any ideas or any information that can help me on my quest to create a new path for seniors to spend their last few months other than in lying on holes in their backside I would appreciate your help. We need for you to join us.

Thank you kindly for you attention,
Sherry Ernst
President and Founder
nodecubitus.com (Website to be up by end January)
email: stopthepain@nodecubitus.com

submitted January 23, 2001

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