Trends in Long-Term Care - U.S. Senate Special Committee on Aging

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I do feel that bed rest and the quality of care at health <strong>in</strong>stitutions
<strong>in</strong> general, <strong>in</strong> the nurs<strong>in</strong>g homes <strong>in</strong> particular, I th<strong>in</strong>k a number of
questions rema<strong>in</strong> to be answered.
Who works <strong>in</strong> these facilities, or their qualifications, who evaluates
these facilities, is of vital concern. They should be given greater
efficiency and fiscal responsibility, and <strong>in</strong> the adm<strong>in</strong>istration of these
<strong>in</strong>stitutions, this should be a primary goal.
Senator Moss. Is your report fairly contemporary, or are you still
see<strong>in</strong>g cases like these com<strong>in</strong>g <strong>in</strong>to your hospital?
Dr. DOBEIN. These examples I collected essentially on a day's notice,
with very little effort at all.
Senator Moss. They are very contemporary?
Dr. DOBKIN. Yes.
Senator Moss. Is dehydration someth<strong>in</strong>g that a patient would have,
if he were hav<strong>in</strong>g full nurs<strong>in</strong>g care?
Dr. DOBRKIN. Dehydration is essentially a very simple situation.
Senator Moss. There is not enough fluid.
Dr. DOBKIN. There is not enough fluid, yes, a state of be<strong>in</strong>g dried out.
It does not occur suddenly. The water does not suddenly fall out of
the body. It reflects long-term imbalance of more go<strong>in</strong>g out than com<strong>in</strong>g
<strong>in</strong>.
Many of these patients could help to hydrate themselves ord<strong>in</strong>arily,
but when it gets to a severe state, they need <strong>in</strong>travenous fluid.
It is someth<strong>in</strong>g that I th<strong>in</strong>k is amenable to nurs<strong>in</strong>g homes.
Senator Moss. It would occur mostly by not assist<strong>in</strong>g that person to
take fluids <strong>in</strong>to his body?
Dr. DOBKIN. Not assist<strong>in</strong>g them, and not help<strong>in</strong>g them take <strong>in</strong>
adequate fluid.
Senator Moss. I know what the cause of bedsores are, but how do
you prevent bedsores from people who are kept <strong>in</strong> bed?
Dr. DOBEIN. There are a number of th<strong>in</strong>gs that cause bedsores.
Elderly people's sk<strong>in</strong> is not as strong as young people's, and it will be
prone to break down.
The more important aspect, is the fact that people are immobilized,
they stay <strong>in</strong> one position for a period of time, the entire width of the
body is <strong>in</strong> one position, on one portion of the sk<strong>in</strong>, this will cause it to
break down.
If they are not assured of ly<strong>in</strong>g on different parts of their body,
mov<strong>in</strong>g around as much as possible. this will occur.
Rough sheets, as you heard described, is the other problem.
An important problem is wet sheets, where the patient will sit <strong>in</strong>
his ur<strong>in</strong>e, and feces, this will cause great risk for rapid breakdown
of the sk<strong>in</strong>.
Senator Moss. And bedsores usually become <strong>in</strong>fected if they hurt,
is that right?
Dr. DOBRKIN. They frequently do, to the po<strong>in</strong>t of death.
Senator Moss. All right.
Mr. HALAMANDARIS. I have a couple of questions. I would like to
direct these to Ms. Jarvis and to Ms. Hopper.
You alluded to some <strong>in</strong>spection reports, I would appreciate if you
enter those fully <strong>in</strong> the record.
One of those reports, which you related, went to the Towers Nurs<strong>in</strong>g
Home, which, I understand, went for 5 days without heat for one