Will Medicare cover a nurse doing bandage changes on moms heels with bedsore like wounds if mom is in a hospice program.

When my Mom broke her arm I took her to the ER. They asked her all kinds of questions and put her in a room. Mom was the only one there. Nurse walks by and says "put this on her" A hospital gown. I said I didn't feel comfortable in putting it on her because she broke her arm. The nurse got snippy and I said "well you are the nurse" she came back and said "yeah guess I am". When Mom was in the AL I did nothing that was the aides responsibility. The facility got paid well for Moms care also that nurse at the Hospital.

If you are uncomfortable doing anything don't do it. Let hospice provide the people needed to care for Mom. And I would check with State law if an aide can do bandaging. From what you have said so far, I would not trust them. They need to know what to look for.

Gd Stacy means that wipes are covered as disposables when disposables are justified by taking the person out-and-about; whereas if the problem is merely an Everest-sized mountain of laundry in your house then you're on your own.

Yes?

Gd, it is quite difficult to break somebody's leg no matter how ineptly you change the dressing on her heel. The same is not true of inadequate training in moving and handling. A Hoyer lift is a very good idea but do not underestimate the care required to use it safely.

Do not touch those dressings - do not lift and peek, do not roll down to see the layers. If there is seepage (as opposed to staining), place a disposable bed pad under the affected foot and call the nurse.

ME TOO (about WOUND care NURSE) and thank you for not telling me I can do it. Listen, a number of years back, with some difficulty, but loads of support from my beloved vet, I took care of one of my pups who had an abscess on her belly. We only had theories as to how this ever developed, but it did and needed care. IT was a challenge for me, but it was me or very expensive bills, so Joan helped guide me through it all, and my pup, bless her heart, was capable of feeling the love and gentleness and let me do what I had to...but even with her she had a say: she objected to the suggested warm compresses so we just did 2x a day dressing changes by my very gentle hands, and in combination with a med known to be good for vet skin infections, we healed her! We had even at Joan's suggestion, trekked to OHio State where they had no help to offer. Back home, gradually this literal hole began to shrink up and the drainage continued to diminish....from the size of a draining orange, down and down it went until the opening went from a quarter,, to a nickle, to a penny and then dime, to vanishing! Just to say I have dealt with rough stuff when essential...but I think this is really pushing it, considering the other stress I am coping with. ANd what if I am alone in the task and mom becomes...well, challenging, could kick around...heck, it was enough just assisting the nurse as I could holding her leg up so she could wrap the heel easier/quicker.
At this point it is my understanding that the hospice house facility is only used for very particular situations and often expected to be paid for not necessarily covered by Medicare. I wouldn't doubt with someone always watching over others of lower status so to speak that the care would be better.
Yes or yes, bless you for acknowledging how hard it is to be the one in person to see the decline. I guess I am blessed to see the flipside of my very active 104 year old father thriving. I am so busy trying to survive and do what I can for mom especially, and taking care of my pup who is the world to me, that I don't have time to feel for dad's pain which he must have...they will be married 72 years in a few weeks (oh and how will we acknowledge that?) and I can't imagine his going to bed of late without her beside him which all happened so suddenly it seems. I don't even want to take my blood pressure because a high reading will stress me more! ANd SHHH...I have been honest with the surgeon, but I am not taking the damn meds. That creates considerable stress for me as I am one of the worlds worst pill poppers. It also generates stress to see the bottles and watch the clock and have to have my life scheduled around the dosing. I have NO YELLING yet to connect with the assigned cardiologist, yet note I was under his roof for over a week and he never saw me either. I would be open to considering a patch but I guess BP meds in patch form are rare or have issues of their own. Trying to eat things higher in magnesium and potassium. Thank you for your love and thoughts and prayers...and the hugs. Means the world to me. Another stressor is the lack of support from my only out of town sibling. It was really hard after all I have done for our folks, to have her incorrectly conclude I had a heart attack, and that it was my own fault...in fact when she moved some 19 years ago, (can it be?!) her parting words were if mom and dad needed help, to put them some place, as I was entitled to a life of my own. SHe feels no sense of family,or need of family or obligation to those who have helped her. That's just not, for better or worse, me. I could never turn my back on my parents. OK I think I will get some clothes on and go see if I can find the A&D and a pool noodle....thanks again....

Found it! - this is what I was looking for, it's a version of the skin integrity leaflet I was given after mother was discharged from rehab.; it includes various checklists and templates for record-keeping for both family caregivers and visiting professionals. If you can't open the link I'll have a go at copying and pasting the sections, just let me know.

https://www.shropscommunityhealth.nhs.uk/content/doclib/10791.pdf

Dressing of open pressure sores requires nursing qualifications. I'd be surprised if the aides were allowed to do it. We're certainly not, in spite of having had skin integrity training.

Have you been told how often these dressings should be changed? I suspect it's not as frequently as you think (which might also give you the heebie-jeebies, I appreciate, but there is method in the madness).

More to the point, positioning - do you have the means to keep those heels clear of the mattress surface without applying excess pressure to other points? Frankly, this ought not to have been allowed to progress - though I'm afraid I might be adding fuel to the flames by saying that.

On the plus side, let me tell you you certainly CAN'T do it. Out of the question. What you can do is report any lifting, curling, clumping of the dressing; any further areas of skin breakdown; any seepage, odour; any redness/breaking in surrounding skin.

Yes, hospice will treat them, and they'll be covered by Medicare.

My mother has been in hospice since January, and she's had a pressure sore on her heel the entire time. It's a ghastly thing to deal with, and under no circumstances should you attempt to treat it. I help Mom's hospice nurse with the wound care (by holding Mom's foot while she treats it), and trust me, you don't have access to any of the medications she uses on that thing. Mom's heel looks like a moon crater, but it isn't infected nor is it wet and soggy, and that's what's important. No matter how much empathy you have, you absolutely should not mess with it.

If you don't like the hospice company you're using, fire them and hire another one. I did that with my dad's first hospice company. I hired another one, THEY notified the first company that they were being replaced, and the two companies coordinated together to switch out all the medical equipment in the space of 45 minutes. My dad merely had to be switched from his hospital bed to his old bed for that time, then we were able to get him back to bed with a minimum of inconvenience.

CNAs should not dress wounds. They are not trained medically. CNAs do the dirty work so LPNs and RNs can do the nursing. They have maybe 10 weeks of training. Certified does not mean they do what nurses can do. It means they have passed a training course and in my State are Certified by the Nursing Board.

Woundcare is a specialty. My daughter did it for years in rehab/nursing facilities. She now is now a Unit Manager of a Woundcare clinic in a Hospital. They know what to look for. With my Dad and open sores on his heals while in Rehab, my daughter saw dead tissue when she looked at them. Those bandaging him did not note this. The DON was made aware and Dad better cared for.

I am with Grandma here. This is a question for the Nurse in charge.
You may also want to approach her about what are the duties of the CNAs. You have made them aware where the laundry room is, ect. Is it not part of their duties to clean up after?

Do you have a trashcan nearby that soiled depends can be put into. By the bed, in the bathroom? If in the bathroom, and seems the bathroom is close, why are they not using it? I bought a small flip top trashcan with a flip lid I lined with a trash bag. I put one of those stick ups in the lid.

I too would not appreciate what these aides are doing. I would question if they are certified. I have a friend who has never been certified and she cares for people. She even worked for Visiting Nurses because of her experience. I would, one more time, talk to the Supervisor. Tell her what you are finding. Then ask if cleaning up is one of the aides duties. If the answer is NO, then you will just have to make things easier for them. As u have already done, a hamper for the towels, now something to hold dirty depends.

I wasn't there for Dad's home hospice. Mom was in a NH. But I did have an aide for homecare. She was able to bathe Mom in the shower but I do think towels were left for me but her soiled diapers were put in the trashcan provided. I was so happy that she was showered and dressed that clean up didn't bother me.

You have a right to question. But you may have to except that these aides are lazy. Our Hospice was associated with a Hospital and did ask for donations. That I would not give in your circumstance.

I’m so sorry for all you have been through - it is so hard to learn all the ins and outs and I have found like you that many places do not make it easy for us as family to learn - hence why this is such a great place to share and learn.
Any time we spent in skilled nursing rehab - acute care or hospitals the CNAs were never allowed to change moms wound care bandages.
They always had to go get moms nurse - moms nurse wound have to be the one to have eyes on it so she could report any changes and she had to be the one to apply the new bandage.
I would ask for either a wound care consult or if their has already been one then ask to see the orders on how it is written up to be treated. If a wound care consult was already done then I believe they follow the case and have to do daily/weekly check ins (depending on the type of wound) to follow and or make changes if needed. Either way ask to see the orders so you can see how often it is suppose to be changed - who has to apply and make progress notes in regard to it?
We have wound care for moms arm in home right now. In home health nurse check it once a week and wound care specialist comes once a week to see if any changes need to be made and how it is progressing (I do all the other dressing changes the other 5 days (but that is because we are at home) and I can call or report if I need them in between those 2 check ups.
Moms wound was not healing so our wound care nurse sent us to the wound care center and the Wound Dr was the one to write up the new orders to be followed. My home health has to order me those exact supplies and treat it under those orders given by the wound care Dr.
Im not a nurse so maybe one of the nurses here can give more insight on whom can change dressings but in my experience it has been only the Nurse who can do so.
Again - request to see the orders for it - some dressing changes may be every few days or every day - some dressing are made to not have to be changed daily unless soiled some can stay on for several days and are meant to do so.
Also do they have anything else protecting her heels? They usually provide things like air boots and I would also ask hospice to order her an alternating pressure mattress this will help her heels as well as her whole body from pressure sores.
Prays for you to get some answers and good communication from her drs and hospice that may help you feel better.🙏🏼

Hospice has specialized would care nurses that they should send to address any pressure sores. Once an evaluation has been done and a Care Plan developed the CNA's in some cases can carry out the treatment and wrapping of wounds. The nurse that visits weekly is also able to continue the care as indicated. If it is a deep wound the Wound Care nurse would be involved as well. But this is all part of Hospice and caring for the patient so Medicare will cover the care.
Any problems that you have with the Nurse, CNA not doing what you asked them to do (if it is reasonable, and within their scope) you should be able to ask them to do if it makes your job of caring for mom easier. You can call Hospice and ask to talk with the Team Care Manager and discuss things with her or him.
AND please know if you are not pleased with the care you are getting, if you feel that they are not following through you have the right to contact another Hospice and interview them and they can help transfer mom to another Hospice.
the staff should treat you and mom with Respect and Dignity. And they should not leave medical waste or "contaminated" items out. Make sure they have a hamper and a covered trash can they can use to put items in.
Before you pay privately for a Wound Care person discuss the problems with Hospice and ask what the ramifications would be if you did do that.
Also just out of curiosity.....
There are 2 types of Hospice. FOR profit and the other is NOT for profit. That might make a difference.

gdaughter,

I am so very sorry that you are struggling with this situation. Don’t worry, I will NOT tell you to treat your mom’s heel sores yourself.

I really feel that a wound care nurse needs to be handling this situation. I don’t think that I would be comfortable having her aides doing this job. My mom was on hospice. She had one bedsore in spite of wonderful compassionate care by the staff. Mom was 95. Her skin was breaking down.

The aides were terrific at mom’s hospice house. They did a good job bathing her. She was bed bound the last month of her life. I respect people who know their limitations. The aides would tell me that they weren’t comfortable treating mom’s wound on her backside. They would make a call to the nurse. The nurse would come out to treat it. Sadly, it never completely healed. It was painful for mom. They gave her pain meds. She was dying. We wanted her to be as comfortable as possible.

It’s really hard watching our parents decline, isn’t it? I feel your pain. It hasn’t been that long since my mom died. She died at the end of April.

I understand about your blood pressure and anxiety. I had mom for 15 years in my house. My blood pressure was sky high. I wish that I could be of more help. You’re in a very difficult situation. You will be in my thoughts and prayers. Many hugs sent your way.