“Oh, that hurts! You’re hurting me. Please, please, just leave me alone. Please stop.” These were the words of Louis Daly, a friendly, cognitively alert African American man in his late 80s, as nurses were changing the dressing on his stage IV pressure ulcer two days before he died. (This is a real patient; his name and other identifying details have been changed.)
So starts “Dying with a Stage IV Pressure Ulcer” in the January issue of AJN. (To read the best version, click through to the PDF version at the above link.) This case study is a truly agonizing look at how care goes wrong in America’s nursing homes; the article also provides an in-depth ethical analysis of the dilemmas confronted by nurses who work in nursing homes with substandard care.
Nurses often first meet older patients and their families at the moment when those patients find themselves confronted with the need to enter some form of long-term care. What guidance can nurses provide? One excellent tool now exists to gauge the quality of the nursing homes. As noted recently at the Wall Street Journal, the Centers for Medicare and Medicaid Services (CMS) recently started Nursing Home Compare, an easy-to-use and free Internet site that ranks facilities “based on government inspection results, staffing data and quality measures.”