Ethics, crime...senior care services--one woman's account

The following monograph is a true narrative of an individual seeking personal closure and justice for her departed mother. It is a story of neglect and theft in a nursing home and the cautionary signs that not all may be up to standards or within the guidelines of the law. It also depicts the rocky road of gathering evidence and how the law functions...even to the point of protecting the guilty.

I’m sorry, Mom…….I wish I had known

by

Jan Payton

March 2011

In loving memory of my Mom,

Verna

PREFACE

My Mom died May 27th, 2009. She didn’t die from a heart attack or stroke. She didn’t die from cancer. She died of severe dehydration and malnutrition. She died while in the care of trained nursing home staff. She died within hours of my conversation with her physician in which we discussed the results of lab work that I had demanded be done; lab work that was delayed for five days due to staff negligence; lab work that undeniably showed her kidneys had shut down. She died because the staff ignored all the signs of her rapid decline in health – denying the obvious weight loss and behavior changes that I noticed and inquired about repeatedly. She died because she was tired of living in pain; pain that she was unable to communicate verbally due to advanced Alzheimer’s; pain that went untreated because the staff, instead of administering her pain medication, chose to walk out the front door with it. She died despite my best efforts to save her.

This is the story of my two-year struggle to hold those responsible for Mom’s needless pain and suffering accountable. It describes the neglect she suffered, my attempts to rescue her from that neglect, my pursuit of justice after her death, my discovery of the theft of over eight hundred Vicodin pills by the staff, and the investigation of the theft by the police and the Department of Health and Senior Services. I tell the story, not to personally attack the nursing home or its staff, but to inform you of what is occurring in many nursing homes today – possibly the home where your loved one currently resides.

My seeking vengeance against the nursing home or its staff by naming names has no positive value. The value of this story lies in the advice that I share that will ensure the safety and comfort of your loved one. It is my hope, that by sharing Mom’s story, I will save your loved one from suffering the same fate as my Mom.

“I’m sorry, Mom……..I wish I had known.”

CHAPTER 1

ASSISTED-LIVING FACILITY

My Dad collapsed from aspiration pneumonia on Thanksgiving Day, 2005. As Mom had been diagnosed a few months earlier with the early stages of Alzheimer’s, I took a leave of absence from my job as an airline screener to care for her while Dad was hospitalized. Neither I nor my sister, Jo Lynn, was aware of the toll the disease had taken on Mom’s mind within such a short period of time. My Dad had taken great pains to hide her mental deterioration from the family. He was doing all the house-cleaning, laundry, cooking, and shopping. Once I began caring for Mom 24/7, I soon realized that she was incapable of caring for herself. If Dad was gone, she would need constant supervision.

Dad passed away on December 8th. Reality quickly set in – I needed to find someone to care for Mom.

I could not care for Mom myself. My husband was retired, and working part-time. Our family financial situation required me to work full-time so that we would have health benefits. Our home was a three-story house with bedrooms on the upper floor. Mom was unable to climb stairs due to arthritis and chronic back pain.

Within a month of Dad’s passing, I placed Mom in an assisted-living facility just minutes from my home. It was conveniently located along my route to the airport. I visited Mom each day on my way to work.

No one in the family expected Mom to survive very long after Dad’s death. They had been together for sixty-three years. She was totally dependent on Dad for all her needs. When she entered the assisted-living facility, it was the first time in sixty-three years she had faced life on her own. She had always been very outgoing – an instant friend to all she met. But now, facing life without my Dad, she withdrew and suffered a severe depression.

The staff of the assisted-living facility immediately stepped in to help Mom deal with her depression. They weighed her on a weekly basis, notifying me of any significant weight loss. Together, the Director of Nursing (DON) and I came up with a plan to stabilize Mom’s weight. I would cook meals at home, and the staff would heat and serve them to Mom. Once Mom’s weight was back to normal, the staff would ensure that Mom found her way to the dining hall, and they would help her select a meal that she would enjoy and eat.

I contacted Mom’s physician, and she placed Mom on an anti-depressant medication. She also prescribed physical therapy to help Mom regain her strength and stamina.

In the beginning, I would go to lunch with Mom and introduce her to other residents. Within a couple of weeks, Mom had made new friends and felt comfortable going to meals on her own. The staff, aware of Mom’s new-found shyness, also made a point to include her in social activities at the facility. She loved playing Bingo, in spite of the fact she had difficulty remembering the number. The facility had a beauty salon on site, and the staff would take her to have her hair done once a week, where she enjoyed chatting with other residents as they waited to have their hair styled.

Within a few months, Mom seemed to be on the upswing; she was enjoying life once again. She had companionship and had fun participating in activities the facility provided. And she was so proud of her studio apartment. We had furnished it with all her prized possessions – it was quite the show place. The management of the facility would always show Mom’s apartment when prospective residents wanted to see a studio apartment. She was happy and content once again. She had survived the death of my Dad. Mom had proven the family wrong – she really was a “tough old broad.”

But Alzheimer’s is an unforgiving and cruel disease. The disease began to ravage Mom’s mind at an alarming rate. Although she was able to dress herself, feed herself, tend to her bathroom needs, her mental capacity was diminishing rapidly.

In less than a year after the diagnosis of Alzheimer’s, Mom had no short-term memory at all. She would ask you a question, listen to your answer, and literally within seconds repeat the same question. The question would be repeated numerous times before she would finally be content with the answer.

She was once a voracious reader. Now she refused to read as it frustrated her. By the time she got to the bottom of a page, she would have already forgotten what she had just read.

She could not perform the simplest of tasks without supervision. Instructions would be long forgotten before she had a chance to perform the task at hand.

Her long-term memory suffered as well. She was once an accomplished pianist, having played since she was a child. Now she had no memory of playing. She could knit and crochet elaborate and intricate patterns. Now she couldn’t remember the basic crochet or knitting stitch. She once solved New York Times crossword puzzles in a matter of minutes – her vocabulary was beyond extraordinary. Now she couldn’t even complete the Word Jumble in the newspaper.

Mom had absolutely no concept of time. In spite of the fact she had four digital clocks in her room. The numbers on the face of the clock meant absolutely nothing to her. During the winter months when it would turn dark early, Mom would undress and crawl into bed at the first sign of darkness. The staff would have to re-dress her in order to take her to dinner. She would awaken early (around 4 a.m.), dress, then head to the dining room for breakfast. The staff would find her sitting in the dark by herself.

More and more Mom began to wander the halls of the facility. She would become bored in her room, and would start roaming the halls looking for someone to entertain her. She would easily become disoriented, would not realize that she could pick up any one of the phones in the hallway to call for help, and would walk until exhausted. Many of those treks resulted in falls out of sheer exhaustion.

Mom had no concept of the relevance of the emergency pull cords in her apartment. In spite of the fact I had printed several “MOM IF YOU NEED HELP PULL THE CORD” signs, and placed them all around her apartment, she never once used the cord to alert staff to a problem. As she began to fall more frequently, the Director of Nursing suggested we place a panic alert pendant around her neck. This was no more effective than the pull cords. She didn’t understand the significance of the pendant. In her words, “I don’t know what this damn thing is, and why I have to wear it all the time!” If she fell, she would either yell for help until someone heard her, or she would crawl out into the hallway where the staff would find her.

Every fall was accompanied by a trip to the ER of St. Luke’s Hospital. The assisted-living staff would send Mom to the hospital to be checked for fractures or head trauma. Toward the end of her stay at the facility, I had been called to the ER so many times that I was recognized on sight by the ER staff and called by my first name. (Luckily, Mom never suffered a fracture or concussion from these falls.)

The beginning of January 2007 Mom experienced two falls within a few days of each other. As with previous falls, she was sent to the ER and then released to go back to the assisted-living facility. After every fall I would always spend the night in Mom’s apartment, so that I could observe her and make sure she was capable of being left alone again. After the first fall, Mom seemed to do fine. She managed to go to the bathroom during the night, and get dressed in the morning without any assistance. The second fall, however, was a different story.

Mom had hit the right side of her temple in both falls. She had a huge knot on her forehead, and her face was severely bruised. CT scans performed at the ER did not show any evidence of a concussion. But the night of the second fall, Mom hallucinated all night long. She saw stampeding horses running through her room; she had long conversations with her deceased mother; she would ramble on about things that made absolutely no sense. I found her pacing her room, not knowing where she was or why she was out of bed. The next morning at breakfast, she became nauseated and unable to eat.

I immediately located the Director of Nursing and explained the events of the evening. She informed me that if Mom was hallucinating, the facility would no longer be able to care for Mom. I called Mom’s physician and explained what was occurring. She instructed me to take Mom back to the ER, and demand that they admit her to the hospital for observation and treatment of a possible concussion.

After Mom was admitted to the hospital, I returned to the assisted-living facility to discuss Mom’s future care. I was told that they could no longer care for Mom; she required more attention than their staff could adequately provide. I would need to place Mom in a nursing home.

CHAPTER 2

THE NURSING HOME

Social workers at the hospital helped me in my search for a nursing home. After a three day stay in the hospital, Mom was to be transferred directly to the nursing home of my choosing. While Mom was in the hospital, I visited all the nursing homes within the immediate vicinity of my home. The nursing home I finally chose was only minutes from my house. It appeared clean; the residents well cared for. It was by far the best of the facilities that I visited, and it came highly recommended by the social workers at the hospital.

January 19th, 2007 I moved Mom into the nursing home. My brother, Jim, flew in from Vermont and together we settled Mom into her room. The nursing home had just recently opened a lock-down Alzheimer’s unit. We selected a room we thought Mom would enjoy. We once again decorated it with all her prized possessions, making it look like a miniature studio apartment. We paid for a private room, as we knew Mom was very possessive of her “stuff” and would not do well with a roommate. Jim stayed in the room with Mom for the first few nights, helping her to get acclimated to her new environment.

In the beginning, I was very pleased with the care Mom received at the nursing home. The Alzheimer’s unit had two CNA’s (Certified Nursing Assistants) that cared for Mom as if she were their own grandmother. Both women understood that Mom did not comprehend the purpose of the call button. They would bathe her, dress her, and check on her every couple of hours to see if she needed to go to the bathroom. They styled her hair after every shower; they would put make-up on her when they knew family would be visiting; they painted her fingernails. Every time I visited, they were either in the room with Mom or would pop in to check on her sometime during my visit. Her falls seemed to decrease in frequency due to their vigilance. She didn’t suffer a major depression as she had when Dad died. I developed a strong friendship with these women, trusting them implicitly with my Mom’s care. Little did I know that later on, they would betray that trust in such a horrendous way!

Mom seemed to adapt to life in the nursing home relatively well. She managed to maintain her weight, plus or minus a couple of pounds each month. She relished the attention the women showered on her. She made new friends. Mom became very attached to a middle-aged man named Dan. He was on the Alzheimer’s unit because he had suffered brain damage in a car accident. She referred to him as “son” (he looked a lot like my older brother, Jerry). He was very kind and compassionate. He would sit with Mom during mealtimes, and visit with her during the day. The other residents Mom would refer to as “crazy old farts”, which tickled me considering she was one of them, but she adored Dan.

In the fall of 2008 one of the CNA’s disappeared from the Alzheimer’s unit. I inquired as to what had happened to her, and was told by the other CNA that she had been fired due to attendance issues. Within a couple of months, the other CNA was gone as well. I began noticing that a lot of familiar faces were now missing. A new administrator was brought into the facility. No one was offering any explanation as to why staff was leaving, why another administrator had taken over the facility. But the answer would become very clear to me after Mom’s death. Had I known what was actually going on, I would have immediately removed Mom from the facility.

The quality of Mom’s care declined after the disappearance of the two aides. Each time I would go to visit Mom, I would find different staff. I wasn’t able to develop a sense of rapport with anyone. I found myself continually reminding staff that Mom was unable to call for assistance due to her advancing Alzheimer’s. Her falls became more prevalent, usually occurring while on her way to the bathroom or in the bathroom. It seemed no one was taking the time to check on her.

Unhappy about the increased frequency of the falls, I confronted the administrator about my concerns. She suggested that we place motion detector alarms on Mom’s bed and recliner that would alert staff to her movement. The staff would then be able to respond, and help Mom before she fell. But this safeguard proved to be worthless.

Each time I visited Mom, I would help her to the bathroom. When she rose out of her recliner, the alarm would sound. Not wanting Mom to fall, I would continue our journey to the bathroom. Only once did a staff member respond to the alarm. Most of the time, the alarm would continue to sound as I assisted Mom into the bathroom. I would then shut the alarm off myself, after placing Mom back into her recliner. I would question staff as to why no one responded to the alarm. The reply was always the same – “We knew you were in the room with her.” How did they know I was still in the room? Mom’s doorway was not visible from the inside of the nurse’s station where staff tended to congregate. I could have easily slipped out without anyone knowing. And wasn’t that beside the point? The alarm was in place to alert them to a potential fall. It was their job to check on Mom. It shouldn’t have mattered if I was still in the room or not!

It wasn’t until the last month of her life that I discovered the staff’s solution to the problem was to put Mom in her wheelchair, and wheel her down to the dining room. She apparently was left sitting in her wheelchair for the majority of the day—many times sitting in her own filth for hours at a time.

You see, my problem was, I was too predictable as to the timing of my visits. I always visited Mom in the morning, an hour or so before lunch. The staff knew my routine all too well. I didn’t find out the real truth of what was going on with Mom’s care until she started noticeably losing weight. I suspected something was terribly wrong, and I began visiting daily at different times of the day. What I found was heart-breaking! How could they treat anyone with such total disregard for their dignity and humanity?

CHAPTER 3

THE BEGINNING OF THE END

Mom’s 89th birthday was April 29th, 2009. The weekend after her birthday, the family had a birthday party for her at the nursing home. I brought in Smokehouse BBQ (Mom’s favorite), baked a chocolate cake (also Mom’s favorite), and all the family, except for my brother in Vermont, came in for the big day.

We noticed that Mom was not quite herself that day. She had always been the regular “Chatty Cathy” of the group. In spite of the fact that the Alzheimer’s was affecting her speech (she would often stutter when trying to talk; she would get frustrated when she couldn’t come up with a specific word; many of her conversations were nonsensical), she nonetheless enjoyed being a part of the conversation, if not the center of the conversation. But on this day, she was uncharacteristically quiet.

We had presents for her to open. She appeared confused, not knowing what to do with them—not understanding why there were presents for her in the first place. My younger brother, Jeff, helped her unwrap the gifts.

We then proceeded to have lunch. I fixed Mom a plate and placed it in front of her. The rest of the family busied themselves with filling their plates, and settling down to eat. After a few minutes, I glanced at Mom and saw that she was just sitting, staring at her food, hands in her lap. She made no attempt to eat. I got my younger brother’s attention, and he proceeded to help her. Jeff picked up her spoon, and fed her a bite of the BBQ beans. She then took the spoon, and continued to eat the rest of her beans. Jeff had to continue this process through the entire meal. She devoured her chocolate cake without assistance, but sweets had always been her weakness. It appeared that the Alzheimer’s was affecting her ability to feed herself -- she needed constant encouragement or someone to feed her.

The first part of May, my sister and I noticed that Mom was still having difficulty eating. At our lunch the weekend of May 9th, we brought in one of her favorites – chicken strips, fries, and a chocolate shake. The same thing happened this day as had occurred at her birthday party. She sat staring at her food as if she didn’t know quite what to do. My sister and I had to verbally encourage her to eat. I had placed a long white plastic spoon in her chocolate shake as it was too thick to drink. We looked over to find Mom sucking for all she was worth on the end of the spoon – she thought it was a straw. It was more than obvious that she couldn’t feed herself without assistance.

The following weekend when I visited, I was astounded by her appearance. She appeared to have lost a significant amount of weight. I immediately located a staff member to inquire about her eating/drinking. I was told that they didn’t notice anything significantly different – she was simply “a picky eater.” When I assisted Mom to the bathroom, I noticed she was extremely weak. I inquired as to her ability to tend to her bathroom needs, and was assured by the staff member that Mom could still get to the bathroom on her own.

I wasn’t convinced by the answers I was receiving. What I was witnessing, and what I was being told by staff, was a complete contradiction. I began visiting every day.

On Wednesday, May 20th I visited Mom around 1 p.m. I wanted to see what, if anything, Mom was eating/drinking. She was sitting alone at the dining table, staring once again at her food tray. All the other residents had finished eating, and had either gone back to their rooms or were visiting with one another at other tables. Mom hadn’t touched a thing on her food tray, and the food was now cold.

I took her back to her room as I had brought chocolate ice cream that day. In transferring her from her wheelchair to the recliner, I caught the strong aroma of feces. It was evident that Mom had soiled herself. I immediately went in search of a staff member. I spoke to the head nurse who assured me she would have an aide clean Mom up as soon as possible. I went on ahead and tried to feed Mom the ice cream while we waited for the aide. She fell asleep, and was unresponsive to my attempts to awaken her. I talked to staff one more time as I left, and was assured that Mom would be cleaned up.

I visited the following day at my usual time. I found Mom sitting in her wheelchair in the dining room. As I approached Mom, I caught the overwhelming stench of urine/feces. I took Mom back to her room, and once again went looking for a staff member. I found a CNA talking on her cell phone in the dining room. I asked her when Mom was last bathed. She went in search of the head nurse, and returned telling me that Mom was bathed on Monday and Thursday nights. I asked that she bathe Mom immediately. The stench was too powerful to wait until that evening for her to be bathed. She said she would take care of it. It appeared from the odor that Mom had been sitting in this filth since the day before. This was not a simple bathroom accident! It was apparent that the staff had not bothered to clean Mom up the previous day.

On Friday, I visited at the beginning of the lunch hour. I wanted to observe a meal in progress. As before, Mom was sitting at the table, hands in her lap, staring straight ahead. I inquired of all the staff as to whether Mom was still eating and drinking. The CMT (Certified Medication Technician) was preparing medications off to the side of the room. She said, “You know your Mom refuses to eat if she doesn’t like what we serve.” I faced her and asked, “Did it ever occur to you that she’s not refusing to eat, she simply doesn’t know how to eat? Have you tried encouraging her to eat? Have you tried actually feeding her?” I then sat down by Mom, and proceeded to feed her.

I confronted the head nurse afterwards. I demanded that she notify Mom’s in-house physician immediately. I requested blood work be drawn that afternoon to determine the reasons behind Mom’s obvious decline in health. I wanted to know why Mom was losing weight so rapidly. If she was still eating, as staff led me to believe, then what was going on? Were her organs (kidneys, liver, lungs, heart) starting to shut down? I wanted answers, and I wanted them by the next day.

I also inquired as to Mom’s ability to go to the bathroom on her own. On this particular day, Mom was odor-free at the time of my visit. The head nurse, once again, reassured me that Mom was capable of handling her own bathroom needs.

On Saturday, I visited around 10:30 a.m. I found Mom asleep in her wheelchair in the dining room. I looked around the room for staff. Two aides were sitting in a corner of the room, braiding each other’s hair. I wheeled Mom down to her room, and immediately took her into the bathroom to check the status of her Depends. I found the Depends so saturated with urine that her slacks were soaked, as well as the seat of her wheelchair. I was livid! I found the head nurse, informed her that we had a problem, and if she didn’t take care of the situation, I was going to the administrator. I didn’t ever want to find my Mom in such a disgusting state again. Since she was in charge of the aides, she would be the one I held accountable. She assured me that she would let her staff know of my concerns, and would pass the information to the other shifts as well.

I also inquired as to the results of Mom’s blood work. She knew nothing about it. She checked to see if my request had been faxed to the physician the previous day. It had not! The head nurse from Friday (she was not a regular on the Alzheimer’s wing) had neglected to contact the physician. As it was Memorial Day weekend, any fax sent now would not be received by the physician until Tuesday morning. The nurse dropped by Mom’s room to let me know she had faxed the request for me.

When I got home from this visit, I sat down and began a journal documenting my attempts to work with the staff. As it was Memorial Day weekend, the administrator’s office was closed, and would be until Tuesday morning. I had every intention of confronting the administrator with this obvious neglect if Mom’s care did not drastically improve. I wanted to be able to give him dates, times, names of staff members involved, and the content of our conversations so that he could discipline staff accordingly.

The family attributed all the changes in behavior and the rapid weight loss to the natural progression of the Alzheimer’s. How wrong that assumption would prove to be! We didn’t know, or even think, that much of it could be due to dehydration and malnutrition.

Sunday, I came in at my usual visiting time. I had a family luncheon planned. I didn’t know if Mom would be able to rally from this latest decline, and I wanted my brothers and sister to have a chance to spend time with her.

Mom was asleep in her recliner when I arrived. I woke her, and took her to the bathroom. To my astonishment, I found Mom sitting in absolute filth once again. I cleaned her up, changed her clothes, and went looking for the head nurse. The first time I confronted this nurse, I did so firmly but politely. This time I was on the warpath! I wanted someone’s head on a platter. I told her, in no uncertain terms, that I would be speaking to the administrator as soon as possible about the staff’s negligence.

The family arrived around noon. Mom was almost catatonic during the visit. She didn’t respond to questions we asked of her. She didn’t respond to the antics of her great-grandson, whom she adored. She ate a half of a grilled cheese sandwich and drank most of her chocolate shake, but did so only with my assistance. She soiled her Depends. My sister and I took her to the nearest restroom and cleaned her up.

After about an hour, it was obvious Mom was tiring. The entire family went back to her room. Mom had not spoken the entire time of our visit. Now, as we were leaving, she said, “Thank you all for coming.” I think she knew she’d never see my siblings again.

On Monday, I visited Mom around 4 p.m. I found her sleeping in her recliner. She was odor-free, and when I checked her supply of Depends, I found that the staff had changed her five times since Sunday morning. I thought, “FINALLY, I’m getting through to them!”

Tuesday morning came, and I received a phone call from staff telling me that Mom’s blood work was scheduled to be drawn the following morning. My intention was to visit the administrator later that afternoon. I called the facility around 4 p.m. to let him know I was on my way. Unfortunately, he had already left for the day. I then decided to wait and visit Mom that evening after dinner.

I had never visited Mom so late in day before. The staff was caught totally unaware by my visit. But I’m sure word of my displeasure had reached all staff members by this point in time.

I found Mom sitting alone in the dining room. All other residents were in their rooms. I grabbed Mom’s wheelchair and began pushing it down the hallway. An aide came running up behind me, insisting that she would get Mom ready for bed. As she took Mom to her room, I approached the nurse’s station to talk to the head nurse. I had an appointment scheduled with Mom’s physician the following afternoon, and I wanted to know her current weight so I could inform him of her weight loss.

This particular head nurse did not even know my Mom; this was her first time working on the Alzheimer’s wing. She could not locate Mom’s weight record, so I asked that she please leave a note for the morning staff to weigh Mom first thing. I would be in before my doctor’s appointment to visit Mom, and get the information.

I then proceeded down to Mom’s room. When I walked in the door, the smell of feces hit me in the face. I waited for the aide to bring Mom out of her bathroom. As she did, I made a comment about the smell. She didn’t respond, and quickly dashed out of the room. I went into the bathroom and found a soiled Depends thrown into Mom’s wastebasket. The aide didn’t even bother to remove the filthy thing from her room. It was obvious from the aide’s behavior that she already knew Mom had soiled her Depends before I arrived.

I’d had enough – tomorrow was D-Day!

When I arrived Wednesday, I went immediately to the administrator’s office to inform him of the events of the past week. The Director of Nursing was in his office as well. I explained to both my efforts to work with the staff. I told them of the journal that I had been keeping, and the administrator asked me to supply him with a copy. He and the DON assured me that they would talk to staff, I didn’t need to worry – they would handle everything. As I was leaving, I told the administrator that if I ever found staff neglecting my Mom again, I would first contact the State (Department of Health and Senior Services), and then I would be contacting my attorney.

After leaving his office, I went to Mom’s room. She was in her recliner, staring into space, totally unresponsive to my presence. I continued on to the nurse’s station to pick up the information I had requested the previous night. It didn’t surprise me to find that the nurse had not notified the morning staff of the need to weigh Mom.

I spoke to the head nurse about weighing Mom. She sent a CNA down to the room immediately. The aide literally yanked my Mom out of her recliner by her hands. Mom moaned loudly from the pain. I admonished the aide, telling her to be careful, she was hurting Mom. The aide moved Mom into her wheelchair, and took off to weigh her. She returned a few minutes later with the weight, and proceeded to plop Mom back down into her recliner. Mom, once again, moaned in pain. I was so angry I was shaking.

I was due at the physician’s office in fifteen minutes, so I left the nursing home without a further confrontation with the administrator. I figured I would have another discussion with him the next morning. I did, but it wasn’t about the neglect of my Mom.

I met with Mom’s physician around 4 p.m. He had just received the results of her blood work. Mom was severely dehydrated and malnourished. Her kidneys were basically non-functioning. Mom was dying. He talked to me about placing Mom in hospice care to assure that her final days would be as comfortable as possible. I agreed.

I went back to the nursing home after my meeting with the physician. I picked up information on various hospice programs in the area. I talked with Mom’s head nurse. The physician had already called the nursing home to notify them of my intent to place Mom in hospice care. I checked in on Mom, then left to go home.

Once home, I called my siblings to inform them of the lab results, and the decision to place Mom in hospice care. I was exhausted – mentally, physically, emotionally exhausted. I hadn’t slept in days. My stress level was at an all-time high. Around 7:30 p.m. I took a sleeping pill, and headed to bed for some much needed rest.

At 8:15 p.m. I received a call from Mom’s nurse stating that there had been an “incident” in Mom’s bathroom. I was under the influence of the sleeping pill, and my mind was foggy from the medication. I didn’t think to question her as to what she meant by “incident.” I assumed that Mom had fallen in her bathroom as she had done on so many other countless occasions. The nurse told me Mom’s physician had been notified, and they were awaiting his orders. (This was nursing home protocol, and had been followed in previous falls.) Around 9 p.m. she called back to say the doctor had prescribed a pain medication (nothing alarming about that – Mom always suffered from back pain after a fall). I tried to go back to sleep. At 11:15 p.m. I received the final call informing me that Mom was gone.

It wasn’t until weeks after Mom’s death that I learned the truth behind the “incident.” I was visiting the nursing home on a financial matter, and happened to bump into the Director of Nursing. I asked her about the “incident,” as I found it curious that everyone on staff kept referring to it in that manner. She informed me that Mom had collapsed, and they were unable to get a blood pressure reading on her. I couldn’t believe it! Had I known, I would have gone to the nursing home immediately. I never would have allowed my Mom to die, without me by her side, had I realized how dire the circumstances were. The staff knew how attached I was to my Mom. I wasn’t an absentee caregiver. I visited Mom a minimum of three days a week. Why didn’t her nurse just give me the facts? Why refer to it as an “incident”? What was she hiding?

CHAPTER 4

THE SAGA OF THE MISSING WEDDING RINGS

After receiving the notification of Mom’s death, I phoned my siblings. These were, by far, four of the most difficult phone calls I had ever made in my life. When Dad passed away, we had sufficient notification of his impending death. The family was at his bedside. With Mom, it was a different story. I didn’t realize her death was so imminent, that it was literally just hours away. I thought we had more time to say our goodbyes.

In my last conversation with Mom’s nurse, I gave her funeral home information. I asked that she notify them about picking up Mom’s body. I also told her not release Mom’s body to the funeral home until I got to the nursing home. I wanted to spend time alone with Mom.

I arrived at the nursing home around midnight. I found Mom’s nurse talking to another staff member at the 700 hall nursing station. I knocked on the door, and she admitted me to the nursing home. We walked together to Mom’s room on the 500 hall. I found Mom’s door shut but unlocked.

We entered the room, I walked over to my Mom’s bed, and pulled back the sheet that covered her body. I reached for her right hand so that I could hold it while I awaited the arrival of funeral home staff. I immediately noticed that her wedding rings were gone from her left hand. I turned to her nurse and asked, “Where are Mom’s wedding rings?” Her reply, “I don’t know.”

I was beyond consolable by this time. After all I had been through the past couple of weeks, the final blow was devastating. How could anyone remove the wedding rings off the body of a dying or a dead woman? Mom had worn those rings for sixty-seven years. Never once during that time, in spite of the fact that she had suffered from advanced Alzheimer’s for several years, had she misplaced or lost her rings. She had huge, arthritic knuckles – she couldn’t remove the rings if she wanted to. What, in God’s name, was going on?

My husband arrived at the nursing home around 12:30 a.m. I informed him of what had happened, and he searched the room looking for the rings. We thought MAYBE staff had removed them, and placed them somewhere for safekeeping. He also searched her bathroom, thinking MAYBE they had accidentally fallen off during the “incident.” They were nowhere to be found.

The funeral home arrived a little after 1 a.m. They removed Mom’s body, and my husband and I left for the night. I assumed that staff would lock Mom’s room until family could return the following morning. They did not.

The following morning I arrived at the nursing home around 9:30 a.m. I went immediately to talk to the administrator about Mom’s missing wedding rings. He was not available to talk, so I went in search of the Director of Nursing. I found the DON in her office. She informed me that staff had already notified the administration of the missing rings. She had questioned staff, and the last reported sighting of Moms’ rings was around 3 p.m. on the day of her death.

I then proceeded to Mom’s room. I was shocked to find the door unlocked. I searched the bathroom thoroughly, and then began searching all of Mom’s favorite hidey-holes. As I was searching, the administrator came into the room. We discussed the events of the previous evening, and he also searched the bathroom. Staff thought the rings may have fallen off Mom’s hand during the “incident.” He found nothing. As I needed to leave to meet my sister at the funeral home, I asked that he lock Mom’s room until the family could return to pack up Mom’s belongings, and search the room thoroughly the following day.

On Friday, May 29th, I arrived at the nursing home around 10:30 a.m. I went directly to Mom’s room. It was locked, as I had requested. I had the janitor open the door for me. My sister, Jo Lynn, appeared within minutes of my arrival. Together, we headed to the administrator’s office.

I explained to the administrator that my sister and I would thoroughly search Mom’s room for her wedding rings as we packed up her belongings. If we didn’t locate the rings, then I would be filing a police report. He offered to file the report for me, and I declined. He then informed me, he would be investigating the disappearance of the rings as well. After our conversation, my sister and I proceeded back to Mom’s room.

Jo Lynn and I began tearing the room apart. We searched through all the drawers in her room. We searched through all her clothing. We moved furniture; we dug through the cushions of her recliner and couch. We searched the sheets on her bed; we removed the mattress and searched the springs. We went down to the laundry to see if they might have found Mom’s rings in the pocket of the pants she was wearing on the day of her death. We went through her belongings with a fine-tooth comb. The rings were not to be found.

On our way out of the building, I stopped by the receptionist’s desk to let the administrator know that I was on my way to file a police report. The police report was filed that afternoon.

Mom’s funeral was on Tuesday, June 2nd. On June 3rd, I called to speak to the administrator about his investigation. He said that he had interviewed all staff members that worked with Mom the week of her death. The last sighting of the rings by family was on Sunday, May 24th, when we gathered for lunch. The last sighting of the rings by staff was Wednesday, May 27th, the day Mom died. No one on staff admitted to the theft, and no one admitted to seeing another staff member taking them.

Staff reported to him that they frequently saw Mom “playing” with her rings. I knew this to be true. As her weight dropped, the rings dangled, and she developed an obsessive/compulsive behavior where she continually rotated the rings around her finger with her pinkie finger and thumb. I explained to him that although she “played” with her rings, she had never removed them in my presence; she was unable to do so due to her large, arthritic knuckle. He believed his staff was telling the truth; I believed they were lying through their teeth.

On Friday, June 5th, I received a phone call from an investigator of the Department of Health and Senior Services (DHSS). Apparently, the administrator had notified them of the disappearance of Mom’s rings. She informed me that she would be investigating the case.

On the following Monday, I received a call from the police detective in charge of investigating the theft. I gave him a description of the rings, and my version of the events.

The police detective interrogated all staff members who had contact with Mom on the day of her death. Most acknowledged seeing the rings on Mom’s fingers sometime during the day. Some staff members told him that Mom “played” with her rings, and they thought Mom had lost them. Some staff members thought the rings had come off during the “incident” in her bathroom. Other staff members agreed with my contention, that even though she “played” with her rings, she was unable to remove them due to the arthritic knuckle. No one confessed to taking the rings; no one admitted to seeing someone else take them; no one admitted to knowing anything.

The detective checked all the pawn shops in the area. The rings were not listed in their inventory. He called me after a couple of weeks saying that he was closing the investigation. We would probably never really know what happened to the rings. Although he and I both strongly suspected staff involvement, he was unable to prove it.
I never heard back from the DHSS investigator. I assumed that she had come to the same conclusion as the detective, and her investigation had yielded no differing results.

CHAPTER 5

THE STATE INVESTIGATION AND LAWSUIT

In my conversation with the investigator from the Missouri Department of Health and Senior Services (DHSS), I mentioned the other issues that I had been having with nursing home staff. She suggested that I contact the DHSS specifically about those issues. The State would then investigate my complaints of neglect, apart from the issue of the missing wedding rings.

The two weeks after Mom’s death were spent with funeral preparations, handling her estate, and the police investigation into the missing wedding rings. I didn’t have the time to contact the State.

At the end of June, I received copies of Mom’s death certificate. When the cause of death was listed as severe dehydration/malnutrition, I decided I needed to ensure that this kind of negligence did not befall another nursing home resident. If this happened to Mom, the likelihood that it was also happening to other residents was more than probable. She couldn’t possibly have been the only resident neglected by staff.

After Mom’s death, the administrator no longer mentioned my journal. All of our conversations following the night of her death, involved discussions of the missing wedding rings, not the issue of her neglect. Her death had, after all, essentially solved all of his problems.

My journal notes were hand-written, a shorthand that only I could decipher. I spent a couple of days transcribing my notes.

As my confrontation with the administrator and DON was prior to my meeting with Mom’s physician, the administrator was unaware of the results of the lab work I had requested, unaware that his staff delayed those results by five days, and unaware that Mom had died of severe dehydration/malnutrition while under his watch. I made the decision to contact him first, before contacting the State. I was hopeful that together, we could resolve my issues about Mom’s care.

After typing up my journal, I called the nursing home to speak to the administrator on three different occasions. Each time I called, I identified myself. I would be placed on hold. The receptionist would then come back on the line to inform me, the administrator was not available to talk. I left my name and phone number for a return call. I made these calls over several days. With each call, I waited for a return call, and there was none. After waiting a reasonable period of time, I decided to move on to the next level.

I contacted the State.

I wrote a letter to the State detailing two concerns: the improper securing of Mom’s property and body after her death and the neglect of Mom prior to her death. I enclosed a copy of my journal which documented both concerns.

When, after two weeks, I hadn’t received a follow-up call, I e-mailed the DHSS to see if they had received my letter. The next day, I received a phone call asking that I resend my letter and journal to the Region 4 Long-term Care office located in Cameron, Missouri. I did so immediately.

On August 20th, I received a letter from the Executive Secretary of the Missouri DHSS. In the letter, she stated, “Your complaint was received and reviewed with the Section for Long-Term Care Regulation’s Region 4 office and it was found that (name of nursing home) acted appropriately. The complaint was found unsubstantiated.” I was stunned. How could this be true?

How could it be considered appropriate to leave a resident sitting in their own waste for hours at a time, day after day; how could it be considered appropriate to leave a resident sitting in their wheelchair for hours at a time because the staff was too lazy to answer motion detector alarms; how could it be considered appropriate to remove the wedding rings off the hand of a dying or dead woman; how could it be considered appropriate for staff, who bathed and dressed a resident on a daily basis, to ignore a ten pound weight loss in a six week period on a 102 pound resident; how could it be considered appropriate for the staff to fail to report this drastic weight loss to the resident’s family or physician; how could it be considered appropriate to repeatedly ignore or deny family members’ observations of rapid weight loss and behavior changes; how could it be considered appropriate to delay life-saving blood work for five days; how could it be considered appropriate to literally allow a resident to starve to death while under the watch of trained nursing home staff; how could it be considered appropriate for aides to braid each other’s hair while a resident sat nearby in her own filth?

The outcome of the investigation temporarily knocked me down, but I wasn’t down for the count! I jumped right back up, and came out swinging, more determined than ever to win this battle!

Senator Kit Bond is a close personal friend. Our families grew up together in Mexico, Missouri. Mom was Kit’s Mom’s personal secretary for many years. Together, Mom and I worked as Kit’s campaign secretaries when he first started running for office. He knew our family well.

I wrote Kit a letter asking that he contact the DHSS on my behalf. I simply wanted someone to take the time to explain to me, how they came to their shocking conclusion. No one from the State had contacted me personally, before investigating my complaints of neglect. Yet, I was contacted personally by a DHSS investigator within days of the State’s notification of the missing wedding rings. Shouldn’t the complaint of neglect have warranted a personal contact as well?

When I didn’t hear back from Kit personally, I assumed that his staff had intercepted my letter.

I called my brothers and sister with the disappointing news. Together, we decided to contact a nursing home litigation law firm and file a wrongful death lawsuit. If the State wouldn’t handle the situation, then we would hit the nursing home where it would hurt the most – their pocketbook.

The lawsuit was never about the money. The family didn’t need or want the money. But we wanted to take a stand. We wanted the owner, management, and administration of this nursing home to understand – we would not idly stand by and let this kind of abuse continue. If they had to pay out a settlement, then maybe they would listen to us and make changes that would benefit the other nursing home residents. Nothing seems to get your attention better than money!

I spoke with an attorney the end of August, 2009. She listened to my story; we drew up a contingency contract; and she began her investigation into Mom’s death. First on her agenda, get copies of Mom’s nursing home records. We needed written documentation of the neglect.

While I was waiting to hear back from my attorney, I received a second letter from a DHSS investigator. Apparently, my letter had gotten through to Kit, and another investigation was launched. But the second investigation was as futile as the first.
As with the first investigation, the investigator did not call me to discuss my allegations before visiting the nursing home. Her investigation showed the residents to be clean and well-groomed. At mealtimes, she found the staff assisting residents who required help.
She found that the staff had faxed the physician’s office to get an order for blood work, and the labs were drawn on May 27th (the day of Mom’s death). What she didn’t know (and would have if she bothered to contact me) was that it was I who had requested the blood work, not the staff. If she had bothered to check the nurse’s notes, she would have found that information.

If she had bothered to locate the results of the blood work, she would have discovered the severity of Mom’s condition. Mom’s BUN (Blood Urea Nitrogen) level was three times the norm suggesting severely impaired kidney functioning; her cholesterol level had dropped from 209 to 70. The lab had called the physician’s office in a panic after determining her status. But her letter states, “I selected a sample of residents who had passed away at the facility. I reviewed their charts for changes in their conditions a few weeks prior to their deaths. The facility acted appropriately and notified physicians when the resident’s condition warranted it.” Obviously, she didn’t check Mom’s chart for this kind of information.

She interviewed staff on duty about Mom’s missing wedding rings. “None of them recall seeing your mother’s rings the evening of her death.” How quickly they forget! According to the DON, staff members recalled seeing the rings around 3 p.m. on the day of her death. The police detective also reported staff sightings of the rings. The administrator admitted staff had reported seeing the rings.

But her letter did confirm what I already knew to be true – the staff didn’t notice any changes in Mom’s behavior the weeks prior to her death. “The aides I talked with said they were surprised when they heard your mother passed away because she did not seem any different to them.”

Trained nursing home staff didn’t notice anything different? They didn’t notice the ten pound weight loss while dressing or bathing the resident? They didn’t notice the resident had stopped communicating? They didn’t notice the resident had stopped eating and drinking? They didn’t notice the resident could no longer tend to her bathroom needs? They didn’t notice the resident spent the majority of the day sleeping? Were they blind or did they simply not care? I think it was the latter.

It wouldn’t be until over a year later that I would discover why the investigator did not witness any negligence.

In a face-to-face confrontation with a DHSS supervisor, I was informed that there is no such thing as a “surprise inspection.” When an investigator enters a nursing home, they must identify themselves and the purpose of their visit. What I had witnessed happening to Mom, would never be witnessed by an investigator.

Within minutes of their entry into the home, word of their presence literally flies around the nursing home. Staff would be on their best behavior. You wouldn’t find residents sitting in filth; you wouldn’t find alarms ringing; you wouldn’t find staff ignoring residents who were not eating; you wouldn’t find aides braiding each other’s hair; you wouldn’t know that staff was ignoring family members’ inquiries into rapid weight loss and behavior changes; you wouldn’t know a resident’s rapid weight loss was going unnoticed and unreported by staff; you wouldn’t observe residents sitting in wheelchairs for hours on end.

It took almost a month for the nursing home to respond to my lawyer’s request for the records. Her office received the records the first week of October, 2009. She and her staff spent the next month digging through the records looking for evidence of neglect.
The end of October, the attorney called to inform me, that even though the records clearly showed Mom was not properly monitored by staff, her firm would not pursue a lawsuit unless they could prove Mom would have lived at least another year—an impossible task given Mom’s age. Another disappointment, another setback – the legal system was failing me just as the State had done. She strongly suggested that I get a second opinion, so that later on down the road I wouldn’t have any “what ifs”.
I contacted another law firm. I told my story once again to the lawyer’s legal assistant and staff nurse. They, in turn, contacted my first attorney and obtained the nursing home records. After another month of waiting, the second attorney called to say that she had come to the same conclusion as the first.

I was heart-broken! Whether Mom would have lived another day, another week, another month, or another year was irrelevant to me. She was denied that time with her family due to staff apathy and negligence. I understood the lawyer’s reluctance to pursue the lawsuit. They weren’t doing it out of the kindness of their hearts; they were doing it for their percentage of a settlement.

I finally conceded defeat.

The nursing home records were delivered to my home. I put them away in my closet. I felt that I had done everything humanly possible to hold those responsible for Mom’s pain and suffering accountable.

The records would remain buried in my closet until the end of January, 2010. Then a call from my best friend, Debbie, would drastically change the next year of my life.
The nursing home may have won the first few rounds, but the fight was far from over!

CHAPTER 6

CAGNEY AND LACEY – HOT ON THE TRAIL OF A THIEF

Debbie called me sometime during the last week of January. Her mother-in-law, Ann, had just had gall bladder surgery, and they were going to have to place her in a nursing home while she recuperated from the surgery.

Ann’s physician had also been Mom’s in-house nursing home physician. As Debbie discussed placement of her mother-in-law in a nursing home with the physician, he mentioned that he was now the Medical Director of the nursing home in which Mom had resided. He, of course, tried to persuade Debbie to place Ann in that nursing home.

Debbie, having lived through my nightmare of Mom’s death and the subsequent months that followed, declined his invitation. I think her exact words were, “Thank you, but I don’t think so.” He appeared puzzled, and she began to relate some of what my family had gone through over the past seven months. His reaction to the story told her that he was totally unaware of what had occurred.

As soon as Debbie got home from the visit, she called to relate their conversation. Debbie, being Debbie, said “Jan, you need to write him a letter and tell him everything that went on. He’s now in a position to make changes that would ensure that what happened to your Mom doesn’t happen to someone else.”

My goal, from day one, had always been to make sure that another nursing home resident didn’t suffer the same fate as my Mom. I had failed to accomplish this feat. Contacting the State and attempting to file a lawsuit had not had the desired results. So why not give it a shot? What did I have to lose? If he listened to my story and made positive changes, then I would have accomplished my goal. If he ignored my story, then at least I would have the satisfaction of knowing that I gave it my all.

I wanted to give him information that he could verify in Mom’s nursing home records. Both attorneys had indicated the records held evidence of the neglect I was alleging. I dug the records out of the depths of my closet.

There were 856 pages in Mom’s file. Sorting through this information was a daunting task, to say the least. I had physician’s orders, medication administration records, physical therapy reports, bowel movement records, nurse’s notes, physician’s notes, fax cover sheets, lab reports, just to name a few. I couldn’t possibly understand Mom’s care unless I organized this mess in some fashion.

The first time I went through the records, I pulled those pages that I thought would hold pertinent information needed for my letter to the physician. I wrote my letter, and placed it in the mail February 3rd, 2010.

After mailing my letter, I began the monumental task of organizing the records. I went through and arranged first by topic, then each topic chronologically.

As I babysit the grandson during the day, and watching a toddler is not conducive to spreading out 800+ pages of documents, I could only work on the task in the evenings. I had neck surgery in 2007, and as a result, have very little range of motion in my neck. I cannot look down for extended periods of time without causing severe pain in my neck. I could only work fifteen to twenty minutes at a time before needing to rest. The task of organizing the records took me weeks to accomplish.

By the end of February, I had the records organized and ready to scrutinize. I began by going through Mom’s medication administration records (MARs). I noticed immediately that she was not receiving her pain medication (Vicodin) as I had believed.

Due to her advanced Alzheimer’s, Mom was unaware that relief from her chronic back and shoulder pain was available to her, just for the asking. Before my surgery in August 2007, I had requested the medication on her behalf when I visited. After my surgery, when I was unable to visit on a daily basis as I had before, I talked to staff and requested that they give Mom a pain pill in the morning with breakfast and again in the afternoon around 2 p.m. I assumed they were following my directions. I remembered my pharmacy billings showed the medication being ordered each month.

I called Debbie and informed her of my discovery. She immediately responded, “Jan, you have your Mom’s pharmacy bills, right? Compare the number of pills ordered with the number of pills actually given to your Mom according to her MARs. See what you find.”

Thus begins the adventures of the next Cagney and Lacey crime-fighting duo! Debbie was Cagney; I was Lacey. We would continue to call each other by these nicknames throughout the investigation. It was the only source of levity we could bring to the incredibly sad and frustrating situation we would be living for the next six months. Cagney and Lacey will have recurring roles in the telling of Mom’s story.

What I found was disturbing, to say the least. From June 2007 through September 2008, staff had ordered thirty-three packets of Vicodin pills. Each packet contained thirty pills, a total of 990 pills ordered. Mom’s MARs for that same time period indicated she had received only 171 of those pills. I had 819 missing pills! Where had they gone?

Lacey called Cagney with the news. “You want to take a field trip to the pharmacy, Cagney?” “When do you want to go?” replied Cagney.

On March 7th, 2010 we headed south to the pharmacy. With Mom’s pharmacy bills, Medicare D records, and MARs in hand, we talked to pharmacy staff. The general manager of the pharmacy, who routinely investigated these types of problems, was not available on that day. We spoke to another pharmacist. He made copies of some of the documents we had, and promised he would get the information to the general manager as soon as possible.

Friday, March 10th, Lacey made a return visit on her own. Cagney wasn’t available to make the trip. I spoke to the general manager, showing her a list I had made of the prescriptions ordered. The list contained each prescription number, the date the prescription was filled, and the number of pills administered by staff each month (according to Mom’s MARs) compared to the number ordered each month (according to pharmacy billings and Medicare D records).

After looking at all my documentation, the general manager confirmed what I already knew to be true – the nursing home staff had probably stolen the pain meds. She suggested I report the disappearance to either the DEA (Drug Enforcement Administration) or the local authorities.

I called the local DEA office to make an appointment to discuss the theft with them. An agent explained to me that the DEA did not investigate the theft of narcotics from nursing homes. I should contact local authorities about the theft.

Cagney and Lacey’s next adventure – visiting the police detective who had investigated the disappearance of Mom’s wedding rings.

CHAPTER 7

CAGNEY, LACEY, AND THE DETECTIVE

I was a high school math teacher for over twenty years. My favorite subject to teach? Geometry. I loved the logic of it, the deductive reasoning – taking a given set of facts and moving in a logical progression to a desired conclusion. This aptitude would prove very useful to Cagney and Lacey in their pursuit of the felon. And the police detective investigating the case wouldn’t know what hit him!

After striking out with the DEA, Debbie and I headed over to visit the police detective who had been in charge of the investigation into Mom’s missing wedding rings on Wednesday, March 15th, 2010. I had developed a very good rapport with him during that investigation.

Luck was with us and he was available to speak to us. We showed him my documentation and explained our suspicions. Although the detective was very sympathetic to my plight, he informed me that he could not investigate the nursing home for narcotics theft – he needed to be directed toward a specific individual(s). He did suggest that I contact the State, and try to talk with the administrator of the nursing home.

I followed his first suggestion. Even though the State had failed me miserably twice before, I thought the seriousness of my allegations warranted a contact. I wrote a letter detailing what I had found and mailed it on March 22nd.

I considered his second suggestion for about ten seconds and then just as quickly discounted the idea. This was a man who had ignored me after my Mom’s death, refusing to answer my phone calls. I had launched not one, but two State investigations aimed at his nursing home. I had pursued a wrongful death lawsuit against the nursing home. I had just recently sent a letter to his Medical Director detailing the staff’s neglect of my Mom during the last few months of her life. Would this man be willing to sit down and discuss the disappearance of over 800 pain meds with me? The chances of that happening were “slim to none,” with an emphasis on the word “none.”

It was time to move on to plan B. Cagney and Lacey were not to be deterred in their pursuit of justice.

We needed to provide the detective with the name of a prime suspect. How to do this?

I called the general manager of the pharmacy, and explained our latest news. (She quickly became one of my favorite people during this investigation. Her unwavering support would see me through setback after setback.) She told me that I could obtain copies of the faxes from the nursing home to the pharmacy requesting the meds. These faxes would show who ordered the drugs. She could also get copies of the delivery confirmation sheets which would prove that the drugs had, indeed, been delivered to the nursing home as well as the date and time of delivery.

I gave her copies of my Health Care Power of Attorney and Mom’s will, showing me as executor of her estate. She faxed these documents to her corporate office. Then the waiting game began.

I fussed with the legal department of the pharmacy for a couple of weeks. The general manager finally got corporate approval for release of the documents after she faxed them a copy of an authorized release of protected health information form that I had signed for my attorney. Because I was a surviving child, and as it was my legal right to pursue a wrongful death lawsuit against the nursing home, I was entitled to obtain this information. On April 5th, the general manager e-mailed me the good news – we finally had the green light to get the records!

The necessary paperwork for 2008 was on the premises of the pharmacy; the paperwork from 2007 was in storage. The general manager would have to requisition a few boxes at a time from storage and then search those boxes to obtain the documents I was requesting. She truly was an angel sent from heaven to help me in my fight for justice. She personally went through these boxes and copied the requested documents. It took her a couple of weeks to compile the information I needed.

While I was waiting for the documents, I began researching the route of a prescription from the time a nurse (or CMT – Certified Medication Technician) faxed a request to the pharmacy, to the time the prescription was received at the nursing home.

I had known from my experience at the assisted-living facility, all narcotics had to be kept under lock and key. I knew the State had very stringent regulations concerning their security. How was it possible for staff to make off with over 800 of my Mom’s Vicodin pills so easily?

I began researching on-line. I sent e-mails to the DHSS requesting information about their regulations for the security of narcotics. I then questioned people who had previously worked in nursing homes, people who were currently working in nursing homes, a current administrator of a nursing home, a pharmacy delivery driver (Debbie’s husband), a licensed practical nurse (Debbie’s daughter), a registered nurse, and the general manager of the pharmacy. I soon had the route figured out.

According to the general manager of the pharmacy, before 2009, the staff of a nursing home was considered an “extension” of the physician’s staff. Nursing home staff could order meds without the pharmacy having to contact the physician. As long as the requested drug appeared on the physician’s orders for that month, the request would be filled.

After 2009, the DEA changed the way that pharmacies handled filling prescriptions. The nursing home nurse (or CMT) could fax a request for a prescription to the pharmacy, but before the pharmacy would fill it, the physician would be contacted. This made stealing of the drugs more difficult, but certainly not insurmountable. A creative thief could still work around the system.

The theft of Mom’s pain meds was pre-2009 – no physician approval was required.

After the pharmacy received the request for the drug, the prescription would be filled. A delivery confirmation sheet would be created listing all drugs to be delivered to the nursing home that particular day. The name(s) of the individual(s) receiving a prescription, the name(s) of the medication(s) being filled, the time the meds left the pharmacy, the time the meds arrived at the nursing home, and the date of the delivery, were all documented on the delivery confirmation sheet. (These sheets would provide me with a lot of damning information later on.)

The delivery driver would then proceed to the nursing home in question. After arriving at the home, he would go to a nursing station and find a staff member to accept receipt of the drugs. The driver and the staff member would go through all the medications, checking to see that all drugs listed on the delivery confirmation sheet were accounted for. The staff member would sign for receipt of the drugs.

Once the staff member accepted the drugs, they would notify the CMT on duty for that particular wing (hall) of the facility. The CMT would then take the narcotics, lock them in the narcotics closet, and place the accompanying inventory sheet for the prescription in the narcotics log book. This was the time period when the theft was most likely to occur.

According to the general manager of the pharmacy, a staff member determined to steal the narcotics would take the entire packet of pills and the accompanying inventory log sheet. If you were the staff member who ordered the drugs, and were also the staff member who accepted the drugs, you could ultimately erase any proof of the existence of the drugs by doing this. And, of course, if you had an accomplice or other staff members who were willing to look the other direction, it would make the theft that much easier and undetectable.

The nursing home was supposed to have an internal auditing system to prevent this from happening. But during the time frame of the theft of Mom’s pain meds, this system was practically non-existent. (I wouldn’t have access to this information until September, 2010 when I finally had a face-to-face confrontation with a DHSS supervisor.)

Now, my next question – who had access to the narcotics? I turned to my experts for the answer. You obviously cannot have multiple copies of the key to the narcotics closet floating around the nursing home. My sources told me that only two keys were available; one in the possession of the administrator on duty, the other passed off between personnel at shift change.

The pharmacy only delivered drugs during first and second shift. So I could easily remove the third shift nurse (CMT) from my list of suspects. They would have no knowledge the drugs had been ordered, no knowledge they had been received.

The general manager of the pharmacy informed me that at shift change, personnel were supposed to check the number of pills in the narcotics closet for each resident against the number of pills shown to have been administered as per the resident’s inventory log sheet. This was referred to as a shift count.

The pills were bubble-wrapped – a card containing 30 pills that could be dispensed by pushing each pill out the back of the card. This packaging made it easy for the staff to determine how many pills of the prescription had already been dispensed. Any discrepancy found in this shift count was to be immediately reported to the administrator on duty.

This brought up my next question. If a shift count was actually being performed between each shift, wouldn’t the nurse(s) on the following shift(s) notice and report the disappearance of pills taken by another staff member? For example, let’s say the first shift CMT is our thief. The second shift CMT accepts delivery of the pills that day instead of the first shift CMT. She places the pills into inventory during her shift. This information is passed along to the third shift CMT at shift change. Wouldn’t the second shift CMT notice the pills missing the following day at shift count? Wouldn’t the third shift CMT notice them missing as well? Surely, out of these two people, someone should have noticed the pills missing and reported it to the administration. At least, that was my thinking.

There were only three ways for the pills to disappear so easily. One, the staff member stealing the pills also ordered the pills and then was on duty when they were delivered. By stealing the pills and the accompanying inventory log sheet, the staff member eliminated any evidence of the pills. Two, the staff member stealing the drugs had an accomplice or other staff members were aware of the theft but not reporting it. Or three, the staff member was stealing a pill or two at a time, recording the dispensation of the pill(s) on the inventory log sheet, and then pocketing the pill. This would have been time-consuming, but if you were using the drugs for personal use, a definite possibility.
Also while waiting for the pharmacy documents, the family contacted an attorney about the missing pain meds. My younger brother, Jeff, had an attorney friend in Rolla. Jeff had spoken to John about our latest discovery. John was acquainted with a Kansas City attorney who specialized in nursing home litigation. He volunteered to contact him on the family’s behalf. As it turned out, this attorney was the senior partner of the law firm I had contacted in August, 2009 about a wrongful death lawsuit.

I organized all Mom’s nursing home records, typed up an account of everything I had been through with the nursing home, and took the records personally to his downtown office on April 16th, 2010. It was our hope that this latest information would help in a second attempt at a wrongful death lawsuit.

Sadly, it wasn’t meant to be. Mom’s pain meds had been prescribed “prn” (as needed). Even though I had requested the pills be given to her twice a day due to her advanced Alzheimer’s, I had no written proof of that request. It was my word against the staff’s word that she needed the pain medication. I was notified on April 26th that a second lawsuit would not be forthcoming.

I wasn’t too disheartened by the news though. I had just received a phone call from the general manager of the pharmacy informing me that she had the documents I had requested. I called Cagney to let her know and headed directly to the pharmacy without further delay.

When I picked up the packet, the general manager of the pharmacy gave me a big hug and said, “I think you’ll find what you’re looking for in here.” Finally, the news I had been waiting for!

Lacey drove as quickly as she could to Cagney’s house. It looked as if all of our investigative efforts were finally paying off. We opened the packet together. Praise the Lord! We had a suspect! High fives all around!

“Ready to go visit the detective again, Cagney?” asked Lacey. “Was there any doubt?” replied Cagney. And so the police investigation begins.

CHAPTER 8

THE STATE INVESTIGATION (OR LACK THEREOF)

Before I continue with Cagney and Lacey’s investigation into the missing Vicodin pills, I want to take a quick respite to discuss the State’s involvement (or lack thereof) up to this point in time.

I mailed my letter to the State (DHSS) on March 22nd, 2010. In my letter I informed them of the disappearance and apparent theft of my Mom’s pain pills – 819 to be exact. I included a copy of the list that I had made for the pharmacy documenting prescription numbers, dates filled, number of pills administered compared to the number of pills ordered. I deliberately did not send them copies of the documents I had supporting my claim. As they had not extended me the courtesy of a personal contact twice before, I wanted to force them to contact me to obtain this information.

True to form, they ignored me a third time. I finally called the Cameron office on April 5th to inquire as to the receipt of my letter. The gentleman who answered the call said, “I think we got it. I’ll check and let you know.”

On April 8th I received a return call from a supervisor of Region 4 Long-term Care division. She related that she was still trying to decide which investigator she wanted to handle the case. She promised the investigator would contact me personally and I would be able to share my documentation before the investigator visited the nursing home. I also related to the supervisor the pharmacy was in the process of duplicating the faxes sent to the nursing home requesting Mom’s meds as well as the delivery confirmation sheets. With these documents, I might be able to provide her with the name(s) of staff involved. She asked that I call her with that information when it became available.

Cagney and Lacey obtained the paperwork from the pharmacy on April 23rd.

On Monday, April 26th, I called the supervisor with the name of the staff member who appeared to be the prime suspect. I copied all of my documents (MARs, pharmacy billings, Medicare D records, faxes of prescription orders, delivery confirmation sheets) that supported this claim. I wrote a letter explaining my allegations and how these documents supported those allegations. The packet of information was sent by registered mail to the supervisor that afternoon.

After going through the documentation in preparation to present the evidence to the police detective, I uncovered the possibility of an accomplice. I sent a letter to the supervisor on May 1st advising her of this information. I also informed her that a police investigation was under way.

I would continue to send the supervisor information about the police investigation as it unfolded either by snail mail or e-mail.

But I quickly observed a reluctance of the part of the State to actively pursue an investigation of the nursing home from their end. If it were me, I would have jumped right on it. It was obvious from the prescription orders and delivery confirmation sheets that Mom was not the only victim. The possible magnitude of this theft was mind-boggling. Why wouldn’t they start an investigation of the theft immediately?

I got my answer several months later when I had the face-to-face powwow with the State supervisor. Apparently the State was already aware of the problem. Remember when I mentioned earlier in this story that staff was disappearing and a new administrator was brought on board? There WAS a reason for it. A State inspection had cited the nursing home for over 30 infractions, among those infractions was the improper handling and security of narcotics. The new administrator was brought in to clean house.

The State would not become actively involved in the investigation until July 28th. It seemed they were simply waiting to see if the police investigation uncovered a definite suspect.

CHAPTER 9

LACEY’S LOGIC

Now, returning to Cagney and Lacey’s investigation into the missing Vicodin pills.

Cagney and Lacey had obtained the documents from the pharmacy on April 23rd, 2010. We had a prime suspect. Now we had to prove to the prosecutor that we had sufficient evidence for a Class C felony theft case. We wanted to have the chain of evidence laid out before we approached the police detective and filed a police report of the theft.

There was a total “rush” associated with finding each piece of the investigative puzzle. Debbie and I felt that we had found our true calling. We were convinced somewhere in our family tree there was a branch with Sherlock Holmes’ name attached to it (thus the assignment of our nicknames, Cagney and Lacey).

I began by taking the list I had prepared for the pharmacy and notating beside each prescription the initials of the staff member placing the order. I discovered that out of the thirty-one prescriptions ordered, twenty-seven were placed by the same woman. The remaining four? They were placed by four different staff members and were spread out over the time frame of the theft (a year). Probably legitimate orders placed due to the number of pills remaining in a given packet at the time of the order.

NOTE: I had documentation of thirty-three orders being placed, but the first two orders were documented on Medicare D records only. I didn’t have pharmacy billings for those dates. When I asked the general manager of the pharmacy to obtain the documents for me, I only requested copies of those prescriptions for which I had pharmacy records. If you wonder why the number of missing pills changes from 819 to 772, this is the reason. Also the time-line of the theft changes from fifteen months to twelve months (June 2007-September 2008 now becomes September 2007- September 2008).

The pain meds (Vicodin) were prescribed “prn” – as needed. The refill of the prescription should have followed suit – as needed. If you only dispense three of a packet of thirty, you obviously don’t need to order a refill. Looking at my pharmacy list, the CMT in question was ordering anywhere from two to four packets a month. Staff was administering a very small percentage of the pills being ordered (4 out of 120, 0 out of 60, 7 out of 90, etcetera – total: 158 out of 930). Obviously, the refills were not justified by the usage. And it didn’t take a genius to figure out what had happened to the remaining 772 pills.

I took a look at Mom’s MARs. I noticed that the CMT placing all the orders was not even administering the meds until January 2008. Why would she be placing the orders? Why wouldn’t staff members who actually administered the drugs and had observed the need for the refill, order the meds?

Next, I noticed that the CMT had ordered refills on consecutive days twice during the time frame of the theft. Why? Did Mom suddenly become so addicted to the pills that she required thirty pills in a day? I don’t think so!

I began checking out the number of refills each month and noticed a pattern emerge. If you remember earlier in the story I told you I had neck surgery in August 2007. Before my surgery, I would visit Mom daily and requested pain meds on Mom’s behalf based on my observations. Her pain was constant; I was making the requests almost daily.

My Mom had suffered from chronic back and shoulder pain for years. Before her admission to the nursing home, she had received epidural spinal injections every three months. A month before her admission to the nursing home I took her for a treatment. Her reaction to the treatment was so severe (dangerously high blood pressure) that her doctor and I decided to forgo future treatments. The benefits no longer outweighed the risks. He prescribed Vicodin to help take the edge off the pain.

I had cervical disc fusion surgery on August 13th, 2007. My neurosurgeon had discussed with me previous to the surgery that I would not be able to drive or leave my home for two months afterwards. I talked to the staff and informed them of my doctor’s order. As I could not visit Mom, Mom could not request the meds on her own due to the advanced Alzheimer’s, I didn’t trust the staff to make an assessment of her pain so I asked that they give her a pain med in the morning with breakfast and another later in the afternoon. The family wasn’t really concerned about a possible addiction; our concern was that Mom would be as comfortable as possible for whatever time she had remaining.

Pharmacy billings showed two packets of Vicodin ordered for September and October. If Mom were receiving the pills as I had requested, this was the proper amount to be ordered. Being the trusting soul that I am, I believed Mom was being properly medicated.

When I began visiting Mom after my recuperation, my visits were not as frequent as they had been previous to my surgery. I could not return to my job at the airport, and needing income, I began babysitting my newborn grandson with the help of my family. Until the baby was a little older my visits were for the most part limited to the weekends. As the baby got older I would visit on Wednesdays as well, taking the baby with me to visit his great-grandma. Many times I would call the nursing home to let them know I would be visiting. Mom’s MARs would later reveal that she was usually receiving a pain pill before my anticipated visit.

The first part of November I visited Mom and noticed she still appeared to be suffering (despite the pain meds I believed the staff was administering). I wrote a note to her in-house physician advising him of Mom’s continuing pain. I asked that he re-evaluate her condition and possibly up her current dosage of Vicodin or change her prescription to another drug. I had the staff fax the note to the physician for me.

My pharmacy billings showed orders for the pain meds increasing from two packets a month, to three or four packets after the note was faxed by staff. At the time, I didn’t question this increase as I thought the doctor had upped her dosage as I had requested. (It wasn’t until after her death that I would know the truth.) The orders for three to four packets of pain pills continued until June 2008.

June 2008, my daughter was no longer teaching school and I was no longer babysitting the grandson. My visits to Mom returned once again to several days a week.

During the summer months, the orders for the meds were reduced to two packets a month. Why? I don’t know. But the pills, according to Mom’s MARs, were administered by the CMT in question almost exclusively and were given on a regular basis. As my visits increased, so did the administration of her pills. Then in September 2008, the orders ceased altogether as did the administration of the pills. Coincidentally, the CMT in question left the Alzheimer’s unit at this time. And by October, she would have permanently left the nursing home to work at a sister facility.

Unfortunately for Mom, after several months of carefully scrutinizing the pharmacy billings, I discontinued the practice. I discovered the wonder of on-line bill paying. The bills would come in; I would notate on the front of the envelope the amount due and the due date; I would then pay the bills on-line when the time came. I had been lulled into a false sense of security. I had no reason to suspect Mom was not receiving her pain meds. After all, previous pharmacy billings showed the meds being ordered on a regular basis.

From September 2008 through May 2009, MARs indicated that Mom only received four pain meds. If Mom showed any discomfort during my post-August 2008 visits, I just assumed that the pain pill from the morning was beginning to wear off. My visits were usually an hour or so before lunch. I anticipated Mom being given another pill around 2 p.m., so I didn’t question her discomfort. It also seems that her physician changed the time of the administration of her naproxen from evenings to mornings in January 2009. This medication may have masked her back pain during my visit. Either way, I didn’t suspect Mom was not receiving her pain meds.

Next on my list of things to do – I needed to find out who was on duty when each prescription was delivered to the nursing home. How to do that? Check Mom’s MARs.
Each monthly MAR contained a wealth of information. Within each MAR were two schedules: the PRN schedule and the regular schedule. The PRN schedule documented the administration of those medications given only when the need presented itself (i.e. pain meds, sleeping pills, anxiety medication). The regular schedule documented the administration of medications prescribed on a daily basis (i.e. vitamins, thyroid medication, cholesterol meds, blood pressure pills).

The PRN schedule documented the name of the drug, the date the drug was administered, the time the drug was administered, who administered the drug, why it was given, whether the drug was effective, and who witnessed the effects. The regular schedule contained much of the same information – date of administration, time of administration, who administered the drug, and the name of the drug.

By examining the regular schedule of Mom’s MARs, I could easily determine who was on duty for each shift. All I had to do was locate the date I wanted and find a medication that was administered during each shift (first shift – 7 a.m. to 3 p.m.; second shift – 3 p.m. to 11 p.m.; third shift – 11 p.m. to 7 a.m.).

I took my pharmacy list and notated who was on duty for each shift beside the delivery date of each prescription.

I had already discounted the involvement of the third shift CMT. If she were involved, then all three were involved – much too complicated. So I concentrated on first and second shift CMT’s as they were on duty when the meds were delivered.

I found my prime suspect was the first shift CMT for all but two of the delivery days. And apparently she was one very dedicated employee – she volunteered to work a lot of double shifts. Ten of the prescriptions were delivered on days when she worked a double shift. How convenient – order the drugs, accept the drugs, steal the drugs, and no one is the wiser. But what about the other twenty-one prescriptions?

I checked further. What’s this? On the days when my prime suspect didn’t work double shifts, the CMT on duty for second shift was always the same woman. The plot thickens. Had I found my accomplice or at least a staff member who was willing to look the other way?

I remembered that the delivery confirmation sheets notated the time and date of delivery. By comparing the time of delivery to the time periods of each shift, I could determine who was on duty when the drugs were delivered.

This is what I uncovered. My prime suspect was on duty seven of the dates working a single shift. She was on duty ten of the dates working a double shift. My suspected accomplice was on duty for twelve of the dates. (On one of the delivery dates I was unable to determine who was on duty, as apparently the staff decided not to give Mom her meds at all that day. The MAR was blank for the date in question. I was also missing one delivery sheet.)

Basic mathematics revealed the following: 17 X 30 = 510; 510 pills easily stolen by my prime suspect. She ordered the pills; she accepted the pills; she stole the pills. But what about the remaining 262 missing pills?

If the second shift CMT placed the twelve packets she received into inventory, then someone (either herself or the third shift CMT) would have noticed them missing the next day at shift count. But, of course, this is assuming that a shift count did indeed take place. I would discover much later that the CMT’s were simply passing the narcotics key at shift change and were not doing the required shift count.

Since I didn’t yet have this information at my disposal, I made the assumption that the second shift CMT had to be involved in the theft as well. It was the only viable way to account for the disappearance of the remaining 262 pills. It didn’t seem logical to me that the first shift CMT would try taking the meds a couple of pills a day, and if she were, the MARs would have shown the pills being dispensed.

So I now had the name of an accomplice. Lacey was on a roll!

I then checked Mom’s MARs to see how often the prime suspect and her accomplice gave Mom the pain medication. Sixty percent of the pills were administered by the prime suspect; less than one percent by the accomplice; thirty-nine percent were given by other staff members.

I checked to see how often my main suspect worked on the Alzheimer’s unit. The MARs revealed she was a busy lady – usually working about twenty-two days a month and working three to four double shifts a week.

I thought the evidence I had uncovered was very convincing – at least enough to warrant questioning of both my prime suspect and her accomplice by police. I called Cagney and related what I had found. We were off to the police station on Tuesday, April 28th, 2010. Time to nail a thief! We were totally psyched!

CHAPTER 10

THE POLICE INVESTIGATION – THIRD TIME’S A CHARM?

The police detective had no clue of his impending future. If he had, he would have turned tail and run in the opposite direction. Two sixty-one year old, gray-haired grandmas who thought they were the 2010 version of Cagney and Lacey were about to darken his door. It was probably a good thing that we were post-menopausal. If we had been menopausal, we would have blown someone away before the investigation was over. The good detective would definitely earn his spot in heaven over the next few months!

I phoned my favorite detective within a few days of the receipt of the pharmacy records. We set up an appointment for Wednesday morning, April 28th. Cagney and Lacey were stoked! But the detective was unexpectedly called downtown that morning to help with an interrogation and we were unable to meet. He left a message that if I wanted to go ahead and file a police report, he would get back to me as soon as possible.

The following morning I went to the police station to file the report. I didn’t know if the detective would be available to speak with me so I went prepared for the possibility he might be busy. I had organized all the pertinent records for him. I had also written a detailed note explaining my suspicions and how the records supported my assertions, copied the document I had written for my attorney explaining the course of events since the death of my Mom, and placed them with the records.

He was at the station when I arrived, but as I had anticipated, he had an interview taking place in just a few minutes. I handed him the folder with all my documents, briefly tried to explain a MAR to him, noticed his “deer caught in the headlights” look, and decided I should give him time to absorb the information before Cagney and Lacey launched their formal investigation into the theft of Mom’s Vicodin.

I then filed a police report with the police clerk. It was April 29th – Mom’s birthday. It seemed a fitting tribute that the police report was filed on this day.

The detective called me back on May 5th. He had decided to use my note and the document I had written for my attorney as my formal statement. We set up a meeting for the following Monday to sign the statement and discuss the case in detail. I called Cagney with the good news. Finally, after weeks of preparation, we were on our way to bringing this felon to justice – or so we thought. We had no idea how difficult that task would prove to be.

It was obvious from the onset of our initial meeting that this investigation was completely out of the detective’s comfort zone – this was not the typical jewelry heist. Most of my evidence was based on interpreting nursing home records, not an easy task for anyone. I had literally lived and breathed these documents for past few months. But trying to explain them to the detective so that he could interrogate those involved was going to be difficult.

I’ve got to give the man credit – he hung in there with me. I could tell by the look on his face he was intrigued by the case. He didn’t want to lose it to the Drug Enforcement Unit. He took it on as a personal challenge and fought the good fight to bring the people responsible for Mom’s suffering to justice. I couldn’t have asked for more!

The detective could immediately sense that Cagney and Lacey were anticipating a quick resolution to the case. After all, we had mounds of circumstantial evidence of the staff’s complicity in the theft. They convicted people with circumstantial evidence all the time, right? (We’d been watching entirely too many of our own reruns.) He was quick to advise us that the investigation would take time. He had other cases that he must give equal treatment. We needed to be patient.

Be patient? Not an easy task when the victim of the crime was your Mom. I wanted the case solved yesterday. But I did manage to contain myself – I would usually wait at least a week to ten days before bugging the detective for current up-dates on the case.

He also couldn’t guarantee our prime suspect and accomplice would even agree to talk to him. Where are the bright lights, rubber hoses, and cramped interrogation cell when you need them? Couldn’t he bring the two women in and question them based on our circumstantial evidence? Apparently not – the real world worked much differently than the world depicted on TV crime shows.

His first order of business was to talk to the nursing home administrator. I warned the detective not to expect much cooperation. I had a long history with the administrator and none of it was positive.

The detective stopped by the nursing home on May 12th. He met with both the administrator and the Director of Nursing. The administrator did not disappoint me. He quipped, “Mrs. Payton is back!” when the DON walked into his office. She, in turn answered, “What does SHE want now?” Exaggerated eye-rolling accompanied the question. None of this unprofessional behavior went unnoticed by the detective.

The detective explained my allegations. They seemed to doubt the validity of the investigation. The detective told them, “She’s done her homework and your own nursing home records support her claims.” He shared the documents that I had given him – pharmacy billings, Medicare D records, Mom’s nursing home MARs, the copies of the faxes sent by staff to the pharmacy, the copies of the delivery confirmation sheets, and the list I had made for the pharmacy of the prescriptions involved.

In our discussion on Monday, I had explained to the detective that for each of the thirty-one prescriptions on my list there should be an accompanying inventory log sheet – thirty-one prescriptions, thirty-one log sheets.

By state law, nursing home records must be retained for seven years after the death of a resident. As these log sheets were documentation of the administration of a controlled substance, they should definitely have been retained by the nursing home. I told the detective to ask the administrator for copies of the inventory log sheets. If he couldn’t produce them, then we would have an indication that they may have been removed by staff when the meds were taken.

The detective and the administrator played “phone tag” for a couple of weeks after their initial contact. Eventually they managed to connect. The administrator had to admit that he was unable to locate any of the inventory log sheets that the detective had requested. (Cagney and Lacey would have loved to have been a fly on the wall of the administrator’s office when he had to make that admission!) Maybe good old Mrs. Payton was really on to something after all. BUT the administrator also gave the detective a list of three additional staff members who may have been involved in the theft.

What? He already knew about the disappearance of pain meds from the nursing home? And guess whose names were on the list? The first name was that of one of the CNA’s who had been so caring when Mom first entered the nursing home; a woman I trusted implicitly with Mom’s care; a woman I was convinced would never betray me this way. The other two names were of CNA’s that I knew extremely well; they called me by my first name and I did likewise.

The other CNA that I loved so much had left the facility before this administrator came on board. He was unfamiliar with her. I happened to run into this particular CNA one day after the investigation was in full swing at a local Burger King. During our conversation I mentioned the investigation and a look of panic registered on her face. Suddenly she needed to leave. She asked for my phone number, placed it in her cell phone, and promised to call me the following day. I never received a phone call. I had my answer – she was involved as well. I had been betrayed by two women I came to trust and consider as part of my family.

As the detective left the administrator’s office, the administrator asked, “I suppose I should expect a call from the State?” Ah, he knew me so well! But his statement also told me the State had yet to do anything about investigating the theft. They had been contacted March 22nd with the information. Why hadn’t they contacted the nursing home to begin their investigation? I wouldn’t get an answer to that question until months later when I had the face-to-face discussion with the State supervisor.

A couple of weeks after admitting his inability to locate the inventory log sheets, the administrator notified the detective that he had managed to locate two of the missing thirty-one inventory log sheets after an “exhaustive” search. The detective called me with the news and then made arrangements to pick up the documents from the administrator. I stopped by the police station a few days after our conversation and obtained copies of the two log sheets from the detective. He wanted my opinion as to what they might hold in the way of evidence for the case.

I began scrutinizing the log sheets as soon as I received them. Each inventory log sheet identified the Rx number for the prescription, the date the prescription was filled, the date the prescription was delivered and placed into inventory, the name of the resident, the name of the drug, the date a pill was administered, the time the pill was administered, how the pills were dispensed (i.e. one pill, two pills), the quantity of the prescription remaining after that dose was administered, and the signature of the staff member administering the pill. This would prove to be the only tangible evidence we would obtain linking my prime suspect to the theft. All other evidence was circumstantial.

Only seven of the sixty pills on these two inventory log sheets were administered by another CMT; the remaining fifty-three were administered by my prime suspect. I had no doubt that she had administered these pills. Her signature was very unique – difficult to forge.

I began comparing the date and time of the administration of each pill to the regular schedule of Mom’s corresponding MAR. By doing so, I could determine if my prime suspect was even on duty at the time she documented administering the pain meds. Guess what I found? On six occasions, this CMT was so dedicated that she came in on her day off to give Mom her pain meds. Lacey had finally discovered a key piece of evidence.

The prime suspect could not claim that she had mistakenly written down the wrong date or time. Prior to and immediately after the administration of these doses, she had documented giving Mom other doses of the medication.

On the other log sheet, I found that the prime suspect had documented giving Mom eighteen doses of her pain medication but Mom’s corresponding MAR showed none of these doses being administered. Any medication given to Mom, especially a controlled substance, MUST be documented on the MAR. This information must be available to all CMT’s, head nurses, and the physician. By not documenting this information on the MAR, she was putting my Mom’s life at risk. Why didn’t she notate the pills on the MAR? The answer was obvious to me. She didn’t administer them; she took them.

I also noticed that on three occasions, my prime suspect documented giving Mom two doses of the pain medication on the MAR, but only one dose was shown on the corresponding log sheet. Apparently she forgot to give Mom the pill she had removed that morning, and saved the same pill to dispense later that afternoon. Yeah, right!

I believed someone (possibly the other CMT who administered the seven doses) had said something to her about not documenting the eighteen doses on Mom’s MAR. The other CMT always documented doses properly. In her desire to cover her tracks, my prime suspect forgot how many doses she had documented on the MAR when she removed the pill from inventory. Also, Mom’s MARs were suddenly showing the prime suspect administering Mom’s pain meds almost exclusively and on a regular basis.

Lacey was literally doing a happy dance in her kitchen after discovering this evidence. The first person she called with the news? Cagney, of course! The second person? The detective.

I informed the detective of my news. We needed confirmation that the prime suspect was not on duty on the date and time these questionable doses were given. I asked the detective to call my new best friend, the administrator of the nursing home, for copies of her time cards for the dates in question. The administrator whined about having to contact the prior management company for the information, but in the end, he did deliver the time cards. And they did confirm that the prime suspect was not on duty for these six doses. Another round of happy dances by Cagney and Lacey!

While all of this was transpiring, the detective had begun his interrogations. He had decided to begin with my suspected accomplice and the three women named by the administrator. His final interrogation would be with the prime suspect.

The detective was unsuccessful in locating the three women. He visited last known residences, made phone calls, and in the end, only managed to contact a former boyfriend of one of the women.

The accomplice (the second shift CMT) had called the detective right after his first conversation with the administrator and the Director of Nursing. The detective had left his card with the administrator and it was passed on to her. But he chose not to interview her at that time – he wanted more time to prepare for the interrogation. When he finally continued the investigation, she did not return his first few phone messages. He finally called her one morning early, got her out of bed, and set up an interview for June 23rd.

The interrogation did not go as I had hoped; I had hoped that she would actually have a conscience. Apparently, she did not. The suspected accomplice admitted to seeing the narcotics closet door being left open; she admitted that keys were simply passed between CMT’s at shift change; she admitted that security was very lax during the time period of the theft.

As she had placed twelve of the thirty-one prescriptions into inventory, I found it very difficult to believe that she was unaware of the theft. A shift count was eventually performed (after at least five people had had access to the meds). She should have noticed the pain meds missing and reported it. But it seems she was more concerned with protecting her own best interests – her job. She would not admit to knowing about the theft or who was responsible for the theft. In doing so, she allowed this woman to continue to victimize more nursing home residents.

The weekend of June 26th, my sister and I traveled to Columbia, Missouri to visit with our brother, Jim, and his wife. On Monday morning, I received a phone call from the detective telling me he had finally arranged an interview with the prime suspect for the following afternoon, June 29th. He wanted to meet with me prior to the interview so that we could discuss the evidence one more time. High five time once again! Lacey called Cagney as soon as she got back to Kansas City with the news. Surely, this interview would yield the results we wanted so badly.

I met with the detective Tuesday morning. The good news – he had received the time cards from the administrator; the bad news – the prime suspect had called and left a voice message saying she would be unable to attend their scheduled meeting; she unexpectedly had to work a double shift.

The detective and I then started comparing the time cards to the times and dates of the questionable doses. Fantastic news! We had definite confirmation of her involvement in the theft. She had not worked during those time periods according to the time cards.

Lacey couldn’t contain her excitement, but the detective quickly curbed her enthusiasm. “Although I find this information to be compelling, I don’t know if it will be enough for the prosecutor.” A confession from the prime suspect or accomplice, another staff member coming forward as a witness to the theft, or finding the drugs in the possession of the prime suspect would seal the deal for the prosecutor. We had none of these things – another possible setback.

The detective tried unsuccessfully to re-schedule their interview. The prime suspect would not return any of his phone calls. Surprise, surprise!

After a few weeks, my impatience began to rear its ugly head. I knew that she could probably avoid the detective indefinitely, but surely, she wouldn’t be able to avoid discussing the events with the State. The State, after all, would eventually need to make the determination as to whether she should retain her certification.

I called the detective with my idea – let the State set up the interview, and then he could attend as well. He liked it. I e-mailed the State supervisor to see if this was even a possibility. She answered back that she had received some additional information on the case and had already contacted the detective about setting up a joint interrogation. The joint interrogation was set for July 28th, 2010.

The additional information? The State had been contacted by the sister facility of the theft of narcotics in their facility and the possible involvement of my prime suspect. Is it a surprise to anyone that this woman continued her thieving ways once she moved on to the sister facility? She left my Mom’s nursing home when she started to feel the heat. As much as I dislike the administrator, he came into the facility and put pressure on staff to correct the thirty infractions cited by the State. She got out while the “gettin’ was good”.

The State supervisor met with our prime suspect first. She interrogated her about the theft of the narcotics at the sister facility. The detective then joined the interrogation to question the prime suspect about Mom’s case. By this time she was crying, declaring her innocence in the theft of narcotics at the sister facility.

The prime suspect was shown the inventory log sheet and asked how she could possibly have given my Mom pain meds on dates when she was not even on duty. At first, she responded that she had worked all those dates. Really? The detective and State supervisor pointed out that her time cards seemed to indicate otherwise. She then responded that the signatures were not all hers, some of them were forged. “Okay, which signatures are not yours?” She couldn’t point them out. She tells the detective and state Supervisor that she always had problems giving Mom her medications. The detective asks, “Okay, describe those issues – did she spit the pill out, did she refuse to take the pill, did she choke on the pill, just exactly what issues did you have?” She couldn’t provide an answer. Throughout the interrogation, she denied any involvement in the disappearance of over 800 of Mom’s Vicodin pills. She wasn’t about to “fess up” to anything. So much for getting the felon to confess to the crime!

I don’t know how much of Cagney and Lacey’s circumstantial evidence was discussed with the prime suspect during this interrogation. The detective only shared the highlights with me – the discussion of the tangible evidence (in a phone conversation on August 4th). But, for all intents and purposes, the police and State investigations were over. The case would now be placed in the hands of the Platte County Prosecuting Attorney and the compliance unit of the Department of Health and Senior Services.

Before the interrogation ended, the detective was able to get the prime suspect to agree to a polygraph test. As she claimed she was so busy, and therefore unable to return his numerous phone messages about rescheduling their interview from June 29th, he allowed her to pick a date and time. He then mailed her information about what to expect during the polygraph, where to report, etcetera, and called several times to remind her of the impending polygraph. The test was scheduled for August 11th. She did not show.

The detective managed to have a few words with the prosecutor after the interrogations were complete, but the prosecutor was on his way to court, and the detective was unable to give him a detailed account. The prosecutor suggested that maybe the case would be better handled by the State based on the little information the detective was able to relate in that conversation. Cagney and Lacey would have no part of that! We wanted our day in court!

Over the next month (August) the detective would try to arrange a sit-down with the prosecutor to discuss the case in detail. He wouldn’t have much luck in accomplishing that task.

The first two weeks of September, the detective went on vacation. Cagney and Lacey were getting tired of the wait. It had been a long six months, and they wanted results. Maybe, while the detective was enjoying a well-deserved break, we could make our case stronger by finding additional incriminating evidence of this woman’s thieving ways. How to do that? Have a talk with the administrator of the sister facility.

Cagney and Lacey went to see the administrator of the sister facility armed with all our documentation. We showed him everything we had and appealed to him for his help in building our case for the prosecutor. If he could provide documentation of our prime suspect’s involvement in the theft at his facility, surely the prosecutor would feel the need to proceed with an arrest and prosecution.

The administrator was more than willing to help us if he could. He knew that our prime suspect was guilty of not only the theft of Mom’s pain meds, but the theft of narcotics from his nursing home as well. He admitted that he had fired the woman for “just cause.” BUT (isn’t there always a but?) he was restricted by HIPAA laws as to how much he could reveal to the detective. In order to give the detective copies of someone’s records, he would have to clear that decision with his corporate office. Cagney and Lacey left the sister facility with a good feeling. We believed the administrator was sincere in his offer to help, and if possible, he would do so.

My little brother, Jeff, quickly burst my bubble of optimism that evening. I was telling Jeff about Debbie’s and my visit with the administrator. Jeff listened to my story then said, “Jan, the guy may be really sincere in his offer to help but it ain’t going to happen. Think about it. He needs the family’s permission to hand over the records. How are you going to get their permission without telling them why you need the records? You tell the family you suspect a staff member has been stealing their family member’s pain meds. The family is going to say, ‘Happy to help. And oh, by the way, you’ll be hearing from my attorney.’ The corporate office doesn’t care about notifying family members of the theft. In fact, they want to avoid doing that. They don’t want to invite lawsuits. Their problem was solved the minute the administrator fired her.”

So much for Cagney and Lacey’s success in providing more incriminating evidence. Jeff was right – the detective never heard from this administrator.

The future of our case would now be based on our circumstantial evidence and our one piece of tangible evidence. Would it be enough for the prosecutor? We thought so. The theft of a controlled substance is considered a Class C felony theft regardless of the quantity taken or the monetary value involved. Cagney and Lacey thought they had provided the evidence to support this.

The detective finally managed a conversation with an assistant prosecuting attorney. He presented all our evidence. The assistant PA didn’t think there was sufficient evidence to proceed with prosecution. He needed a confession, a witness, or drugs found in the possession of the prime suspect to strengthen the case. We had none of these. The case was closed. Cagney and Lacey would now have to rely on the State to step up to the plate. God help us! We were going to need it!

CHAPTER 11

THE STATE INVESTIGATION (OR LACK THEREOF): PART II

I sent several letters and e-mails to the state Supervisor apprising her of the progress of the police investigation. Every detail, every new piece of evidence, every setback, was relayed to her as soon as the information became available to me. Any additional documentation found (the inventory log sheets and time cards) was immediately mailed to the State supervisor.

Repeatedly, with each letter and e-mail sent, I would question the state Supervisor as to the progress of the State’s investigation. Had they visited the nursing home yet? What had they found? Had they interviewed other staff members? Had they talked to the administrator? I would receive no answers to my questions.

After the discovery of the two log sheets and the vital information they contained, I would repeatedly ask the supervisor to send an investigator into the nursing home to search for more of these log sheets. The detective had expressed his doubt that the administrator would be placing our request for the log sheets on his priority list of things to do. I had serious doubts as to how “exhaustive” his search really was. If we could uncover more of these log sheets, then we would have more tangible proof of the prime suspect’s involvement in the theft.

I thought the State would be able to go into the nursing home and search through the records themselves. The State was supposed to have unlimited access to nursing home records, right? Wrong. I would later discover that yes, the State could request to see certain records, but what they received was dependent on what the nursing home chose to share with them. They had to trust the nursing home to provide them with all requested records.

After months of unanswered questions, I finally received the following e-mail from the State supervisor. “Currently, the (name of nursing home) case is in the hands of the detective and prosecuting attorney. We can only regulate the facility’ current practices and monitor employees of concern to prevent harm to residents. Unfortunately, regarding records, considering the time frame and turnover of staff at the facility, I think we have all the records we are going to get. To obtain sufficient evidence, in cases such as this, sometimes requires tracking and establishment of a solid pattern, to obtain sufficient evidence. When the facility system fails, there are frequently multiple variables. As far as this and/or additional investigations involving (prime suspect’s name), we have started preparation and review processes required, for referral to our next level of review, in our central office compliance unit. During that time, we will have the abilities to track employment status and additional concerns as well as over sight of any concerns.” I received this e-mail on August 26th, 2010 – a month after the joint interrogation of the prime suspect.

I was outraged! They needed to see a definite pattern to this woman’s behavior to be able to proceed? Hadn’t this woman’s complicity in the theft of narcotics in two different nursing homes been sufficient evidence to establish that pattern? For God’s sake, how many nursing home residents did this woman need to victimize in order for the State to consider a pattern established and decide to proceed?

What exactly did it mean that the case was being referred to the next level of review in the compliance unit? How is the State going to track employment status and additional concerns? Why hadn’t the State removed her certification? Why was she being allowed to continue to work in nursing homes? I needed answers and I deserved answers!

I sent the State supervisor a scathing e-mail in return. She ignored it. After a week or so, I had calmed down enough to write an e-mail apologizing for my outburst – surely she understood my frustration with the system by this point in time. The prosecutor had abandoned me and now the State seemed to be doing the same. I asked for a face-to-face discussion of the case. I wanted to understand how the State intended to proceed with Mom’s case. She agreed to meet me on September 23rd, at her office in Cameron.

Cagney and Lacey were off to Cameron, Missouri for a show-down with the State. Bring it on!

We met with the State supervisor and her boss. We had an hour of their time to discuss the case and ask our questions. Cagney began, “Has the State gone into the nursing home to determine if there were other victims? How extensive was the theft?” The answer – Due to the amount of time that had passed since the theft, the turnover of staff, the time, money, and personnel that would be required to do such an extensive investigation, no, the State would not be investigating the magnitude of the theft or searching for additional victims.

Lacey asked the State supervisor, “Would you please explain exactly how the State intends to proceed with Mom’s case?” The answer – The State supervisor felt that I had enough circumstantial evidence of this woman’s involvement in the theft and she was forwarding all my documentation to the compliance unit in the Jefferson City office of the DHSS.

“Okay, now it’s in the hands of the compliance unit, what does that mean?” inquired Cagney. The answer – The State’s legal team would determine if there was a “preponderance of evidence” to initiate proceedings to place the prime suspect on the Employee Disqualification List (EDL).

Next question, “What is the EDL, and how would it apply to our suspect?” The answer – The EDL is a list of employees who have abused or neglected a resident (patient) or have misappropriated property belonging to the resident (patient) while employed by a nursing home, hospital, hospice service, or home health agency. All the above agencies are forbidden to hire anyone whose name appears on the EDL. Before hiring any employee, these employers must check the EDL to see if the name of the prospective employee appears on the list. Furthermore, if our CMT’s name is on the list, and there is a federal marker placed beside her name, she would be unemployable as a CMT in all 50 states. A federal marker is placed beside the individual’s name if they were working in a Medicare facility during the time of the neglect or misappropriation of property. That’s the good news. The bad news? It apparently takes an “act of God” to place an individual on the EDL.

The State supervisor then went on to tell us that we did have one thing going for our case – our prime suspect “acted guilty.” Thank God for that bit of news! I wish the prosecutor had used that as his criteria to continue with prosecution! She acted guilty and this fact was going to convince the legal eagles in the Jefferson City office to start proceedings to put our prime suspect on the EDL. Cagney and Lacey’s prospects of stopping this woman were looking pretty grim.

“Okay, what happens in the meantime, while we’re waiting for the decision from the compliance unit’s legal team? Is our CMT free to continue working in another nursing home facility?” The answer – Yes, but the State would track her employment. If she went to another Missouri nursing home, the State would be notified of a background check on our CMT and would know where she had relocated. (That’s assuming, of course, that our CMT remains in Missouri. What if she moves to Kansas? Iowa? Then they have no way of tracking her movements.)

“If you know where she has relocated, will the State go into the facility to check and see if she’s still stealing narcotics?” The answer – No, the State cannot go into a facility and perform a narcotics count with the sole intent of determining whether our CMT is continuing to steal narcotics in her new place of employment. They can only do a narcotics count during a routine yearly inspection (every twelve to fifteen months), or if they are called into the facility to investigate another complaint. In that case, they may be able to say, “While we’re here, we’ll do a narcotics count as well.”

Apparently, our thief has rights. It’s considered harassment on the part of the State to check on her behavior at her next place of employment. She can continue her behavior for as long as she’s able to by-pass the facility’s internal auditing system that tracks the administration of controlled substances. This could be weeks, months, or years. In my Mom’s case, she avoided detection for over a year. In the sister facility, she avoided detection for about ten months. If no one stops her, she can keep this up indefinitely – moving from nursing home to nursing home conducting her very lucrative drug business.

“If she’s placed on the EDL, will she be able to appeal the decision?” The answer – Yes, she will be notified of the State’s intent to place her on the EDL. She has a month to respond, and set up an appeal hearing. If she chooses not to respond, her name will automatically be listed on the EDL.

“Will the family know if she’s placed on the EDL?” The answer – No. No? The family who made the original complaint, the family who has lived with the knowledge that our Mom suffered from chronic back pain for two years due to this woman’s behavior, the family who has pursued finding justice for our Mom for the past ten months, the family who has worked relentlessly to make sure this woman didn’t victimize another nursing home resident – we won’t have the satisfaction of knowing she can no longer harm another innocent nursing home resident? Unbelievable! The woman has more rights than our Mom. The information on the EDL is considered privileged – available only to prospective employers.

So, as far as Cagney and Lacey were concerned, this woman was still working in a nursing home, still stealing pain meds from innocent nursing home residents (possibly working in the nursing home where your loved one currently resides). We left the State supervisor’s office that afternoon even more determined than ever to right this wrong. But how? My neighbor, Sam, would make Cagney and Lacey an offer they couldn’t refuse!

CHAPTER 12

LIGHTS! CAMERA! ACTION!

Over the past two years, I had kept my neighbors apprised of the progress of my journey to hold those responsible for my Mom’s needless suffering and death accountable. Their never-ending support would give me the strength to continue my journey after each setback, each roadblock.

One of my neighbors, Sam, is a producer for one of the local television networks. At the end of each of our discussions about the latest roadblock or setback I was currently encountering, Sam would always quip, “Jan, just give me the word and I’ll set you up with one of our investigative reporters.”

I never seriously considered that possibility. I thought I could handle the situation through the police and the State investigations. But it was always lingering in the back of my mind. When both the prosecutor and the State abandoned my Mom’s case, I decided it was time to go public, time to take Sam up on his offer. I could not prevent this woman from victimizing more nursing home residents, but I could certainly alert the public to that possibility and educate them as to how to protect their loved ones from becoming her latest victim.

Cagney and Lacey would soon be scheduling an interview with an Emmy-award winning anchor and investigative reporter. Lights, camera, action!

After both the police and the State closed their investigations, the family wrote another letter to Senator Kit Bond. As a proponent of nursing home reform, we wanted Kit to know what the family had been through. The letter outlined my journey of the past two years.

I took a copy of Kit’s letter to Sam. I asked that he show the letter to one of his investigative reporters and see if they would be interested in doing a story about the theft of Mom’s pain medication. The next day Sam gave me the business card of one of their top reporters. The reporter wanted to discuss the story further.

I e-mailed the investigative reporter as soon as I walked through my door after speaking with Sam. As I have a vocal cord disease, had just had a treatment and the treatment leaves me unable to speak on the phone, I knew a phone conversation would be difficult. He responded to my e-mail almost immediately and told me he would phone the following morning (Friday, October 1st, 2010). He quickly discovered my inability to speak over the phone, so we arranged for a personal interview at my home the following Monday.

Lacey was thrilled with the prospect of a television news story about the theft of her Mom’s pain meds. And Cagney? Cagney was doing a happy dance all over her house after receiving the news!

Cagney and Lacey met with the investigative reporter on Monday, October 4th. Lacey couldn’t possibly do the interview without her crime-fighting partner! To say we were excited would have been an understatement. Finally, justice would be served!

I had all my documentation laid out on my dining room table – a paper trail of more than 200 pages attesting to my prime suspect’s involvement in the theft of 800+ Vicodin pills. The investigative reporter was blown away by all the information. We talked for over an hour about the disappearance of Mom’s pain medication, the documentation that I had supporting my claims of this woman’s involvement in the theft, my failed attempts to hold this woman accountable through both the prosecutor and the State, and my desire to educate the public about the prevalence of narcotics theft in nursing homes. He was clearly intrigued by the possibilities for the story. He left with a promise to get back to me as soon as possible.

He was true to his word. I received a phone call the following day. Could he meet with me on Monday, October 11th and bring his boss? Is there any doubt as to how I replied? I called Cagney with the news. She would definitely be there for the second interview as well.

The investigative reporter’s boss had experience in interpreting nursing home records. He carefully scrutinized my documentation, asked further questions about the police and State investigations into the theft, and promised the station would proceed with an investigative news story about the theft. I supplied him with the names and phone numbers of all key players (the police detective, the general manager of the pharmacy, the state Supervisor, the administrator of the nursing home) so they could verify my story.

The investigative reporter spent the following week checking with my sources, further studying my records that substantiated my claims of narcotics theft by the nursing home staff. (I had made copies of all my documentation for him.) He contacted the station’s lawyer about certain legal concerns. He also contacted the administrator of the nursing home for a statement about the theft. Friday, October 15th he called to ask if I was ready for an on-camera interview. So soon? I didn’t have my voice back yet! I sounded like Gravel Gert. “No problem. We got microphones.”

Lacey was about to make a television appearance. Monday, October 18th would be show time!

I called all my siblings with the news. I had kept my brothers informed of my progress (or lack thereof) over the past two years with weekly e-mail “Maw updates”. All three lived outside the Kansas City area. But my little sister, Jo Lynn, lived just thirty minutes away from me. We spoke almost daily throughout my two year struggle.

Jo Lynn was a constant source of support. My brothers were also very supportive, but there’s something about that “sisterly” connection that’s hard to describe. We cried together, we schemed the downfall of the nursing home together, we strategized as to how to proceed after each setback, we happy danced when I received good news, we cursed the legal system, the nursing home administrator, the State, the prosecutor, the prime suspect when I received bad news – we did it all together. She and Debbie (Cagney) would be the only reason I managed to maintain some semblance of sanity during this ordeal. I needed Jo Lynn by my side during this interview.

And Cagney? What can I possibly say about my crime-fighting partner? Had it not been for Debbie, I would have never discovered the missing Vicodin; I would have never begun this incredible journey. She has been with me since day one. We delighted in our investigative skills, we secretly plotted the eventual demise of those responsible for Mom’s suffering, we celebrated every victory and cursed every defeat, we dreamed of the arrest of our prime suspect (we would put the cuffs on her, of course), we fought the good fight, undaunted by any obstacle we met along the way, we were Superwoman and Wonder Woman all rolled into one, we were invincible – we are best friends. Lacey couldn’t possibly make it through the television interview without Cagney.

But Cagney declined to go on-camera. “This is your family’s story to tell, not mine.” But she was rooting from the side lines. I could do this!

The investigative reporter and his cameraman were at my house by 10:30 a.m. After introductions were made, we moved into the dining room to conduct the on-camera interview. Jo Lynn sat by my side; Debbie watched from the kitchen doorway. Microphones and the camera were set up. We were ready for Mom’s big day – her story was finally going to be told.

The reporter asked questions first of me, then of my sister. The interview lasted for approximately forty-five minutes. After the conclusion of the interview, the reporter told me he would let me know when the air date would be. I knew the forty-five minute interview would be edited down to about a four minute piece. I asked if I could preview the story. “I’m sorry, Jan, you have to trust us.” And I did.

The air date was Thursday, November 18th, the ten o’clock news – a prime-time slot for the story. Hundreds of people would see the story, and hopefully hundreds of nursing home residents would be helped. The story surpassed all of my expectations.

The investigative reporter and his cameraman had done an outstanding job of telling my Mom’s story. I watched nervously from my family room couch, tears running down my cheeks. “We did it, Mom – we finally did it!” I knew Mom was smiling down on me from heaven. My journey was finally over. My Mom’s story had been told.

But I found I still couldn’t let the issue rest. The television segment had only related a very small portion of my Mom’s story. The whole story needed to be told. “I’m sorry, Mom ……. I wish I had known” is the whole story. It is my sincere hope that in reading my Mom’s story, you will be able to ensure the safety and comfort of your loved one.

CHAPTER 13

THE MORAL OF THE STORY

The moral of the story: YOU are the only advocate your aging parent or loved one has! They cannot speak for themselves. You must be PROACTIVE rather than reactive. If you wait to react, you may be too late to save them. Their life depends on you.

Nursing home residents are easy targets for neglect. Alzheimer’s residents are particularly susceptible to neglect. The mind of an Alzheimer’s resident is no longer capable of rational thought. Their mind does not allow them to communicate their pain or discomfort. They feel pain just as acutely as anyone else, but their mind will not allow them to describe their level of pain or to know that relief is available, just for the asking. Their mind does not allow their bodies to feel the sensation of hunger or thirst. They lose their appetite, and sometimes, their ability to feed themselves. Their mind does not allow their bodies to feel the need to void their bladder/bowels. It just happens – they have no control over it. They depend on others to assess their needs and respond accordingly.

You cannot trust nursing home staff to properly assess your loved ones’ needs. The staff may be untrained in the proper assessment of pain, dehydration, and malnutrition, the staff may be over-worked and unable to devote the amount of time needed for a proper assessment, or the staff may simply not care enough to make the proper assessment. The reason behind the neglect is irrelevant. What IS relevant is that you, better than anyone, know your loved one. You can speak on their behalf. You can ensure their safety and comfort. And you can do this by asking the right questions, requesting copies of specific nursing home records, and knowing the signs of dehydration/malnutrition and neglect.

Nursing homes have one of the highest staff turn-over rates in the country. Your favorite CNA may be there one day and then suddenly gone the next. She may have been well-trained and compassionate, but the person who replaces her may not possess those same qualities. Nursing home staff are under-paid, over-worked, and receive few benefits. You cannot begrudge them the opportunity to move on to a more profitable career. But the resulting fallout from their departure may well include the neglect of your loved one.

During my two year journey to find justice for my Mom’s needless suffering and death, I have uncovered information about the inner workings of a nursing home that most people are unaware of vital information that will help you ensure the comfort and safety of your loved one. My finding this information is an exception to the rule. Had I not pursued a wrongful death lawsuit, had I not received copies of my Mom’s nursing home records, and had I not had a best friend whose desire to help innocent nursing home residents avoid possible neglect was as strong as my own, I would never have found this information. If I had had this information when I first placed my Mom in the nursing home, she never would have suffered needlessly and she would probably still be alive today. It is my hope that by sharing my story, Mom’s story, you can keep your loved one safe.

The following chapter contains this vital information. Please read it, study it, and then put it into action as soon as possible.

And always remember – never allow your naivety or trusting nature to keep you from following your gut instincts. If you feel something is wrong, don’t doubt it – do something about it! Do what you know is right to protect your loved one. I wish I had known!

CHAPTER 14

MY ADVICE

DOCUMENTS YOU NEED TO OBTAIN BEFORE YOUR LOVED ONE BECOMES INCAPACITATED:

Long before there is a need to place your loved one in a nursing home, the family needs to sit down with the loved one and ask some tough questions. If the loved one becomes incapacitated for whatever reason, who would they want making health care decisions for them? Who would they want handling their financial affairs?

A Durable Power of Attorney will allow your loved one to decide who should handle their financial affairs once they become incapacitated.

A Durable Health Care Power of Attorney will allow your loved one to decide who should make all health care decisions once they become incapacitated, including life-prolonging procedures.

A Health Care Directive (or Living Will) will allow your loved one to state what life-prolonging procedures they want followed if they should become incapacitated.

An Authorization for the Release of Protected Health Information (more commonly known as a HIPAA release form) will allow your loved one to name who has access to all their medical records (nursing home records) if they are not incapacitated.

All the documents must be signed by your loved one while they have the mental capacity to understand what they are signing and what is contained in the documents. Both Durable POA’s will not go into effect until the loved one becomes incapacitated. Two physicians will have to attest to their inability to handle their own financial and medical decisions. The signatures on the POA’s must be witnessed and notarized; the signatures on the Health Care Directive must be witnessed; the signature on the HIPAA release form may or may not require a witness. (I recommend the form be witnessed.)

These documents must be in place long before your loved one becomes incapacitated or placed in a nursing home. All the documents can be downloaded from the internet. Simply Google “Durable Power of Attorney” to find a list of websites. I personally recommend the website associated with the Missouri Bar Association. You can also have an attorney draw up these documents for your loved one.

It is imperative that before you place your loved one in a nursing home, you have access to their medical records/nursing home records. Access to the nursing home records is essential in order to maintain a close eye on your loved one’s care. These documents will give you that access. When you place your loved one in a nursing home, be sure the home has copies of all these documents. The documents will then be placed in their nursing home record for all personnel to see.

HOW TO SELECT A NURSING HOME:

When you realize that a nursing home is in your loved one’s future, select five to six nursing homes in your area to visit. You can find a list of nearby nursing homes on the internet. Call each home and make an appointment to visit. As you tour the facility, take note of the following:

* When you first enter the facility, does it smell clean or does it reek of urine?
* Are the floors/carpets clean and vacuumed?
* Are staff members friendly?
* Do you observe staff working with the residents or are they smoking in the courtyard/lounging around the nurse’s station?
* Does the facility have an Alzheimer’s wing? Is it a lock-down unit? (Very important for Alzheimer’s residents as they tend to wander and get lost.)
* Do you observe a large number of residents sitting in their wheelchairs being ignored by staff?
* Does the facility offer physical/occupational therapy on site?
* What amenities does the facility offer? (i.e. beauty salon)
* Is the facility a Medicare/Medicaid facility?
* Do you hear alarms going off? Are staff responding to the alarms or ignoring them?
* Ask your tour guide for information about the cost involved. Private room versus semi-private?
* Chat with some of the residents. Ask how they feel about the facility. Old people are just like kids – very honest.

After each visit, sit down and make notes of what you observed. What did you like about the facility? What did you not like about the facility? After visiting all facilities on your list, narrow your list down to the top two. Now it’s time to do some on-line research.

The Missouri Department of Health and Senior Services (www.dhss.mo.gov) is an excellent website to visit for information on specific nursing homes. You can access each nursing home’s latest inspection by the DHSS. You can visit the Medicare website (www.medicare.gov/nhcompare) for even more information. You can also visit each facility’s website.

After you finish your on-line research, go back and visit each nursing home again. I would suggest you go back at least once while the nursing home is serving a meal. Take note of the following:

* Are the meals served quickly or do the residents have to wait a long time before being served?
* Do the meals appear to be appetizing?
* Are the meals served hot?
* Is there enough staff on duty to help the residents who need assistance with their meals?

You might want to talk to friends and neighbors about the nursing homes you are considering. Have they heard positive or negative things about the nursing homes? Have they placed loved ones in these facilities?

Make your decision based on your observations during each visit combined with your on-line research. Hopefully, your final choice will be the right one for your loved one.

YOUR LOVED ONE IS IN THE NURSING HOME – HOW DO YOU PROTECT THEM FROM NEGLECT?

1. Make an appointment to visit the in-house physician if he is not currently your loved one’s physician.

Prior to the admittance of your loved one to the nursing home, ask the administrator if you will be able to retain your loved one’s current physician or if he/she will be assigned to an in-house physician. If your loved one is to be assigned to an in-house physician, ask who and get contact information. Make an appointment to visit this physician as soon as possible to discuss your loved one’s medical needs. (If the in-house physician is already your loved one’s current physician, then you don’t need to worry.)

I was given no choice in the matter. I was told that I must use an in-house physician to care for my Mom’s medical needs. I never met the man. I didn’t know his name until I received Medicare statements for his services. I trusted that the man was a geriatric specialist and would offer the best possible care for my Mom. I gave the nursing home admittance counselor a detailed accounting of my Mom’s medical history. The nursing home was to obtain her medical records from her previous physicians. I assumed the in-house physician would be aware of Mom’s condition. I assumed wrong!

The in-house physician visited my Mom once a month. I was never notified of any concerns. The first part of November 2007, I was visiting Mom and happened to notice the physician sitting at a desk in the nurse’s station. I approached him to discuss Mom’s continuing back pain. He looked up and asked, “Have you discussed your concerns with the staff?” I replied in the affirmative. He said, “They’ll tell me what I need to know.” He then got up from the chair and walked away. I was so incensed by his rudeness and lack of concern for my Mom, I immediately found a staff member and inquired if there was another in-house physician. There was, so I signed the necessary documents to switch physicians.

I met the second in-house physician only once prior to my consultation with him on the day of Mom’s death. My best friend, Debbie, spoke highly of him – he was her mother-in-law’s physician. I talked to other friends as well. Everyone gave him a “thumbs up”. I thought I had made a good decision in making the change. (He would be the physician that I contacted later in November about re-evaluating Mom’s back pain and changing/upping Mom’s pain meds.)

Once I received Mom’s nursing home records, I had access to the in-house physician’s notes from each of his monthly visits. It was apparent from each entry that he had no clue as to how advanced my Mom’s Alzheimer’s was.

You should never assume that the in-house physician will have all relevant information about your loved one’s mental status from the medical records supplied by the nursing home. And you should never assume that the physician will be able to make a determination of the severity of your loved one’s Alzheimer’s based on their ten minute monthly exam.

In your visit with the in-house physician, explain your loved one’s current condition in detail. Share all past medical information that the physician needs to be aware of. The nursing home is supposed to obtain your loved one’s previous medical history but you should never make the assumption that those records will be complete. Chances are good that they will not.

2. Get to know the staff.

One of the biggest mistakes I made was the regularity and timing of my visits. I always visited in the morning about an hour before lunch. I only got to know the first shift staff and that staff knew my routine all too well. You need to vary the times and dates of your visits so that staff on all shifts get to know you and you get to know them. Never allow your visits to become too predictable! Don’t call to let them know of an impending visit. The staff should never anticipate your visit.

3. Go prepared to the quarterly Plan of Care meetings.

It wasn’t until I received Mom’s nursing home records that I discovered that the nursing home must have a written Plan of Care (POC) for each resident. I was invited to quarterly discussions of my Mom’s care with the administrator, but never once was I shown a copy of the POC or given a copy. The administrator simply told me what a nice woman my Mom was, told me she was doing great in physical therapy, and asked if I had any questions. I eventually stopped going to the quarterly discussions, as I thought they were a waste of time and I didn’t want to find a babysitter for the grandson. After all, I was a regular visitor to the home. The staff saw me at least three times a week. If the staff had any concerns about Mom’s condition, they could talk to me personally during one of my visits. I didn’t even know a POC existed.

The POC will outline every facet of your loved one’s care. It contains a wealth of information – information you need to have. After your loved one is admitted to the nursing home, ask for a copy of their POC. Attend each quarterly meeting with your POC in hand. Notate any concerns you have that are not currently addressed on the POC and discuss them with the staff member conducting the quarterly meeting.

Each quarter, the nursing home is to review and revise your loved one’s POC. At your meeting, ask what adjustments have been made in their care since the last quarterly meeting. Have all of your concerns added to the POC if the nursing home has not already done so. Ask the nursing home to provide a copy of an up-dated POC as soon as it’s available.

4. How to guard against narcotics (controlled substance) theft

Your loved one’s MARs are the single most important nursing home records that you need to obtain. As you know from my story, these records provided me with the documentation of the theft of over 800 of my Mom’s pain meds (Vicodin). Unfortunately, I didn’t receive these records until months after Mom’s death. You need to request a copy of each month’s MARs! Without fail! The nursing home may charge you fifty cents a sheet, but isn’t it worth a couple of bucks to know that your loved one is receiving the medication, and the medication is not walking out the front door with the staff?

Make sure that your copy includes both the PRN schedule and the regular schedule. The PRN schedule will list all medications prescribed on an “as needed” basis. The regular schedule will list all medications administered on a daily basis.

If you do not know whether a medication listed on either schedule is a controlled substance, simply check it out on the internet. Google should become your new best friend!

If a controlled substance happens to be prescribed on a daily basis, then you can easily determine how many refills of the controlled substance should be requested each month by checking the regular schedule to see how often it is administered (i.e. if the pill is given twice a day, 2 X 30 = 60, two packets a month). But the majority of controlled substances are prescribed “prn”. These are the prescriptions most likely to be refilled needlessly and then stolen.

Once you have identified all medications on your loved one’s MARs that are controlled substances, keep a vigilant watch on the amount of refills ordered by nursing home staff. Your pharmacy billings or Medicare D records will give you that information.

If a controlled substance is listed on the PRN schedule, compare the number of pills administered during that month (MARs) against the number of pills ordered (pharmacy billing). If the number of pills administered does not justify the number ordered (a refill ordered when 3 pills out of 30 have been dispensed would be suspicious; a refill ordered when 24 pills have been dispensed would not be suspicious), then go immediately to see the administrator and ask them to explain the discrepancy.

There should be no more than two packets of a “prn” controlled substance in the narcotics closet at a given time – one, an almost empty packet; the other, the full refill. Ask the administrator to take a quick trip with you down to the narcotics closet to check and see if both packets are in the closet. If the full refill is gone, he’s got a major problem. Ask to see the inventory log sheets that accompany each refill.

If the log sheet for the full packet is missing, he’s got an even bigger problem. He should notify the Missouri DHSS immediately, and so should you.

If both packets can be accounted for, then the administrator should talk to the staff member who ordered the pills. This staff member needs to explain the reasoning behind the refill. Also, ask the administrator to compare the inventory log sheet for the packet currently being dispensed to your loved one’s corresponding MARs. If the staff is dispensing pills without properly documenting this information on the MARs, they are putting your loved one’s life at risk. All medication, especially controlled substances, must be documented on the MARs for all staff to see. This is an issue that needs to be addressed immediately by the administrator and reported to your loved one’s physician.

Although the pharmacy will contact the physician for his approval of the refill, you have no guarantee that the physician will check your loved one’s MARs to see if the refill is justified. As long as the nursing home staff doesn’t order more than the prescription allows in a given month, the physician’s staff may not question the request for the refill. As I said before, a creative thief can easily circumvent the security measures the nursing home has set up to prevent theft.

If, for some reason, you want a “prn” medication to be administered on a regular basis (I requested that the staff give Mom a pain pill in the morning and another in the afternoon as she was unable to do so due to her advanced Alzheimer’s, and I knew her back pain was constant), either put the request in writing, or call your loved one’s physician and request that your loved one be placed on a pain med that could be administered on a regular schedule. Your word means nothing – every request that differs from the norm should be documented.

5. Signs of dehydration and malnutrition

Unfortunately, many of the symptoms of dehydration/malnutrition are also symptoms of dementia and Alzheimer’s. But each symptom should be evaluated to determine the underlying cause.

The most obvious sign of dehydration/malnutrition is rapid weight loss. Always trust your gut instinct on this one! Even though staff is caring for your loved one 24/7, they may not respond to your loved one’s rapid weight loss appropriately.

Nursing home protocol is to weigh each resident once a month unless instructed otherwise by the physician. To my way of thinking, any resident identified as a high risk for dehydration/malnutrition by the nursing home’s dietician, should be weighed on a weekly basis. (I found out my Mom was at risk after obtaining the nursing home records.) This is not the case.

Nursing home protocol also dictates that if any resident loses more than five per cent of their last recorded weight or five percent of their weight in a month’s time period, the resident’s family and physician should be notified. Don’t count on that happening. Nursing home staff must make a proper assessment of your loved one’s rapid weight loss, and weigh them immediately to determine how much weight has been lost since the last time the resident was weighed. I found that the staff did not take the initiative to do this.

My Mom lost ten per cent of her last recorded weight before she was finally weighed. Staff never thought to weigh my Mom ahead of the appointed time at the end of the month, even with my constant questioning of her very obvious weight loss. It was I who finally demanded that she be weighed so that I could inform the physician of her rapid weight loss. If you want your loved one weighed weekly, then contact the physician and have him notify staff to do so. It’s better to be safe than sorry!

If you want to know how much weight your loved one has lost (gained) between each weighing, simply ask to see their weight chart. The staff must keep a record of each weight obtained.

And don’t hesitate to demand the staff weigh your loved one immediately if you have any doubts. Insist that they do so while you wait for the results. There is a staff member somewhere in the facility that can accommodate your request. If need be, they can pull someone from another hall or pull someone off break.

Did you know that the nursing home must keep a written record of your loved one’s meal and liquid consumption? I didn’t. Each month the staff must document what percentage of each meal is consumed and how many ounces of liquid they drank with the meal. If your loved one is losing weight, and the staff denies noticing anything different in their eating habits, ask to see their meal consumption log for that month.

Also visit the nursing home during a meal. Observe for yourself what your loved is eating and drinking. The nursing home is required to offer an alternative meal if your loved one does not like what is being served, within reason of course. My Mom loved soup so the dietician recommended that the staff serve her soup on those occasions when she didn’t like the meal offering. Of course, I never observed this occurring during the meals I observed. I also didn’t know it was even an option until I received nursing home records.

If the nursing home dietician (or physician) has identified your loved one as a high risk for dehydration/malnutrition, they will prescribe a power shake and/or house supplement to counteract this risk. The regular schedule of your loved one’s MARs will document the dispensation of both. Check your copies of each month’s MARs for this information.

Another sign of dehydration/malnutrition is persistent fatigue – sleeping all the time. Every old person likes to nap; I like to nap. But if you find your loved one constantly sleeping, unresponsive to your attempts to wake them, failing to stay awake after you wake them, falling asleep during a meal, something is clearly wrong.

Your loved one’s urine output will be greatly diminished. Their urine will have a strong, foul odor to it. The urine will appear very dark in color.

As your loved one’s condition deteriorates, they will become too weak to tend to their bathroom needs. Muscles become flaccid due to the malnutrition. Walking, even the short distance to the bathroom, is difficult. Although incontinence (or loss of control of bowels) is not a symptom specific to dehydration/malnutrition, and it is a frequent occurrence in a nursing home, it is one that should be immediately noticed and addressed by nursing home staff.

Staff leaving my Mom to sit in her own filth for hours at a time, day after day, was inexcusable. Staff indicated on her April Monthly Summary that she had become incontinent. She should have been taken to the bathroom on a set schedule (every two hours). The odor emanating from Mom’s body was overpowering; the smell was unmistakable. This was not a simple matter of not making it to the bathroom on time. This was negligence.

Do not tolerate this kind of behavior. If you have discussed the situation with the staff on several occasions, don’t hesitate to bring it to the attention of the administrator if they continue to ignore you. The magic number is three. First time – it might have been staff oversight. Second time – they have been forewarned, but you’re giving them a second chance. Third time – they are ignoring you and it’s become neglect. You need to head to the administrator’s office immediately.

You might also notice rapid breathing, sunken or glassy eyes, yellowing of the skin. My Mom’s eyes definitely had the glassed-over look and appeared sunken in her face. Her skin did not have a normal appearance to it. Her breathing became shallow and rapid.
Skin will lack normal elasticity. If you pinch a fold on your loved one’s arm, the skin will sag back into position slowly.

Your loved one will be confused, unable to answer questions. As this is one of the major symptoms of Alzheimer’s, it may be difficult to ascertain whether their confusion is due to their Alzheimer’s or dehydration/malnutrition. But it should not be ignored.

6. Other helpful hints

In your attempts to work with staff, it is a good idea to keep a journal. Record the name of the staff member, the date, the time, and content of the conversation. When you finally go to the administrator, give him this information. He needs to be aware of who on his staff is not responding to your requests for assistance.

All falls and bruises must be reported to the family immediately. If you notice bruises on your loved one for which you have not received previous notification, then you need to notify the staff of your find and question what might have happened to cause the bruising.

If your loved one has a history of falls, request that a motion detector alarm be placed on their bed, wheelchair, or recliner – wherever they spend most of their time. Test the staff’s response to the device. If they ignore the alarm, speak to the staff on duty. Let them know that if they continue to ignore the alarm, you will be going to the administrator with the information. Then do it! The devices are in place for a good reason – to alert the staff to a potential fall. Ignoring the alarm is not an option. It shouldn’t matter if you are in the room or not, the staff should respond immediately.

Do NOT leave anything of value or anything that is irreplaceable in your loved one’s nursing home room or on their body – especially jewelry. I found out the hard way that nothing is considered sacred, not even a resident’s wedding rings. You might want to consider having precious stones replaced with less expensive alternatives if your loved one doesn’t want to be without their jewelry. Take the jewelry to be cleaned, and then return it to your loved one having made the switch. They will never know the difference.

If you notice your loved one going to the bathroom excessively during your visit, suspect a urinary tract infection as the culprit. Residents are placed in Depends because it is easier for the staff to clean them up. Depends underwear are a breeding ground for bacteria – especially if the staff does not change them on a regular basis. Ask the staff to notify the physician of the need for a urinalysis. Treatment for the UTI should begin as soon as possible. An untreated UTI could result in hallucinations, loss of balance and ultimately a fall. Each time my Mom fell, it was discovered that she had a UTI.

When you request lab work (or blood work) be done on your loved one, you should expect an order for the tests to be received from the physician by the following day. Ask the staff if they have received the order and when the tests are scheduled to be performed. If an order hasn’t been received, cut out the middle man (the staff) and contact the physician personally. Always ask the staff about the results of the lab work (or blood work) you have requested, or if you contact the physician personally, ask that his staff contact you with the results.

If you notice a rapid decline in your loved one’s condition and the staff are denying or ignoring your inquiries as to what is going on, contact the physician personally, or perhaps even better, head to the nearest ER. Always go with your gut instinct. No one knows your loved one like you do. If it turns out to be a false alarm, so what? At least you have the peace of mind knowing your loved one is okay. This is especially true if the need arises on a holiday weekend.

Please learn from my mistakes. You will be able to ensure the safety and comfort of your loved one if you do.

CHECKLIST

BEFORE PLACING YOUR LOVED ONE IN A NURSING HOME:

* Obtain the following documents: Durable Power of Attorney, Durable Health Care Power of Attorney, Health Care Directive, and an Authorization for the Release of Protected Health Information (HIPAA) form.

IMMEDIATELY AFTER YOUR LOVED ONE’S ADMITTANCE TO THE NURSING HOME:

* Schedule an appointment with the in-house physician.

* Get a copy of your loved one’s Plan of Care from the administrator.

HOW TO PROTECT YOUR LOVED ONE FROM NEGLECT:

* Vary the dates and times of your visits. Get to know the staff on all shifts. Never allow your visits to become predictable.

* Attend each quarterly Plan of Care meeting prepared. Make a list of all concerns you may have that are not currently addressed on the POC and take them to the meeting.

* Obtain copies of your loved one’s MARs at the conclusion of each month. Be sure that you obtain copies of both the PRN schedule and the regular schedule.

* Compare the administration of a controlled substance as notated on the monthly MAR to the corresponding pharmacy billing. If you notice discrepancies, talk to the administrator immediately. If they cannot adequately explain the discrepancy, then notify the State.

* Is your loved one losing weight? Ask the staff to supply the following: their current weight, their last recorded weight (ask to see weight chart), and a copy of their monthly meal/liquid consumption log. If your loved one has lost more than five percent of their last recorded weight or has lost more than five percent of their weight during the last 30 days, notify their physician immediately.

* If you have any concerns about your loved one’s weight, contact their physician and request that they be weighed on a weekly basis instead of monthly basis.

* Visit during a mealtime at least once a week to observe your loved one’s eating habits and how the staff interacts with your loved one during that meal. Does your loved one appear to need assistance with their meals? Is the staff responding to that need? Does the staff offer encouragement? Are they feeding your loved one if they are incapable of feeding themselves? Does the staff offer an alternative meal choice if your loved one doesn’t like what the nursing home is serving?

* Is your loved one sleeping all the time? Napping is normal; sleeping continually is not.

* Has your loved one become incontinent (or unable to control their bowels)? Is the staff responding to the problem immediately? If not, address the issue first with staff, and then notify the administrator if they ignore you.

* Watch for other signs of dehydration/malnutrition (sunken or glassy eyes, yellowing of the skin, loss of elasticity in the skin, confusion, rapid breathing, urine that has a strong odor and dark color, inability to walk short distances, pronounced weakness).

* Keep a detailed accounting (name of staff member, date, time, content of conversation) of all conversations you have with staff about your loved one’s care.

* Discuss any bruises that you notice on your loved one’s body that you have not received prior notification of.

* If your loved one has a history of falling, request that a motion detector alarm be placed on their bed, recliner, or wheelchair – wherever they spend most of their time. Staff should be responding to the alarm immediately.

* Do not leave valuables or irreplaceable items in your loved one’s room or on their body. You might want to consider replacing valuable stones in jewelry with less expensive alternatives.

* Suspect a UTI if your loved one goes to the bathroom excessively during your visit. This is a common occurrence in adults who wear Depends underwear. Request a urinalysis be done immediately to check for a possible UTI.

* If you have requested lab work for your loved one, follow up on that request the following day. If the staff hasn’t received orders for the procedure within 24 hours, then call the physician personally to request the tests be done. Always obtain results of the tests from either the staff or the physician.

* When in doubt, call the physician personally or head to the nearest ER.