Dislocated Shoulder

Archived Q&A and Reviews

Elderly parent's shoulder dislocated by caregiver

Jan 2014

My father has Alzheimer's disease (very advanced) and is now living in a skilled nursing facility out of state in the town where he grew up. Recently the facility notified me that one of the caregivers, while attempting to dress him, dislocated his shoulder. Apparently my father was being ''resistive'' -- their word -- and his shoulder ''just popped out'' of the socket. They insist that this happens easily in elderly people and I'd like to know if that's true. I'm not planning to sue them, but I would really like to know whether this is common and not really preventable, i.e. that it can occur even if a caregiver is being extremely careful and gentle. To my knowledge, my dad has never dislocated his shoulder before, so this isn't something he would be especially prone to. upset daughter

It's pretty easy in general to dislocate a shoulder. Even more with someone who is yanking himself away. They are very painful, but also will pop back in, relieving the pain immediately. Probably caused the caregivers a lot of stress too.

This sounds very upsetting for you; your father is lucky that you are involved in his care. What I do know is that it is totally reasonable for an alz patient to be combative, especially with grooming/dressing etc. so a dislocated shoulder sounds reasonable. I like that the facility told you; long distance, they could have tried to not tell you if they are not trustworthy.

If it were my parent, I would want to know what other peoples' experiences are. Do you know other families of residents there? Are there reviews on yelp/similar? If it is in his hometown, do you have family friends who could help connect you? It is worth putting the event out to the ombudsman for review, especially if it is far from you and you can't go check yourself.

If this persists, you may want to look into moving your father and researching the best ways to move a person living with Alzheimer's. I also thought that you might want to read about some best practices in caring for people living with Alzheimer's disease in this excellent article that I read a few months ago: http://www.newyorker.com/reporting/2013/05/20/130520fa_fact_mead. anon

Well, I was a geriatric aide for about 5 years many, many, many years ago. This was before all the bullshit about using machinery to move people around -- we were using Posey belts and lifting techniques to move immobile patients from bed to bathroom, bathroom to bed, bed to wheelchair etcetera. Let me tell you that in the five years I did this NOT ONE PERSON was injured. There were times, in those prehistoric days, when we might have had to let someone down to the floor gently because of their weight, combativeness or other issue (and this was very, very rare). We also always had a male aide on staff to help with both the male patients as well as the heavier people. The point is: NOT ONCE did I or any of our staff member EVER dislocate a shoulder. To dislocate a shoulder, one must pull on the arm. This is NEVER a modality used to move or reposition a patient. Granted, it's been 30 years since I did this work, but we had far fewer gadgets to work with, and we were required to use appropriate techniques to move patients no matter what. Combative or not, not ONCE did the 13 patients I cared for on a nightly basis for five years EVER have anything more than a bruise (usually from bumping on a guard rail or something). I say, file a report because this is unusual and not something to be written off. heather

I thought you'd get a lot of answers so I didn't respond the first week, but if you have concerns that your father is getting substandard care, or being abused, you have some recourse. Here's a wide range of steps you can take, not necessarily in this order: Speak to the director of nursing or administrator at the nursing home and ask for an explanation. Speak to your father's physician, who may or may not be affiliated with the facility and ask if s/he has concerns, is aware of the dislocated shoulder, etc. Contact the ombudsman for your area. I don't know which state your father is in or I'd have looked it up for you, but I believe every state is required to provide ombudsmen who will look into concerns at skilled nursing facilities. I did a ride-along with one in San Francisco and their job is to meet with residents and address their complaints; they are independent and work on issues ranging from theft of personal property to bad food to medical orders not being followed. You can also call the local Area Agency on Aging for more information on ombudsmen and other programs, including Adult Protective Services.

There's a lot you can do despite not living near your father. Don't be put off by the nursing home if you have concerns. good luck and hope all is well with your father

Sorry to be late replying to this post. I would contact http://www.canhr.org, and see what they have to say. They are a great, no wonderful org and often if you call you talk directly with an elder law attorney. For free! Even if it's not their exact focus they can be incredibly helpful. California Advocates for Nursing Home reform. Check it out. And each case is different. And Elders are fragile. And combative Alz patients can be very strong. You may never know exactly what happened but you can do more research on possibilities. Good luck. A live in Family caregiver.

I am a physician specializing in geriatrics and was appalled when I read your letter, as was the physical therapist I read it to. A shoulder dislocation during the course of routine care is NOT common. Without some underlying pathology - such as an old shoulder subluxation related to a stroke - it takes a fair amount of force to dislocate a shoulder. Moreover there are several red flags here: the description of your father as being "resistive" not only indicates the nursing facility is trying to shift the blame, but also that they do not seem skilled at dealing with a demented patient who resists care (which IS very common). I am also concerned that they seem to have shrugged off possible mistreatment by one of their staff without investigating what happened.

You are correct to be concerned. First I would contact the nursing home ombudsman where your father lives, explain your concerns and ask them to investigate. Do you have family or friends who can visit the facility (preferably unannounced) and get a sense of how your father is being treated? Do staff seem to treat him with affection, or are they irritable? Overworked? Contact me if you would like to discuss further. laurie