What are reasonable expectations?

MMC.2004

Moved my dad into a Memory Care facility and am wondering if maybe Skilled Nursing a better fit? He has vascular dementia and has severe physical limitations on top of dementia. I estimate he's Stage 6. The main issue that we are struggling with is his fecal incontinence. Memory Care can't seem to get a hold of it and numerous friends and family have reported his being dirty and dirty bedding at times. I know they check on him every 2 hours and I tend to think that visitors are seeing what it looks like in between checks. But the rest of my family is upset and thinks that he's not getting proper care. What is reasonable in terms of expectations? Is Skilled Nursing a better match for total incontinence?

Lsjogren56

We are just one week into a switch to memory care with my mom and have a similar issue. They don’t seem to be getting her to change depends often. The memory care unit of same AL community she was in touted themselves as able to better care for and redirect residents with dementia but I’m not seeing a lot of help at this point. I have a family meeting scheduled with director and nurse this week and will try to get some answers. Does your facility have a personal care plan documenting what personal services they provide? My mom’s does and it says they will help clean and direct her to change several times a day. I plan to go over the written plan line by line with them at this meeting. Will update this post afterwards.

MMC.2004

I would love an update after your meeting! We have a care plan but the meeting happened the first week he was there and I just didn't know what questions to ask and how to handle putting together a plan. .

RanchersWife

My mil just became completely incontinent. She’s still mobile. I don’t see how any care facility can keep someone clean. I’m on 24/7 poop watch. I still miss.

harshedbuzz

At dad's MCF, checks were hourly during waking hours and every 2 overnight unless residents were out in the walled garden (3 x hour to make sure no one got dehydrated or sunburned). 

If there was a guest, they might poke their head in and ask if he needed anything assuming they would ask for a clean up if needed. If my mother was the visitor, they peak in his Depends which she found off-putting. 

That said, if mobility issues are causing a problem, maybe skilled nursing is the better fit. My aunt started out in MC but we moved her to SN once she was unable to be prompted/assisted with hygiene tasks like toothbrushing.

Emily 123

Hi,

You might want to go ahead and ask to discuss with the director since this may be an issue of staffing or timing.  You can say that  you've heard from several visitors that Dad and his bedding appeared dirty to them.  If you can narrow it down to times of day that may help them when they investigate.  They should have completed a care plan for him prior to his intake and given it to you to sign off on.  If changes need to be made to it then they should share the new care plan with you.

 I think standard scheduled checks with bowel incontinence are every 2-4 hours, so even in a nursing facility he might not get more than that, though there might be a push in a nursing facility to switch to a collection system, not something like Depends. 

They should be trying to get him into a predictable voiding schedule--as you say, this may be a timing issue.  Still, dirty bed linens are not good. Good luck...

MMC.2004

Yes I tend to feel like it's super hard to handle and stay on top of and everyone is doing their best.

Klgm326

I have often wondered if she was getting all the care I want her to. I was told in the beginning that they were checked every two hours for clean “diapers.” They are checked in on every hour. I see mother twice a week and videochat her daily. I do notice that everything is always clean—new clothing every day, clean bed línens that I see with each visit. No bad smells in the community or on her. Sometimes I think her hair is a little oily, but then the next day it’ll be clean and fluffy. When I think maybe there isn’t enough care for her, I recognize that they definitely keep her (and the community) very clean. She also complains that they are always “yanking” her blankets up to “wash them!” I always laugh with her and tell her I like things clean!

Sjodry

MMC,

I am sorry to hear you are going through, but can absolutely echo your frustration. This was a recurring problem in both skilled care stays and a regular occurrence in my mom’s memory care unit.

I just took my mom out of memory care a week ago after her 6th or 7th fall since December and substantial injury. During that time period, I had at least 4 conversations with the facility CEO with no changes in the sub-standard care and issues we faced. 

I have always thought that if one is going to complain, one should also try to find solutions. With that thought in mind, I went to my office and spent a good 5 hours writing/ identifying the issues I observed and experienced on this memory care unit (including consistent toileting and hygiene issues). I tried to think about it from the perspectives of all: Resident, Caregiver, Family Member(s) and Floor Care Manager. I tried to present thoughtful solutions, which also included ideas which would incentivize caregivers. I suggested a Family Resident Council specific only to memory care. I suggested video devices in each resident room and all common areas for those who opted in (Hippa). This would add more security as both family members and caregivers could access resident rooms when not at the facility. Teepa Snow and others have shown the therapeutic benefits of music in the Alzheimer’s population. The devices can scroll family pictures for the resident. The devices could be helpful when the floor care manager is not on site and could access an acute situation with a resident/caregivers from home. I had other ideas and suggestions also.

The CEO was polite, said all of the right things, but I knew that this facility was/is a large franchise with many locations and my ideas were likely to be thrown in a drawer/garbage.

I did attempt to have a meeting with the Floor Care Manager who is often abrasive and defensive. I asked her to explain to me, the caregivers day. What is supposed to happen in the day of the caregiver? She presented a very idyllic explanation of someone else’s reality that I have never seen in my mom’s 7 (+) months there. If what she told me about the amount of times that a resident is checked/taken to the bathroom really happened, then that astronomical amount of money we were paying, might have come closer to being worth it. But as we found out..her explanation was yet another load of ca ca!

I apologize that I don’t really have a solution for you. I tried every solution and angle I could brainstorm. I even talked to caregivers asking them various questions about how comfortable they felt in going to the floor care manager with problems. It was apparent from their answers to me that they were not happy in their working conditions. One caregiver even said to me: “ Someone should get Undercover Boss in here to film so they could see what is happening here. I truly felt bad for the quality, hardworking caregivers and it helped me to greatly understand the turnover in this industry.

So with all of that said, I don’t know what the answer is. When I just turned in my mom’s 30 day notice. I indicated that I would be sharing our experience with the great, big CEO at the top of the corporation. I think he needs to understand what is happening at the bottom of his company. I did receive a call from the Regional Director and interim CEO within two hours of sending that email. I thanked them for reaching out, explained that I would be happy to speak with them, but would still be contacting the CEO. Perhaps that may be an option for you after exhausting the chain of command.

Good luck to you!

Sandy

towhee

Sometimes a medication change or a diet change can lead to multiple loose stools in the course of a day, so you could check for that.  Also a PWD can get their hands in their brief and smear poop on the bed. Special clothing can help with this. Sometimes the act of turning and changing a person will stimulate elimination which occurs right after the CNA has left the room. Timing can help with this. Memory cares, unlike skilled care, do not all keep records of bowel movements. If your relatives could help narrow down when problems occur as Emily suggested it might be helpful. All that said, sometimes CNAs just do not look closely enough. Plausible deniability.

Sjodry, IME, anything that requires CNAs to learn something new or adds to their responsibilities is pretty much a non-starter. Wish it were different.