Help with Aide asking if my mom wants a bath

DawnOfANewDay

We have a hospice aide that comes in to bathe my mom 3 x a week.  Every time she asks my mom if she wants a bath.  Often  my mom answers, No, so she won't bathe her without my mom saying yes.

My mom is stage 7 dementia and has no capacity to understand what is being said to her.  I am her guardian.  My mother can not consent to anything.

Today it end up in a tiff because my mom said no and I said that my mom can't consent just do it and if she fights you, then stop.   I went into my mom's room and told my mom that she was getting a bath and then  my mom said okay and a bunch of incomprehensible sounds.

The aide proceeded to school me on how my mom knew yes and no.  I was frustrated and said, "You're right," and walked out.  My mom had alread said Ok.  

I guess she knows my mom better then me, her physicians and the judge who signed the guardianship papers.  (I didn't say any of this.)

I was pissed.  I admit it.  I had an attitude.  I feel like the aide is just trying to get out of bathing her. This has happened so many times. 

jfkoc

Lack of training. I do not know what you can do about it except try a different aide. 

It must be so frustrating.

mommyandme (m&m)

My first thought is why does she need a bath 3x a week?  Since hospice is about comfort, if your mom is not keen on it then they’d be consistent in not doing it.  Our hospice CNA came in twice a week, once for a bath, the other day, she’d do her nails, put lotion all over her, change the sheets, sit and talk and hold her hand, change her diaper or brush her teeth etc… I’d at least get that 45-60 min away to do me.  For my mom, a bath is not her favorite thing, once a week is enough. I do clean moms booty most everyday with warm soapy water.  Her face and hands get washed daily.  

I do understand your frustration.  Just saying “ok, bath time” would be more conducive. But 3x? Yikes.  Just my humble opinion.  Use the time when the CNA is there to do some self care. Don’t worry what they’re doing too much.  If your mom is clean and comfortable, go with it.  If your mom’s skin begins to break down then hospice will have to fix it.  The CNA and nurse should be watching for that.  

I hope you can ease your mind soon.  

DawnOfANewDay

You think 3x week is too much?  We wash her every day that hospice isn't here. It is just a bed bath where she gets wiped down.  The aide is here maybe 15 mins. 

We have never had the aide do anything but wipe her down.

My mom is fine with it.  She has no idea what is going on most of the time. 

If my mom says no, she just leaves.  

Her skin is starting to break down on her bottom.  I think from urine.  

M1

I would be pissed too and would discuss with her supervisor.  This is just like with a toddler, you don't give them an opportunity to say no.  You just say, it's time for your bath.

DawnOfANewDay

I did call to ask about it.  I don't want a pissing match.  

I am almost to the point of saying nevermind.  I hate going throught this all the time.  

It is 15 mins.  Literally.  

I have NEVER gotten an hour. I can't even take a shower in the time she is here.

If my mom says "no", the aide leaves.

mommyandme (m&m)

Ok so just a wipe down and the aide is only there 15 min? I was thinking a full on bath.  My mom has bed baths too (wipe down) but more thorough and a hair washing with actual soap and rinse water too.  I use desitin to ward off urine skin breakdown which has been successful for us for awhile.  I know that’s not for everyone.  When mom was still mobile and actually stepped into the shower we only did that once a week.  For us, 3x would be way too much.  She doesn’t like the process of getting bathed and except her bottom, she’s not too dirty. My mother’s “no’s and yes’s” don’t match the question, usually, so asking about the bath would be kind of silly in our case.  

I think your CNA situation would be concerning and especially frustrating. I’d be talking to the nurse about what you see as skin breakdown and have her/him check it.  Also, if a task is expected to happen, your mom can’t be the decision maker.  Unless she’s completely agitated, the task should be completed IMO. Our demented LOs, bless their hearts, shouldn’t be relied on to decide what’s best for them, that’s what us POAs are for and why they appointed us.  

Also, before the CNA would come over I’d prep my mom as best I could to let her know what was going to happen.  “Paula is coming over to give you a bath, yippee, and wash your hair, yay” or something like that.  There was never a need to ask cause “we” all understood what was going to take place. 

I’d be pissed too. 

DawnOfANewDay

My mom is usually pretty compliant.  

It doesn't do any good to prep her as she has no memory.  She doesn't remember from minute to minute.

I wash her hair once a week in a bed hairwashing inflatable thing.  It works pretty well.  The aid says they only do the non-rise shampoo which causes a build-up and makes her scalp itchy and flaky.

My mom's answer are random. Her speech is mostly word salad and often incomprehensible.

mommyandme (m&m)

Seems as we have similar situations.  I hope you have a resolution soon. Thanks for sharing!

Jo C.

Hello Dawn, I can only imagine the frustration trying to work with this.

I am an RN who has been Administrator of Patient Care Management, and I also was a Quality Consultant with Home Health and Hospice entities.

In this particular situation, the absolute best way to deal with your very real concerns is to make a phone call to the Hospice and ask to speak to the Nursing Supervisor.  This is acceptable and even welcomed by most Hospices. 

You can simply state to the Supervisor, (not the nice person answering the phone), that you have some questions and concerns regarding an ongoing issue and  that you are concerned about this in regard to your mother's care.

Then let the Supervisor know that

1.  The aide asks your mother who has advanced dementia IF she wants to have a bath and that your mother is unable to process such a question due to her dementia. If your mother says no; the aide then refuses to bathe her despite your wishes; but if you ask your mother within a minute or so if she wants a bath, she says "yes," again, but the aide will not bathe. Inform the Supervisor that your mother is no longer able to process such communication nor is she competent to format her own plan of care.

2. Express that when the aide is there and does give a bath, the aide is only present for 15 minutes before leaving.  

3.  Ask if the aide is supposed to only give a wipe down with a pre-moistened cloth or an actual bed bath with water and soap?  Some entities may choose to use anti-microbial pre-wet washing cloths; (should be heated for comfort), others may use water and soap or even alternate according to needs; so find out the Hospice protocol.   Explain that the swiftness of the wipe down does not appear to be getting the job done adequately and you are concerned about the potential for skin breakdown or infection.

By the way, the aide should be covering your mother with a large towel or draw sheet or other covering when your mother is undressed and should only uncover the area being washed before covering it again and going onto the next body part to be washed.  This is for comfort, to avoid chilling and for the patient's dignity.  Not doing this really is not acceptable so if not being done, you can request that this be part of the process.

4.  If this aide is not a good match, you might want to ask if a different aide could be assigned or if you would rather; how can the Supervisor assist in working with the aide to assist in better understanding and obtaining adequate care.

I can tell you that in my acute hospital experiences, in some instances, some aides even in an acute hospital setting will ask a patient if they want a bath or not . . . if the patient says "no," then the aide is off the hook for a time consuming chore which is not acceptable.   Not all aides do this; most work very hard and so many are wonderful with great professional pride in their work and in providing for their patient's comfort.  Sometimes a patient will absolutely refuse bathing and will not approve no matter what; that is of course an individual matter and there are reasons why this may happen, but it is usually with patients who do not have dementia and who have reasons for this stance. 

Instead of wondering and questioning which may be adding to your stress, why not give a call to the Supervisor and getting the information that may explain the situation and also giving the Supevisor the information re advanced dementia which the aide may not fully understand.

If a Hospice is overall not a good match or perhaps not providing adequate services, then one can change Hospice entities ONCE in any Certification Period.  Be cautious of the Cert Periods; Hospice can explain this to you and there is as lot of information re this that can be found by using Google.

Best of wishes being sent your way for a good outcome,

J.

Elliern

I agree with a simple wipe down as needed. And Desitin is great for preventing skin irritation. 

I also used wet hair wipes to ‘wash’ my friend’s hair when she was in the hospital following a stroke. They help keep hair clean without making scalp itchy. And there is no wet mess, they are just damp wipes.  Just comb hair and let air dry.

I am also a retired RN and unit nurse educator              

dayn2nite2

My mom was in a NH with hospice and the hospice bath aide came 1x a week and the facility handled the 2nd bathing.

She really doesn't need to be bathed 3x weekly.

DawnOfANewDay

Thank you to everyone for your response (especially Jo. C.!!)

I did reach out to her hospice nurse.

harshedbuzz

DawnOfANewDay wrote:

Her skin is starting to break down on her bottom.  I think from urine.  

Skin can also be damaged by pressure from lying in the same position. If she'd bedbound, ask about an alternating pressure mattress to prevent bedsores.

May flowers

Our hospice CNA doesn’t ask our Lo, she just comes in and bathes him once a week and applies Eucerin lotion to his arms and legs. She’s really quick though, and his caregivers usually have to double check that she was thorough.

Because my FIL soaks himself (nearly head to toe) and bed in pee every night, we have clean him daily. We do 3 bed baths a week, and the other days wipe downs with a no-rinse foam and warm water - anywhere he has had urine in contact with his skin, armpits, and face. We always follow up with lotion. Some caregivers give him a good massage and a little range of motion exercise while doing the lotion. So far this routine is working, his skin is in good shape so far.

I second the idea of an alternating air pressure mattress if you don’t have one. Our hospice provided it. 

If you are using wipes for cleaning, I really have enjoyed the a baby wipe warmer - if I forget to turn it on, he really fusses at diaper changes! I do have to turn it off at night though, if the wipes dry out, it starts cooking them.

DawnOfANewDay

My mom soaks herself from head to toe, also.  We've tried differnt diapers, pad that go inside, etc. and most mornings she is wet.  

I have the wipes that you microwave for warmth.  I think I will get a wipes warmer. I never even thought about it.

We do wipe everywhere when we change her when she gets up.

We do put her in a wheelchair most days especially when the weather is nice. She can sorta bear weight on her feet if you hold most of her weight and pivot her feet.   She has a big porch with windows/screens and I try to take her out as often as possible since winter is coming and I doubt that she will be able to pivot come spring.

I did talk to someone and asked if we could stop with the,"Can I give you a bath?" and require a "yes" comment since she will says "no" reflectively and often says nothing or makes incomprehinsible sounds.  If she attempts to fight/scream (she has never done either) then the aide can stop.