Unreasonable to expect?

Nowhere

For those of you with spouses/partners in care facilities. Is it unreasonable to expect aides to brush residents’teeth or stand by remind / assist? Is it unreasonable for them to suggest /assist  one to put on pjs for sleep? My husband does neither on his own. It’s like after dinner he retreats to his room and just gets into bed. He is capable of dressing himself and brushing, but doesn’t remember to or think he has pjs and tooth brush. Heck, he says he doesn’t have even a bathroom, but somehow he finds the toilet. This doesn’t mean he changes his underwear though.

HollyBerry

When my mom was in assisted living, she got exactly the help you describe as well as similar help in the morning. Talk to the staff (nursing?) person who is in charge of the CNA 's or whoever helps the residents and ask to have it included in his care plan. That's what you're paying for. Be sure to attend the next family care conference, or whatever they call it. At my mom's facility I think they happened quarterly,  or more often if someone's needs were changing.

Beachfan

My DH is in a stand alone MCF (they serve only Alz/dementia residents).  There are 14 residents in DH’s cottage; all with varying degrees of involvement.  Caregivers remind, verbally encourage, and/or partially or fully physically assist patients with all ADL’s.  DH is severely compromised; he is bathed, shaved, dressed, teeth are brushed, hair and nails are cared for.  He is also hand fed and physically assisted to sit, stand, walk or climb into bed.  I pay $6200./month all inclusive and I expect him to receive total care.  So far, I have not been disappointed.  I would have a chat with the caregivers at your DH’s facility, leading to a comprehensive care plan that meets your DH’s needs.  Best of luck.

Nowhere

Thanks for your replies. I have a meeting next week. I’ve previously worked with the RN and Director in setting goals for showering and teeth brushing, but I’m told he declines accepting assistance. I went away during the holidays and returned after two weeks to an obviously hygienically neglected husband. He was in same (very dirty) underwear and clothing. When I visit (in disguise as his barber- long story) he will readily shower following a haircut. He’s very paranoid about his wallet and keys and coins he carries in his pant’s pockets. And so it’s tricky to get him to accept he must put his pants to the wash. He’s worried he won’t get the wash returned, and checks his pant pockets repeatedly. Writing this, I just now understand why he doesn’t put on pjs- where would he put his wallet. He’s on medication for anxiety. Maybe I should talk to his doctor about increasing.

zauberflote

My mom did not get that in AL, but everybody got it at her 45-bed  MC. Towards the end they were hideously short-staffed, but they did what they could on their back-to-back 12-hr shifts....

Belldream

Hmmm, just an idea, but could you get him a number of similar pants, and maybe find PJs with a pocket? This way he could move his precious belongings to a cleaner pants / pj's.

Joe C.

Nowhere, DW needs help with all ADLs and the aides assist with all including dressing and dental care. DW is definitely not a willing participant in personal hygiene care but they get it done. On Wednesday the facility had on mobile dentist come in when he was doing the exam on DW he commented that whoever was doing her daily care was doing a good job on her teeth. Similar to Beachfan’s facility, DW is in a stand alone ALZ/dementia facility and they will assist with changing needs as the disease progresses.

Jo C.

Our LOs that were in care facilities did indeed receive mouth care.  In fact, this would be considered part of mandated care.  To come back after two weeks to a spouse wearing the same pair of dirty undershorts is NOT acceptable on any level, not to mention being in the same dirty outer clothing.  Something is very off kilter.  Most of the time, staff will have a way to work around the refusals and manage to get adequate care done.  

If dear husband will not take off his trousers at night as he wants to keep his wallet and coins with himself, well; he can have a clean pair of pants for at night.  OR one can remove all slacks and replace them with soft track suit pants that have pockets.   I am sorry this is happening; it must be difficult for you.  If your husband has a special aide he likes, perhaps the DON will agree to have that person assigned to him each day.  Sometimes that happens and makes a big difference with getting things done.  He can have a bath or shower any time of day and if he has a trusted aide, that may be something that he would be willing to eventually do.

Before I would have medication increased as long as he is not suffering, perhaps you could request a multidisciplinary staff meeting with you in attendance which is supposed to be done at timed intervals as well as when problems arise that need to be addressed.  In this meeting, the supervising licensed nurse from the patient's unit, the med nurse, an aide, the social worker, a physical therapist, a dietary supervisor, and activity director attend, and sometimes the DON will show up.  At this meeting, each staff gives a report re the patient AND problems are identified. The point of this meeting is to develop a concrete measurable written plan of care to deal with the problem issue and a care plan made part of his record to be shared with shift change reports; this is done with everyone's input at the meeting which is to be shared on report with ALL shifts and all staff is expected to adhere to it AND to document approaches and outcomes in the record.   May be worth asking for such a meeting. 

So hope the staff will be responsive and that they are capable of managing to deal with the much needed care issues.   You are an excellent advocate for your dear husband and I can well imagine this is a bit distressing for you.  Let us know how it goes; we will be hoping for a good outcome for you and your dear husband.

J.

Michael Ellenbogen

If they don't want to do it call the states ambusmenst office.

Nowhere

I will, Michael. 

I’ve requested a meeting of all the team administrative members. I’ve been far too respectful of “his wishes” for privacy and need to feel safe and the staff has always considering it a fine balance with his peace of mind at stake. He was a successful exit seeker at his first facility and a window smasher at his second determined to be free. It’s like I have ptsd and afraid to rock the boat, but this is akin to abdication of duty. Thank you, Jo, for listing what I can bring to next week’s meeting. I’ll update here afterwards the results. 

sandwichone123

The term "assisted living" varies, but in many cases does not include intrusive personal care (offering care but not pushing it is pretty typical). If you push for a higher level of care than they offer they may discharge your husband. I'm not saying they will discharge, but it's wise to be aware of the possibility. He may be ready for a higher level of care if he regularly needs physical assistance with personal hygiene.

Nowhere

Update: 

Directory very apologetic and determined to not let it happen again. His care plan was “needs reminders”, not “stand by assistance”, and therefore showers never on a schedule! I didn’t know. He is on one now. I know the assigned shower days and I’m told if he refuses showers the aidea are to report it to an administrator and I’ll be notified. As far as PJ and tooth brushing at bedtime that’s been written in to his care plan, too. Was informed they’d had a pipe burst / major flood over the holidays, short staffed, and director working the floor- came down with the flu. He wasn’t making excuses though- agreed the overlook was deeply troubling. I’m dubiously hopeful, and will be diligent they follow through. 

PastorB

I went through something like this with my wife and her MC. They considered her "high functioning" the first year and acted like this meant they could leave her to manage which clothes were clean, dirty, etc. She could not, coupled with a strong (and medicated) paranoia that her clothes were being stolen when I took them home and the facility did them. Worse, I had to reduce my visits per week because when I was there more often, she would become difficult to manage - masterminded schemes to convince me she was in peril and I should take her home.

Fast forward to I had to go out of town for a short period and I came back to find her wearing obviously dirty clothes. The unit director was working from home 2 days per week. I spoke to the director of nursing who assured me the problem would be resolved. I came back several times over the next few days and found the same thing. Strategies:

1) Make sure you get to the unit director/manager/head nurse responsible for care and try to work out a solution.

2) Failing that, go to the director of nursing and the social worker assigned to your LO. The facility has at least one social worker. My DWs turned out to be a Godsend.

3) Failing that go to your state's ombudsman for skilled care facility patients, the state health department. Skilled facilities are regulated and subject to routine and unannounced audits.

The facility is required to have a care plan for each patient and document that it is being followed. After much inaction and little progress, I went to the state. Within three days I had a meeting with the social worker, director of nursing, unit director, and facility administrator. I have a copy of the care plan and I check weekly to make sure they are following it. After changes in DWs condition, I made sure they updated it accordingly.

I consider failure to maintain a clean environment and make sure DW is wearing reasonably clean clothes neglect. So does the state. I do not believe it was intentional, but neglect does not have to be intentional. It was a failure to recognize that DW is not as "high functional" as they allowed themselves to believe. She takes dirty clothes off and puts them back on the next morning or whenever the mood strikes her.

Relations with the MC don't have to be unfriendly,  but they do need to know that you are watching closely. If I had not found someone who responded quickly and stays in regular touch with me, DW would have been out of there in a heartbeat, disruptive as that would have been.

Best to you!

Nowhere

Pastor B,

Thank you for sharing your story. You’re wife does sound like my husband He doesn’t want dirty clothes leaving the room for laundry as he verbalizes he’s “afraid he won’t see them again”. I have a copy of his updated care plan. You’re correct, I need to talk with those doing his assistance and be sure to give them credit or encouragement. I will closely watch for evidence he’s needs (he isn’t wanting) are being met. It’s a three hour to and from transit so visit him, and that hasn’t helped. All the best to you and your wife.