Standards or regulations related to changing diapers

SEM_BOS

Mom recently shifted from walking and occasional incontinence to being wheelchair / bed-ridden. She's in rehab now (South Florida) following surgery. My question is around expectations (and legal/regulatory) for how often they should be cleaning/changing her.

The rehab facility is "ok" in general. However, tonight around 5pm she finished Physical Therapy and the therapist mentioned to visiting family that mom needed to be cleaned/changed. The family member told an aid, who basically said that since she goes to bed (normally 7 or 7:30), that the aid would come back then and just clean/change her the one time, rather than twice in 2 hours. The aid (responsible for this row of rooms) was busy serving dinner and had a few other tasks on her list.

Obviously the "right" thing to do is to clean/change someone who's in a wet diaper. But I'm trying to figure out how much of a stink, if any, to make with management? Or just accept it? It was just urine (not feces) and we aren't concerned that she sits in wet diaper often, but this also isn't the first time. The aid is compassionate with her once she's 'on task'.

The aid was doing other tasks. I know everyone is short (or borderline) staffed. I'm trying to decide how much of an issue to make of this. Is there any standard practice or regulation around this that we can point to in any discussions?

Much appreciated, From the care-givers.

PS- she'll be headed back to MC once rehab is done, so we'll likely still have similar issues there around frequency of cleaning/toileting/etc. I imagine any advice I get now will carry over.

towhee

I spent 3 months with my LO at a rehab, also time at an MC and nursing home. From my experience, expecting an aide to stop serving dinner and change a urinary only brief is akin to expecting a miracle. They have good reason to ask you to wait. It is going to take them at least 10-15 minutes away from serving food, the food will get cold, and hungry people complain. I know it seems unfair, but unless they have kitchen staff that helps serve, once they start serving a meal they usually will not interrupt unless it is something serious. Also, you do not want someone to be in a hurry when they are changing your mom. Then they would not want to interrupt her meal. Should they have come after her meal, yes, but I would not raise a stink about it unless it gets to be a pattern and they are not answering the call bell. The usual practice at all three facilities I was at was to try to change, if necessary, every two hours, or if called. Usually it worked like this- Morning shift changed brief right before shift change at 3. Afternoon shift changed before supper, usually between 4 and 4:45, then after supper 7-8:30, then 9:30 to 10:30. It sounds as if your mom missed a change because she was at PT. Since people do not always urinate on the aides' schedule this will lead to your mom occasionally being wet for longer than you would like. They should change a bowel movement as soon as they possibly can. You can request her doctor to prescribe that an OTC barrier cream be used when they change her. With good quality briefs this routine should not cause her physical problems. Do, however, make sure they are doing a through skin check at least once a week, since she is not as mobile as she was. If you notice change times starting to slide to 3 and a half to 4 hours, then talk to the supervisor. When she moves to a MC, they should be able to adjust to her schedule a little better.

As to regulations, especially at an MC, they differ by state. You should hope that any facility will live up to their own policies regarding changes, but it does not always happen. Care often depends on that days' staffing and the care of a particular aide.

MN Chickadee

Regulations may vary by state. In our facility they toileted everyone and changed Depends on a two hour schedule or unless called. A bowel movement should be changed immediately, a wet diaper is usually ok for a bit unless the person has skin issues. We never had any problems with the schedule.

SEM_BOS

tganks For the replies Follow-up:

Another family member /caregiver had a meeting with the facility exec and this came up. The exec said this one CNA is very good, but physically slow and often looking for ways to compensate for her slowness (like combining two diaper changes) She said mom should have been changed as soon as dinner was over rather than waiting for bed time

Not a full resolution, but interesting update

Olly_Bake

My LO was in a total of three different nursing homes before being brought home.

I’ve never known the rules around underwear changes but had my expectations. No overly wet because urine causes skin problems, no smells as in number two because that causes bacteria type infections and of course skin problems. No dirty looking catheter or one that was running over. But my expectations fell short and I had to be the spokesperson for my LO.

These facilities would accommodate a sooner change but never immediate. I was okay with helping. I’ve even had an aide in the home setting tell me, he wants me to change him every time he does the second one and I want to wait until he is finished once and for all. I bit my tongue on that one because at the time that was my only help in getting a day off. Thankfully that aide decided to quit and is no longer with us.

Glad you got an answer and glad you had help in getting an answer.