UTI Test for Incontinent?

LucyStone

Hello. Is there any way a nursing home can test a patient who has Alzheimer's and is incontinent? My mom is 87, and recently, her agitation and combativeness have continued to escalate. She is hitting, biting, scratching, screaming, and, as they said, "speaking in tongues." She sleeps mainly all day and does not eat as much. I have begged them for a UTI test. They responded that she does not meet the qualifications required for a UTI test in Pennsylvania. No pain, burning, smell… I told them that with Alzheimer's, their symptoms can be different. They finally relented and, last night attempted to catheterize her. Well, that did not go well. Is there any way to test without doing that? Are there strips or something to put in her Depemds? I am so upset seeing her suffer this way. They keep telling me it is the progression of the disease. Thank you.

harshedbuzz

@LucyStone

In order to get a good sample, she'd need the area to be cleansed and have it done via clean catch or catherization. They'd need her cooperation for either. The problem with strips in the Depends is that it will pick up on bacteria on her skin.

I've never had an issue getting a urinalysis done for my mom (no dementia diagnosis at this time) either at her PCP or local ER. I'm in PA.

HB

LucyStone

Thank you. I am wondering about a hospital visit.

Iris L.

Search the internet for a "nun's cap". It goes in the toilet.

My career was as a pediatrician. In rare instances n if a proper specimen cannot be obtained, but there is high suspicion of an infection, the patient can be treated "as if" she had an infection. This means that if no specimen can be obtained, your mom could be treated "as if" she had a UTI. This technique requires a level of confidence and cooperation with the professionals involved.

An alternative might be a female urinal device, and then having the specimen derived from the resulting urine.

Iris

fmb

My DH is in hospice care and has been treated with antibiotics for suspected UTIs as part of his comfort care. He has a chronic Foley catheter, so getting a clean catch is not possible due to catheter contamination.

LucyStone

Well, The nursing home sent her to the ER. It was twenty miles in the ambulance. She was there all day. The ER Doctor was excellent. He ran many tests and did labs. The only thing he was unable to get was the urine sample, as my mom became so upset she was out of control. He told me that with patients presenting with her symptoms, he feels comfortable prescribing a mild antibiotic to cover her. We know it is a UTI if she improves in a few days. If not, then we can look at it as her Alzheimer's progressing or pain somewhere else. He gave her one dose and sent her back.

The following day, the head nurse contacted the provider group and told them she did not have proof of a UTI and wanted the mild antibiotic discontinued. I was not notified. I only found out by reading Mom's notes on the portal. When I called, no one would speak to me. I am so frustrated.

Jgirl57

LucyStone, I want to scream for you !!!!!!!!!!!! I am so sorry your mom and you are going through this !!!!

ronda b

https://alzconnected.org/discussion/comment/232273#Comment_232273

Are you her mpoa. If so they have to.

LucyStone

https://alzconnected.org/discussion/comment/232300#Comment_232300

Thank you!!!!!!!!!!!!!

Emily 123

Yes—and it's a bit odd that the nurse is gatekeeping the antibiotic prescription, since you've jumped through the hoops and the ED doctor was ok with it. It may be that the ED doctor didn't document their comfort level and that may be why she's doing more back and forth, but I'd incorporate that into your discussion with the provider group and push back.

• more…
• I'd add that to put your mom through all that for her to be returned with a prescription on a 'rule out' kind of basis, and then for the facility to continue to gatekeep prescribed care after a medical assessment is a bit passive agressive. I'd be asking for a meeting with the facility director as to why Medicare and possibly your mom's own insurance will be billed and why they chose to put your mom through that if they had no intention of considering antibiotics for a presumption of a UTI. And I'd consider taking your business elsewhere. Have you considered hospice for your mom as she progresses? They might be helpful advocates in situations like this.

LucyStone

https://alzconnected.org/discussion/comment/232397#Comment_232397

Passive Aggressive is exactly what it is!!!!!! I will look into Hospice. Thank you!

LucyStone

I wanted to update you all on my sweet mamma. She passed peacefully last Friday, and I was blessed to be with her at the time she left us. It is true what they say. The moment she breathed her last, her face became incredibly peaceful, and she was free from any pain. Thank you all for your help during this journey.

If I may, I strongly encourage you to continue advocating for your loved one. You are, of course, because you are here. But, as I found, comfort and peace are often not a nursing home's first priority. My mom had become so aggressive and combative that we transferred her through the ER to a senior behavioral psych unit, hoping for some medication analysis and change that the nursing home was missing. When she arrived, however, the most wonderful doctor called and told me that she was too far gone on her journey.

The first thing he did, however, was put her on an antibiotic for a UTI! Exactly what the ER doctor had done a few weeks ago, and the nursing home nurse had taken her off due to no proof! Mom immediately began to calm down and rest and sleep. I cannot imagine what her death would have been had she not seen that compassionate doctor. Also, the first thing the nurse in the behavioral center asked me was how long my mom's legs had been contracted! Suddenly, it became clear that this was why my mom had been in agony while the nursing home would try to dress her and change her. I had asked for therapy, etc., for Mom as she was confined to a wheelchair. We had no idea her legs were contracted. Every time I phoned and asked what could be done, they told me her arthritis was bad and they put cream on her knees.

In a final act of disrespect, the nursing home sent my mother to the ER wearing only a hospital gown! They stated it was the easiest thing to put on her because she was so aggressive. The Behavioral psych doctor could not believe they would let my 87-year-old mother go in an ambulance in freezing cold weather for a thirty-minute ride.

When the doctor told us Mom's behaviors were a result of the extreme pain she was in, we knew she would not return to that nursing home. God somehow made the stars align, and a bed opened in a nursing home closer to our house. There, for three days, my mom received the most beautiful, compassionate, loving end-of-life care ever. When she passed, she was clean, cozy, and peaceful.

Sorry, this is so long. Thank you for your help and support over these long years. Just don't ever be afraid to advocate. Don't ever stop pushing and asking. There are caring, compassionate people out there. You just have to keep looking.

fmb

I am so sorry for your loss. It is good that you were able to get the care she needed to be able to die peacefully. Unfortunately issues like ignored UTIs and transporting residents in only hospital gowns are all too common; we have had both happen to DH. You were a fierce advocate for her and an example for all of us. Thank you for sharing your journey with us.

housefinch

I’m so sorry for your loss of your beloved mother and the suffering you and she had to endure. You did an incredible job. Thank you for sharing your wisdom.

Iris L.

Immobile patients must have range of motion exercises to prevent contracture, plus they should wear braces in the position of function at night.

Please accept my condolences in the loss of your dear mother.

Iris

Jgirl57

Sorry for you loss. Thank you for sharing your update and good to hear those last few days are ones you can always remember and comfort you. You did an amazing job caring for your mamma.(((HUGS))) and peace.