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!