Toileting care for bed-bound LO in MC

chelsea846 · September 30

My father is bed-bound with late-stage Alzheimer’s in MC. He needs complete assistance with diaper changes, repositioning, eating and drinking. He sometimes resists care and screams and scratches during diaper changes, especially when being moved, so changing him really requires two people.

My concern is that he sometimes appears to be left in a wet/soiled diaper for many hours, possibly 10–12 hours. He is generally changed after breakfast and again after dinner, when I am present. I’ve also found meals left in his room when he cannot feed himself because staff are busy with other residents.

The MC director claims diaper checks happen six times a day (twice per AM/PM/night shift) but staff have been honest with me, saying some shifts leave him unchanged when he is sleeping or being difficult.

I understand that MCs are often understaffed and that someone who resists care is more difficult to manage. I want to move him to get him attentive care, but I can’t tell if all MC facilities are like this.

For those with a bed-bound LO:
-Have you experienced staff delaying changes for many hours because your LO resists care?
-Has anyone found that home care with dementia-experienced caregivers provides better care for someone at this stage?

I’d really appreciate hearing what others have experienced and what has worked for your LO.

easy23 · September 30

My DH was in MC and started with urinary incontinence. He was unable to walk to the bathroom because he had the toes on one foot amputated and he wasn't completely able to walk on his own. He stayed in a recliner 24/7.

I slept over at the MC a few nights and saw that they only made a half-hearted effort to see if he needed to be changed. In the middle of the night they would open his door, turn on the lights and yell into the room asking if he was wet. Of course he said no.

During the day they left him sitting in soaking wet clothes. He refused help. I had to eventually change him myself.

Due to the amputation and development of a pressure ulcer, I moved DH to a nursing home. He is there now. The care he gets is so much better. The doctor adjusted his meds to make him more compliant with getting changed. Hospice is in the nursing home, so he has hospice aides 5 days a week, who get him ready in the morning. The nurses are in and out all day giving him meds and taking his vitals.

When I think back to my first meeting with my eldercare attorney, she told me I should skip MC and go directly to a SNF. I didn't listen.

I don't know about bringing your LO home, hopefully someone else with experience will reply.

April23 · October 1

My dad isn’t bed bound nor fully incontinent but I can tell you with absolute certainty that there is no way he would be left sitting in soiled undergarments for any amount of time at the RCF where he is now. The first MC AL he was at? That’s a different story. The level of care over facilities varies greatly.

If your LO is late stage and bed bound, I recommend hospice. He would have an aide to help with changing and hygiene at least in the mornings and a nurse to help with monitoring his skin. He’s at high risk for skin breakdown. They would also get him an air mattress for his bed which can help with prevention. Medication to help with combativeness can also be prescribed. I’m so sorry you’re in this situation.

While the SNFs where I live are abysmal, the RCF has been an absolute game changer. It might be time to think about getting more help. In your area, a SNF might be the better facility. If a part-time private aide is possible financially, that is also an option. I wish you luck.

harshedbuzz · October 3

@chelsea846

Hi and welcome. I am sorry for your reason to be here but pleased you found this place.

IME with family members, while many MCFs do allow residents to age-in-place, they all expect family to bring in private pay aides and/or hospice to help with hands on care and showering when they reach the later stages. With my aunt, her guardian made the decision to transfer her to the SNF part of the community because of the better staff ratio and higher level of care offered.

That said, it's highly unlikely you could even move him to a different MCF at this late stage. Typically, they require a PWD to be ambulatory and self-feeding. A SNF would be the option now.

HB

April23 · October 3

https://alzconnected.org/discussion/comment/283570#Comment_283570

I was told day one at my dad’s first MC that if I wanted him to have help to go to the bathroom before the 2 hr limit, I needed to hire an aide for him. He was only mid stage, fully continent and mostly ambulatory, but needed some assistance. That’s when I knew MC was not for him. He only made it there 4 months.

Arrowhead · October 10

My wife is in the later stages of Alzheimer's and has been in MC for three years. She is mostly bedridden, though they do get her up and in a chair at times. I have often arrived while they were in the process of changing/bathing her. The staff takes good care of her.

Toileting care for bed-bound LO in MC

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