Help! My grandma is in LTC, advice needed!

[L&Dnurse2Be]

My grandmother has recently been admitted to a LTC facility for rehab reasons. Right now she can not walk, and they have only been able to get her up in her wheelchair. She is a large woman, so it is at least a 2 person transfer.

I got some disturbing news from my mother about grandma's situation. The doctor ordered her foley to be D/C'd. I just assumed that they would transfer her to a potty chair or at least use a bed pan. They are making her where a diaper! :angryfire She is not incontinent, never has had a problem in that area! She lays in a dirty diaper all night long because no one will change her :angryfire and she is too timid to do anything about it.

I told my mother that grandma should not be in a diaper, that she can refuse it. She should ask for a bedpan. I figure if she hits the call light for the bathroom and they don't come for her, they will have a bigger mess on their hands.

She has also not had a shower in 3 weeks. They hardly clean her with a bed bath. I would think if they can transfer her to a wheelchair, they can transfer in to a shower chair and take her into the shower room!

I don't know what to do. It is my dad's mom, and when he hears all of this he is going to hit the ceiling! :angryfire I'm afraid of how he is going to respond.

I guess what I am asking, am I crazy to think she has the right to a shower, and the right to choose not to be in a diaper and lay in her own urine all night long?

Please help, I don't know where to begin or who to even speak to at the LTC facility.

Sorry about the long story, but I just had to get that off my chest. Any info would be appreciated!

[Marie_LPN, RN, LPN, RN]

Report this place to the state ombudsman!

[meownsmile, BSN, RN]

OH for sure be your grandmothers advocate and go speak with the DON immediately. From experience, they will leave someone on o2, put them in attends(because its easier and adheres to "their" bedcheck schedule. NO she shouldnt be in attends( i hate the phrase diaper when used for a mature adult), she should be offered a bedpan and she should be showered no less than every other day. It should also be her choice as to whether she gets a evening shower or a morning shower. In my opinion people who have to go to LTC lose enough of their dignity without being dictated to how their personal hygiene will be managed. If they can make the choices competantly, they should have that right. JMO

[TreetopAngel_RN]

I concur with the other responses. You should talk to the DON first and make a poibnt of being at your Grandmother's care conference. If things do not improve, you should contact the state ombudsman, details should, by law, be posted conspicuously in the facility.

Elizabeth

LTC is my life!

[FROGGYLEGS, LPN]

I would definitely pick either the administrator or the DON and speak with them about your concerns.

She can most definitely choose to not wear the briefs.

I've never known of a facility where it was an acceptable practice for a resident to be in bed with briefs on because it increases the risk for breakdown. The only exception being those residents who have insisted (or their families insist) to wear them in bed, but that has to be careplanned. Personally, I think incontinence briefs worn in bed are a big red flag.

The staff are obligated to transfer her to the toilet or assist with the bedpan. Having her to wait until she goes in the bed or brief is considered abuse.

Usually facilities have "shower days" scheduled for which residents shower on which day. Again they are obligated to assist. Usually I've seen it scheduled every 2-3 days with bed baths in between. If a resident is in need of a shower on a non-shower day or if they just request it someone is supposed to assist.

It is sad but true that the residents who have friends or family checking up on them receive better care. That is my opinion anyway. I think someone should let them know on her behalf that none of this is acceptable. Each thing you mentioned constitutes abuse, neglect, or both.

You may also want to report it to the state as they do frequently show up at LTC facilities to investigate complaints of abuse and neglect.

I had a very similar experience where a relative was in LTC for rehab. She too was continent and needed assistance of one to transfer to the bathroom. She was told repeatedly that she should just use the bathroom in her diaper since that was what its for and they'd change her, etc. She complained about it to her daughter who was of course furious. In the end more than one staff member was fired and placed on the abuse registry for these things.

[L&Dnurse2Be]

Thanks so much for all of the advice. My dad is going to contact the DON tomorrow and ask for a care conference. Hopefully they can fix the problem and eventually transfer her to a better facility.

[DG5]

You simply can't put up with that kind of apathy at a facility. You are her only advocate if you don't speak up, no one will. The only reason I could think of if they have her in a "diaper" is because she has suddenly become incontinent due to stress of new facility? or delirium if she is otherwise continent. This would only be short term and anyways she should never be left wet in one all night! Definitely go in there and speak to the DON or administrator.

[meownsmile, BSN, RN]

OH and please,, make sure your grandmother is getting all the water/fluids she needs in this hot summer weather. These people get dehydrated during hot weather, even in air conditioning and if she isnt able to reach it they should be offering her a drink on a regular schedule.

[ValerieB]

I used to be a QA director/infection control nurse in a LTC facility. Taking the foley out was a good thing and most LTC facilities don't like them unless there is a medical reason for them e.g. stage 3 or 4 pressure ulcers on the buttocks, neurogenic bladder, etc. I know where I used to work, it was policy not to use adult diapers at night and if the family/pt. insisted on using them, they had to purchase them also. I agree that diapers are bad for the skin and really shouldn't be used. I would definitly have a meeting with the DON/administrator. If that doesn't change things, then report this facility to the state. Where I live, any complaints have to be followed up within 48 hours. Believe me, things will change when the state shows up unannounced.

Good luck hon.

[txspadequeenRN, BSN, RN]

This is a situation that needs to get fixed right now. You need to go to the charge nurse on the unit and if you dont the response you need ( and that response being a immediate shower and everyone in the buiding looking for a potty chair) you stomp yourself into the DON office. I hate to say this but alot of people dont get the care they need unless the family speaks up. If they know you are coming to inspect then they will stay on top of the game. Show up at all hours of the night . When my mom was in for rehab thats what I did , at my own job no less. I also did alot of my mom's personal care to inspect skin and such. Alot of nurses in LTC dont have time to verify every shower , they may not even know she hasent been bathed. I am a LTC charge nurse and whhhoooo would be hot to trot if this happened on my floor... This is neglect.

[L&Dnurse2Be]

I just wanted to give an update. We met with the DON. Basically nothing changed, in fact things got much worse! Right before we arranged for a transfer to another facility my grandma ended up in the hopital with her kidney's beginning to shut down and she was in a coma like state. We were told we could lose her. I cried for 2 days until I found out she had woken up and couldn't remember what happened. The doctor said this happened from her not getting the correct medications and some of them were not at the appropriate time. (She is diabetic) I am going to file a complaint on that nursing home! Grandma is now doing much better and in a very nice facility for rehab.

Thanks so much for all of your information. It's great to have so much support on this forum! :)

[dbsn00]

I'm so glad your grandmother is doing better & at another facility. Please follow up on reporting the previous LTC facility - there is major neglect going on there!