LTC ...I have a question

The expected standard of care in my facility would be to check and change every 2 hours. Can you set your watch by this.. unfortunately not always, but every 12 hours is completly unacceptable. This is a major skin risk, let alone a dignity issue. And we do still have some old crank beds in our facility. Good luck to you, I'm sure this is very difficult.

Adult incontinent briefs should be changed ATLEAST EVERY TWO HOURS! More often if they are known to be heavy wetters or known to have had a bowel movement. Your mom should not have to ask to be changed, but she can and should ask if she knows she is wet. Please see the DON about this. If she says thats is the facilities rules, report the facility to the state.

A baby can stay overnight in a diaper without a problem a lot of times, but their skin is not thin, wrinkly, and onion like like an older adult's can be. A baby also only drinks breast milk/formula and has limited solid food, so their urine isn't as irritating to the skin. Baby diapers are also much better quality than adult incontinent briefs.

Being changed only 2 times a day WILL (not may, but WILL) lead to excoriated skin and eventually open sores that can become infected. You can also ask them to put a barrier cream (its like balmex or destin but for adults, not babies) I am so sorry your mom isn't getting changed! It doesn't matter if she is 500 lbs and unable to move at all by herself and is a 5 person transfer. She deserves to be changed regularly!

I hope this situation is taken care of in a speedy fashion, since it is so much easier to prevent skin breakdown than to treat it.

About the crank beds... The last hospital I worked for recently got rid of the last of their crank beds. Although I think the nursing home affiliated with them still has crank beds. I hate those. Some staff forget to tuck the crank under the bed when they are finished, and then staff and pts trip and fall over the cranks. Its also a pain b/c the pts have to ask for help to adjust the position of their bed. Or they fall trying to do it themselves. You can always ask if they have an electric bed available. Maybe they only have a few and give them to those who ask. Would your mom be able to operate one by herself having MS? (you didn't say how severe the ms was)

When I worked in an intermediate care facility for the DD, we changed incontinence briefs at least every two hours and as part of a bladder training program-meaning we removed the incontinence briefs, assisted the patient on a toilet in the bathroom, waited for them to do their thing and then applied a fresh incontinence brief.

Electric beds are extremely expensive and hospital stays are extremely expensive--14,000 for two days in some cases (no surgeries or procedures). Mechanical beds are much less expensive and nursing home stays are much cheaper (150 a day vs. 14,000 per day at a hospital). Something has to give....... My facility uses the mechanical beds but will occassionally order electric beds for private pay people or private insurance people.

Isn't there some danger of someone who is not alert and oriented using an electric bed-could they accidentally position themselves poorly, cause asphyxiation, ect?

The frequency of changing incontinence briefs is definitely an issue, but I wouldn't be so concerned about the mechanical vs. electric bed situation. I would be more concerned about the quality of care provided by the staff in this case.

Sadly people do leave their babies in diapers forever because they think incontince briefs are these bottomless resevoirs for urine. I would like every CNA or direct care worker to wear incontinence briefs once and "go in them" and see what it is like. You bet those briefs who fly off the second those CNA's as much as dribbled in them.

THANKYOU FOR ALL THE REPLIES!!

I am going to address this issue regarding the changing of the diaper/briefs..

Something is defintely wrong with this picture....

The bed is a minor as compared with the above.

Please go to the supervisor or DON with this issue! It must be addresed and dealt with. Not everyone will be changed q 2 hrs. It is a newer reg that a bowel and bladder program needs to be started on all residents and individualized to them and their own B and B patterns!

We try to base the brief changing/toileting plan on the resident's own schedule. Some people want to be toileted before meals, some after...but certainly it is never acceptable to wait 12 hours between toileting or brief changes. Electric beds are very nice. My former facility spent $110,000 to get a new bed with a geo mat for all 142 beds....didn't quite make up for short staffing, though!

At my facility we (CNAs) are expected to at least check every 2 hours, although as busy as the unit is, this ins't always possible. I always tried to toilet/change my patients at least 3 times during my shift (7-3): when I get them up/dressed (7-8am), between breakfast and lunch (10-11am), and after lunch (1-2pm). Everybody has to go after they eat.

Contact the DON/administrator immediately. Every 12 hours is not only inexcusable, it is abuse. If I caught my CNAs letting someone lie in a urine-soaked brief for 12 hours, they would be fired. I'm so sorry you are having to go through this. Please let us know what happens after you speak with the head honchos concerning this issue.

I filed a grievance report today....

I also spoke with the administrator this morning....she first said that is impossible ,,,it could not have happened...."well ,guess what it did"...then she said she would followup and it would not happen again.....well guess what ? it was going to happen again,if i didnt call today....By 4:30 , no one asked her if she needed changing or attempted to change her....it took another call (that is 2 calls todays)to the administrator's office...by 5pm she was changed. That was from 10:00-11:00 in the morning....

I am going to transfer her out of there by Monday if this continues....

This is so sad....

As a charge nurse in a ltc facility I would write everyone of my workers if they only changed my residents every 12 hours. What you need to do is bring this up to the administrator or the social service person. If you don't get the answer or help you think you should, call the ombudsmin. They are your advocate in health care. Remember the squeaky wheel gets the oil. So complain everytime you find her wet or in need of care.

If the DON is not helpful I would approach the omsbudsman and get them invoved. If it is hapening to you mother it is happening to other patients who are not A & O. Also, and LTC facility is licenced by the state. Make a complaint to the state if you don't get the responce you need to ensure the health and saftey of you parent and the other residents.

Tracy, DON Assisted Living