Non-diapering nursing home patients

[ASSEDO]

My Mom was transferred from an inpatient rehab facility to a nursing home with skilled rehab. She has incontinence, but I was very shocked the nursing home facility has a non-diapering policy, so Mom urinates on a cotton pad on the bed. The nurse said it cut down on diaper rashes, fungus, and skin breakdown. I realize that some air exposure is good. They put on adult diapers only when the patient get up in a wheel chair. The nurse explained that policy was in place at another local nursing home. Is this a quality of care issue? Where is the research? I failed to find it. Thanks

[CapeCodMermaid, RN]

????

[ltcnurse4u, CNA, LPN]

On 5/10/2014 at 11:14 PM, sbostonRN said:

We don't even stock the incontinence briefs at my hospital. If a patient wants them, they have to bring their own but we don't condone their usage. We'd rather have them go on the bed pad and then change it than walk around with half a days worth of urine in a diaper and get skin breakdown. I don't know what the research says but this is a magnet facility.

I am not sure where you work or where you saw someone walking around in a "diaper" with a half a days worth of urine, but that is not normal and is very neglectful. At my facility, we have a toileting program when they are offered the toilet every two hours, and the resident's needs are care planned. During the night, they wear an overnight product, or they are open to air, depending on their care plan. Most residents wear "protective underwear". Calling them diapers or pull-ups is a dignity issue.

[amoLucia]

I can accept 'pullups' but 'diapers', even 'ADULT diapers' is humiliating. And then one manufacturer even calls them 'Depends', like the baby wear.

In any facility, I will never supply my own supply for the true realization that they will likely 'take feet' (otherwise known as 'stolen'). It's because the larger/bari sizes are more rare than a winning lottery ticket! Maybe if I slept with them under my pillow... SAD!

I have found super duper absorbency incont pads that I can wear inside my underwear. NOT the best option, but it can work if I get to a BR freq.

I do change my clothes freq for the freq leaks I endure. Have to.

And just so y'all know, the cost for incont supplies is usually out of pocket. I believe only Medicaid pays for them. ('caid pays for most about everything.) And they can be quite costly, so being carefully frugal is nec. So wearing them until full is the usual practice.Another reason why I won't be supplying the facility for other pts' use.

I don't know if the majority of NH pts are truly aware of everything happening around them. But basic toileting urge is something that doesn't fade away too easily. That's why 'potty training' causes such angst for little ones. I don't think adults are OK with just peeing themselves, even if they can't verbalize it. To me, being bare bottomed would be very undesirous just to pee. So some kind of bottom-wear would be preferred. Now unless a pt is so far advanced dementia that that level of cognition is long-gone...

What would be more acceptable to you - being incont WITH a brief or just being incont WITHOUT one??? A 'diaper' or some kind of 'undie'???

So sorry this post has morphed into some kind of didactic on the art & science of incont care for those with urinary issues. I prob could ramble on about issues with BM problems as well. Not now!

[Leader25, ASN, BSN, RN]

On 5/14/2014 at 11:01 PM, Here.I.Stand said:

f your mom is A&O and is most comfortable wearing a brief at all times though, I would think they could just explain to her the rationale for their policy and then make her preference part of her care plan. That way they've covered themselves AND honored her preferences.

My mom wears an overnight diaper or panty (I researched to find the best one) ,she was getting very exhausted from getting up at night to change the leaky panty)now she gets a good nights sleep,in morning washes and lies in bed and airs herself,then wears smaller pads during day,which she changes about every two-3 hours.So far this is working for us.Difficult to make a forgetful person use toilet every two hours with out accidents.

[Thanksforthedonuts, BSN, RN]

I’m just reading this older thread now and WOW I’m am angry at the situation you were in AmoLucia! It seems horrifying, and honestly, is quite a normal experience in LTC.

I work in a residential care facility where we have max 6 seniors and generally 2 caregivers on staff all the time. This would never be acceptable and I have fired ALL my staff for certain locations for issues such as this. CNAs or HCAs are replaceable, sad but true.
next time you need rehab, I would look into a residential care facility. Remember these are small independent businesses, so make sure to do your homework on the facility and make sure they are a good Place for you, many take short term/rehab stays.

I generally don’t hire staff that have worked in large LTC/rehabs before hand because it’s a PITA to get rid of the bad habits they’ve picked up. I prefer new aids with no experience so I can train them the right way from the start.