showers on nightshift and time for residents to get up in the morning?

LibAnne10 · Dec 5, 2007

North Carolina regulations do not allow residents to be disturbed before 6:30am. Residents may choose to get up earlier, but it cannot be for staff convenience. Our third shift is assigned 2 residents each to get up each morning, starting at 6:30am. It is always challenging for 1st shift staff to get residents up and into the dining room by the time breakfast is served. We are trying to work with the dietary dept. to help with "culture change" to allow those residents who are not early risers to still be provided with a fresh hot breakfast.

Simplepleasures · Dec 6, 2007

#9 people for two CNAs to get up all before days gets there?!!Oh my things have gotton even worse since I left LTC two years ago. Pathetic.Just goes to show how much the nursing home owners really care for the elderly victims in their facilities. Where is state when you need them?Do their families know their loved ones are being dragged out of bed that early, maybe a little birdie should tell them, anonymously of course.And if anyone does report this to ombudsman, make sure you tell state too, I know in my state you have no legal protection from retaliation by the nursing home unless you report to state, ombudsman are not included in that protection.

pumpkin92356 · Dec 7, 2007

I think that the day shift at your hospital can do those morning baths unless the resident wants to shower before they come on. I used to work graveyard shift at a veterans home and we had one resident who had breathing problems and needed to have the shower room door open so he could breathe better so he asked for his bath at 2am but this was a request! There are way less staff on nights and residents tend to "Sundown" on night shift and keeping up with them at night sometimes can be demanding if one aide is in shower with patient and other one is on her own answering lights and dealing with dementia patients. The nurses try to help but mornings are usually their most busy med pass and they have to focus on the medications to be given etc. And why in the world would they expect your shift to get up all these residents before they come in when its been my experience that residents that shower in the middle of the night and dressed , up in chair that early sleep through their meal which is not a good thing.

mercy1975 · Dec 7, 2007

Recently I have been instructed to have my CNAs to get up certain residents for a shower on 3rd shift because of the residents refusal to shower on 2nd shift. I have two excellent CNAs working with me on this dementia unit. We have 30+ residents who are ALL expected to be up and dressed before the morning crew arrives. We try to wait as long as possible before waking the residents up but the CNAs start dressing people by 5am at the latest. I am unable to offer them much assistance with their tasks as I have morning meds to pass on this hall plus one additional unit that I also have to begin giving very early.
In order to give any showers the residents will have to get up even earlier and many already don't seem thrilled to be gotten up at 5am. Of course the notion of showers did not go over very well when it brought up to the res that early. 11-7 showering was declined and never requested by resident.
I have heard more than once that you can't give showers at night. I have it set in my mind that I've been advised at least once that having residents get up that early to shower was against regulations or against their rights. In the years I've worked nightshift I can't think of a single time that a shower was given to a resident on 11-7 unless the resident had gotten something all over themselves that a shower was necessary to remove it or unless they simply wanted to take the shower at that time. Some coworkers on nights agreed that they were also under this impression while coworkers from other shifts disagree. Perhaps I am mistaken but I'm quit sure that I didn't just conjure this up in my mind.
I've tried to search out information on this from the internet without any success. I'm hoping someone can set me straight on what the guidelines are for showers or for what time in general is acceptable for residents to be awakened and dressed for the day. I want to say the time to wake up is supposed to be no earlier than 5am or 530am but I'm not sure. If I've got things completely wrong, I don't mind being corrected :wink2:
I'm primarily concerned with this because it seems like they introduce things slowly to start and then leave you with a whole list of new tasks. I'm hoping this isn't going to turn into regular shower days being set for 11-7 on multiple residents but I wouldn't be surprised if thats what happens.
Thanks for any information or thought you may have about this

As a former state surveyor, the guideline was that residents should not be gotten up before 6am. It's a resident rights issue. Anytime a situation like this occurs, ask yourself "would a resonable person want to be showered at 5am? Unless they are early risers and prefer it, most of us would not want to be up at 5am. This is the question the surveyors ask themselves.

25(2)+2 · Jan 19, 2008

I work 3rd shift in LTC and have given showers to residents that request them before dayshift arrives. I had one resident who wanted his shower at 4:30 am on Thursdays and it was his right so I gave it and another who wanted hers no later than 5:30 and I had no problem accommodating their wishes. Other aides have told them they must wait till dayshift arrives. In my opinion it is all about what the resident wants....remember they are the ones paying our wages.

CapeCodMermaid, RN · Jan 19, 2008

This is what patient centered care and culture change is all about...making our schedule fit what the resident wants. However, it's more likely that MY tax dollars and YOUR tax dollars are paying for them to be there.

25(2)+2 · Jan 19, 2008

maybe i should of worked that a little differently. We are getting paid to take care of them and whether it is out of our taxes or directly out of their wallet they still deserve to be taken care of the way we would want to be taken care of. Someone once said to me that a residents bed was not made right and that resident is private pay so would i go in and fix it. That is sooo wrong, it should not of mattered whether he was private pay or not the bed should have been made right.

caliotter3 · Jan 19, 2008

I once worked at a small facility on night shift when my DON told me that we would be given a list of residents that would be showered and up in their chairs before day shift came on. My CNAs had to start at 4 AM in order to accommodate this request. It did not go over very well with anyone concerned except the day shift personnel, for whom the policy was changed. When this DON went to another facility that I used to work at, I was told by one of the nurses there that it would be made known to State that she was doing this. I don't know if that ever happened. It probably did, as the DON did not last long at that facility.

The best answer, one which I saw in practice at one facility, is that of the shower team. Having a team of CNAs who come in at various hours to do nothing but showers is the best utilization of manpower that I've seen when it comes to patient care.

CapeCodMermaid, RN · Jan 20, 2008

We only do showers on days and evenings. Our day shift starts at 6am. Some of the residents want to be up and dressed early so we just started the 10p-6a crew do some get ups. So far it's working quite well.

And you're right...everyone deserves the best care we can give them no matter what their payor source.

softstorms · Jan 22, 2008

In the last placed I worked in LTC, we were told by the state surveyers, that in this situation, we were not providing a "Home Like" environment for the residents by getting them up prior to 5 a.m. This included drawing blood, giving showers or providing any care that would not be appropriate if they were in any homelike setting. As a result of this, they could not give showers or do blood draws prior to 5 a.m. They had to do a survey of the residents or thier families and find out if they were early risers or minded getting up at that time. It was documented Only those early risers could be gotten up.

firesun · Jan 30, 2008

I work 7:30 pm to 8:00 am shift, and the cna's start getting the residents up and and bathed at 4:00 am. I think this is wrong, but I'm told this is how it's always been done. When the daylight shift gets there at 6 am they start complaining that not enough people are up yet. Meanwhile we have 6 cna's on midnight for 112 residents. How in the world are 6 people to bathe 112 people in two hours I'll never know. I can't tell you how many times the daylight shift will complain and try to get the midnight girls in trouble for "not doing enough", and how many times I've gone and defended my midnight staff. For some reason the 8-4 shift never thinks the midnight shift does enough work. It's so frustrating!!