I need some feedback on this matter. I work at an assisted living facility and this resident is already known to be too much for assisted living and family is looking for a LTC facility.
Here is the situation she is very immobile and VERY difficult with transfers. We have called paramedics/fire dept to help get her off the floor several times. She has good days and bad days with transfers. She alert and oriented and she is continent of bowel and bladder. She wears depends as a back up. She does have a small area of skin breakdown starting up. Well others have told her to just pee herself and they will change her then have to get her up to the bed side commade.
In assisted living they do not have CNA's that learn about tranfers. We don't have a hoyer lift or anything like that. So the "companions" think it is easier to change her every 2 hours. I understand they are concerned about hurting themselves with transfers but I am also thinking about the resident because if she is continent then why make her pee herself?
If this person is immobile and requires 5 people to lift her yet some staff still hurt their backs, when there have been times the fire department was called in to lift this person, when there are no mechanical lifts available ... what exactly do you propose they do?
It doesn't matter one bit if this woman is continent if she can't get to a toilet or BSC.
As I see it, she has three choices: bedpan, foley, or wet her depends. Sorry, I will not nor will I expect anyone else to harm themselves trying to lift a person as you describe.
I understand what you are saying and I am torn bout my coworkers and the resident. Here's the thing when we got hired they ask if you are able to lift. If we all help we can do this. Its hard to tell a resident to pee herself cause it makes our job easier. Some days are better than others and the day we had 5 people was a hard day for her.
I understand what you are saying and I am torn bout my coworkers and the resident. Here's the thing when we got hired they ask if you are able to lift. If we all help we can do this. Its hard to tell a resident to pee herself cause it makes our job easier. Some days are better than others and the day we had 5 people was a hard day for her.
Why can't she simply use a bedpan? Or someone get an order for a foley to protect her skin until she is in a facility that can give her rehab and has the equipment necessary to move her?
'able to lift' to assist with transfers and the situation described here are two different matters.
this person needs to be assistedto the bsc with mechanical lift, and the reason that there isnt one at the facility is because it's an assisted living. if a person needs a hoyer or sara lift to transfer, then they should be in an approriate exteneded care facility.
it is not excusable to force a woman to pee in her britches, nor is is right to let her go through the humiliation of a botched five person transfer.
Why can't she simply use a bedpan? Or someone get an order for a foley to protect her skin until she is in a facility that can give her rehab and has the equipment necessary to move her?
She had a doctor appt a few days ago and I sent a fax with all my concerns to her doctor with no new orders. Until she is moved we need to take care of her the best way we can. We risk moving her we risk her skin by allowing her to pee herself.
Specializes in LTC, assisted living, med-surg, psych.
At the ALF where I work, the RN/DNS/DON (or whatever you call the nurse in charge) is the ultimate arbiter of when a resident's care needs exceed the facility's ability to provide for them--not the administrator, not the family, not even the resident him/herself. This is as it should be, for it's the NURSE'S license at stake when something hits the fan! I wouldn't work in any facility where this is not the policy; I may not be the administrator, but when it comes to resident care and safety, it's my expertise and assessment skills that mean the difference between ALF or a higher level of care for a resident on the edge.
That said, I would advise you to make every effort to get this woman out of your building as soon as possible. I also hope you are documenting every incident and every intervention to prove that you're doing all you can for her and she still exceeds your level of care. She is totally inappropriate for ALF and it's only a matter of time until she and/or your staff are seriously injured during a transfer, or her skin completely breaks down, or some other disaster befalls her. I don't want to scare you, but this is when adult protective services will step in and your facility will be investigated for neglect, among other things.........not a pleasant process, I've heard. You yourself may even be called before your state BON and asked to explain why you allowed the resident to remain, despite all obvious evidence that her care needs exceed ALF standards. It doesn't matter that your corporation and the administrator are really at fault; the BON will hold the nurse accountable every time.
Scary stuff, I know. I'm glad you're working on getting this lady into an LTC, but you MUST be persistent and stand up to anyone who gives you a hard time about it. Your primary job is to protect your resident, and your staff as well; however, you can't protect anyone if you lose your license! Believe me, I know how hard this job is; just this past week, I had to send two of my long-time residents to nursing homes. They had become two-person transfers and needed 24-hour monitoring, but as much as I loved them and their families, they simply needed too much care to be safe in an ALF setting. It happens.
I wish you the best of luck. Thank you for advocating for your resident, and keep up the good work!
She had a doctor appt a few days ago and I sent a fax with all my concerns to her doctor with no new orders. Until she is moved we need to take care of her the best way we can. We risk moving her we risk her skin by allowing her to pee herself.
its a hard situation
I guess I fail to see what's so hard to decide here. Yes, nurses and assistants are told they are required to 'lift' in their job descriptions. But I know of no job that requires a person to lift what would take 5 people, firemen, and mechanical aids to do. There is a limit to how much you're going to be able to safely do for this woman. A diaper rash (so to speak) will be the least of your concerns if you all continue to try to lift and move this woman as you describe here. Not only are you and the other staff at risk for injury, but she is as well.
She had a doctor appt a few days ago and I sent a fax with all my concerns to her doctor with no new orders. Until she is moved we need to take care of her the best way we can. We risk moving her we risk her skin by allowing her to pee herself.
its a hard situation
You don't need a doctor's order for a bedpan.
When I worked in home health, I had a client in a similar situation. She required too much care for the ALF where she lived, but the court appointed care provider and her family got around that by hiring home health aides to assist with her ADLs. The ALF wanted her out, but as long as their staff didn't have to provide for her needs, they couldn't really kick her out. Fortunately, she was capable of a stand-pivot transfer from wheelchair to toilet, wheelchair to shower chair, wheelchair to recliner, etc. Once she became incapable of this, she would have had to go to LTC. I don't take care of her anymore, so I don't know if this ever transpired or if she's still doing okay in her ALF with home health aides.
It may be different in your area, but where I live and work aides and staff in assisted living centers may ONLY be SBA for toileting and getting into out of bed. More than that is considered skilled nursing.
You may be required to lift a certain amount of weight but that requirement does not transfer to lifting a patient.
Since we seem to all agree this woman no can no longer eb safely cared for... what plan has been put in place by your employer to protect them selves legally and the patient and staff physically? Perhaps if you approach your supivisor that why it may get the ball rolling.
Specializes in critical care; community health; psych.
I understand the OP's concern for the resident. So you do the best you can with what you have without anyone putting themselves in harm's way. This does not sound like a case of a max assist x1 or even maybe x2. It is unreasonable and unsafe to ask staff, who are untrained in transfers, to toilet the woman every two hours though that is clearly what she needs.
Will she break down? Undoubtedly. Until she can get to a SNF with a hoyer lift, the best protection is a duoderm (ordered by her MD of course) and very frequent brief changes. Admin has to light the fires and get her to a facility that fits her needs.
I guess I fail to see what's so hard to decide here. Yes, nurses and assistants are told they are required to 'lift' in their job descriptions. But I know of no job that requires a person to lift what would take 5 people, firemen, and mechanical aids to do. There is a limit to how much you're going to be able to safely do for this woman. A diaper rash (so to speak) will be the least of your concerns if you all continue to try to lift and move this woman as you describe here. Not only are you and the other staff at risk for injury, but she is as well.
Again. Why not simply use a bedpan?
I understand what you are saying. She sleeps in a recliner and a bed pan may be too difficult to get under her in such a small area and not really able to roll her. We were able to get her up with three people just a few minutes ago. Being the nurse that I am I am going to take care of her the best way that I can until she is moved into a LTC which will be soon.
This is a huge dignity issue, and there are some answers to this. Assisted Living is about being creative and finding a way to meet your resident's needs even if you don't have all the resources you would like.
If the facility doesn't have bedpans in their supply closet, as the family to run to the local pharmacy and buy one. If staff have trouble turning the client, put a tri-folded flat sheet under her and have the staff teach her how to turn her using a draw sheet. It also maybe worth asking the family to rent a mechanical lift or an electric sit to stand recliner. If all else fails look into getting her hooked up with a home health agency. In my experience they are exellent at getting the things you need.
I understand what you are saying. She sleeps in a recliner and a bed pan may be too difficult to get under her in such a small area and not really able to roll her. We were able to get her up with three people just a few minutes ago. Being the nurse that I am I am going to take care of her the best way that I can until she is moved into a LTC which will be soon.
Thank you for your opinions
Well good luck. Like someone else said, you best light a fire under administration and get her moved ASAP.
dv0806
15 Posts
I understand what you are saying and I am torn bout my coworkers and the resident. Here's the thing when we got hired they ask if you are able to lift. If we all help we can do this. Its hard to tell a resident to pee herself cause it makes our job easier. Some days are better than others and the day we had 5 people was a hard day for her.