What is normal / typical?

[Meraki]

My grandmother is 91 and is in a LTC facility. She has significant physical health issues and limited use of her limbs. She uses an electric wheelchair to get around and can walk a few feet with a walker. Cognitively she does okay although her memory is poor (days run together and she forgets a lot) and she finds it hard to make any decision - it is too stressful. She is very anxious / worrier in general. She is also fiercely independent. She is incontinent and in diapers and does all her own care (not well). The home has reduced her diaper quota to 3 per 24 hr period and recently stopped carrying her size so she is 110 lbs in a size 16 diaper. She is stressed out and upset almost every day over this. There is leakage everywhere. She has started putting towels on her bed and chair and her clothes and room smell. I often come in and find soiled towles and clothes in the room. She also has been getting rashes / blisters in her groin area and I really don't think she is able to do any peri care. She really isn't able to manage it all on her own. She receives no personal care other than bathing. Partly because she is defined as independent care and so no staff time is allotted to her and partly because she her finds the idea of someone changing her diaper and cleaning her up completely humiliating. I have raised these issues with the home director of care and she is pretty much indifferent - basically infers that incontinence and soiling and smelling is part of being in LTC.

I have contacted the next people up in the chain and they kind of make me feel stupid - as in you want to make a complaint about diapers??? I however think that this situation is worth attention from someone and there has to be some discussions around getting the proper size and quantity of diapers and also getting the soiled towels / clothes taken out of her room on a regular basis.

I intend to keep working my up until someone listens - am I taking this too far - is this really typical for LTC?

[HolyRomanOne]

I have been a nurse for nearly ten years and have never heard of such a thing! My suggestion would be to write a letter to the director of the facility and state the concerns that you have, why you have them, and suggest an appropriate resolution such as "I feel it would be appropriate to provide my grandmother with "x" size because the larger size does not provide adequate protection from wetness and that it places your grandmother at increased risk for skin breakdown.

Additionally, tell them straight out that if reasonable measures are not taken within a specified number of days that you will report this to the Department of Health and Human Services and to the Joint Commission for Accreditation of Health Care Organizations (JCAHO). I assure you that this will get there attention.

[ohmeowzer RN, RN]

that is the sillest thing i have ever heard ... 3 diapers i 24 hours.... if she were my mom .. i would buy her a case of diapers and tell her to use them whenever she wanted.... and notify the staff and the scrooge of adminstration .. those diapers are for her use only and they are not to pt them on anyone else..... i am sending some hugs to you and your mom .. i'm sorry she is going through this , at her age she should not have these problems....

[Katnip, RN]

Rationing briefs? Ridiculous. When my in-laws were in LTC we had to provide their briefs for them in an appropriate size. We checked with multiple facilities in our area and they all had the same policiy. If either of them were going through briefs faster than normal we were asked to bring in more.

I remember one time when I smelled urine on their unit, and that was because a resident with dementia confused the corner for a urinal. It was addressed immediately by staff.

I don't think I'd bother to give warning to the people about reporting them. Just do it and tell them afterward. And start looking for a different facility.

[Meraki]

Thanks all,

I have brought diapers in for her before but she hates me buying them for her as a) she pays for them as part of her 'rent' and b) she worries the staff will be upset with her for bringing in extras so she hides them and then forgets she has them. I have asked them just to leave an extra 3-5 in her bathroom but they said no - it isn't in their budget. Also they do disappear - we put a stash in her dresser and someone took them out.

When i spoke with the Director of Care she told me the diapers they use are special 'wicking' material so no matter how long the residents sit in them they will never feel wet and that research has shown there is no risk of skin breakdown or UTI's when using these diapers. They are basic TENA diapers you can buy at the drug store so I really don't see anything special about them at all.

I have put a voicemail in to the VP of Client Services at teh company that ownes the home and also sent an email to the governing body. we shall see if either get back to me.

[retiredlady]

Um, does she pay for care every month? I know someone who pays $4,000 a month for care. I would really make a big stink if I had to pay that and not get what I needed. Good Luck!!

[Whispera, MSN, RN]

When my mom was in an LTC, she paid a special fee for her adult briefs. Each time they opened a bag, she was charged. Sounds like your grandma's facility just gets one size and uses them for everyone.

It's ridiculous that they limit her to 3 in 24 hours. I would expect a person to urinate at least every 3-4 hours, and to sit in it is awful. Shouldn't we expect at least an ounce per hour? That would be a cup full in 8 hours. If nothing else, it would be heavy and embarrassing for a lady who wants to be as independent as possible. Even wicking fibers get full and the "stuff" in the urine is caustic to skin, especially that of elders. A LTC facility should hardly ever smell like urine. Sometimes things happen that make it smell, but that should be very very rare.

Check with the health department and the elder ombudsman associated with your Area Agency on Aging. Most communities have them. This LTC is not taking appropriate care of those who live there.

[classicdame, MSN, EdD]

call the state health dept and request an inspection

[Ruthiegal]

maybe the powers that be that ration briefs should be made to sit in their own urine for 8 hours between changes... Report these nuts... I've worked LTC many years in the past and we all know what sitting in urine and feces does to the skin... makes my eyes want to spin.....

[CapeCodMermaid, RN]

I worked in a place once where the regional director told us in HIS building, they used 3 briefs per patient per day and he couldn't imagine needing any more. I suggested he wear one brief to 8 hours and then imagine it. I ordered as many briefs as I needed for my residents despite pressure to cut down on the budget.

Each facility is different. We provide briefs but if the person wants a pull up, they have to buy that.

My facility never smells and we don't have any skin issues.

And, despite the resident wanting to be independent, if they can't clean themselves sufficiently to prevent odor and skin breakdown, we help them. End of story.

[Charmander]

most states have an assisted living, nursing home, senior citizen or long term care ombudsman, who basically is the 'people's representative'. they have the connections and resources to make things happen. this is atrocious. next time your there, find out who accredits them, should be on a wall or a pamphlet- and find out what their standards are. report them to everyone... and / or write a letter to your local paper.... bad press usually helps things along. keep being a great advocate for your grandmother... and good luck.

[SuesquatchRN, BSN, RN]

Report, report, report. This is abuse, pure and simple.