And I'm deeply frustrated.
For some context: Mom was moved from SAR to MC/AL on July 4. Within a few days of that move, it was apparent that her level of care exceeded the facilities ability to provide, and we called hospice in. Overall, it has been a good thing, with the exception of two areas. She is still waking in the night and complaining of constant sleepiness, and I am constantly changing her sheets from an overnight wet bed. We have doubled up her diapering, put pads in the tabbed diapers, we have added extra overnight checks, and we have put extra washable pads on her bed. All this has proven to do is to add to my laundry at home. (A whole other issue, as the facility is poo at keeping up with laundry and even worse at getting things back to the residents.)
I've discussed the overnight accidents in light of the wakefulness, but no one can be clear on what she's on for sleep, and how often she's being checked in the night. The 3rd shift staff at her facility is less than reliable, and even the head nurse on staff is having trouble keeping them in line.
NOW, mom has started taking the diapers off!! Claiming that she's slept naked down there for 36 years (she's in 79, so that number doesn't add up, and should have raised red flags for competent staff) and she WILL DO THAT NOW, thank you very much. When I raised the issue with her hospice nurse and staff I was told that they can't tighten the diaper/pull up with tape as that counts as "restraint". She is LITERALLY a two year old in her mind... would you let a two year old make this decision for themselves???
This morning, when I spoke to the hospice nurse I was genuinely told "Not sure then... I've offered all the suggestions I have" after she has not offered anything but putting regular underwear over her diapering. A solution which will do nothing when she is pulling them down.
Is hospice generally this uncreative? Does anyone have suggestions for speaking in a way that will generate more ideas? This is all without even discussing her sleep meds and attempting to help her sleep through the night so that she doesn't wake up to take the damn thing off in the first place, one of my first lines of defense, were she home with me!
I'm exhausted with being the most adult and creative problem solver in the room, and would love thoughts....
Thanks.
I think she should be reassessed for Skilled nursing since AL can not seem to SAFELY manage her care.
There are "onesies" for adults that would prevent her from removing her briefs (aka "diaper")
(Oh, the sleeping naked for 36 years...that does not seem out of the realm of possibility.)
While I do disagree that using tape on the brief is a restraint (I have never heard that before) but I would be worried about skin irritation if the tape was rubbing on her skin. And it would make removing them more difficult for the staff.
You can request to talk to the Hospice Nurse's Team Manager. and see what she/he says.
Have you spoken to the Hospice social worker?
Perhaps that’s causing the change in behavior . Perhaps she’s having pain or burning .
Also, who is the hospice doctor who is overseeing mom's care plan? In my mother's case, it was her cardiologist. Is it the doctor at the facility or another doctor? (S)he should be the "go to" person to talk about changes in medication. If it's not the facility doctor, that might explain his extreme reluctance to change any medication.
You also have the option to "fire" this hospice company and find a new one, if there is another one to choose from and this current one isn't meeting your expectations. But hospice, in and of itself, does very little actual hands-on caregiving - at least that was my experience when my mother was on at-home hospice. I can't attest to how much they handle with a client in a managed care facility, however, since I have never personally had experience with that.
As a side note, my mother had the use of a PureWick catheter system when she was hospitalized and couldn't say enough good things about it,
It is the night shift in particular that seems unable to follow through with what I'm asking.
Uncontrolled incontinence is a legitimate reason that qualifies her for SNF .
Mom’s MC is not able to give your Mom what she needs even with hospice .
Skilled Nursing. I got it. The current facility said in July that she no longer qualified for Skilled Care, and that's why she was moved to AL with MC. I'm at the point where people are rolling eyes when I walk in the room... they don't want to talk to me at her facility, because I "care too much".
Is Mom bedridden? If not get pullups. They can be torn at the sides for easy getting off. They have elastic around the leg openings. Never heard that putting the tabs tighter is a restraint.
Not sure how doubling up on Chuks works since they have plastic backing. They do come in different sizes. There is the blue but also a peach color larger one that I think is more absorbant. Walmart has tuckable bed protectors. May save the sheets.
Mom is pulling both the pull-ups and the tabbed "diapers" off like underwear, so the style isn't the issue.
I would certainly start with purchasing several of the adaptive clothing back-zip anti-strip dementia jumpsuits that you can find on Amazon or Walmart.com, as your mom won't be able to remove anything then.
And of course continue with the heavy duty diapers and extra pads with several chux under her, to absorb the majority of the pee overnight.
And you may have to call the hospice doctor or PA to find out what kind of medication your mom can be put on to try and help her sleep better, if the nurse isn't being helpful.
One thing I know after having my late husband under hospice care in our home for the last 22 months of his life and that is that you have to stay on top of them ALL the time to make sure that your loved one is getting the care that they need and deserve.
Best wishes in getting this issue addressed.
I had used one recently while hospitalized. They aren't the most comfortable device but it wasn't so bad. And my LO NEEDS that extra dryness as her skin was breaking down. The pure wick has helped with that.