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I am severely concerned about bedsores, I have stressed to the staff that she needs and should be turned at least 12 times in a 24 hr period however they continue not to do so.
You know what my daughter* told me when I started the Dementia journey with my Mom? I asked if I should leave notes for the Staff and she said NO! You don't tell NH staff how to do their jobs. You are not the trained professional, they are. You can talk to the DON and tell her you are concerned about pressure points and wonder if she is being turned regularly. You want staff on your side not saying "oh no, here she comes". Always ask, don't accuse.
Its hard having a LO in a NH. Things will not be done the way you did them for Mom. Some things you just have to "let go" and pick your battles.
*Daughter, RN, has worked in NHs since she was 19 she is now almost 47. She was my "go to person" when I wondered if I should complain or let it go. My thing was my mothers hair, it was cut short but they never seemed to know how to comb it. She would have been horrified if she saw how the aides combed her hair. So, I carried a brush and a small can of hairspray with me and did her hair when I saw her.
Have the doctor order an "Alternating Pressure Mattress" this helps in the movement as the mattress itself moves, the tubes in the mattress constantly inflate and deflate. Mom might do better with Hospice. They can order the bed, the mattress and they will be another set of eyes on mom and constantly checking skin for breakdown.
"she needs and should be turned at least 12 times in a 24 hr period"
Why? What are you hoping this will achieve?
Prevent pressure injuries (bedsores) 100%? It won't.
Body position is one factor. Nutrition, skin condition & circulation are other very important factors.
By all means aim to prevent painful bedsores but please be realistic. Preventing frailty from progressing is near impossible.
Things to try; + alternating pressure mattress + neutral skin cleansers + barrier creams for moisture prone areas of skin + protein drinks + gentle bed exercises (if possible)
Things to avoid; - harsh soaps - skin left soiled with urine/feces - firm mattress
I've seen people, quite immoble that never develop pressure injuries. Yet others that have developed awful pressure injures within hours of laying down. Imho the body condition has so much to do with it. Heart, liver & kidney function - things we cannot see. One woman had black heels (unstagable deep tissue injuries) to both heels despite walking. Was using her heels to scoop along the floor while sitting on her wheelie walker seat.
Awinton, in your situation, I would focus on what I could control: obtaining an alternating pressure mattress & ensuring neutral cleaners were provided. I doubt staff in an ICU do 2 hourly turns - I would let that idea go.
100% agree here. My 300+lb FIL - who tended to lay in bed for 15-18 hours a day at home (and at the SNF when he told them he wasn't doing anything anymore) and ALWAYS on his back - in the almost 3 years of doing this regularly - had ONE bedsore/pressure sore.
Vulnerable places were covered in barrier cream regularly. The alternating pressure mattress was used.
OP why are you ‘severely’ concerned? Why don’t you accept the staff’s expertise? Why does your mother need more care than average? What is your own ‘must and should’ based on?
Does mom lie primarily on her back in bed? If so, get her a pair of waffle boots to protect her HEELS. They are most vulnerable to getting sores because, as Funky said, your mom IS being moved every time she's changed or bathed. And people have a skewed view of what it means to be "moved" in bed every 2 hours....its a very slight turn, in reality!
As others have mentioned, it is unrealistic to expect the staff to turn her every 2 hours. The averaged CNA is assisting 8-16 patients/residents in a given 8-12 hour period. just making the rounds of all of those people could take them 4 hours each round depending on the needs. (side note: changing my very large FIL's adult diaper typically required the CNA assigned to him AND an additional person to complete the task - and if he had a bowel movement, that could end up taking 30+ minutes just to do it - frequently longer)
A more realistic option might be to hire a 1:1 caregiver to turn your mother if you require the turning every 2 hours.
Otherwise, keeping an eye on her yourself, documenting any concerns and asking staff to keep an eye out when they are completing their normal rounds are likely your best bet.
The hardest part of putting a family member in a SNF, especially if they have had 1:1 care prior to moving - is coming to the understanding that they are not going to get care that meet your expectations - unless you also temper your expectations with the understanding that your loved one is not the only person they are caring for.
My FIL (and his sister) quite literally expected staff to be standing outside of his room waiting for his call. Any time we visited the staff was always on the move, there was rarely anyone at the nurses station, which had seats for 8. If you needed to ask a question you either had to wait at the nurses station until they had a moment to talk or push my FIL's call button if it was something for him directly.
It is hard to come to terms with the fact that your loved one will not get the same care that you would give them. But the goal of a Skilled Nursing Facility is to have care round the clock, multiple caregivers so that you don't have a concern of someone getting sick or not coming in or taking vacation and not having coverage, of having a schedule as much as possible. But the only way to get 1:1 care is to take care of them at home, hire 24/7 care at home, or hire your own 1:1 caregiver to supplement what the staff already offer.
An air mattress would also be something that should be requested.
Your mother is being moved every time the CNA comes in to change her diaper and bedding along with when they give her a bed bath, so at least she's being moved some. Expecting a facility that is more than likely running short staffed to turn her every 2 hours sadly is unrealistic. If you want her moved more you may have to go do it yourself or have other family members do it.
My late husband was completely bedridden in our home for the last 22 months of his life, and because he watched TV 24/7 when he wasn't sleeping, he stayed on his back the entire time except when the aide came daily to put him on the bedside commode, or the hospice aides to give him a bed bath twice a week, and he thankfully never developed any bedsores.
Just make sure that the aides are keeping an eye out for any developing sores and it may not be a bad idea to bring hospice on board as they will be extra sets of eyes on your mom as well.
Is she in LTC? On Medicaid? Is it a reputable facility? Does she have any funds to purchase any products that help prevent sores, like a specialty mattress pad, cushions or dressings, etc?
Sometimes the staff can only do so much if they don't have enough aids.
Also, is your Mom cooperative? Does she have any dementia?
If you check her and see any hotspots, make sure to tell staff (verbally and in an email because you want a "paper trail" to prove they were told) and take pics of it.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Its hard having a LO in a NH. Things will not be done the way you did them for Mom. Some things you just have to "let go" and pick your battles.
*Daughter, RN, has worked in NHs since she was 19 she is now almost 47. She was my "go to person" when I wondered if I should complain or let it go. My thing was my mothers hair, it was cut short but they never seemed to know how to comb it. She would have been horrified if she saw how the aides combed her hair. So, I carried a brush and a small can of hairspray with me and did her hair when I saw her.
Mom might do better with Hospice. They can order the bed, the mattress and they will be another set of eyes on mom and constantly checking skin for breakdown.
Why? What are you hoping this will achieve?
Prevent pressure injuries (bedsores) 100%? It won't.
Body position is one factor. Nutrition, skin condition & circulation are other very important factors.
By all means aim to prevent painful bedsores but please be realistic. Preventing frailty from progressing is near impossible.
Things to try;
+ alternating pressure mattress
+ neutral skin cleansers
+ barrier creams for moisture prone areas of skin
+ protein drinks
+ gentle bed exercises (if possible)
Things to avoid;
- harsh soaps
- skin left soiled with urine/feces
- firm mattress
I've seen people, quite immoble that never develop pressure injuries. Yet others that have developed awful pressure injures within hours of laying down. Imho the body condition has so much to do with it. Heart, liver & kidney function - things we cannot see. One woman had black heels (unstagable deep tissue injuries) to both heels despite walking. Was using her heels to scoop along the floor while sitting on her wheelie walker seat.
Awinton, in your situation, I would focus on what I could control: obtaining an alternating pressure mattress & ensuring neutral cleaners were provided. I doubt staff in an ICU do 2 hourly turns - I would let that idea go.
Vulnerable places were covered in barrier cream regularly. The alternating pressure mattress was used.
Maybe he was just lucky.
https://a.co/d/7u86LFO
Best of luck to you.
A more realistic option might be to hire a 1:1 caregiver to turn your mother if you require the turning every 2 hours.
Otherwise, keeping an eye on her yourself, documenting any concerns and asking staff to keep an eye out when they are completing their normal rounds are likely your best bet.
The hardest part of putting a family member in a SNF, especially if they have had 1:1 care prior to moving - is coming to the understanding that they are not going to get care that meet your expectations - unless you also temper your expectations with the understanding that your loved one is not the only person they are caring for.
My FIL (and his sister) quite literally expected staff to be standing outside of his room waiting for his call. Any time we visited the staff was always on the move, there was rarely anyone at the nurses station, which had seats for 8. If you needed to ask a question you either had to wait at the nurses station until they had a moment to talk or push my FIL's call button if it was something for him directly.
It is hard to come to terms with the fact that your loved one will not get the same care that you would give them. But the goal of a Skilled Nursing Facility is to have care round the clock, multiple caregivers so that you don't have a concern of someone getting sick or not coming in or taking vacation and not having coverage, of having a schedule as much as possible. But the only way to get 1:1 care is to take care of them at home, hire 24/7 care at home, or hire your own 1:1 caregiver to supplement what the staff already offer.
An air mattress would also be something that should be requested.
Yes, expecting aides to turn her every two hoursvidvnot realistic.
Expecting a facility that is more than likely running short staffed to turn her every 2 hours sadly is unrealistic.
If you want her moved more you may have to go do it yourself or have other family members do it.
My late husband was completely bedridden in our home for the last 22 months of his life, and because he watched TV 24/7 when he wasn't sleeping, he stayed on his back the entire time except when the aide came daily to put him on the bedside commode, or the hospice aides to give him a bed bath twice a week, and he thankfully never developed any bedsores.
Just make sure that the aides are keeping an eye out for any developing sores and it may not be a bad idea to bring hospice on board as they will be extra sets of eyes on your mom as well.
Sometimes the staff can only do so much if they don't have enough aids.
Also, is your Mom cooperative? Does she have any dementia?
If you check her and see any hotspots, make sure to tell staff (verbally and in an email because you want a "paper trail" to prove they were told) and take pics of it.