I never really considered: .one night a CNA who does not work full time came to prepare my mother for bed.
She had a cart and on the cart were clean wash cloths and towels. I had never seen this before.
She indicated that residents are supposed to be cleaned before bed.
Makes sense to me given that they are in diapers all day..
At bedtime some cna's take off the old, often wet diaper and merely replace it with a new clean dry diaper; no wiping...that urine has sat on my mother's thighs surrounding private areas until the change so some of it must be dried onto her skin...Hence, the bedtime cleaning seems appropriate.
On a few occasions I have commented to a cna, will you be doing any cleansing and I get the response oh yes at which time I've seen them grab and use a paper towel~
I have observed therefore 3 ways of preparing for bed; cleansing with washcloth and towel; no cleansing whatsoever or paper towel?
Isnt there some regulation or protocol regarding this subject?
Similarly a resident is toileted throughout the day. What I have observed and what this method is referred to is a dry diaper change. Old wet diaper removed clean new diaper placed with no wiping of any genitals or surrounding arounds.
Would you go without wiping yourself throughout the day? Further more, these patients sits for periods of time with wet diapers against their skin, the skin of the labia and the skin of the surrounding areas including but not limited to the thighs.
Whats up? Whats the rule? What is the gold stanard?
I need a knowledge base because if I don't have one the NH will say I am asking for too much care or extra care.
Thank you
8 Answers
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As far as actual requirements, I'd check with your state and/or county licensing board. One way you could find the right place to check is to contact the ombudsman for that nursing home. Go to www.ltcombudsman.org and type the home's Zip code into the proper space. The contact information for your ombudsman will come up. This person can be very useful for many things related to the NH. If he or she can't give you a direct answer, they'll tell you the appropriate local authority to ask.
Good luck,
Carol
Towels are a nice thought but I worry about cross contamination. With wipes you can toss them right away. If they use towels I hope they have a bin right nearby to put the dirty ones in and don't rest them on anything. And, just as a reminder, wipe front to back. I also use corn starch for any areas outside that have folds. To keep the moisture away. I think that is OK to do. You may want to check with the doctor, though. Especially if there at any breathing problems. -that fine dust like powder .
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Unfortunately, I live several hours from my mom who is in a brand new Alzheimers Care Facility. They say they are different with much more individualized care. A few family members wanted to move her in the month it opened. I felt very strongly that, since we already had round the clock care for mom at home, we should give the staff time to learn to work together, develop their routines, procedures, etc. Especially since "they approach it differently". There's always a bad hire or two in any kind of start up. My family couldn't be persuaded to wait and moved mom in. Poor mom endured a significant miscommunication on a medication she wasn't supposed to have on a regular basis, they dressed her "commando style" for a visit home with no underwear or depends, and about month ago when I visited her, I found a horrible rash in her groin area. Mom... she's been in the hospital twice since moving in (possible TIA and a horrible gastro intestinal bug) and, as a result of the poor hygiene, ended up with a raging urinary tract infection. It was diagnosed on a Friday, but they couldn't get antibiotics until Monday!!! When I discovered mom's rash, she had been recently toileted by the staff, but there were feces in all the folds of skin between her legs. It was so bad, I tried, but couldn't clean her myself. I worried about her falling and also about aggravating the angry, red, bumpy rash so I called for an attendant who used well over a dozen wipes tying to clean her and I asked at what point do they just put her in the shower... which she then did. I got the impression it was up to each CNA to use their judgement on toileting routines. Mom (and many Alz patients) don't like the shower, so they do a waist down version for peri-care. I too wondered what the protocol and gold-standard for peri-care is. I found some instructional videos on YouTube and let me tell you... if done "by the book" expect to use about 15 wipes after a straightforward BM. The cleaning I witnessed did not follow that procedure.
The Nurse explained a few days later that, because I had brought this to their attention, they had implemented new procedures for all patients and staff. While she never actually apologized, it was clear she found mom's condition to be totally unacceptable. She's been very responsive to my follow ups. My sense of the new procedure is that a completely incontinent resident like my mom is to be monitored at EACH toileting for any redness whatsoever, hypo-allergenic wipes are used for cleaning each trip to the toilet... even if just urine... and that barrier cream is now required and must be reapplied a few times each day. It's no longer up to the judgement of the caretaker. This might be due to the condition of mom's skin, but other caregivers have told me of the importance of barrier cream (a really thick zinc oxide based paste) for anyone that is in depends 24/7. They do use terry cloth towels and Dove Body Wash on her peri-area in the shower. I think she gets one at least 3x/week or more as needed. The facility does the laundry. I think ordinary paper towels would be irritating. Wipes are much softer. You can use Amazon's subscription service to stay well stocked in peri-care products at a discount. I hope that what I learned from mom's horrible experience will help prevent one for your mom. If you do learn what the industry standards are for peri-care, please let us know :-)
I love research so I imagined, to self, of removing all toilet paper from all public restrooms in the faciilty (one) and see how long it would take for the staff to report no toilet paper. My question of course would be, if paper towels of industrial strength found in their restrooms is good for a patient then its good for the staff. Haven't done such a test (yet) but how interesting it would be. When I asked the paticular CNA not to use a paper towel when cleaning mom she replied "I wet it"...o h good, a cold harsh paper towel. I witnessed it myself and said nothing because I would have choked her. That was one night I had to walk away.