Care in nursing home?

what if the person has dementia and cannot talk? How will s/he let the staff know - verbally or otherwise? They don’t even know they just had a bm. What then?

At my Moms NH, the policy is to respond to a call bell (for whatever reason) within 10 minutes. After 10 minutes, the RNs pager would go off, and she would arrive to take care of whatever is needed. Of course if a resident told a CNA personally that they needed to use the bathroom, they would be taken there immediately. Remember, the elderly can sometimes lose the feeling down there that they’ve gone, they maybe tell them “too late”. Aside from that there is a standard to check everyone for either changing a pullup or assisting them to the bathroom every 2-4 hours, depending on the resident, and their care plan.
If a resident can not express what they need or use a call bell, expectations of someone being there “immediately” to assist in toileting issues are pretty unrealistic.

Dont listen to horror stories and rumors about skilled nursing facilities. Some people who have had one bad experience lump all facilities everywhere into the same pile and it’s just not true or fair. My mother’s facility was a superior one. If I ever have to place my husband, he’s going there.

However, a 30 minute wait for a change is unfortunately not that unusual. My husband is in a rehab facility right now and he tells me he’s waited 45 minutes. He’s also told me his aide left at 11PM one night and was back on the job at 7AM. Because the pay isn’t anywhere near adequate for what these people have to do, facilities are woefully understaffed.

There is a certain amount of acceptance of how things are in facilities. Waiting for the aide doesn’t unduly upset my husband. If he soils himself, he feels bad, but it’s not really his fault no one showed up, you know? It doesn't happen that often.

Remember, if you have any issues, you can always call a care conference with the staff. It’s your right.

I don't think it's reasonable to expect any staff member to be there immediately when a resident in a SNF needs a diaper change. It's the same in an Assisted Living Facility.........the staff work on a priority basis, so there will be times when a resident will wait 30 minutes to have a call light answered. I can't imagine having to hire outside care givers, however, since the costs of these facilities are so astronomical to begin with! I can tell you that when my father became a 2 person transfer while living in Assisted Living, I was given a choice: I could either hire someone to help him (the ALF is only allowed to provide ONE person to help a resident transfer; I'd be hiring someone to live in, basically, to be the second person), or, move him into a Skilled Nursing Facility where they WILL accommodate a 2 person transfer. In the end, it would have been way more expensive for me to hire a 24/7 care giver to live in his room than it would have been for me to transfer him to a SNF. It turned out that Dad needed hospice, so the ALF kept him there and he passed away 2.5 weeks later.
In any event, the other thing to consider is that the resident would have to be alert/aware enough to push the call button to ask for help with a diaper change to begin with. I don't know how often the staff make their rounds to check on residents for those kinds of needs, so that would be a good question to ask up front. I do know they come around very early in the morning, like 4 or 5 am to do diaper changes, so the residents do not wind up laying in soiled undergarments for longer than necessary.