NancyO132 Asked January 2020

What is a reasonable response time to expect from the nursing home when my mother pushes her button to request assistance?

My mother is 98 and has been in a nursing home near me for 8 months. There are several nursing homes in my area. My sister and I placed her at this one because it seems to be the consensus around here that this is the best one, although it is not fancy at all and is an older building. However, I have had many friends place their parents there, and they have had little if any complaints. A lot of the staff have been there 10+ years and seem to be very patient and caring. The administrator has lived in the area her whole life and has been working there at least 20 years.

Mother has had incontinence problems for at least 5 years now and has been wearing adult pull-ups on a regular basis. For a while she was able to handle toileting by herself for the most part, sometimes with assistance from the aides at the assisted living facility where she previously resided. After a bout with pneumonia and being hospitalized for a week, she was not able to walk and we placed her in the nursing home. She does have a private room with her own bathroom. She is not happy about not being able to have the door closed, but I understand this is a policy meant to insure her safety.

She has fallen a few times since being at the nursing home because she tries to get in/out of bed or into the bathroom and onto the toilet by herself. So far she has not hurt herself. She has been told to use her call button to summon assistance, but yesterday she tried to get into the bathroom by herself without calling anyone and she fell trying to transfer to the toilet. My sister thinks the reason she didn't call for help is that when she does do that it takes too long for the aid to come. I go there every day and spend a couple of hours, and when I'm there I have noticed that it may be as long as 15 minutes to get help. My sister thinks this is way too long. Since I am there every day I can observe what usually goes on, and I don't see anyone slacking off. They are always busy doing something. Needless to say, the other residents there are quite mobility challenged and need assistance also.

Should we be pressing the administrator to get someone to my mother's room more quickly? This is our first/only experience with a nursing home, and we're not sure exactly what we should be expecting.

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15 minutes is way too long when you need to get to the bathroom! How long does it normally take, though? Was that delay exceptional?

It's a tricky issue; but there is another point you raise that I think is important.

Your sister believes that your mother didn't press her call button because your mother didn't expect anyone to answer promptly. That's possible, of course; but I'd be suspicious that your mother didn't press her call button because it didn't even cross her mind to do so; and if that comes into it then no matter how many times your mother is reminded to ask for help, and no matter how quickly the aides would respond if called, your mother is going to be off on her travels to the bathroom before anyone can get to her. Watch out!

The solution to this problem is pressure pads under your mother's mattress and armchair cushion that will alert staff when she gets up. Because of - sigh - "deprivation of liberty safeguards" these alarms are sometimes controversial: check what the nursing home's policy is.

Helpful Answer (13)

It is possible that she just didn't think about the call button. Her short-term memory is terrible at this point. Sometimes she will remember something I tell her and sometimes she won't. That is one reason I'm not sure what the situation actually is when I'm not there. She has been known to be a little disconnected from reality at times.

(2)

What does the call button look like? My mother with MCI and short term memory problems wouldn't/couldn't use the panic buttons on the security system to summons help - either the little pendent around her neck or the larger wall mountable button. Those buttons just were not part of my mother's life during the years she was an active adult and following cognitive decline she never could remember to use them. Mom still understands what she reads, so I printed HELP labels and pasted them to the wall mountable button. She will push the HELP button.

Helpful Answer (10)

At Moms NH the “expected” time was 10 minutes, but in reality it could be faster or slower depending on what chaos was happening at the time. Her place had silent call lights...when the resident pressed the button a light would go on outside her room (no actual bell). If no one responded to turn it off after 10 minutes her aids pager went off. If after 15 minutes it’s not turned off the LPNs pager goes off. And up the ladder. I would suggest talking with the nursing director to see what is procedure there.

Its tough when the resident is semi-mobile or thinks they are. Or can’t remember to press the call button. Or can’t find the call button. Mom was blind in one eye and eventually both, so she was given a really big round call button. It was flat and probably 4” in diameter. It was grey (what moron thought grey was a good idea?) so I put green duck tape all over it so she could find it, but she still would forget to use it. At Moms NH they could not use the motion detector bed pads. (They were ok in rehab but not the LTC for some unknown reason.) So when she was in bed we would tuck this big green call button by her legs so it would send the signal if she tried to get up. Not ideal but better than nothing. Perhaps you could investigate a different button if that would be more obvious for her.

Getting your Mom on a toileting schedule may help. That way the call button is just a secondary tool. She may already be on a schedule that’s just not obvious so you need to find that out too.

When I was there (daily) if she had to wait much more than 10 minutes I’d be in search of an aid, especially if she said it was for #2. And no, there were no slackers, just incredibly busy and understaffed. I tried to help them as much as I could.

Helpful Answer (8)

All your answers are very helpful. My sister is coming to town soon, and she will talk to the administrator and the social worker. She is better at confronting people than I am. I am the one that has to see these people almost every day, and I actually consider them friends at this point. They have tried to cater to mother quite a bit. I know my mother, and when she wants something she wants it now so I know it's not easy--especially when there are 30 other people wanting their issues attended to. My mother is an R.N. and was a nursing instructor in her former life, so anything that is done differently than the way she thinks it should be done (i.e., the way it was done 30 or 40 years ago) draws her disapproval.

(2)

I would have a care meeting and point out that she is falling because it takes to long, ask how it can be dealt with so that she isn't falling and potentially getting injured as a result.

15 minutes would be the very outside of acceptable time for answering a call button.

I would also ask straight out what the company policy is about the time allowed to answer, they all have some criteria for this.

It is always okay to ask questions and it is always okay to ask how things can be improved when they are causing potential injury. They don't want a fall with injury because they take to long to answer requests for help, those are the things that cause lawsuits and the government getting involved.

Let us know how it gets resolved.

Always be kind and understanding when speaking with the care providers, if it needs to escalate to get results use the proper channels, in writing and copy the entire facility hierarchy and then you go to the ombudsman and the state board and on up. The idea is that you are part of the team that provides care for mom and we all want to provide the best care possible.

Helpful Answer (7)

It would take the caretakers in the facility where my mother was anywhere from 5 to 15 minutes. We think there were times she couldn't remember to use the call button but there were also times that she forgot what she needed by the time someone showed up. We know the people who worked there worked themselves to death and were not ignoring her and we just had to come to terms with things were what they were. We stopped having the energy to get upset and knew it did no one any good, plus many times, we were wrong about jumping to the conclusions we jumped to. My quote for the year ended up being-It is what it is. I said that a lot!!

Helpful Answer (7)

Looking at this in another way...

The best way to deal with this might be for your mom to be on a toileting schedule, i.e., taken to the toilet every 2 hours.

15 minutes is too long to wait, but at certain times, say mealtimes or during shift changes, it might be difficult for staff to respond more quickly.

Helpful Answer (6)

We tried suggesting a 2 hour potty schedule ( when MIL was in the nursing home), but apparently it is not in the vocabulary anymore.
It took a lot of meetings and a lot of our attempts to “fumigate/disinfect” the room before we could walk down the hall without a gas mask.
Unfortunately that was not soon enough to save the chair we bought to help MIL stand ( not that she used the function).

(1)

You say your mom's been in depends for 3 years and could not make it in time, even before she was in a wheelchair. Her brain was already broken about the time it took between noticing the urge and reaching the bathroom. So no, she will not be able to summon someone to get her to the toilet in time.

Since you are happy with the nursing home in other areas, I think this is one where you let it go. Perhaps your sister would like to hire a private sitter who can help your mother get to the bathroom during the day. Your mother and sister are being unreasonable if they think that she should be able to make it in time with help that has to be summoned from far away when mom could not make it when she could walk.

Helpful Answer (5)

I think it depends on the staff to patient ratio and what time of day it is. Most facilities in the states are understaffed and have a large patient to caregiver ratio so 15 minutes doesn’t sound too outrageous to me. For someone who needs to use the toilet, it’s a very long time. But unless you move her to a smaller facility with a smaller ratio, I don’t think you will have much luck in finding a faster response time.

Helpful Answer (4)

LOL My Mom is a retired RN too and is very critical of the nurses when they don’t live up to her standards!

(4)

I think the hardest adjustment for the person newly admitted as well as the family is too accept that this is group living where others have the same or more extensive needs than your mother. That being said, I would say 15 minutes is a reasonable amount of time to wait. However, if she's waiting to press the bell until she us past the point of having to go then 15 minutes may be too long. Toileting schedule, maybe?

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What is a reasonable response time to expect from the nursing home when my mother pushes her button to request assistance?

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