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Soon I will be attending the Plan of Care meeting and I want to bring the subject of a roach, and a dirty trash bin in my husband's bedroom. This is the first time in almost two years I witness these failures. I do not want to go as far as the Ombudsman. I know it takes diplomacy, but I am not sure I possess that gift.

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I had roaches once in my house, and I am a clean freak. Turns out I brought them home from the grocery store in the paper bags, they like the glue. So they could have arrived accidentialy by someone. I'd be kind about this, I am sure they will get on it quickly
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Boric acid kills roaches without poisons that can compromise the health of the residents. Maybe make the suggestion that they try this powerful non toxic to humans solution. In lieu of that, my best friend killed every roach in an entire apartment building with putting out boric acid in her unit (we were young and couldn't afford expensive housing back then) It works.
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If there is one, there are many. What would you do if you saw one in your own home or your own bedroom where you sleep? If "you" saw it, then no doubt others have see a "problem". Personally, I would not let a moment go by without it being addressed. If extermination was not done by the next day, I would call the State Health Department, which I have in the past. This may sound somewhat harsh, but it is an issue which should not be allowed to continue.
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When the trash can is dirty, I just grab the first CNA that is in the hall and ask them to replace the bag or whatever.

As far as the roach, I wouldn't wait to tell them. Perhaps the facility was just treated and that made bugs "run."
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A good facility would want to know about this. It could be that there is a new employee who needs additional training, or perhaps an employee who is just not doing his/her job. Housekeepers are expected to spend a certain amount of time in each room or apartment, and if they get distracted by the TV, or just decide to sit and rest for a bit, well, the time for that room is gone.
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Write a letter to the administrator. If you bring this up to the care team at the Plan of Care meeting, nothing will be done about it, especially if you only tell them verbally. A written complaint to the administrator, sent certified mail with return receipt, will get attention. This way, you have proof that you said something about it. If something ever happens (like a facility-wide infection or virus), you'll have something in hard copy that proves you complained about it, because if the state comes in to inspect the administrator will say "We've never had a problem with cleanliness before". Make sure you keep a copy in a secure place. This way, you don't have to worry about "diplomacy" or blowing up at someone. You can just put the facts into writing. Make sure you leave out the emotions.
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ask the nursing staff for some gloves, disinfectant, sponges, what they use for roaches, and if they have someone on staff to help you clean your loved ones room - NOW. It needs to be done now, and you are not willing to wait..Maybe they will the the message.
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There is never just one cockroach! You shouldn't avoid bringing this to their attention for fear of angering the staff or getting a housekeeper in trouble. It's no one person's fault if the place has roaches but it is the administrator's responsibility to address the problem. If you see something crawling say something.
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The trash bin could have just been an oversight...The roach could have been brought in by a new resident. I make them aware so they can get on exterminating.
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In terms of diplomacy, I think you want to give props to the fact that this is the first failure in sanitation that you have observed in 2 years, and that the cleanliness of the facility has been one of its strong points, one that you always mention when you recommend it highly to your friends. However, you feel that recently, there has been some sort of change in the level of cleanliness, and wonder how best to get this addressed. Has there been a change in the cleaning service? Has there been a change in the exterminating company? Is there someone higher up that they would LIKE you to contact to bring this situation to greater attention? Sometimes NH are taken over by larger corporations that cut back staff, services, and the folks on the ground KNOW that things aren't right, but can't complain themselves. They NEED families of patients to contact the parent company, or the ombudsman, with complaints. As mentioned above, be one of the team!
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Go up the chain of command (put the request/problem in writing) documenting the problem. At home, get a black speckled notebook, and write each date you visit your husband and what is subpar. If the problem exists on day 2, give the note stating the problem was reported yesterday to nurse x. Go up the chain of command.
I would write the CEO of the NH and then get the state agency which is supposed to regulate the NH involved. The NH like any health institution should do its best to provide a clean environment. Infection rates may be high in such a setting.
Keep your eye on what is best for your husband and his health or recovery.
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I agree with Linda5. You can be very non confrontational by telling him/her what you saw in a non accusatory way. Your tone can be like, "I don't want to get anyone in trouble but I saw a roach in my husband's room. You don't think this is a widespread problem, do you?" Based on the reaction you get, you can decide what, if anything, you need to do next.
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My mother is in a Nursing Home and if there is a problem I talk to the nurse who is on duty about the problem and tell them to please chart the problem so each shift can see it. If the problem is not solved I go to the head nurse who is in charge of all the nurses on my mother's wing. Believe me they will not want you to go to anybody that is higher up.
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Has the problem been chronic? From your statement I would assume it was a one time thing in 2 years. If that's the only thing you have found I would not say anything and count yourself lucky.
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Any changes in staffing lately that affects his room?
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Take photos if you can, so that you can document the situation; otherwise you have no proof.

Perhaps you can think of yourself as part of the team (which you are), and are bringing to their attention the issue of sanitation. If you were an on-staff nurse, how would you raise the issue?

How can you present it to them in such a way that they see you as a compatriot, nonthreatening, and someone who is problem solving oriented?

To do this, imagine that someone found a roach in your house. Yes, gross, I know. Makes your skin crawl. What kind of approach would be alert oriented, nonthreatening and helpful? Then take that approach.

Non threatening is I think the best approach, with firmness to indicate concern.

If you don't want to involve an Ombudsperson, don't, unless changes aren't made.

Perhaps you could present your own plan of action for their consideration - be "proactive" as the biz people like to say. Think about how this could be done with vulnerable elderly - spraying wouldn't be a good idea, I would think.

If you can think of alternate plans, present both so they have an option.

Ask when they think they can address AND resolve this problem.

I'm not sure how much of an issue a dirty trash bin is. Is it overflowing with bacteria infested material? Flowing onto the floor? Smells?
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