Mom has been in SNF for 4 years with multiple chronic conditions, including legal blindness. The first 2 years she was cooperative with staff and a favorite of many workers and residents. The last 2 years, she has deteriorated both physically and cognitively and is non-cooperative. In particular, she will go a month without a shower and weeks without allowing the staff to clean her room.
I am her advocate with POA and have spoken several times with the Directors of Nursing, Social Work, and Housekeeping, as well as attended quarterly Care Plan Meetings for Mom, but now they respond that they cannot make her do things due to her Patient Rights. This is a 5-star facility that is clean, organized, and offers many resident activities with a professional and competent staff. I feel upset and frustrated that even I cannot reason with Mom who just a few years ago kept a clean, beautiful house and was primo about her hygiene, dress, and makeup.
Any suggestions?
If they cannot, then who CAN?
And do they then allow rooms to remain in squalor?
I would like to know what remedies they suggest when you speak with the admin about this.
Do you believe that your mother is in an adequate level of care?
Do they consider her competent in her decisions? Because if not, as staff they are beholden to keep her cleansed, to check her skin, to make certain her room is hygienic.
As long as they tell her what they are doing and they maintain her dignity, there is nothing wrong with cleaning a resistant patient with cognitive impairment.
There needs to be a sensible balance.
if you have concerns it may be best to doesn’t to her doctor and then the management if the care home after you hear what your doctor
Says and if he/she feels it appropriate to offer advice
It’s a hard one as care homes are responsible for maintaining. Safe and hygienic environment but there is also the element of an individuals rights and dignity
speak to her doctor
my father went thru a stage of not wanting to wash
Boiled down to the pain it took and his fear of falling after a slip
plus a tad of laziness - very disturbing as he was always proud n kept clean. My sister adopted a no nonsense approach
and a set time - and instead of a shower we got a bowl with flannel and a little disinfectant n liquid soap and we helped him take. Clothes off turning fir him to wipe private parts
and we switched to pull on disposable pants
and it became routine
which showers at intervals
maybe your mother needs help
dressing and in dressing
We also bought clothes size bigger to allow ease of taking them on and off
its now a routine
maybe explore if your mother is in pain
and don’t forget to give her space for dignity for example
And
In my father's case, they were putting him in the hoyer lift and transporting him down to the shower. He hated the hoyer lift because of the pain it caused due to longstanding back and knee issues. My sister told them not to use that. With help, he was able to transfer to a rolling shower chair and transported to the shower.
He rarely got a more than a few hours of sleep at night which was from as long as I could remember, possibly related to the demands from being in the Air Force. They were waking him at their convenience during the night to give him a shower. My sister told them not to wake him for showers.
Another family hired a specific aide after hours, that their mom was most comfortable, to give her showers at least once a week. When our father was in their AL section, he commented that he felt more comfortable with a specific aide because she did a better job but we were not able to afford that added cost when he moved to SNF.
By offering alternatives to the SNF routine, the situation improved. So by adding that her room should be cleaned only when she was being showered, attending PT or an activity may improve your Mom's situation. First see if she will share any insights to why she is refusing and maybe you can suggest alternatives to make her less agitated.
Smell is irrelevant, otherwise, but condition of skin and tooth decay are important.
1) Definitely one for the Ombudsman. Yes, the ‘rights’ are not consistent with the ‘obligations’, and it’s a legal issue.
2) It applies to more than just your mother. Can you find out whether the same issues are coming up with other residents? It will make more sense for the Ombudsman to work on the bigger picture, not just one resident and one ‘difficult’ family. You might even find another family willing to take on the battle – which is potentially quite a lot of work.
3) Can you get facts about your M’s mental conflict now with normal (and her own previous) decision making? Can you show that this is about her need for care and her deteriorating mental health, not just a case of her disagreeing and exercising rational ‘rights’.
4) My guess would be that this has been argued at length in the nursing profession, the last time that the rules were written down. The largest public hospital and the nurses college could perhaps give you references to the arguments, and that would be useful for your reference to the Ombudsman.
5) Can you make an estimate of how much the facility ‘saves’ by not using staff to provide the personal and room cleaning? A decision that saves them money is more questionable that just a disagreement about the actual responsibilities.
6) Take it your local legislature, if the facility won’t listen to the Ombudsman. Be ready with a compromise. If the facility is likely to get some bad press if the issue goes public, they may be more willing to back off.
7) Interesting that the patient has the right to say "less" service but not the right to say "more".
A real PIA and potentially a lot of work for you, when all you are looking for is good care!