Behavior of the hospice bath aide makes me uncomfortable. Any advice?

Dear Nicolette,

Your feelings are understandable. It is hard to see another caregiver help with showering, it does feel so personal. Because you are uncomfortable with this person and the way they are handling the tasks, I would talk to the manager and see if another caregiver could be assigned. I know there are male caregivers who also help with showers, maybe this would make you feel better. Take care. I know this is extremely difficult time. Thinking of you.

If DH isn't being treated with the dignity that you want, ask for another. As far as morphine or ativan before bathing, it may help with the anxiety or pain caused by moving around, but the down side is that he might be unsteady on his feet. I would avoid if I could

It isn't unusual for people to take their meds before doing something that might cause pain and/or anxiety so her advice wasn't necessarily wrong, and unless your husband has dementia as well as lung disease he should be able to judge whether or not he needs either of them before bath time. As for preserving your husband's modesty, well, she did say he should do as he liked and it must not bother him nearly as much as it bothers you. Next time just make sure to bring his robe to them and ask her to use it, or ask her to help him get into his underwear before leaving the bathroom to protect Your standards of propriety.

I think the important question in all of this is how your husband feels about the bath aide. Is he comfortable with her? She sees bodies all day long, so I'm sure one more naked body is just one more naked body to her, just like a doctor or a massage therapist. It sounds to me like it may be more of an issue to you than to your husband. My dad had some bath help from younger women and he was fine being naked. I think women are much, much more concerned with our bodies than men are. And I agree with others, she's probably trying to make sure he's comfortable as far as advising him to consider taking his meds before her visit.

So I'd ask him how he feels, without sharing how you feel. If he's OK, I'd leave things as they are.

I would be concerned that she's offering medical advice. My father once experienced that with a physical therapist who was advising him on something related to alternative diets and medicine.. While I didn't necessarily disagree with the philosophy, I knew nothing about her or how much research she had done, and felt she was overstepping her boundaries.

I agree with GardenArtist, I don't think a Bath Aide should be giving medical advice. Contact your husband's hospice group and ask for a new bath aide, all you need to say is that this isn't a good fit, let's try someone else.

As a bedside Intensive Care RN for 30 years, I can truly say that there is no need for inappropriate uncovering of anyone's private parts.
This particular aide has not had adequate training.
Unless it is the groin area that is being cleansed, the groin area should be covered with something as simple as a washcloth. This can even be accomplished while seated on a shower chair .
As far as medications, this should be discussed prior to the aide's visit with the RN or Doctor .

Then why are you not doing the baths since you know better. Your husband would appreciate someone he knows anyway.  

I would advice that you consider how your husband feels before changing the caregiver who aid with bathing, the reason being change might cause more anxiety and you sure don't want that. As far as I am concerned the caregiver main interest is for your husband to feel free to do what ever he want as long is not hazardous to his safety. Sometimes families has to stop being too much demanding. Imagine if caregiver insist on covering him and he doesn't want to be covered and uncovered every 1 min,

Hi: I have 18 years in hospice administration and quality assurance/quality improvement. I also am a senior advocate (patientadvocacyexchange.com) . I assure you your questioning the professionalism of the caregiver is WARRANTED! (1) The aide is practicing outside of her job description in making any recommendations to any patient regarding medication or any clinical (skilled nursing LVN/RN) duties. (2) The patient's privacy/dignity is to be respected at all times including and especially during personal care/bathing. The whole purpose and mission of hospice is quality of life and the dignity of the patient NOTHING LESS! You were wise enough and concerned enough to ask the question and I applaud you for that but just think of the hundreds of family members who don't ask because they're afraid or they think this is the norm. Asking the manager to replace the aide is just a bandaid put on several issues that are a bad reflection of the aide as well as the agency. As an advocate and a hospice professional myself I would speak with the owner/administrator and tell him/her the same things you've mentioned here. File a grievance/complaint and have them report to you what their intentions are and how they plan to resolve it for you and make sure it doesn't happen to anyone else. The problem with health care today, even though I'm also in the health care industry/arena, is that the needs, care and well-being of the patient isn't always #1. The bottom line and patient count has become more than just numbers. Not all agencies or employees are like this one but take if from someone who has been in health care for over 40 years it's becoming an issue that should be exposed every time something like this occurs. Don't accept this as the norm because care like actions and disregard for the patient should never be excepted as this is how health care is delivered now and something that should be accepted under any circumstances. Your husbands rights have been disrepected. If you need assistance, please contact me. You can find my info on my site. You did the right thin, please consider my recommendations.

This is not common and should not take place.
Discuss this with the Nurse, Social Worker or call the Hospice Office and talk to the team supervisor.
All patients should be treated with respect and dignity.
You can request another Aide. But I really think that the Hospice needs to know what is happening.

I would discuss any concerns with the the hospice agency first. I don't believe filing a grievance without taking this first step is the right move. Have some dicussion, get some facts, then make your decisions based upon this. If you want to change personnel, then do so. And yes, including your husband in this process is the right thing to do.

It's so hard to gauge, because context is everything.

Timing pain relief so that you're as comfortable as possible moving around is just sensible. As an experienced aide she would know that and be confident saying so, and as long as she isn't contradicting or subverting medical routines there is no problem.

The 'doesn't bother me if it doesn't bother you' remark, again, is the mark of a good "let's pretend I'm not here" bathside manner - but it depends on whether your husband meant he *was* uncomfortable and could she please do something about it, or meant he didn't want to make the effort of putting on a robe so could they not bother please; and you can't tell without actually being there.

All that really matters is that your husband is happy with her work, and as long as he is you must turn a blind eye. But until you're confident that he is happy, and that he isn't just not wanting to 'make a fuss', be ready to speak up for him if you think he'd privately like you to.

Would you be comfortable speaking with the aide about your concerns? Does your husband already take those medications, can the timing be altered to allow that he receives his regular dose before the aide comes to bathe him? If not ask the Hospice RN about the medications. I have a feeling that the request was to help him especially having a stranger assisting with bathing.

Good luck on finding a male caregiver! They are scarcer than hen's teeth, as my granny used to say. Most women who do this aren't really trained, either. If they are they cost big bucks!

As a student nurse I was taught only to uncover the area being washed. This was always my personal practice. In any case leaving someone uncovered makes them feel cold and uncomfortable.
However times have changed and it appears not to be unusual to have a male aide doing your bath. Pretty shocking the first time but I got used to it.
As far as the OP's question is concerned. I agree that it is all about what the patient is comfortable with.
I would suggest that the wife goes off and does something for herself and leave the bath aid and hubby to get on with it unless wife feels there is something inappropriate going on or her help is needed to move the patient.
Some patients will ask to wash their own genitals so holding a towell over the area while they do it is appropriate.
I had one patient who I had known personally for many years die and his wife was very concerned that I did not see his private parts. However there was a catheter that needed to be removed. She became quite agitated so I put a tool over the area and removed the catheter without seeing anything,

I agree with Countrymouse, I'm not sure I would go as far as filing a grievance or anything. More likely is that this aide isn't trained or supported (ongoing training) as well as she should be and heard his question about covering up differently then you did and or he meant it. Sounds like this is a new situation, perhaps the first time she or anyone has come to help him bathe so it's new to you and to him but not to her and she may be forgetting that. I also agree that she shouldn't be making medication dosing suggestions that sound like directions but I would bet she has either heard a nurse suggest this or had clients who had this medication set up for comfort or something and heard them remark on how much it helps or something so she thinks she is being helpful. You are absolutely right however, these are not meds that should be given whenever it suits you unless prescribed that way (it may also be that when a patient gets to The Hospice phase they are more generous with these medications) and not knowing anything about his dosing schedule or how/why they are used for him specifically she should be suggesting you ask someone qualified or ask them herself not making what came across to you as a change. It seems to me that while they are there primarily for your DH, his comfort and care you are a big part of that and they are there for you as well, your comfort is an extension of his so if you are uncomfortable with a caregiver it's better to just change that caregiver now before anyone get's used to each other. It matters of course but ultimately whether your husband truly doesn't mind or is just wanting to be cooperative doesn't matter in the end if you are simply unhappy and uncomfortable with an aide and I'm sure Hospice works with these things all the time, personalities sometimes just don't work together, it doesn't mean either person is at fault, it just is so let the person in charge of his case know your concerns just the way you have here and simply ask that someone else be assigned if possible. My thought's are with you and your family, I know this isn't an easy time.

Forgive me in advance, but if her bathing him bothers you that much - why aren't you bathing him yourself?

Working around towels, etc. can also be a safety problem and the caregiver would be trying to wash him but keep the towels dry.

Why is he leaving the bed? My father, during Hospice, was bathed while in his bed. I didn't bathe him because he was still "aware" and I felt it would embarrass him as his daughter touching his private areas. I explained that to the Hospice Nurses and they agreed. Had my father "lost it," I would have bathed him myself.

If your DH is embarrassed - he can always cover up no matter what someone else says. And the patient is always encouraged to wash "those" areas himself if at all possible. I learned that from one of DH's many hospital stays. Now the wife is expected to do the bathing but years ago it was the nursing aides who did it.

If she makes you feel uncomfortable, call up the hospice team that dispatch this worker and tell them what you described here. You can also see if they have someone else they can send out and just tell them you're not letting this woman back in the door. This is exactly what I would do if I just didn't feel comfortable like you're describing. It sounds to me like she's probably not getting none, catch my drift? She doesn't need to be lusting after your dying husband, just send her packing by calling the agency but do it discreetly if she happens to be there and see if you can catch a video of what's going on in case you need proof. That way, you can play it back and you can also get a hold of whoever is up over hospice

How is your husband being taken to the bathroom? If he leaves his bed without wearing clothes, he probably feel cold. There in nothing wrong with suggesting that he be draped with a bath towel or a robe when moving from one room to another. 

If they are using a shower stool then placing a wash cloth over his groin area shouldn't be a problem. Depending on how much he can wash himself I have always used the maxim "I will wash down as far as possible and wash up as far as possible. You can wash possible."

I think that it would depend on how your husband feels about the situation. When he was asked the question about undressing him, his choice should have been considered. He should have been asked what would make him more comfortable. How does he feel about being naked for the time it takes him to go from the bed to the bathroom?

Once he is in the bathroom, the door should be closed over to keep the bathroom warm and to keep everyone else (including you) out while the Aide gets on with her job---because that is exactly what it is to her--- a job. Once he is washed and dried, the Aide should put on fresh clothes (fresh pj's?) to the extent they both are able, before taking him back to bed to continue dressing him.

I am sure you have done a wonderful job caring for your husband over the past few years. I also know how exhausting it can be--no matter where you are, you are always "on".

I am sure the Aide was brought in to relieve you from a somewhat exhausting task. Leave them to get on with it and go and do something restful/interesting for YOU. See this time as a relief from the exhaustion you have been enduring all these years, even if it just a cup of coffee with your next door neighbour. Yes, I know that it can be an absolute honour to care for your husband but you are human too. You, too, need a break.

Or, if you still need to get involved, you could use this time to tidy up his room and change the sheets etc. on his bed so that it is clean and fresh after he has been washed, especially if he is practically "bed ridden". I am sure he would appreciate being able to get into a freshly made bed.

Is your husband able to wash "possible" (his groin) by himself, with a well soaped washcloth? If so, he can be doing that when she is washing the rest of his body. Washing his feet/legs without covering his groin area conjures up a picture that I would not like to see. (Where is her face?)

As for his medications--are they prescribed on a prn (as needed) basis? If so, does that mean that you can decide when to give him his medications?

If you are uncomfortable with the option of him getting medication before being washed, ask the Hospice staff to get an order from his physician or the Nurse Practicioner, so that he will be able to get the required medications before having ANY procedure that he will have to endure and not necessarily before being bathed. It is common medical practice to have a medication order that will address his signs/ symptoms of discomfort. If he gets pain during being the process of being bathed, giving him pain medication at that time is too late.

I agree that the Aide is probably well used to this practice. If bathing your husband has caused him any pain or anxiety beforehand (to him), it would make sense to get it ordered that way so that YOU do not have another reason to be concerned. I am sure you have more than enough things to  worry about.

I am so sorry that you have yet another cause for concern. Having someone come into your home to bathe your husband was probably done to relieve some of YOUR stress. It is too bad that, not only is it not relieving some of your stress,  but is actually increasing it.

In the old method of addressing a concern, the golden rule was to start at the bottom and, if no satisfactory result ensues, then go up to the next level. The Aide may be totally unaware of the anguish this bathing is causing you. For her, it is an every day event. You need to satisfy yourself that there is no cause for concern.  If you are unable to do that, then you could go "up the ladder" to achieve the outcome that helps both you and your husband feel comfortable.

Husband's comfort level should be the driving force here, but that isn't to say Wife's comfort level should be ignored. Bath aide's comfort level is pretty irrelevant here, in my opinion.

How about one of those wrap-around towels that close with Velcro? He could keep it on in the tub and you could throw it in the washer after the bath, along with the other towels. The dry towel goes around him as he takes the wet one off.

The dignity and privacy practices are not up to the aide. The COUPLE gets to decide that.

DigitalBanker, I would hate to be on the receiving end of the attitude portrayed by your response. "It sounds to me that she is probably not getting none, catch my drift?". I am absolutely horrified that that  comment, plus your remark about not needing her to "be lusting after your husband" should be made as a response to Nicolette's dilemma. 

Passing judgement on someone, anyone, without knowing the whole story, reflects more on the "judge" than on the one being judged.

We all need to be careful that what we say, or write, does not lead to a case of slander or libel. The wonders of Internet, and internet providers, tracking posts etc. means that we have to be very careful with what we say on line, on Facebook etc. because someone, somewhere, has access to what we put on the Internet.

DigitalBanker, I wonder if your words and opinions come from your own experience, something that has caused you deep pain because, after I had expressed my horror about what you had written, my next thought was that there is someone out there in great pain. Of course, it is the business of no one, except except your own. But, if you are carrying all this pain perhaps it is time for you to reach out to someone who would help you to be able to share your pain. (IMO).

By the way, going on what I have read numerous times on this site, it appears to be illegal (in the USA, anyway) to record the words or actions of another without their permission. Perhaps well need to educate ourselves about topics that we may not be fully understandby and certainly before making such a suggestion to another.  Follow what Ellen says, be kind to yourselves.

In NO way, should this person be offering medical advice. Good grief! Let her supervisor know.

She may be suggesting the meds prior to visit so that he would have less discomfort when he is being moved while being cleaned & washed - just like if you have a bit of cold you would take cold meds before a plane flight just for comfort especially your ears

She may also find covering up & uncovering 1 minute later is time wasting & she may feel that time is better spent on care not modesty - you seem more uncomfortable than your DH - just make sure care is what husband wants not just what makes you comfortable - men generally are more comfortable nude than women

Those aides have a routine when performing their duties & I bet it takes her less than 15 minutes to get his bath complete. If I was uncomfortable with how the HHA was doing it, I would leave and allow her to finish (as stated, your DH doesn’t appear rattled by her methods & probably just wants to get it done) or speak with her or her supervisor.

Regarding pre-medicating prior to hygiene, the aide is not giving an order. The nurse or someone who wrote the care plan probably wrote it in the instructions for the HHA to ask as maybe the nurse had witnessed that the physical moving and repositioning of your DH during care causes him to be in pain. The recommendation was given to her by a skilled professional (RN case Mgr, Hospice Doctor, et al. 

HHA don’t just think this up prior to their visit. As a rule, the RN documents a plan of care in the person’s electronic record including directions to the HHA. To me I would be pleased the HHA even took the time to review any notes regarding the patient’s specific care. She isn’t prescribing nor administering the medication, just following directions given to her by the RN.

I may just say to her - “here, can you please use this to cover his private parts to help keep him warm? I would prefer you do so for me. Thank you”. See if that works.

These aides do so many bed baths their routines are like a well functioning machine. Gently discuss it as above.

As far as your thoughts about the aide recommending pre medication prior to hygiene, call the RN in charge of your husband’s case & discuss this with her. She/he will provide her rationale to you as to why this is requested. Maybe the nurse sees signs of your husband in pain that the family doesn’t recognize or DH has bone pain from his illness & is trying to provide this information to HHA’s as part of his plan of care.

You as the CG can refuse her recommendation as well & let her know that is a suggestion you don’t feel is warranted.
The important thing is to communicate - the problem can’t be fixed if no one knows there is a problem.

I am getting two different views of the comments of this posting. One stops at #10, another one has 20+ responses. Any one any idea of the reason?

Cathberry, under the original question is a drop down box from which you can choose to see, "most helpful," or, "most recent," responses to a question. If the, "most helpful," response is chosen only a limited number of responses can be seen. It usually seems to be about one page of responses but I'm not sure exactly how the website defines, "most helpful," because occasionally it is more than one page. I suppose it has something to do with the number of thumbs up answers receive.

First of all listen to your feelings on the matter! My husband is bedridden and on Hospice also. Your bath aide is out of line. Contact your social worker as well as your nurse case manager. Get yourself a new health aide as she is only that, not a nurse.