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

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.

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.

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 .

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.

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.

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.

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

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.

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.

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.