What should be the best way to bring out some sanitary failures at the NH?

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?

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.

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.

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.

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.

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.

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."

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.

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.

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.