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As I posted before, my mom is in a SNF after suffering a stroke. She is wheelchair-bound and has significant vascular dementia. Seemingly like many elders, she is absolutely obsessed with going to the bathroom, sometimes asking to be taken there several times an hour, much of the time not doing anything (and then asking to be taken again). She does not have a UTI. I know her behavior must be annoying and exhausting for the staff. This afternoon, one of her aides apparently complained to my mom that she had asked to go to the bathroom eleven times in the course of two hours. My mom, of course, says that the aide is lying, but I have no problem believing that it's true. However, I feel that the aide should not have said that to her. My mom is helpless, very vulnerable and extremely anxious (despite being on both Seroquel and Ativan). The aide saying this to her upset her greatly and embarrassed her and now she is even more anxious about asking for help. Am I right to think this was way out of line? Should I say something to her care manager? I try very hard to stay on the good side of the people taking care of her (and know how hard their job is), but I am really angry and upset that the aide complained to her about something she really has no control over.

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What do you think the CNA should have said or done? Should she have just walked away and ignored your mother? Should she have said, "No, I just took you". I don't think there is anything the aide could have said as in situations like this, there is nothing they can do that won't be upsetting. That is because of the situation, not the aide.

My mother is in the same situation and I have been in her room when they say, "No" or "I will come back later". I know it upsets my Mom but I don't think there is anything else they can do as she won't ever understand why she can't do simple things she used to do.
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This reminds me of the time one of the aides at my mom's care facility came over to me and my mom and said that we needed to get her some bedpads because she has been "voiding" at night. When she walked away my mom looked at me and said "well I guess I've been put in my place." She was a little embarrassed but we laughed about it and she was ok. I don't think what the CNA said to your mom was really out of line, in an ideal world all carers would be perfectly gentle and kind respectful of individual patients' anxieties at all times but everyone has their limits. And dealing with dementia patients tests those limits constantly.
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Split, I think you are feeding into her anxiety by saying, "that must have been upsetting."

Being mindful of not playing into the dementia reality is a balancing act.

I found saying something that doesn't get into the emotions was more effective when dealing with my dad, if I thought it must have been upsetting he was automatically justified in being upset.

You don't have to say anything, she is picking up on your vibes.

I am glad you aren't taking someone to task based on what your demented mom told you. That is thin ice.
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Splitsecond, I am wondering if you see the same flags I see.

You say mom has a hard time asking for help, yet she asked for 12 bathroom trips in 120 minutes. I don't see that as having a problem asking for help.

I think she is feeding off of the anxiety she feels from you and is saying things to get you to act. No rhyme or reason why or how people long gone in dementia know but, maybe we get our sixth sense back as we revert to infancy?

Who told you that the aide was inappropriate or frustrated when/if they commented on her already 11 trips?
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notgoodenough Sep 2022
I agree, ITRR. I think the anxiety that mom suffer from is also feeding into this scenario.

My daughter has an anxiety disorder, that is generally managed well with medication and therapy. But every so often she has a "flare-up", usually when she's stressed about something. And when she does, my goodness - she can take a passing comment someone makes with no intent to offend and worry at it like a dog with a juicy bone, until it has escalated into a scenario where the comment was absolutely unforgivable - essentially, a verbal slap across the face with a glove before insisting on pistols at twenty paces.

I understand how hard it is to say to yourself "this person that I love and want to protect is SO overreacting to something that they misinterpreted or misunderstood". And since you don't want to upset your LO further, you become loathe to point it out. I also get the urge to tell the "offending party" to cease and desist the behavior - whatever it might be - even though in your heart of hearts you know what they did was, in the greater scheme of things, really no big deal, because you just want your LO to have peace and calm in their minds. But this is the world we live in - you can't change everyone else's behavior for your anxious LO, you must find a way to help your anxious LO to live in the world in which they exist. And you have to understand that, even with meds, there are going to be times that the anxiety is ramped up and the only thing you can do is try to calm the situation as best you can without hurling recriminations at anyone.
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SplitSecond,

I understand many aspects of this situation and you're strong advocate for your Mom. I read further and saw that you did the best thing by setting up a meeting with her care team. Hopefully, some solutions will come from that and your Mom's anxiety can be reduced.

My Mom has fecal incontinence and is utterly mortified about these incidents. She went through the clothing layering phase until more confident that the more heavy weight pull ups I requested will contain most of these events.

I would bet that most of the women in any care situation have urinary urgency/ frequency due to childbearing, aging tissues with low hormones, chronic UTIs, lowered hygiene standards in-care as compared to their usual habits, sitting on boney prominences for hours, generalized anxiety too.

One possible suggestion is to have your Mom placed on a high quality probiotic. There's a condition called IC where the bladder lining loses its integrity, allowing the acid urine to cause burning of the urethra and constant pain signals. Oxalates, a by-product of digestion and found in most all foods can cause bladder irritation and if any abx have been used, one can lose the gut bacteria that break down oxalates. I order Desbio spore-based probiotics for my Mom and it helped her IBS, mentation (the gut-brain axis), and possibly reduced her urinary urgency. Mom is still independent (for the most part) with toileting but needs assist to ascertain having a pull up on at all times.

I manage everything for my Mom and use her estate monies for anything that will benefit her. I've gotten the care team to OK her being on good, food-sourced vitamins, the Desbio probios, natural D3, Magnesium malate, and psyllium husk to help bulk up her stools.

Interestingly, I began my career in health care as a CNA at the very care home she's now in, at age 17, for $1.38 an hour, not kidding. Of course, having ended as an RN, I made way above those early wages! But, having worked in so many areas, incl supervisory, I have a lot of empathy and often sympathy for the CNAs. I see so many who like me, care for these folks tenderly, but have no say in their care mgmt, no ability - apart from their time with them - to improve their quality of life. That frustration was what drove me to pursue my RN - and I loved working in health care, loved it. I ended my career in Hospice and Home Care. Loved. It.

I get your frustration, but pls just give the constructive criticism, you don't want to be the one who breaks a CNA's heart over a careless venting, even tho she could have held her tongue, maybe try to see this as simply an opportunity to improve the situation for your Mom and for those who provide her personal cares. I am so grateful for the people who are wiling to do these cares and they don't get paid half of what they should. I try to express my gratitude whenever possible, even when the care is below my rather stringent personal standards as an old school RN.

I hope that your Mom's anxiety lessens and she'll grow more accustomed to relying on depends. Once in-care, they have so little control over anything and her focus on toileting may be a symptom of that. And what proper lady would ever want an accident?

In both medical-surgical and critical care nursing, there's a term for demanding female patients that we'd use in report-off at shift change; GSS, for Golden Slipper Syndrome. When dealing with life and death, you gotta have some humor, however cryptic ,and It doesn't mean any lack of understanding and compassion. Anyway, I always loved those patients and would go in for my initial and scan the room for each and every possible need or want and cover every one of them. Leave the call light near and tell them to call if they need any little thing. I left them flummoxed and unable to think of a thing I left undone. I usually never had their call light come on, simply by seeing to every possible need in advance.

Just love your Mom and do your best.
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Pick your battles, and this isn't one to pick. A friendly "By the way, Mom gets weirdly upset when anyone points out how many times she asks to go to the bathroom, and it's making her hesitate to ask for assistance."

No blaming a particular CNA, just a friendly FYI to help them learn Mom's quirks.
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PeggySue2020 Sep 2022
Except mom insists on assistance
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I've heard a lot of comments directed at my LO which could possibly be construed as negative... but I never gave them a second thought. I don't think it's cruel for an aide to say "Claire, you've been asking for the restroom every 10 minutes. There will eventually be a time when I cannot get here." I have been present when such statements have been made. Knowing the aide is correct, I never questioned it. Another statement that comes to mind is "Claire, you JUST wore those pants. Don't you remember?" I don't have a problem with that one either.

I have spoken privately with aides, but not to correct them. I'd speak privately to tell the aide that I experienced the same thing when I was "Claire's" primary, hands-on caregiver and I understand how Claire's demands come across. I would ask what the aide has seen work with other patients or what I can ask the doctor/APRN about that would help all of us. The aides know various solutions but they don't have the authority to place orders.

The aides caring for your loved one are important and the communication lines need to remain open. Please don't shut them down because they said something out of frustration. She could have been at the end of a 16 hour shift for all we know.
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Your mother is being unreasonable in refusing to ‘trust’ her depends, and expecting multiple (pointless) trips to the toilet instead. She was upset to get a comment on the 1-to-1 immediate service she expected every time.

Mother is very similar to many others on this site – unreasonable requests, and a mini-meltdown if there isn’t immediate service as requested. The emphasis here should surely be on mother’s behavior, not on the aide.
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my comment box is not working properly.
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Have your mother checked by a urologist. There might be a medication that would help. Or perhaps she can have aa Botox shot in her bladder for the problem. My friends mother has the Boxtox shots every so many months and the shots have been very effective. My mother had an InterStim urinary pacer inplanted. It was effective but expensive and had to be reprogrammed every few months and battery replacements.
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If you expect your mother to be taken back and forth to the bathroom every 10 minutes by a CNA in nursing home environment and get "really angry and upset" when her every whim is not met, I'd hire a companion to sit with her and take her to the bathroom all day long. Someone to wait on her hand and foot needs to be hired because it's totally unrealistic to expect the staff at the SNF to do such a thing. Toileting every 2 hours is reasonable, expecting it every 10 minutes is ridiculous.

Either your mother uses her Depends in between times and gets toileting every 2 hours, or you hire a companion for her or sit with her yourself and take her back and forth to the bathroom every 10 minutes. If shes that anxiety ridden about all of this, she needs her meds increased in an effort to calm her down. Thats a talk to have with moms doctor. Dementia often creates ramped up OCD scenarios like this and extra meds can help a lot. It's not fair for her to be so anxiety ridden and it's not fair for the staff to be punished for not jumping to her demands, either. The logical answer is to get mom more relaxed and she won't care about going to the bathroom quite so much, or worry that she's using the Depends when necessary.

Good luck to you both
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SplitSecond Sep 2022
I think you (and others) misunderstood my point. I don't think it's reasonable to expect the aides to take her to the bathroom every ten minutes. I fully understand in fact that it is not reasonable. What I found upsetting is that the aide communicated her impatience and annoyance to my very anxious, depressed, vulnerable mother. I still don't think it's appropriate to take that impatience and annoyance out on her -- though I also do understand that the aides are human, that their job is incredibly difficult, and that sometimes it's very hard to hide the frustration.
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Im sorry your mom is dealing with this. Hopefully it will get figured out
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I had a CNA say the same thing to my Mom. Though it was only 3 times within a couple of hours. Of coarse on a weekend when alot of the CNA's are from an agency. My Mom does have a history of UTIs which is what put her in Nursing home to begin with. If I was there I would have laid into her. I'm sorry about your Mom having to have gone through that.
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BurntCaregiver Sep 2022
@Laura22

Would you "have laid into her" really? We're you ever a nursing home CNA?
Let me tell you something. I was a homecare CNA for almost 25 years. I quit the nursing home I worked in after less than a month. The work was back-breaking miserable and the pay was an insult.
It's hard enough to deal with the care needs of one elderly person with dementia in their home. Nine, ten, sometimes a dozen at a time that a nursing home CNA is responsible for?
Never be a 'Karen' to the people who actually do the care for your loved ones.
Knit-picking helps nothing and no one. Go ahead and complain to an administrator about a good CNA who can't play the bathroom game every five minutes because one resident is bored and wants attention. So they get fired and a round of applause for you making that happen.
Ever give a thought to what will replace them? Maybe not so good or nice. That CNA is the one actually doing the care for your loved one. Not the administrator or nurse you complain to.
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The aide was not out of line at all in telling your mother who asked to go to the bathroom 11 times in two hours. Enough is enough.
The aide was not complaining to her she was letting her know that she is not going to be toileted 11 times in two hours and enough is enough because the CNA has work to do.
That's not out of line at all. The CNA is not exclusively there to play the game of let's go to the bathroom every ten minutes literally.
They have other residents who they have to care for.
Don't get the aide in trouble. No one is perfect and if she's a good aide who provides decent care, they are hard to find in a nursing home.
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I am a little confused. Your mom can't remember that she has just been to the bathroom but, she can remember a comment made by the aide that has helped her go to the bathroom 11 times in 2 hours.

I would be careful you aren't believing her or projecting your own upset over this comment. If there was even a comment made.

Personally, I don't find it offensive, it was true. This is why it's impossible for so many people to care for their loved ones at home, they think they should let the demented mind be in control, jump to every request immediately and do it with a smile and never correct the senior. Nope, it's okay to say you've been 11 times in the last 2 hours without it being a federal offense.

Obviously, your mom is getting good care, I don't know of any facility that would take a resident to the toilet every ten minutes. If I was you, I would be bringing treats to the care meeting, telling them you know how difficult your mom is, how much you appreciate the great care and asking what they recommend to help her feel less anxious and less urge and be less of a burden. Complaining about this could make you a PITA and affect the great care your mom is getting. I would tread carefully if it was my mom. She needs to learn to live there.
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You evidently have no idea how hard their job is. Not if you are "really angry and upset" that the aide "complained" to your mother about something your mother has no control of.

This is leaving aside the logical flaw that your mother can't remember that she went to the bathroom five minutes ago but is going to be mortified forever by being taken to task on this occasion.

The aide challenged whether or not your mother needed the bathroom because she had already been transferred eleven times in two hours. She probably sounded impatient. She shouldn't have allowed any vestige of impatience to be detectable, of course she shouldn't. All I can say is: you try it.

I've heard worse (looked at from both sides). An aide was driven to drink by a resident who asked continually where her budgerigar was, have you seen Petee, I can't find Petee, where's Petee... and eventually the aide told the resident "we ate him." This was very cruel, the resident was extremely upset, and nobody -including the judge who handed down the sentence - even tried to see the funny side.

More to the point - your mother is experiencing urinary urgency. Ask her stroke team whether anything can be done about that rather than upping her anxiety meds. If she keeps transferring to the toilet and trying to pass urine when there's nothing there she's going to do herself no good at all, and little dribbles (I guess) could encourage infection. How is her fluid intake, by the way?
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BurntCaregiver Sep 2022
If the resident continually asked where "Petee" was she wouldn't remember the aide telling her they ate him. I think that's funny in a dark noir kind of way.
I think worse than the comment about eating the pet budgerigar is that so much fuss was made over such total nonsense that it was taken into court and a sentence passed.
I think what everyone knows but few will ever admit to knowing is that old people (with and without) dementia can get on our nerves the same way a brat child acting up does.
No one is perfect. We're all human and sometimes people reach a breaking point. That's when they say, 'we ate it'. Or when the child gets punished with a time-out.
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I would leave the aide out of it. Have you ever addressed this to the Doctor or DON? It sounds like its anxiety related and maybe there is something that can be given to her. The average bathroom time is every 2 hrs. Really I can see the aide getting frustrated your Mom is not her only resident. She has a schedule to keep.

Just approach it as "what can be done" followed by "I know this must be frustrating for the staff". I would not talk directly to the aide. If I mentioned it to anyone would be the DON. Saying that you do not want the aide reprimanded because you realize its frustrating, but the incident upset Mom and caused her anxiety. What can be done to help her not have this feeling she needs to go all the time. You do realize that this might not be physical but mental if she suffers from Dementia.
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I think you need to have a care team meeting: (SW, DON, etc)

We have a problem that I'm like your help in solving. My mom is asking to be toileted every 10 minutes or so. The aides are frustrated--one of them went so far as to complain directly to mom! I don't know if this is behavioral, physical, psychological or what, but we need to find an approach so that meets everyone's needs."

I would get a urine culture. I would have mom in pull-ups "just in case". I would review the anti-anxiety meds with psych doc or APRN.

Good luck!
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SplitSecond Sep 2022
Thanks. I actually just scheduled a care meeting. I was thinking that maybe it would help to have her aide come in to offer to take her to the bathroom on a predictable schedule (like maybe once an hour, which I realize is still a lot) so that she can relax and know she will have the opportunity to go again relatively soon. Assuming she remembers....

A urine culture was done and came back negative. She does wear pull-ups but is terrified of wetting or soiling herself and refuses to go in them (though she does have bouts of incontinence). I think the best bet is changing her anxiety meds (again), which I will bring up at the meeting.

Thanks again.
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Moms insisting on being pottied every 10 minutes actually means she’s insisting almost as soon as she gets off of it after not peeing. It’s as unreasonable for staff to spend their time doing this as it would be staff facilitating fantasies that their children will care for them in their own home teleported back to 1975.

If there’s any criticism merited, it’s that staff is enabling Her.
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SplitSecond Sep 2022
I appreciate your response and understand what you are saying. But she gets extremely upset and anxious if I (or the aides) tell her that she has just been and does not need to go again. She says she "did not do what she wanted to do" and insists on being taken back. I agree it's unreasonable but I am not sure what to do about it. It is a constant source of extreme stress.

On a related note, I am not surprised the aide was frustrated by her behavior. I just don't think she should have complained about it to her. For a while we did have private aides who were there during the day (9-9) for just this purpose but that's just too expensive to continue indefinitely (and she refused to have anything else to do with her aides so it's not like they were providing companionship or any stimulation - they just sat outside her room and waited for her to call, which sometimes happened every 10 minutes and sometimes not for hours). Now that she has to wait longer, she has become even more anxious about it which I think makes her call them even more.
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I don't think it's way out of line that she said that. It wasn't the best thing to say but it is quite unreasonable to think they can take her to the bathroom multiple times an hour - how can they possibly have time for that? If it were an emergency, an unusual bout of "something", ok fine. But all the time? Not feasible.

So, I would instead converse with staff about "I know this is a big problem. What do you suggest??". I would think the only solution will come in the form of a pill. She has dementia - does she even know she's just been in the bathroom 10 minutes ago? Is she really feeling the urge or just thinks she should go? Probably can never get an answer to these type of questions but I just wonder what is going on. If she really is feeling the urge, maybe she needs a med for overactive bladder. Or her anxiety is not being properly managed by the meds she's on and that needs to be addressed.
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Complaining about the CNA could possibly escalate in you being asked to hire an aide to sit with your mother to take her to the bathroom.
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Have you talked to the aide before? By that I mean have you said hi, had a conversation, chatted a bit?
If so if the comment she made to your mom was the first time she has said or done anything to upset your mom then I might just talk to the aide.
Say something like...
"I know my mom asks to be taken to the bathroom a lot but the comment you made upset her a bit and it seems like it has made her a bit more anxious. I know you know that she has little control over her requests I hope you don't make any more comments to mom about things she has no control over"
See what she says.
For a first time thing I probably would not say anything to the Care Manager. See what happens.

I may be off base because I have not had to deal with staff in a facility on a day to day basis, other than when I took my Husband for day care/respite several times a week.
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I think your mom is pretty fortunate having a staff toilet her once every ten minutes.
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