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I am a CNA at an assisted living facility, my supervisor said I am neglecting my residents if I do not change them every two hours. I disagree personally because I know my residents and check them to make sure they are okay. I don't believe in waking them up and do my best not to. But now my supervisor is assisting me with changes to "make sure they are done." Our facility provides wet wipes and no warmers so they are cold! Not only that my supervisor uses the wet wipes even if they are dry then dries the skin with a rough dry wash cloth then puts cold barrier cream on them (even if they did not wet). I've had multiple residents cry as this was happening and I don't agree with it but I need to know if I should wake them up to do this or not? I feel its your tire and my heart goes out to them, they are like family and I don't want to see them hurt or me get neglect in my file. Please help!

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Sorry if what I said upset anyone. I felt that I had to be "the bad guy" this time. I have worked in long term care for over 20 years (I am semi-retired now) and I loved my residents like they were my family. People like Kccheshire are hard to find and I would have been honored to have her as my co-worker.

I was actually told by a Director of Nursing, a Nursing Home Administrator and State Survey Auditors: "I know that they may "feel like family", but unfortunately, they are not family...they are your "clients" and you are providing a service to them.” So for those of you who are wondering…I did not nor do I consider residents as “clients”, they are “family”.

I also know firsthand what can happen when a facility (or the staff) DO NOT follow State Department of Health & Human Services-Nursing Policies and Procedures. The facility can lose their Medicare and/or Medicaid funding, the facility can be put on probation and not allowed to admit new residents, or the facility can be CLOSED DOWN!

It isn’t easy being a caregiver, whether at home or as a professional in an assisted living facility or a nursing home or a hospital. Throughout my nursing career, I tried to follow the motto of my School of Nursing—“Vita Aliis Vota” “Life Devoted to Others”.
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Your kinda stuck if that is what the charge nurse says. However, as a former Nursing Home nurse.. I can tell you that we checked and moved them every 2 hours. That was for the clients that couldnt move. So they wouldnt get bed sores. We certainly didnt wake or change if they didnt need it . You might want to ..um very carefully mention that to her or check if that is actually facility policy or hers. Be careful if you go around her
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My opinion...she is your boss and you do it her way. I really don't think that you r hurting your residents, they just get the point they don't want to be touched. Also, I found with Dementia people, everything is over exaggerated. Urine can burn delicate skin. Like said, read up on procedures. If that is how it is that is how it is. The State has a lot of say too.
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" providing a service to them"!!! Yea,  but also with gentleness and patience and love !
... this topic makes my heart sick

I want my parents treated like family at their AL!!!

I would love to have you as my parents caring CNA!!! There needs to be more loving kind souls like you working in these facilities especially the director of nurses then maybe they would role model the people under them how to treat these people at the end of their journey!!!
Not saying all DON's are bad and uncaring...I know it's a very hard and unappreciated job most of the time!!!
Deeply grateful for the kind and loving employees in all these facilities!!!  Just wish everyone that went into this field of employment knew what they were getting into because it's got to be the hardest job ever!   I Make sure I go out of my way every day I visit my parents to smile at the employees and let them know that I am grateful for what they do!!
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OMG! That seems like cruel and unusual behavior. Wake someone up to change them when they are dry? That is crazy. Checking them quickly once an hour and changing them as needed makes a whole lot more sense to me. It also seems to me that the practice wastes a lot of expensive paper products. But the main objection is what a nasty and unnecessary thing to do to sleeping senior.

Kccheshire, you and I could write some sensible policies and procedures, couldn't we? But we haven't been hired to do that. So, as the earlier posters say, we need to follow the official guidelines. (Well, you do. I had to follow the mandated practices on my job, too.)

I think if I had a resident who was particularly disturbed by this practice, for example one who has sleep disturbances, and cries when you wake her up, that I would ask for an exception for that particular resident.

And I'd also know what to ask about when I was looking for my next position.

My late husband was in a transitional care unit after being hospitalized. He had dementia. He had a diagnosed sleep disorder that he took medications for. New surroundings were confusing. He was not incontinent. When I came in in the morning he was all upset about a great big man who was molesting him during the night. Yikes! I tracked that down to a night aide (football player build) who woke up his charges and took them to the bathroom so he wouldn't have to change them. Wow! I was so angry I could scarcely stay polite.

The next time we was hospitalized I turned down a tcu stay flat. Nope. He can do his post-hospital recovery much safer and comfortably at home.
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You are in a tough spot---wanting to do your best for your residents, but by caring too much, you might not be following your facility's policies and procedures correctly.

What are the assisted living facility's policies & procedures regarding toileting, doing pericare, etc.? Many facilities CHECK their residents every 2 hours (some even reposition their residents every 2 hours), however they might not change briefs or pads or take the resident to the toilet unless they are wet. Not every facility provides warmers for wet wipes so they are used "cold" at other facilities too. Dry wipes don't clean as well as wet ones do, but if that is what you have available, then you have to use them :( Again, not every facility provides something other than rough dry wash cloths to dry a person's skin with. What is the facility's policies & procedures regarding barrier cream? How is it to be applied and when?

You need to know what your facility's policies are so that you can follow them, EVEN if you DON"T AGREE with them. It is possible that someone with more authority (Nursing Director) has noted that you are NOT FOLLOWING POLICIES & PROCEDURES so that might be why your supervisor accompanies you on your nightly rounds...to insure that you are following the facility's policies. Or the State Board of Nursing Auditors might have thought that your facility was not giving care correctly and according to State regulations &/or guidelines; so the Nursing Director is trying to make sure that the facility is following State regulations &/or guidelines.

If you go to work at another assisted living or nursing home, you might find that your new place of employment doesn't do things the way that you want to do them either. Where ever you work, YOU NEED TO FOLLOW POLICIES and PROCEDURES! (even if you don't agree with them). You can write new policies and procedures and submit them to your Nursing Director as an attempt to have pericare performed the way that you want it done.

I commend you for wanting to give the best care that you can to your residents. But sometimes caring too much can hinder how you care for your residents. I know that they may "feel like family", but unfortunately, they are not family...they are your "clients" and you are providing a service to them. Maybe you can find some other way to show how much you love your residents without disobeying policies or procedures. Good Luck!
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Every 2 hours seems excessive to me. It's hard for elders to get to sleep and stay asleep so sleep is precious.

I would say that once during the night (every 4 hours on known incontinent patients) should be sufficient. A good, absorbent diaper, a thorough cleansing to get the urine or feces off, patting dry with a soft towel and a barrier cream to prevent skin breakdown is good skin care to prevent skin breakdown.

But, she's the boss and, if you want to work there, you have to follow her rules. Fortunately, your job has a high turnover rate, so there are always openings at other AL's or nursing homes.
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