Are the memory care caregivers able to apply a band-aid, icepack, administer aspirin/Tylenol when needed? Normal health care we do at home, our morning routine, clean our ears, provide Kleenex to blow our nose, trim finger nails, toe nails, to prepare ourselves for the day, or do you need home health care professional to carry out these instructions?

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Yes JoAnn I will chime in.
I went thru so much when Luz was in either the hospital or rehab. I found that I really needed to be there for just about everything until I learned just how much and how well the staff provided what was needed.
I gave up on trying to dress her up. I provided her with some of her good T-shirts. I did her laundry. I kept at least three sets in her ward robe. Her slacks were too long to wear since she used platform shoes before. So I bought her some lounge pants and shortened them for her. That worked good until I came in one morning and Luz had tried to dress herself. She had both of her legs in one leg of the pants. She gave her help me moan. We both had a good laugh over that one.
Luz quit wearing bras because we could not find one that fit correctly and they were all too tight. She did develope the yeast infections.So I found maternity/pregnancy bras. They need some adjusting with safety pins since her breast would slip out. She seemed to like them. Infection problem solved.
I learned how to shampoo and blow dry her hair using one of those plastic hair brushes. I was actually getting pretty good at it.

When in rehab I did use the beauty shop for hair and nails. And scheduled the podiatrist for her feet. He was good. He provided cheer and a flower to all of his patients.
Luz hated pills. they had to be crushed. Well the nurses did their best but s soon as the nurse would leave, Luz started spitting out all of the little chunks of the pills. I think Luz was smarter than the nurses. We fixed that by crushing the pills into a powder and continued to mix that dust into the pudding. No apple sauce. she hated that stuff. Another problem solved. Only had one instance of an RN not crushing the pill and tried to get her to swallow a whole pill mixed in with the pudding. Luz spit that out just as soon as she left the room. I told her what happened and she said sshe could not give her another one that it would kill her. I never saw her again.
Hygiene at home or in rehab was done very well. Washed and dried and medicated with creams by all attending. Most hospitals and rehab in this are no longer used protective underwear. Instead they used two pads. one length wise and one cross wise. The length wise one was brought up between her legs. Worke very well until she had a BM and urinated at the same time. That created a big wet brown spot the width of the bed and just as long. Still a very good job of cleaning her.
If there was a need for some additional meds the RN or DoN wold call the doctor and get verbal approval. Or if I noticed something I would talk to the doc when he/she came in that night and it would be addressed. The staff was very limited in what they were allowed to do.
I did have to explain to the RN that Luz could not be given the little test shot for TB because she had had Renal TB back in the 70's. It took a little bit of explaining this to her before she learned I knew what I was talking about. And other arrangements were made.
I should also explain that I was there seven days a week from about 7:00 AM until after dinner. And at home I was there even more and did everything for and with her.
No otc meds without medical approval.

I did learn that hospitals should be watched more than rehab staff. Home health care is restricted on just what they are allowed.
Luz actually worked in that field for awhile and would tell me what she was allowed to do. Mostly it was monitoring the patient, providing the meds prescribed, preparing small lunches, escorting patient to various medical appointments, maintaining personal hygiene.
I hope there is some help for you in this. I wish you the best and try to relax.
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threepines May 2020
Thank you everyone for sharing your stories. I see what is wrong, since COVid-19 have not been able to attend a support group to talk with others, have not tried virtual.  After reading your answers I do feel more relaxed.  The kids are out-of-state and have really distance themselves from their mom’s disease, they have so much to learn if they have to take charge.  I am not without support, the Alzheimer’s phone number and this Caregiver Forum. OldSailor, after reading some of your answers it seems we are in the same boat, married 52 years, 72 years old, alone, an empty house, and now my only friend is in memory care. My wife has left little “bread crumbs” of her disease since 2005 but in the past year like yourself the demands became too great. If it is God’s plan would like to move into a retirement community, independent living where my wife is, or another city. Everyone in the subdivision works during the day and know I need more socialization and activities but stay busy downsizing all the things we accumulated over the years and like you, getting all the photos, certificates and awards organized. All the residents in memory care are being tested for COVID-19, oral swab, this Thursday, May 14.
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Sorry, I hit a nerve and believe me I know where you are coming from. I figured Mom was suffering from Dementia she should at least look her best. Because Mom had Dementia and for many reasons I could not take care of her at home. I was able to find an AL near home with 39 residents. I washed my Moms clothes. That facility did wash each residents clothes separately. I hung her clothes in sets to make it easier for the Aide to dress her. Plus, if I didn't she would have been mismatched. They couldn't match her socks to her clothing. She would be wearing brown and they would put on gray socks. The place was not perfect. I had complaints. I had to fix Moms hair because the aides had no idea how to brush it. TG my girlfriend was the hairdresser there. After a shower, I found her shower chair with poop on it and the washcloth used to clean her up in the sink hours after they had given her a bath. Housekeeping wasn't dusting anywhere. My daughter told me to pick my battles so I got where I asked her if I should complain about such and such.

Then on to LTC on Medicaid. By this time I was used to things not always going the way I would have liked. By this time Mom was in the last stage of Dementia. She was actually kept cleaner (if u know what I meam) So were the other residents. Everyones clothing was really clean. No smells. They still couldn't do her hair. I was upset that they didn't use Moms special brush so her hair wouldn't fly all over. They kept using those plastic bristle things. The bra thing, they were in the drawer with her socks. It was in the paperwork I supplied that she needed to wear one because she would break out in a yeast infection if she was allowed to be skin on skin. Thats when my daughter told me about the head down. So I started putting her bra on the hanger with her outfit. Still wrong colored socks and shoes. I supplied 3 pair, blue, brown and black. You know where I am going.

My brother told me I was my own worst enemy. But I wanted my Mom to look nice. So I do know where you are coming from. But sometimes things are just out of our hands. My Mom passed 2 years ago. I don't know what I would have done if she was still alive during this shutdown. Her LTC was just 15 min away so I was there all the time. Maybe when this Virus thing is all over, you can make sure she has her lipstick on and her nails are done. But I do understand where you feel that that should be part of the aides job.

The following is how it is in my state of NJ and Del. were my daughter worked.

DON - Director of Nursing, She is over the RNs, LPNs and CNAs
RN - Register Nurse - State test to be licensed
LPN - Licensed Practical Nurse (other states may have a different name)
They take a test with the State to be licensed.
CNA - Certified Nurses Aide - put thru an 8/10 week course to get
Certification. Certification filed with the Nursing board.

As I replied to Worried, this is my State of NJ and Del where my daughter worked. At the one facility my daughter worked, the staff had different colors for what they were. Ex: Navy Blue was an RN, Maroon was an LPN. But all staff should have their ID on so you know who you r talking to at that Moment. RN, LPN, or CNA.

We had a man who posted regularly named Old Sailor. His wife passed so he doesn't post as much. He, like, you was very good to his wife. Maybe hecwill chime in.
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threepines May 2020
Thank you JoAnn29 for sharing your story and after reading other caregiver’s stories in this forum with worst conditions then mine will try in the future to “pick my battles” or I will be a basket case. This is such a horrible disease with so many medical conditions that can go wrong, having to deal with uncombed hair, mismatched clothes, lost clothes and other items; whether they wash her back with a warm wash cloth like I did, whether her socks fit comfortably over her toes and into her shoes, does not always show the caring and compression their job description implies. I know how hard their job is but there are three or four of them on eight hour shifts, not one person doing the job 24/7; that may go on for years. As bad as some of the conditions are that has been described in this forum, hoping other caregivers that have loved ones at home will reconsider. The socialization and activities that the memory care facilities provide are what is best; they always try to pair up residents during activities and meals of like mind.
"The little things we do to start the day, our daily routine, are sometimes not always done, sometimes no earrings or bracelets, sometimes the wrong color fingernail polish or lipstick. I did mention to the nurse that the nurse practitioner assigned to my wife about the wrong lipstick and the nurse told the “caregivers” she was sensitive to makeup other than her own, I would have never thought of saying that."

I read this and my first thought was, your expecting too much from a CNA. My daughter is an RN and for 20 yrs worked rehab/LTC facilities. This is how she described a CNAs job to me, after I complained about Mom having no bra on, for those coming in on 7am shift:

First thing is toileting the resident. Changing the Depends. Brushing of teeth. Then CNA has to dress the person. Thats removing their night clothes and dressing them from the top down. With little help from the resident. So its the bra on first. Then the top, then the pants, socks and shoes. CNAs are not hairdressers so Moms hair never looked all that great. I carried a brush and a small bottle of hair spray and fixed her hair. Then its on to the next resident. There is no one on one. She may have a few more residents and they all have to be done and down to breakfast by 8am. There's no time to put jewelry on. Let alone lipstick. Some CNAs may help with feeding but its usually making beds and cleaning up while residents are at breakfast. Baths are usually given later and not everyday. Before you know it its lunch time. Manicures are usually an activity. Then will take a day and do the residents. They are not allowed to cut nails or toenails. Its against the law actually. CNAs are responsible for all the dirty work. Cleaning up after accidents and vomit. Abuse from residents. Taking them to the bathroom every couple of hours. Changing multiple times of the day. Nurses do not do this work.

Nurses, there is usually a DON. Under her are the RNs, under them the LPNs and then the CNA who has no medical training. The DON and the RNs are few. They mostly do the Administration part. Not much hands on. Actually an LPN does that. They can do med passes and in some States give shots. My daughter specialized in woundcare so more one on one than most of the RNs.

I understand where ur coming from but most of these places are understaffed. The CNAs do what they can when they can. But you can't expect them to make sure your wife is picture perfect.

And when it comes to something like lipstick, they should not be using the same tube on all the residents. Thats very unsanitary.
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worriedinCali May 2020
Joann.....CNAs most certainly do have medical training. It’s required. The CNAs today do the same things an “LPN” In most states did. We don’t even have LPNs in my state. We had LVNs which is what my mother was. But they are a thing of the past. They’ve been replaced with medical assistants & CNAs. Only nurses that get hired here are RNs.
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An aide is limited to what they can do in a home situation or working for a facility.

"band-aid, icepack, administer aspirin/Tylenol when needed." Can't be done by an aide working in a facility. These are done by an LPN or RN. Unless a medtech, medication can only be given by an LPN (and that depends on the state) or RN. And only under orders of a Dr. So if a person wants Tylenol, a Drs. order has to say "when needed".

An aide can give a resident a tissue. They cannot cut fingernails or toenails. For toenails a Podiatrist is called in. Aides are responsible for getting a person up, dressed and down to meals. They take the person to the bathroom and change Depends. They bathe. They get the person ready for bed.

In home care are usually CNAs. As is pretty much most aides. Some people can be aides without certification but not in a facility. What an aide does in your home is between you and them. Some will do light housekeeping if there is not someone in the home who can do it. State law, though, makes it so they cannot give medicine. I think they can remind the client maybe had them the pill planner. But I don't think they can touch the pills.
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threepines May 2020
Thank you JoAnn29 and Ahmijoy for your response. JoAnn29, my wife lost her mother in 2016 even though she does not remember, she said she is making her a Mother's Day card this weekend. Ahmijoy, we visited Barberton for the history, and what they did to the silos at Quaker Oats Square. For the sake of what I am trying to say, in the memory care community I will call the ones that take care of the residents “caregivers” and as JoAnn29 points out, these “caregivers” can only administered medication after an order is placed to a doctor or nurse practitioner. I was not aware of this procedure when admitting my wife, which the “caregivers” as JoAnn29 points out can only get a person up, dressed and down to meals, also provide activities for the day. I think this is important for ones admitting their loved ones into a memory care to know. Along with all the required legal documents, Power of Attorney, Living Will, etc., a person should have a working relationship with a reliable Home Healthcare Professional even if your loved one does not require constant supervision. This can be easy if you have been using Home Healthcare in the home but I was caught off-guard knowing I would need Home Healthcare in the memory care community. The “caregivers” will need to put an order in to a Podiatrist to trim fingernails and toenails. The memory care community has mobile dentistry or my wife gets periodontal disease easily, will need to still take her to the Periodontist. My wife has drop foot on both feet and wears AFOs to help her walk. There was a complete procedure of how to install these AFOs, but since the “caregivers” did not secure her shoes tight enough her feet slipped around and caused severe sores. Since I did not have a Home Healthcare I could trust I relied on the memory care for the ones they use. They suggested removing the AFOs to give time for the sores to heal and of course with no AFOs she fell. This brings me back to my original question. It was up to me to ask the “caregivers” to put in an order to have her knees x-rayed, ice packs administrated, Tylenol given. The “caregivers” at the memory care community do a great job and take very good care of my wife. I am not there every day or should I have to be, my wife made the transition to memory care very easy. The little things we do to start the day, our daily routine, are sometimes not always done, sometimes no earrings or bracelets, sometimes the wrong color fingernail polish or lipstick. I did mention to the nurse that the nurse practitioner assigned to my wife about the wrong lipstick and the nurse told the “caregivers” she was sensitive to makeup other than her own, I would have never thought of saying that. It was just important to me to let anyone considering admitting their loved one into a memory care community to find a Home Healthcare Professional you can trust and know your expectations.
The things you mention are usually left up to nurses. Bandaids and ice packs mean there’s been an injury that needs to be recorded and attended to by a nurse. Other hygiene is usually performed by aides. Unless the resident requires constant supervision, there shouldn’t be any reason for the family to bring in additional caregivers. Home healthcare professionals don’t work in facilities, only in private homes.
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