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Received care from Covenant HomeCare and were told a certain day and time that they would arrive and sometimes never show. Told us that they were just there to teach and we were responsible for changing the dressing on a Decubitus Ulcer. Is this accurate? Told us to use bleach water on the ulcer. A tablespoon per bottle of water. Never heard of this. Someone please tell me if this is medically acceptable. Switched to Hospice a few days ago with the same problems. Someone please explain to me while you have a terminally ill family member why would they shy away from helping with the dressing changes when it takes two to three of us family members to change it and it is very difficult for us to do it the right way, correct way, for optimal comfort and optimal cleanliness for our loved one.

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jeannegibbs- it's just simply easier to make by the gallon. We have used it in spray bottles for cleaning ( then wipe up) on wounds via wet pads, spray ect. very useful thing dakins is. Just had a friend use it on her horse that kicked thru a wall and debrided both her back legs. Horse is now healed little scaring. My daughter had a staff infection in her knee as a kiddo, we used dakins in a syringe ( no needle) to flush the injury, she healed without a scar.
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I have enormous respect for the nursing profession. The combination of training, ability, experience and personal qualities that go into a skilled nurse is often underestimated and undervalued.

But all the same, when you are caring for only one patient, whose needs are well identified, there is no reason why you as a normally competent human being cannot learn to carry out many of the nursing tasks that will make your loved one comfortable. And since you have only the one person to focus on, you have the time to make a pretty good job of it, too.

It can be the steepest of learning curves, and ulcers are nasty and frightening, please don't think I don't sympathise. But if you take the attitude of "if you want a job done properly, you'd better do it yourself", and set out determined to make this the best cared-for ulcer that ever existed, you may even find some satisfaction in learning to deal with it. Plus, your loved one will have it attended to whenever it needs it, and not according to the hospice team's schedule.

Where is it, exactly?
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Yes diluted bleach solution is used to moisten gauze to apply to certain wounds. It is very diluted, not direct bleach placed on a wound. Wound care physicians order the type of dressing.
In my experience home care nurses' job is to teach the patient's caregivers to provide the woundcare on days they do not visit. Unless you hire a private duty nurse/ professional CG it is not expected that a nurse come every day to do woundcare. A nurse may come weekly to assess the wound if it is chronic but only during the home care episode. Once Hospice takes over they provide the care; a home care agency will discharge the patient to the hospice provider as the Medicare "rules" (& other insurances as well) state one or the other, not both.
So sorry you are going through this stressful situation.
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worried13, thanks for sharing your experience with Dakin's solution. A gallon sounds like a lot to have on hand for home use. Do you use a lot for each application? I guess if you used 1/2 cup each time that would only be 32 applications, so maybe a gallon would be practical. Or would you tend to make a smaller amount for household use?

Very interesting information! Thanks.
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My husband was on hospice care in our home for five weeks. Most of the time the workers came within the time slot they stated. A few times they were late or rescheduled to another day. All of their clients are dying. Sometimes there are issues that keep them with one client longer and the rest of the appointments that day get pushed back. If we needed extra help I'd want them to spend the extra time with us, so I accepted that those delays happened some time.

I think the caregiver is supposed to continue daily care. I took care of a pressure sore daily but when the nurse came she did it, which gave her a good chance to inspect it.

Perhaps it would be a good idea to read the papers you signed for hospice to see what kind of help is included. Also, discuss it with the nurse or social worker, so that you know what to expect. Perhaps it is something like if an RN comes she or he can help with wound care, but if it is a volunteer visitor she or he cannot.

It is such a stressful time caring for a loved one at the end of life. Knowing what to expect from the hospice service can help manage that a bit. Have a calm and polite discusson with them about who does what, when.
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Dakin's solution is GREAT for general cleaning. We used it one horses for years and then on our own injuries as well. Easy to make, cheap but will bleach clothing. per gallon of distilled water, take out 21 ounces of water ( throw away) add 21 ounces of plain bleach ( no scented kind) add 1 heaping table spoon of baking soda, wala a gallon jug of Dakins.
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Huh, I did some searching and it is called Dakin's Solution and used to flush wounds. Live and learn.
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I've never heard of bleach for wound care either, that doesn't sound right. Are you sure it wasn't saline to cleanse the ulcer?
I think in general daily wound care has to be taken on by the family when someone is in their own home, however I imagine you can have any level of service if you can afford it. This would be considered skilled nursing care though and you would have to pay accordingly. You should discuss this, and the lack of punctuality, with the agency you have hired.
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