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My mom is in a small ALF. She’s end stage Alzheimer's and has hospice. Hospice sends a bath aide 7 days a week. My mom is bedridden so she bathes her and changes the sheets everyday. I appreciate that she is being kept clean but one thing really bothers me. I’m allowed to have a camera in her room so I observe how she is being bathed. The aide will come in very early in the morning, wake her up then start to take off her gown. My mom is still sleepy from her medications and fights to keep her clothes on. Then after she removes her clothes she starts washing her whole body and doesn’t cover her up or dry her right away. Leaves her naked and wet as she turns her from side to side to change the sheets. Her bed is under an ac vent and she’s cold!! So many times I’ve asked them to please keep her covered at all times. My poor mom looks so uncomfortable and struggling to keep herself covered with her arms. Every bath aide she’s had does the same thing. I’m so fed up. Don’t they get training? How should I handle this?

This REALLY infuriates me! After my mom passed away and I was her live-in caregiver for a year, I took a CNA class and hoped to join a local hospice to "give back" in Mom's honor and for the hospice's CNA wonderful care.

We are taught to bathe one area of the body at a time, keeping the remainder of the body covered and dry and warm and to maintain the person's dignity. Period. To force a person be essentially all-over naked and wet violates training and, I have no doubt, the standard procedure for the facility. This is offensive to me on so many levels.

The only thing I can--almost--understand is the aide trying to get your mother bathed before she's fully awake. Most facilities don't have enough aides and there's just no extra time. Since this is a small ALF I would hope they'd wake everyone, if needed, than return later when the client is more awake.

I'd get photos or video of these occurrences for documentation, then meet with the DON (Director of Nursing) and complain like crazy, then threaten to contact the State. Even if the aides are overwhelmed, the clients deserve--AND NEED--to be warm and dry and to allow them their dignity.

Side note: The ALF where I took my practicals had a fluid schedule and allowed the elders to sleep until they woke up (aides often checked on them), then they were assisted with dressing if need be, bathed, and wheeled to breakfast, et al. This facility was Native American-owned and their clients were treated as the honored elders that they were, which was SO beautiful. How the aides performed and how the elders were treated should be freakin' national standard.
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cherokeegrrl54 Apr 15, 2021
Yes!! The Native American people treat their elders with much respect, also the elders are the ones who pass down their history to the next generations.
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As the previous answers indicate, there are better ways to handle this. Just being suddenly awakened with bathing is cruel, the not covering up added to it is wrong. Please speak with the employer of the aides, request a different time and better attention to keeping her modest and warm. If you don’t get a favorable response know that there are choices in hospice care. Your mom is blessed to have you looking out for her
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Ncl007 Apr 19, 2021
Thank you!
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My mother spent the last 90 days of her life in a nursing home. It was horrible. Her relatively mild cognitive decline turned into full blown dementia by the end. She needed help being fed and they would not allow family members into the dining room claiming "HIPPA privacy" issues, which was an excuse. I observed the dining room from outside the building and when they were supposed to be feeding my Mom, they were ignoring her and setting the food in front of her and going off the chat with each other. Then they wheeled her back to her room. I went to her room and she was delirious, literally. I demanded the nursing supervisor come in and examine her. She had been consistently losing weight because the aides were not feeding her. She was perfectly capable of eating and she did so with assistance. I was livid. Also, I happened to be there during bath time for residents and found they were undressing the residents in their rooms and just wrapping a sheet around them and wheeling them down to the "shower room". It was robotic to them and they would often talk to each other and never to the resident. They'd "hose them down" and rewrap them in the same sheet they brought them to the shower room in. The shower room was freezing. I know this because at the end I stayed with my Mom 24/7 so I could see exactly what was going on at hours after "visiting hours". It was beyond cruel. To those who say, well they have a lot of residents to bathe, I get it. But the moment you forget you're job requires you interact humanly with human beings, it's time to pack it in. No one should be treated like a piece of meat. Oh, and this was a supposed 5-star Medicare rated nursing home.
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Ncl007 Apr 19, 2021
Thats horrific! Your poor mom suffering unnecessarily and how distressing for you. I don’t understand why anyone goes into this field if they have no compassion for the elderly. We know it’s not for the money. They can earn more working at Walmart.
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I have steam coming out of my ears. If these people were on my team they'd get a piece of my mind - and my line manager would rip them each a new one.

From "Skills for dementia care" from the Michigan Coalition for Dementia:

2.8 Recognize that every person has a need for: 
• Relationships with others 
• Inclusion (being part of a group) 
• Occupation (having things to do) 
• Individuality (feeling unique) 
• Dignity 
• Feeling secure emotionally 
• Privacy 
• Intimacy and touch 
• Socialization (being with others) 
• Meaning 
• Physical comfort 
• Meaningful activities 

So - don't these people get training? I'm sure they do. Whether or not they are given the leadership that reminds them to make it part of daily practice appears to be a different question.

I'm too cross just now to find the right words to suggest you might put to the manager - in your position I'd be too apoplectic to speak.

Does your camera record these images? You might make an appointment to see (or Zoom, or MS Team, or whatever) their manager at hospice, ask them to observe what you've seen, and tell them you'd like to hear their comments.
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Reply to Countrymouse
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This is very unusual, to be frank. We were, as nurses, always taught to guard the privacy of patients. Bath blankets, which were like flannel sheets, were always used. You need to speak to hospice about what you saw. This is NOT OK, and the aids just got "caught". They will be spoken to at once I would imagine. There are many reasons to use this. Comfort, privacy, dignity, warmth. This is NOT OK. Call Hospice today.
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Reply to AlvaDeer
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Proper way is to use a bath blanket ( those are the soft thin blankets at med centers ) and only uncover what you are washing then use towel to dry and move on - for example - uncover wash dry and recover one arm , then the next etc . Should start with face and work way down - skipping privates and bum - those are last . This is how it used to be taught - although also nowadays they sometimes use the wipes instead of soap and water so might be slightly different . Speak with the aide or with hospice nurse - their whole purpose is supposed to be to alleviate suffering not cause any.
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I heard a co-worker of my YB's (he's an EMT) once refer to a client as a 'sack of meat'. I guess I was in a mood--but I barely knew the guys and blew UP at him.

In fairness, he was pretty young (21?) and elderly people 'grossed him out'--so he should have been in a different field.

I don't CARE how old you are, how demented, how sick, everyone has the right to be treated with a level of dignity. I know what I said to him resonated, he actually didn't last long in the field.

I remember having my babies (c-sections) so I wasn't allowed to shower--the nurses were SO GENTLE and made the bathing experience so pleasant and comforting. At no time was I exposed to cold air--I was covered completely in a very warm, wet blanket and then parts of me were slowly uncovered and washed and then recovered. A backrub follwed this bed bath and a fresh gown and I felt so much better. I always had long hair and they even made the effort to wash my hair.

Yes, it took about 5 minutes longer to do my bath than if they just dumped a basin of tepid water on me--but it was a sweet and gentle gesture.

I've had to bedbath DH many times and while that is a whole different dynamic--I used the method the nurses used and he would always feel so much better. Even if it were just a 'bath wipe' bath, we took it slow and gently.
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Reply to Midkid58
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Why 7 days a week? Normally with Hospice its not more than 3. Does she really need a full body wash every time? Can they not just wash under the arms and make sure her butt is clean? The AL aides should be cleaning her up well after each change though. Can they not turn the AC off while bathing her?

I would ask that they show up after breakfast. I did this with the "in home" agency Mom had for therapy who also handles Hospice. Explain that the aides wake up Mom. She is one disoriented, and two frightened. Not a good experience for her.

If this does not work, you have the right to change Hospices. And I would tell them that. They make money off of Medicare.

My husband does not agree with me on this...telling agencies when a time is not convenient for me. I figure my home and I have a right to dictate the time convenient to me. With my Mom, she did not wake till 8am. It was get her up, get her dressed and feed her breakfast. If I woke her up, she would be disoriented. The agency wanted to be here at eight for therapy. I said No, 10am would be better. Because after I got her ready, I then got my shower and dressed.
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NeedHelpWithMom Apr 15, 2021
I was wondering the same thing about seven days a week!
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Talk to the administration of the ALF or the agency that provides the bathers. Let them know what you have witnessed. This is not the way I was taught to give bed baths as an RN. The supervisors should address your concerns promptly.
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Reply to Taarna
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The caregiver providing the bath must use a bath blanket. Bath blankets are a staple of hospitals and nursing homes and have been forever. This is a google definition: "Bath blanket is a flannel covering used to prevent chilling when administering a bed bath."
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