I would appreciate some input from those that have experience with this issue.
The short version is that I think the skin in mom's groin area has deteriorated considerably since dad moved mom into an Alzheimer's Care Facility in December. I would like to know what is "normal" and acceptable for totally incontinent patients in this setting so I don't make a bigger deal of this than necessary for mom's health. I would imagine some redness is inevitable but she has what look like scabby areas and several other bump headed in the direction of sores. Her buttocks are purple and her groin area is very red. I would appreciate some guidance in recognizing whether they are doing everything they can for her. I live out of town. My dad is sometimes more concerned with his relationship with mom's Alzheimer's Facility and how much they love HIM, than he is with dealing with these issues. He doesn't like to rock the boat and always makes me the bad guy when a significant issue comes up. I'm trying to pick my battles. Below are more details if helpful.
Mom began wearing depends 24/7 last summer. We were cautioned by the Home Health Care provider to watch for any kind of breakdown of the skin and to apply Calmoseptine as a barrier if she got pink. Within a few months, we had round the clock professional care for mom at home and a few months later Dad moved her into an Alzheimers Care Facility. I see mom every 3-6 weeks. I take a careful look at her backside and underside each time to see how things look. When I saw her this weekend I was very concerned. Her buttocks are very dry and purple, there are some areas that were recently scabby and others that seem headed in the direction of open sores. Her groin is more red than purple. There was no evidence of Calmoseptine on her. I discovered this as I was taking mom to the bathroom for a straight forward BM. Her depends were clean and dry when I took down her pants. She had a small BM. Her backside was clean, but her underside was not. There is no possible way the current BM could have ended up in her vaginal creases. It was already there. I tried for 5 minutes to get her clean and couldn't so I called for help. The attendant used over a dozen wipes to clean her. She did not use a clean one with each wipe and honestly, was cleaning her vaginal area with wipes that had feces on them. Every few wipes she would fold it over before taking another swipe. I asked "at what point is it best to just put her in the shower" and she agreed we were at that point. My concern is that mom had been soiled for at least a few hours and in combination with the condition of her skin, I'm concerned they are not always keeping her clean.
I talked to my dad about this. He is a very self absorbed person who insists on controlling everything. He really doesn't want any "bad news". All communication with the facility is to go through him. I suggested he talk to the nurse TODAY and let her know I monitor mom's backside and feel it's deteriorated substantially in the last 6 weeks, ask her to examine mom and provide her assessment/treatment plan, etc. And follow up in 3 days. Any other suggestions? I've been wondering whether a (female) geriatric care specialist would be more beneficial for mom than her primary physician who is a (male) Nurse Practitioner who has never examined mom "down there".
Thanks for your help and input.