Hi all, I have concerns and am seeking advice and guidance. My grandma started living in a SNF and now memory care after having a stroke 2 years ago. She needed to start using a walker, but was able to move around on her own fine like using the restroom and walk around the hallway of the floor she was on. She has become a lot weaker though and in a pretty bedridden state where it’s difficult for her to sit up in bed by herself, can’t walk, has difficulty removing her pull-up, and says she becomes tired quickly when she sits up for too long. Also, she was in the hospital for 10 days for a pretty severe case of pneumonia almost 2 months ago, and I feel like she started becoming a lot weaker a few weeks before her admission and after discharge.
My concern is that I’m not sure if the staff are taking her to the restroom as often as she needs, and not getting to her in a timely manner since she seems to soil herself kind of often (and tries to change herself). She has incontinence and uses the restroom pretty often where it seems like she needs to use the toilet every hour or two, and has trouble controlling her bladder sometimes. She calls me every few days or even a couple of times within one day to ask me to call the front desk for someone to take her to the restroom – I think she gets impatient too because I think she expects them to come very quickly after she clicks her call button, but I think the staff also don’t go to her quick enough as there have been times she would call me 10 minutes later asking if I was able to get a hold of someone at the front desk of the nursing station (30 min passed on a couple of occasions). She has a good memory and is pretty good cognitively, so I wouldn't say that she is forgetting if staff already helped her. The aides and nurse manager say that they take her to the restroom when she clicks her call button but now I'm starting to wonder how true that is for some of them... I wish that she would be able to live comfortably where she would be taken to the toilet (or at least a bedpan) in a timely manner and not have to sit in a soiled pull-up for long (I’m curious as to how long it takes for someone to help her and what their interactions look like because she doesn’t speak English, so I am also thinking about using video monitoring – what do you all think? I’ll of course notify the facility and work on any necessary paperwork). It hurts and makes me mad whenever she calls me to say that no one is responding to her call light, especially if she calls me back 10 min later to ask if I was able to connect with someone at the front desk.
I’m thinking about moving her to a different facility that would be able to assist in her toileting needs in a timely manner. So I suppose my question would be, is it realistic to find a memory care that would be able to assist her within 10 minutes of her clicking her call button for toileting (especially when she needs to use the restroom pretty often, how difficult and physically laboring it can be to take her to the toilet, and how she’s pretty incontinent)? Or maybe I need to accept that it’s not realistic? Since her toileting needs just started more recently, perhaps I should bring this up again at the next care meeting and see if they can resolve it then or if I should escalate as needed? It would bring me peace of mind to know she’s being toileted according to her needs so that she has the decency of not always using her pull-up to relieve herself and she can stay clean that way, and to get a break from her calls, but I’d also love to hear thoughts from others as to whether this is realistic and if I am putting unnecessary stress and worry on myself. Thank you so much for reading; I sincerely appreciate any input and advice.
In my state I see a lot of privately paid caregivers in facilities with clients.
You haven’t cared for GM since her health deteriorated. Her“toileting needs just started more recently”. You both want her to be taken physically to the toilet within 10 minutes, so that “she has the decency of not always using her pull-up to relieve herself”. However she “has become a lot weaker, is more or less bedridden”, has trouble sitting up, “can’t walk”, and “has difficulty removing her pull-up”. Walking her the toilet, removing her pull-up, waiting, re-dressing and returning her to bed, is really time consuming. It might even need one-to-one care if you add in her non-toilet needs (food, washing etc). Perhaps you could try a day of doing it yourself?
You and GM probably need to reconsider whether your own expectations are realistic, quite apart from any staffing issues the facility has. Options reduce as needs increase.
So if she has a good memory, why is she in memory care? You also say she is incontinent. This means she can no longer hold her urine or bowel movement. By the time she feels she has to go she is going. No aide is going to get to her in time to get her to a toilet. The best you can do is ask that she be toileted every two hours. But even then she will have accidents. Incontinence now means Depends because grandma has no muscle control now. No matter where she goes, staff is not going to be able to toilet her every hour or get to her in time to get her to a toilet even if they come immediately.
Her weakness. Ask if the doctor can order Physical Therapy for her. Pneumonia does a number on the elderly. Especially cognitive wise.
I would encourage you to volunteer some time if you are able at the facility to give you a good idea what they are up against. As a Nurse who did primary care during my career (no CNA and responsible for TOTAL patient care, I often had six patients and would be stuck with one and unable to get to others. Not that we didn't try to help one another; we did. It wasn't always possible.
In facility care is very difficult and often very poorly paid work. I suspect it is about to get worse from things I recently have heard about fears for elder care of the future. A horribly imperfect world all around.
As to your OWN loved one, advocate for her with your facility as much as you are able and maintain a calm and non-adversarial relationship. She sounds to be failing and if you can get Hospice care for her then you are insuring there is more time, more help and more visits if you ask Social Workers and clergy to attend her as well as the RN visit and the CNAs for bathing.
Good luck. I am sorry. It is a constant litanies of woes here, as you will see if you remain on the site.
It's just the sad reality of care today.
No place is perfect even the most expensive ones, so you must learn to be at peace with less than perfect.
When ever we visited my FIL I can almost promise you that in a given hour - most if not all of those call buttons were going off. First come first served and all. And let's say that it takes even 15 minutes to help the first person.(and that is lowballing) then the second person is going to wait at least 15-20 minutes because the CNA has to clean up and move to the next person. That's actually the ideal situation with the current staffing situation in health care in general, but especially in elder care.
Now let's talk about the outliers - because we had one. My FIL weighed almost 300 lbs when he was in the SNF. It took not one but TWO CNAs to help him with anything. But if he had a toileting issue that had to be changed- you were looking at 45 minutes bare minimum for TWO CNAs. Which means that it took 2-3 times as long and DOUBLED the resources. So an entire other group of residents didn't have a CNA for that time and he had two of them.
While I completely understand your focus on your family member and it is perfectly natural - the only way a resident of a SNF or Memory care is going to get immediate assistance is if they/you hire a person to stay with them as their additional care. The staff at most SNF and memory care facilities are stretched more than thin. And that's when everyone scheduled shows up.
That isn't likely to change if you move to another facility. The only way to manage this within the standards that you currently are looking for is 1:1 care at home or an aide that is paid for strictly for her at the facility.
I think the hardest part of moving a loved one to residential care is changing your expectations for the level of care they will receive. Especially if they have either been able to help themselves at home or had someone with them at home that immediately responded. That kind of care just isn't possible when you have multiple people in a facility.
What do you mean by ‘soiled’? If grandma is sitting in excrement, that’s a different matter. If GM is calling for wet diaper changes frequently, staff may be less willing to rush, which may mean that they don’t go when it really would be best.
You give the impression that you may not have a great deal of experience with this, and that GM may have some habits and expectations that need to be worked on by the staff.
What do other posters think? Have I got this right?
It's frustrating! But there are about 90 other residents and of course the place is understaffed. (aren't they all?) He wears pullups during the day but is incontinent overnight so has a more absorbent product for sleeping.
All of that, to say: I think your grandma is probably getting adequate care. Do continue to keep track, though. And definitely bring up your concern at the next Care Meeting.