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Several times a week her sheets are soiled in the a.m. and she will make her bed to cover it up. Since her bowels are fairly regular, I know they are not checking her before she goes to bed in the evening. I am there every day (in the a.m) and I tell them at the desk that she needs a clean pad after I clean her up. They are inconsistent with her showers too. Every week I ask if she has had a shower and they come up with an excuse ( she refused, they don’t know, the evening shift will blame the day shift) When I press, they do it. Am I asking too much and should I just hire a personal care aide to shower her once a week?

If you have not yet called a Care Conference, you need to call one immediately. Insist that the administrator be there, the social worker and ideally one of the nurses in her section plus the aides assigned to her. Be polite but firm and ask why you’re getting the runaround about her personal hygiene. Explain that you are aware that poor hygiene can cause infections and bed sores and you’re certain that none of you want that to happen. If she is regular, there should be no problem for an aide to get her on the toilet. If she is mobile and can more or less make her bed, is there some reason she cannot get to the bathroom? Perhaps a bedside commode chair?

It’s possible that the aides have come to rely on you to be there and clean her up each morning. Even though you may complain about her hygienic care, or lack thereof, you’re back the next day caring for her. You are, for all intents, your mother's uncompensated aide. I know this is a “Cstch-22” because now you feel sure that if you’re not there, Mom will be lying in her own excrement. This is why it’s important to call a conference ASAP.
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GAinPA Mar 18, 2019
Thank you ahminjoy for your input. It was insightful as well as concise. I plan to focus on setting up a routine that works.
The situation is that my mother is mobile and can get out of bed on her own and walk to her bathroom as well as complete her hygiene routines If she is prompted. She is not prompted. She is not checked before she goes to bed and she is not bathed on a weekly basis unless I persist. Yes, I will take your advice and request a conference.
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This is how I looked at it. Mom was paying 5k a month half of that was her care. So, it was the aides job to toilet and bath her. Where I live 2x a week is the norm for bathing. And yes, if Mom refuses, they can't force her. But, I found its the way they ask. "Do u want to get a shower" of course they say no. I think it should be "come on Mrs. B, time to get a shower". More likely to go along with it. My daughter says there is a way to get them to do what you want its making them think they made the decision. Like "Mrs. B, wouldn't you feel so much better with a nice shower" That gives them the decision.

Meds and showers have to be recorded. You have a right to see the records and ask why no shower. Check with other facilities and see what the State requires bathing wise.

If she has been there 3 months you should be having a care meeting. Its required in my state. Ask how long are the meetings. If 15 min tell them you need more time.
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These are all great suggestions but I can tell you from working in hospitals, nursing facilities etc (Im a nursing assistant) that sometimes its a factor of the patient NOT wanting to get up at night to go to the bathroom. I had to ask patients that were perfectly capable of going to the bathroom on their own, why? “Why dont you get up?”
The answer was ALWAYS pretty much the same ”Im scared, I dont want to get up in the dark, I cant see, theres no light, Im afraid I will fall” some were just plain scared of the dark and felt safe in their bed. It didnt matter that they soiled it, they didn't have to get up in the dark.
My 87 yr old father in law who lives with us keeps a light on in his room at night. Even tho the bathroom is less than 5 feet from his door, he complained that he wanted a hall light, so we got a small nightlight. “No, it has to have more light so I can see to go to the bathroom” as unreasonable to us as it seemed to us because the bathroom is literally right there by his door, we got the bigger nightlight. Then he wanted us to put a light in the bathroom so it wouldnt be dark. He sleeps with the TV on all night too.
Elderly seem to not like the dark. If we go to the store after the sun goes down, my father in law is like “You wont be gone long? You will be right back? Ok make sure you lock the doors”
This big, tall, strong 87 year old man is afraid of the dark and being alone at night.
My point being check her lighting and ask her “Mom, is there enough light for you to go to the bathroom at night? Can you see to get up? Would you like more lighting at night?
Go there at night and turn the lights off and check the lighting in her room. You may be surprised at how she acts when the lights are off.
Also, tell them to MAKE SURE her “call light” is next to her at night. That way she can call them if she wakes up and has to go. She just may want someone to be with her when she gets up to go to the bathroom?

(PS. A bedside commode is also a great idea for at night 👍🏻)
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jacobsonbob Mar 20, 2019
Thanks for providing your perspective and helpful suggestions!
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As Ahmijoy mentioned, since you are there every morning to check her, you are unintentionally making night staff job a little easier. They dont deal with the poop, you do
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If the issues persist after the conference, it is time to move to another facility.
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I agree with everyone here, esp Mom1928 because I received the same response from the memory care where my husband stayed at briefly a few yrs ago. If he needed someone to help him with toilet and daily showers, we had to hire a private caregiver. MC would only wash him every Friday. At $10k a month, I would expect more help. I pulled him out after 2 months and now he is cared for at home. Less expensive and 1-1 care.

Please remember that NH and MC are a business. They are there to make money, not to look after your loved ones like at home. If you go into a NH and MC with that in mind, you should be fine.
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GAinPA Mar 20, 2019
I have realistic expectations and
I live a half a block away, so I have the ability to be there every day. I don’t miss much. I am considering hiring a caregiver to go in once a week to guarantee a shower and entertain her by taking her downstairs to the activities. (The cost per month where she is at is $5,400.00)
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This doesn't sound like a MC at all. VERY odd indeed. I might discuss with the head of the MC facility or just go to the ombudsman. It's outrageous. Residents in MC are not capable of being relied upon to handle their own toileting or hygiene. There are schedules for Depends check, take to toilet, dress for bed, dress for morning attire, bed made, etc. It's not on her to take care of stuff. Anything she does, they are to double check to confirm that's it's right, clean, proper, etc. If she is refusing care, like showers, then they work on a strategy to figure out how to get it done. They are professionals and capable of taking care of it. It's not on you or her to figure out and get it done. It's on them.

I don't disagree with finding another facility, but, MC units are not common everywhere. I hope they can figure it out and get their act together or you can find alternate care.
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Mom1928 Mar 20, 2019
I can agree with that. Been through it with 3 parents, and honestly, the majority of them just don't care and can't manage the residents with minimal staffing. They've all cut thier budgets so residents suffer.
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That shouldn't be happening. But it does. Quite a bit. It's very sad that our loved ones are not cared for in a "care facility".
My dad was in skilled nursing for rehab. He had LBD and they told us right out that watching him all the time wasn't thier job and if we needed more care and someone to watch him, we would have to hire an independent caregiver. That would be what I would do. Have someone in at what ever time you think best to help take care of her needs. I often wonder what we are paying for in these places. I can understand asst living because the resident is supposed to be able to do basic things. But not memory care and skilled nursing at big $$$$ each month. We are caring for my mom at home and when the time comes plan on hiring full time in home caregiver. I don't trust the facilities. They hire $8 an hour cnas, are understaffed and not equipped to manage the residents they have. Its sad.
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I would say look into placing your Mom in another facility. Since this one cannot do what they are charged with doing, they can get in big trouble over it. File a complaint with the state ombudsman and ask that they look into it. In the meantime, I'd also look into getting your Mom some adult diapers for her bowel issues. Good luck!
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Definitely ask for a care plan meeting, and request that assistance with toileting be implemented. As you said your mom can do it, she just needs the reminder. That is not uncommon for those with dementia. As the disease progresses they are not even aware of the need that they have to go. Nor do they have the signals or coordination to initiate or follow through with the toileting.

Good luck to you!
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