What are bed bath protocols? I don't want to make the task or our visit by hospice aides any more difficult so today I kept my mouth ...

I have been able to reduce the number of aides that my wife has to 4 different women throughout the week. Between them they provide about 70 hours of care. (10 daily xs 7 days). Of the 4, only truly know how to give a proper bath.

I have bought 5 extra long towels that they can use to cover her whole body. They can either move it up and/or down to keep her covered or roll it as they travel down her body.

The two well trained aides keep her covered through her bath time. They also report to me any changes in skin conditions anywhere on her body. They are very gentle as they bath her. ( They both have told me they bath her the way they would like to be bathed if they were in the same condition.

One of the other two is trainable. She is in her early 20's and has a marvelous attitude. She plans to go to nursing school soon so she is interested in learning all that she can. I work with her through her work day ( I day a week so that I can show her how to do it properly.) The other one is in her early 60's and either is showing early signs of dementia or exhaustion. She works as many clients as she can and tries for overtime every week. No mater what I show ot tell her today she goes back to what she was doing that I corrected and when I correct her again, she will answer, I didn't know that, I'll try that, I know, I know.

Each of these women have a different strength. I ministers to my wife on her 4 days. One does her hair and nails, girly things . The young one, she real good at doing whatever my wife wants. The one that may have dementia or exhaustion is a cleaner. Last week, she scrubbed the walls in our home. She sweeps and mops the whole house every day she works, usually 5. She will pull everything out of cabinets and put it all back neatly and organized. So with her I can overlook some weaknesses and continue to "remind" her.

I help them all to varying degrees when they are working on my wife such as turning, holding her in position while they bath her bottom, and moving her to and from her be and wheel chair with the life.

I have had better aides and I have had much worse, but with the current team, they help me tremendously.

( I am disabled myself , back injury in 1996 with 2 failed surgeries)

As a caregiver I have learned to not "crowd" a patient when there is someone else attending. The best place to be is out of the way unless asked to assist. Patients often don't want to feel more than one person at a time with them. During bed baths, a warm washcloth can be set on privates for the patient & then often times a clean disposable incontinence bed pad was set upside down over the patient for privacy concerns & because their bed was set up in the front room of a studio. Interviewing a family member or client on occasion is always a good idea. Just sit and ask them random questions about what they would prefer & work with their perception & ideas with rational improvements.

Privacy should be important. There comment that they finally got it from her demonstrates that she told them of her preference. That is how I would address it. They need to work within her preferences.

Some other practical suggestions to make the task less uncomfortable
-Warm up a blanket or some towels before hand and ready to wrap around her when she's undressed.
-Warm the disposable wipes in the microwave before use so they aren't so cold. Be sure they're not too hot either!
-Use moistened paper towels to wipe away the majority of the soil (cheaper than wipes) and finish up with disposable wipes.
-Better yet, purchase some second hand beach towels from the thrift store, cut or rip to the desired size. Use only once for soap and water cleanups and then dispose. They aren't worth washing and reusing.

gdaughter: I did see your update. It's good that you contacted the agency for your issues.

Aides sometimes forget simple things as being understanding of a patient’s privacy. Still, it’s NOT acceptable, by no means. I’d correct the aide 1 or 2 times before asking the agency for someone fully trained. Why pay for substandard performance? What other shortcuts are being taken by the aide when you’re not around? Would the aide be ok with laying naked on a bed while waiting for a bath? No, this is NOT acceptable.

Hi all, just wanted to let you know that I contacted the agency, confirming that the nurse on mom's "team" was the one over seeing the care by the aides, they had her call me and I explained, she basically in agreement with me, and managed to contact one or both of the aides prior to their arrival yesterday. Things appeared to be improved in re to the issue; however, mom was somewhat combative, and it fell to me to hold her arms/hands/wrists to keep her from pulling on or at the aides. I was exhausted by time they departed...wondering now (or a friend was) about the use of the ativan prior. I'm on the fence about it. Not to mention their visits are close to the time her meals on wheels are delivered and as it is we debate giving her lunch before or after aides; also note that dad reports she did not want breakfast this AM, which is not a concern, but that when he went to give her (as we were directed) the nightly senokot s generic she spit it out and/or threw it. So now guess who has to try and find the thing? Don't want my pup to be the one:-)

You need to speak to those IN CHARGE of the aids. They are the ones to report this to. The aids are in violation of patients privacy, and your Mom's feelings are what's important now. They may be experiencing difficulties of some kind with her getting bath blankets into "the mess"; I can't know, but this is against all crucial rules of bathing. A patient deserves a bed bath blanket not only for warmth and protection but for a feeling of privacy.

Law requires that all Aides are supervised by an RN. The nurse should be timing her visit during the bath time to be observing the aide. If the aide is a CNA (Certified Nursing Assistant) then giving a bed bath would have been part of her training. It is the organizations responsibility to hire or train competent staff. No patient should be stripped naked and cold EVER.

When we first got hospice for my Mom, the aide had never given a bed bath previously! As my Mom couldn't easily turn on her side due to the broken ribs from the lung cancer, it was a challenge. I (retired RN including Hospice and home health) taught her how to bathe Mom. To change the sheets, I had Dad, her elderly father, sister and the aide lift Mom in the air on the dirty sheet while I made the bed under her. I then stripped the dirty one from top to bottom to reduce the pain

Clean her yourself--because your mom is complaining. You do realize the privates will eventually have to be exposed because if the privates are not cleaned well -- it will become a urinary tract infection. I think she would feel more comfortable if you did it instead of a stranger. My mom never had an issue with me bathing her. I want my mom CLEAN so I did it myself and did not trust any stranger, who will probably do a haphazard job and she will end up with skin breakdown or a UTI. If you mom is bedridden, bed baths can be learned on youtube.

My mom was on hospice for two years and I did all the care myself and did not bother with the aide since I had to change mom's diaper 6 - 8 times a day anyway. I showered her for years because she could not do it on her own and I made certain her privates were kept clean because of the dangers of urinary tract infection. I did not like doing that, but if she can't someone has to do it. Or die of infection.

The skin MUST be kept clean and free of urine or breakdown will occur quickly and you will end up with a bed sore. Right to my mom's death her skin was in perfect condition, age 90 and 3 months with insulin dependent diabetes.
Skin and mouth care are top priorities..and of course a bowel schedule. I had to keep my mom on a strict bowel schedule or she could become impacted. She had a bowel movement every Tues, Thurs and Sundays. After the bowel movement you better make CERTAIN she is clean -- and I mean really clean-- because stool is the main reason for urinatory tract infection.

I worked very hard to keep my mom mobile which meant daily walks using a specialized walker. I did this daily for 5 years which this made her care easier since she was able to get into the shower. She was only bedridden for 2-1/2 months after 15 years of ALzheimer's, which ate up her brain to the point she forgot and could not focus on standing. The bed bath was much harder to do but the hospital bed hospice provided made it easier but it was still very very hard work. Still, she did not die of Alzheimer's but the complications of being an insulin dependent diabetic and associated kidney and liver disease so if she were a walkie-talkie the same would have happened. God killed my mom due to her other chronic diseases.

I had to get her a feeding tube in the end since she forgot how to swallow but it was a very last resort. Oral care is still needed with those. Never had a problem with it. The tube took a LOT of work, but she did very well with it and she did not die of dehydration which can take weeks. Mom died very comfortably since all her needs were met and she was kept CLEAN to the end and she died with perfectly intact skin.

I rescinded mom's hospice so she could get the feeding tube, and put her back on hospice on hospital discharge. That was easy. I bought an "tube top" on amazon to cover the tubing which was much better and more comfortable than an abdominal binder. I did this so mom did not have to die of dehydration which is slow and terrible way to die. Mom never bothered it, and she sure was comfortable to the end and we never used any narcotics or psychotropics because she knew she was loved, surrounded with love.

The Aides did the same thing to my 97 yr old Dad and it is chilly to lie naked on a bed while being wet.

I simply told them that I would like half of his body covered at all times as he is cold and to please keep a blanket or big towel over the top or bottom while they bathe him.

Also, if you mom can clean herself in her private area, that should be allowed.

My 87 ye old Dad has dementia so he is not able to

You are absolutely correct. Patient privacy and dignity should be foremost and are legally and ethically required. Demonstrate that you know resident's rights and file a complaint.

As an RN, I was trained that you only expose the area that you are cleaning. The rest of the body should be covered and kept warm. Please look up "bed bath" online and you should find a procedure - usually face first, then arms and chest area, moving on down front of body with privates being the last area.

I find it hard to believe that aids are not trained to cover client in this day and age. Unexpectabl... We as family members for are elderly and children ARE there health care advocate period... I as a caregiver dont have a problem speaking to whomever when things are not right. Good luck

Threatening and acting like a jerk is not the way to handle this as one poster recommended. Look up the proper protocols yourself. Tell the caregivers politely but firmly that you are not happy with the way they are bathing your mother and tell them how you want it done. If they argue with you or do not follow your directions, tell them once again. If they still resist or give you attitude, tell them that you are calling the agency to discuss the situation further. Overkill and threats will only cause the agency to evaluate whether they want you and your mother as a client. However, there is no doubt that the caregivers are showing no respect for your mother’s feelings or her personal privacy and they know full well that they are not following the proper protocols. If you have any doubt about what the agency policies are, call the agency social worker and ask for a copy of their protocol.

I'd stay by her head, hold her hand, and placate mom (as you would a child) with a soothing, running dialog of: "It's just us girls here, mom, and it will be over soon. They're almost finished! Won't it feel good to be clean again?" The aides are doing their job and it doesn't sound like abuse to me. But I'm biased, because if hospice aides came to bathe my mom every day instead of once a week, I'd be handing out gifts.

Those aides working for your mom are slacking off on the proper bed-bath procedure. This happens sometimes with homecare because it's a more relaxed environment then a nursing home or hospital.
The client's privacy must always be respected when giving a bed bath. That means after their clothes are removed a draw sheet or large towel is used to cover them. The only parts of the client's body that are supposed to be exposed at any time are the ones being bathed. There's no excuse for an aide to slack off the way your mom's are.
Talk to them ONCE about it. Let them know that if they slack off like that again or treat your mom with such indignity, they will be fired at once. Also, let them know you will get them in trouble with their agency. You do not allow them to criticize you for telling them something. Oh no, I don't think so.
There's no excuse to justify slacking off like that and I'm sorry your mom got treated like that. Caregivers like hers give all of us a bad name.

My mom just moved into the same bedridden situation a few weeks ago. She objects to the weekly bathing mostly because the wipes are cold & she’s very private. The quicker it’s done, the better. I find warm sudsy wash rags are more efficient, comfortable & quicker than all the small wipes. Hospice bathes her weekly & visits 5x a week helping with brief changes. Regarding the hospice employee who criticized you for covering her. This is a sensitive time for you & your mom. Hospice is there overall to provide comfort for the patient & family. If you know your mom needs covered, tell them she will do better if they keep her covered most of the time, then you do it for her. I had 2 different hospice employees that were not positive for my mother. 1 was loud & pushy, the other berated me over my mom while we were changing her & everything was still very new to me as I was trying to learn. My mom’s comfort, the peace & harmony in the house & positivity come first & foremost for the optimal best loving environment during this time. I won’t tolerate negativity while I’m doing my best. I talked to the hospice manager on both occasions & was given new employees to come out. I could seem picky but when I feel good about who’s coming through the door & my mom & are aren’t tensing up from overbearing people with a predisposed attitude, we are much calmer & mom is way more comfortable in the TLC hands of good people who are kind & caring. Do what’s best for your mom & don’t care what anyone else thinks about that. ❤️😊

First I have to say WOW!!! You actually get to have hospice aides come every day to help clean up your mom? I honestly have NEVER heard of that in all my dealings with hospice. You are lucky for sure.
In my husbands 22 month stint with hospice, they only came twice a week to bathe him, and not at all during the 5 months when Covid first appeared.
But that being said, they should be covering your mom with bath towels while they're cleaning her up, if not for her privacies sake, then to keep her somewhat warm. My husband was very particular on how he wanted to be bathed, and so I made sure I let the aides know, as most often we had different aides weekly. With my husband it was more of a "being cold" issue as he was very cold natured, so they learned to keep his top half covered with one towel and his bottom half with another.
Don't be afraid to speak up. You now have to be your moms advocate. Hospice is there to serve you and your mom, so make sure they are doing things the way you both prefer.

Use towels, and plenty of 'em. Any areas not in the process of being cleaned should be covered. Basic.

The aides ought to have done that anyway, without being told, as soon as they removed your mother's gown; so I have a slight red mist forming at the thought that they actively resented your covering her (though I wouldn't have used her gown, myself).

What to do... since you didn't deck them at the time, very restrained of you... put it in writing to their service manager, subject heading "respecting privacy and dignity during personal care." Indeed this ought to have been covered in their training. Perhaps they need a reminder.

Just to underline the importance and versatility of towels: I did a 2:1 round with a male colleague which included a call to a lady bedbound after a stroke. The client was friendly and welcoming, but when it came to changing her pad she called out to her son and said to him: "you know what I want to tell them, don't you?" She was both too embarrassed to have a male helping her, and too afraid to tell us herself directly.* But she's a 2:1 client for a reason - no moving and handling training is going to make it possible for 1 female to turn and wash her - so we reassured her with a compromise. Bath sheet over her, both of us helped her to roll, male worker held her in position, female worker made a sort of tent and did the care. Blushes spared, client happy, and equal opportunities rule!

*Another red flag for me. I seem to spend half my time encouraging people to give feedback and express their needs freely - how else can we get things right? - and it makes me very tight-lipped when they're afraid to. What's been going on?

JoAnn, this is not the only issue with this Hospice agency.

In isolation, I woul ask for a supervisor to intervene. Given the other issues reprted, I would look elsewhere.

I don't think at this point a new Hospice agency is needed. This same question was asked not long ago. Maybe aides are being trained this way. Maybe its inexperience. I would first ask that they cover Mom as much as possible. My Mom became modest as her Dementia progressed. Also, they feel the cold more. If they object or you get that look "who is the aide here". Then call the supervisor and ask what is the protocol when bathing a client. If as you describe leaving them totally naked, then I would call another agency asking them their protocol. If they cover, then change Hospice agencies.

Gdaughter, from everything you've reported here, you need a new hospice organization.

You're well within your rights to ask for clarity from the aides or their supervisor.

The Hospice CNA that was assigned was extremely cautious of exposing my Husband.
Taking him from the bedroom to the bathroom she made sure he was covered.
When bed bath became necessary she would expose only the part of his body that she was washing at the time. She would wash, rinse, dry and cover then move to another part of the body.
If the aides are not following this type of process you can say something. If they ignore your request you can call Hospice and and talk to a supervisor or Care Manager.
If your request is still ignored I would contact another Hospice agency as this is one I would not want caring for my loved one.