What kind of post wound care is needed for a severe case of scabies? I am being told a memory care facility can handle that. I disagree.

I know, the nail thing is weird. In ALs and NHs the activity staff can paint finger nails but can't cut them. I did my Moms. Kept them short.

I looked up on the net who cuts fingernails, and it is surprisingly controversial. Podiatrists cut toenails, but their training apparently doesn’t usually cover fingernails. This means that their professional insurance may not cover it, so some podiatrists decide that they won’t or can’t do it. Or for some that they shouldn’t charge for it, and for others that they won't do it because they can't charge for it ???

Dermatologists can cut fingernails, but it seems like a massive over-qualification for simple nail clipping. There is nothing to say that other people aren’t allowed to do it, eg beauty practitioners, mom, your next door neighbor etc. ‘Competency’ is the only requirement in some places, which seems pretty reasonable. We now have 'nail technicians' in the local shopping mall, but they aren't in the aged care market.

There is no special training for cutting nose hair either, so there are some questions about who is OK to do that as well. Apparently it’s not part of hair dresser training, not surprisingly.

Nail cutting isn’t in the training of most care workers, so back to the insurance liability issues and the can't/ won't argument. What seems reasonable is for staff to cut normal nails (though dermatologists think the clippers should be sterilised), but to get a medical professional to do it if there is infection or damage to the nail. But what is ‘normal’, when old people’s nails can be so thick and horny?

Whoever would have thought that fingernails would be such an issue? However it may explain why these nails are in such a bad state. It may not be as simple as negligence in the facility.

My daughter had a resident transferred from the Hospital to her Nursing home. The woman complained to Renee that she had been itching for months. My daughter diagnosed it as scabies. This woman had been to her doctor's and the Hospital for something else and no one knew the cause. The woman was quarantined at the NH. These are very contagious. I doubt the Memory care would take her back.

When it comes to nails, I have always been told that aides are not allowed to cut nails or toenails. I do think in this situation, though, it should be done.

I believe you need to leave this in the hands of the hospital Social Worker. I doubt they will be able to place this patient and will HAVE to opt for skilled nursing. As to the long fingernails, of course that should have already been addressed; that it hasn't been is somewhat negligent on the part of the hospital, as with long nails and dirt there will almost certainly be infection. You are correct that the post hepatic syndrome complicates this a whole lot. I sure wish you good luck. This is going to need nursing management and the administration of medications to keep the itching in control in my opinion as a retired RN, and at the very least several weeks of healing.