Question for people who know about nursing homes

[pnwmom]

Last edited Mon Dec 23, 2013, 04:08 AM - Edit history (1)

Is it common and/or considered acceptable for nursing homes to require that continent patients wear diapers, because there are not enough staff people to help them to a commode or toilet when they need it? In other words, to train previously continent people to use a diaper as if it were a toilet?

My mother broke her hip and had a hip replacement. In the hospital, she was going to the bathroom using a commode, with the assistance of the nurse, who was also helping her learn to walk with a walker.

After a week she was moved into a nursing home to continue rehab. In this nursing home, they required her to wear a diaper, and to use it, because they don't have the staff to come whenever a patient might need to go to the bathroom. This seemed to me like a huge, horrible, and demeaning step backwards, but I live thousands of miles away and I know my sister (who found the nursing home) is doing the best she can. She says that none of the nursing homes in the county are any better.

So is this standard procedure? Or is this something to complain to state regulators about? This is in Texas.

I've looked for links about this subject, and can't find anything except for people like me, complaining. I'd like to find a discussion of this on a medical site, or by a qualified medical person. If anyone knows where I can find more info, I'd appreciate it.

EDITED TO ADD:

w8liftinglady linked me to a U.S. News and World report ranking of nursing homes. In my mother's city there are 9 nursing homes and this one was ranked #1 -- with 5 stars. It had a gold medal for being one of the nation's best nursing homes, despite the pathetic ratio of staff to patients. This is truly scary.

[kcr]

1. That doesn't sound right to me.

I don't know. I'm not a medical professional either. But I just can't believe that would be right. I've had loved ones in nursing homes and do not remember anything like this.

[pnwmom]

3. Thanks. I don't remember it with my MIL either. n/t

[kcr]

7. I hope your mom recovers soon

[pnwmom]

17. Thank you. She's supposed to come home on Christmas Eve.

Hopefully she'll do much better once she's home.

[elleng]

2. Not from what I recall,

when my mother was in a nursing home/rehab facility.

I'd sure as heck complain.

[newcriminal]

4. Not in the nursing homes I have visited.

My grandparents were both in a nursing home for a short while. My grandmother needed assistance because of her leg and she never wore a diaper. I would have pitched a fit if they had even suggested that.

[Scootaloo]

5. I never heard of such a thing where i worked

It sounds like a staffing issue. Even so, yes, you absolutely should contact state regulators about it, as it is a violation of the patient's rights.

[NYC_SKP]

6. I feel for you. I also feel for them. And I wonder if you've considered other options.

I'll say this much, and both my parents were in a facility at my doing, this time last year. When dad died I brought mom home to die.

All that said, I don't blame a facility if they put tenants/patients/guests in an adult diaper.

I DO NOT expect that the typical setting allows for 24/7 attendance to take people to the bathroom.

We have an increasingly large segment of our population that is becoming increasingly dependent upon the care providers.

I recommend that you go there and see for yourself but be realistic about the options.

Best wishes for a great outcome.

Pease.

[bettyellen]

8. I have seen this, also when my mom was unable to feed herself, they just took the uneaten food away.

never said anything. a lot of places are on auto pilot.

[truedelphi]

9. Nursing Homes in Texas are the worst in the nation!

http://nursinghomereportcards.com/2013/08/08/texas-named-best-nursing-home-state/

From, the above article:
“It seems skeleton crews are working the hallways of Texas nursing homes,” said Lee. “With so few staff to care for residents, it’s not surprising that less than 20 percent of Texas nursing homes scored above average inspection ratings and almost 95 percent were cited one or more deficiencies.”


And since nursing homes overall are not adequately staffed, it is good to be concerned. Be very concerned.

If you can't move your mom closer to where you are, can you perhaps help your sister financially so she can hire part time or full time nursing assistants?

It is almost irrelevant as to whether the situation is legal or not. What is important is that your mom have adequate care. And this includes her being able to get out of bed with assistance and move around, including trips to the bathroom. Otherwise, as you are probably fearing, she could end up with bedsores or worse.

I worked as private hire Nursing Assistant for patients in nursing homes in California. Among items of my concern were these: little provision of adequate liquids, even when temps were above 95 degrees.

Poor heating and cooling situations. Patients are overheated in the summer and often cold in the winter.

Often people in charge were only concerned with state regulations. For instance, in Calif., a patient must be weighed every thirty days. But if you have a patient who is suffering with dementia, and not eating, and you are only seeing what their weight is every thirty days, thirty days is far too long a time period. Site supervisors don't care about special needs - only state regs being followed.

On edit: Don't mean to imply you shouldn't care about a legal battle. I would love to see so many people take these people running these places to court. But such battles take time. And in the interim, you need to first and foremost get someone on duty who will take care of her. In many places in the USA, the only way you can do that is to get private duty people.

[pnwmom]

21. I asked my sister about a private duty person. She was intending to hire someone

Last edited Mon Dec 23, 2013, 12:35 AM - Edit history (1)

at first, but then changed her mind because she thought Mom was getting enough attention from the nursing home staff during the day.

But looking back on it now, I think that wasn't the best decision. I think we should have gotten someone in there to be with her. (She's going to my sister's on Tuesday and I've already told my sister to hire some help.)

We had a private caregiver in with my MIL when she was hospitalized. I was surprised to find out that my mother's hospital, citing liability issues, wouldn't allow us to hire an outside person. And yet they were calling my sister at 10 pm, asking her to send a family member to spend the night. How come a family member could be there and not a paid helper? Mom loves the lady who helps out with her at home.

[pnwmom]

22. Thanks! I hope we never having to deal with a nursing facility there again. n/t

[pnwmom]

38. Unfortunately, my sister didn't tell me how bad it was till recently.

I first asked her about hiring extra help for my mom when she was in the hospital, but the hospital didn't allow that, for liability issues, they said. Then I suggested we hire someone to help in the rehab place, but my sister thought Mom was getting enough attention there, at least during the day. My brother did fly out and spent several days there, and he thought it was "dreary." But he had no experience with these places and didn't know what questions to ask or what to look for.

I guess I should have pushed harder, but you're in an awkward position when your sister is doing the hard stuff and you're just managing the bills.

[truedelphi]

87. Having been my mom's

"Other daughter" I know it can be quite difficult managing with all this. You really ahve my total sympathy in this.

And it is a situation that requires so much thought and concern that it is difficult to deal with when you are also working at a job, and trying to take care of your own kids and spouse and what not.

[Wash. state Desk Jet]

10. Tough question

There are senior citizen agencies in every state that provide free information and home care assistance such as giving baths to seniors for those who take care of loved one's at home.
Such agencies provide a wide verity of services and training class's for those who provide care for seniors.
I would suggest you contact senior services in your mothers locality and find out as much as you can.They can tell you what you need to know about what the laws are regarding the welfare and care of seniors in or out of care facilities. You will find they do have trained experts in the field of care giving for seniors on staff who will give you all the information you need. There are many issues you need be aware of regarding your mothers care. And you do not want to sign your mother over to that nursing care facility which is something they may try to get you to do.

Make some calls ,find out all you can,relate what you come to know to your sister and keep finding out all you can. And check on Alzheimer's help agencies in Texas ,those people can provide a wealth of information regarding adult protection where it is about seniors in nursing care. If she doesn't have Alzheimer's just say she might have . You need all the information you can get.

Also find out if the nursing facility your mother is in has or had any outstanding law suits filed against it down the avenues of negligence . Check the internet for complaints against it.Just type into search the name of the facility and it's location.

You might want to get a copy of the hospital operation and the procedures applied and those who did the medical treatment as well as those who assisted.

Again it is all about getting the information-you are way far away but there is nothing stopping you from going after the information. You can't do anything for you mother if you don't know much about what is going on with her. your sister dealt with it and deals with it as it is happening and it all happens fast. Do you think she has had the time to find out all she needs to know ?
You can get a lot done right from where you are.

good luck.

[pnwmom]

40. Thankfully she's going home to my sister's on Tuesday,

where we will be getting an aide, too.

But I do want to pursue this with the state, for other people if not for her. (And we never know what the future will hold.)

[w8liftinglady]

11. Where in Texas?

http://health.usnews.com/best-nursing-homes/area/tx

http://www.carepathways.com/nhg-state-TX.cfm

And, no- the facility is violating a resident's rights if they insist on wearing adult diapers.

Here is the State's link to complaints issued,etc.
http://www.dads.state.tx.us/services/index.cfm

[pnwmom]

28. San Angelo.

Thanks for the links!

[pnwmom]

41. OMG. In the rankings, Mom's place is ranked #1 out of 9 in the county.

With 5 stars. I'd hate to think what the other places are like

[TwilightGardener]

12. Is the staffing level the reason they gave for her wearing diapers? Because that is

unusual. That said, some people are continent in terms of knowing they have to go, but have difficulty with mobility and can't make it to the commode in time, or it's too painful/too much of a production to have to change them out of wet clothing. Or, they're on diuretic medications (blood pressure and heart meds) that cause them to have to go so frequently that they would have numerous accidents. These types of patients (assuming they're not suffering from dementia) usually don't mind the diapers or pads, in my experience. What does your mom say?

[sammytko]

15. Especially after a hip fracture.

My mother has had a cracked hip and now a compressed vertebra from a fall.

It's because she thinks she can still do things she did when she was, well, 80. After the last fall, she finally decided to ask for assistance to go to the bathroom and to dress.

After that incident, she had to wear a hospital gown so it was easier to clean her up. She couldn't get out of bed. She is okay now.

[TwilightGardener]

16. Yep--hip fracture or replacement would be a big factor. Glad your mom is OK.

[pnwmom]

43. I'm glad to hear she's okay now! nt

[TwilightGardener]

19. I'll add this: If the staff is actually TELLING her to go in her depends because

they are too busy to take her to the commode, when she WANTS to go, that's a different ballgame--and you need to say something to the administrator or director of nursing about it, or consider moving her if they can't answer to your satisfaction. If they just have her in them for occasional accidents, and she doesn't mind and doesn't have skin breakdown issues or mental distress from wearing them, then that's not very worrisome, IMO. Every nursing home I've worked at makes a pretty big effort to toilet their patients, so you should be able to expect that.

[pnwmom]

44. Mom is compliant. But she would be happy to use the commode if they

would let her. Instead, they put the diapers on because they don't have the staff to come to her when she needs assistance.

[tazkcmo]

67. Exactly

It's all about the resident's dignity. They are not children, they are adults. You mother is probably compliant due to insecurity and intimidation, intentional or not.

This makes my blood boil. My favorite job ever was at that facility. I loved having 200 grand parents and always being the youngest one in the room! These folks are gold.

[pnwmom]

42. Mom didn't complain to me. But I knew she wasn't wearing them

in the hospital (or previously at home), but that all of a sudden she was being required to wear them in the nursing home. If she could manage with assistance in the hospital, why couldn't she at the nursing home? My sister said it was because they only had one person working in this large area, and when she was busy serving meals (or whatever), she couldn't help people with toileting, too.

[TwilightGardener]

47. Well, she should never be "required" to wear anything she doesn't want to, especially

pads or diapers. However, since hospitals are a higher-acuity setting, there is more staff and attention, by necessity, than a less-acute setting like a nursing home. She would almost certainly have more immediate assistance in the hospital. That's not to say that she shouldn't be taken to the toilet whenever she wants to go--they should be answering call lights (or requests to go) within a few minutes, and making sure she is mobile and functioning according to her care plan and doctors' orders. All of that should be in her chart, the nurses and aides should be well aware of her particular abilities and needs. If it doesn't seem that way, you need to look into it.

[sammytko]

13. Is she fully continent?

My mother is in a nursing home in Texas. She wears the pull up type underwear. She is 90.

I'd rather she wear that and stay dry than sitting in wet clothes, getting an infection or start smelling. The home she is in is old, but they take good care of her. She went there after trying to take care of herself at home. She was on hospice and with their hands on care, was brought back to life.

Maybe because someone goes to see her every day and we have relatives and friends that work there, makes a difference. Sure it's not perfect, but they do a much better job than we ever could. And we tried.

Your poor sister has her hands full. Heck there are four of us right here and seven more in the surrounding area and it is still stressful.

Talk to the county social worker at the hospital where she had her operation or her doctor.

And they don't make them go in the Delends, it's just to keep accidents to a minimum. I suffer from stress incontinence and I wouldn't go anywhere without my Tena pads!

[pnwmom]

35. She was before she broke her hip. And she was using the commode

successfully in the hospital (though she had to be helped out of bed to use it.)

[pnwmom]

36. Actually, they did tell her to go in the Depends.

And as far as talking to the doctor . . . that's another problem. In the three weeks my mother's been in there, my sister has never succeeded in getting the doctor to return her calls (and she watched the administrator leave a message for her, and still the doctor didn't call her.)

So my sister never met the doctor who's been in charge of my mother's care. I helped her write a blistering letter about that.

[sammytko]

39. They tell my mother the same thing, but in a reassuring way,

don't be embarrassed to use it if you have to type of thing, not, YOU better use the depends!

We tell her the same thing too. Don't worry mom, don't be embarrassed if you pee in the Depends.

Does your sister work or have kids? Sometimes it's hard to be there when the doctor shows up. We are a large family, so we can be at the hospital in shifts. You never know when the dr will show up.

[pnwmom]

45. My sister goes there every day, during the day, but has never met the doctor.

But the aggravating part is that she has left messages over and over to talk to the doctor, and the doctor never called back. The social worker and the hospital administrator left their own messages to the doc to call my sister, and they didn't succeed either. We understand that the doc did see my mother at least once, but my sister has never even spoken to her.

[SoCalDem]

85. Maybe it's time for you to "conference call" a reporter for a newspaper

Loss of dignity can lead to depression for an older person.

[pipi_k]

14. After she broke her hip

For the second time my MIL came here to live

She was sometimes continent and sometimes not

She did not like getting up from her chair to walk the 14 feet to the main bathroom, and we had a porta potty next to her bed that she often did not use either.

So I had her wearing Depends even though there were two of us here to care for her

I didn't see it as training her to use the Depends as a toilet...I saw it as insurance against accidents...which didn't always work, like the time she took it off without us knowing and hid it, then stood at the bathroom sink and peed a very large puddle all over my carpet (not an area rug) one morning in her nightgown

Or she would wait till the last minute before trying to rush to the bathroom without her walker, nearly falling on her head. It got to the point where we had to install a camera above her chair so we could leave her alone for five minutes.

One day just before Christmas we were both having our hair done at a salon when she shit herself and I didn't have an extra pair of underpants for her

So I dunno...it would seem to me that the nursing home, if it's short staffed, is doing the best it can with what it has

[pnwmom]

34. The question is why they're so short staffed. Texas is on the very bottom

of rankings of nursing homes. I think they don't want to hire more because it would cut into their profits.

[El_Johns]

53. They're short staffed because the law allows it, most likely.

Federal law requires Medicare and Medicaid certified nursing homes to have an registered nurse (RN) director of nursing (DON); an RN on duty at least 8 hours a day, 7 days a week; and a licensed nurse (RN or LPN) on duty the rest of the time. However, there are no minimum staffing levels for nurse's aides, who provide most of the day-to-day care. Instead, nursing homes are required "to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident." In addition, nursing homes must provide a minimum of 75 hours of training for the aides.

The important factor in improving quality of care is the amount of nurse time each patient receives. If a nursing home met only the federal nurse staffing requirements described above, a resident would receive 20 minutes of nurse time per day. In 2000, the Centers for Medicare and Medicaid Services (CMS) reported that the preferred minimum staffing level was when nursing home residents received three hours of total staff time per day -- two hours of nursing assistant time and one hour of licensed nurse time. The optimum staffing level, according to the CMS, is one hour of licensed nurse time and three hours of nursing assistant time.

Most states have standards that are higher than the federal requirements, but still fall short of the levels recommended by the CMS. According to a recent study, the key to improving nursing home staffing levels is increasing state standards. The study by Charlene Harrington, a UCSF School of Nursing professor, found that states with the highest standards for nursing staff levels are the only states where nursing homes have enough staff to prevent serious safety violations. According to the study, the act of raising the state minimum staffing ratio has a direct impact on the quality of care nursing home residents receive.

http://www.elderlawanswers.com/what-nursing-home-staff-levels-are-required-6496


It appears, from this comment from the TX Attorney General, that the ridiculous federal standards are also the TX standards:

"What is the ratio of nurse aides to residents for the day, evening and night shifts? Is there a facility policy about this? How often do you call temporary employees?"

Most of the day-to-day direct care that residents receive is from nurse aides, with licensed nurses supplementing this care in good facilities...

A nursing facility is required by law to maintain "sufficient staff to provide nursing and related services (1) in accordance with each resident's plan of care; and (2) to obtain and maintain the physical, mental, and psychosocial functions of each resident at the highest practicable level, as determined by the resident's assessment and plan of care."

While no specific number or ratio is required, the National Citizens' Coalition for Nursing Home Reform has concluded that minimally acceptable ratios of direct caregivers to residents, for three daily work shifts, are as follows...


Day: One direct care giver to five residents
Evening: One direct care giver to 10 residents
Night: One direct care giver to 15 residents


https://www.oag.state.tx.us/elder/select.shtml

But that's just a toothless recommendation.

It's such bullshit. If you look at the items of care nursing homes are "required" to provide, then look at the absence of staffing criteria beyond the minimum required to fill out paperwork and keep the place from burning down, you can pretty much say that it's DELIBERATE MALPRACTICE.

You can't maintain the level of care required by law with the federal staffing ratios, you just can't.

[pnwmom]

57. Thanks. I bet prisons have much better staffing.

[pipi_k]

102. Probably quite a few reasons...

Maybe the bosses suck. Or the working conditions.

Or even the pay scale.

Crappy pay was actually one of the reasons why, when I was working in Human Services back in the 80s, a lot of the homes (for MR adults, as they were known at the time) were always short staffed.

There were times when the managers themselves had to work triple shifts for weeks at a time because of the short staffing. We were lucky enough to be close to three colleges, and many of our staff came from there, but they never stayed very long, and, as a result, didn't get the proper training.

[pnwmom]

105. They told my sister that they couldn't answer my mother

when she needed to go to the bathroom because they had only one aid to feed all the patients in the unit, and when she was busy with that, she couldn't do anything else.

So it sounds like a question of numbers. You don't have to be that skilled to feed people, but you need time.

[El_Johns]

18. I never heard of such a thing with any of the elderly relatives I had who spent time in nursing

homes. ESPECIALLY if she is there for rehab from a broken hip.

Not only is it degrading for a continent person to pee & poop into a diaper, when people are allowed to sit in dirty diapers, it causes skin breakdown & infection -- exactly what you don't want for a person recovering from surgery.

And if the facility is so terribly understaffed that they can't assist the residents with toileting, you KNOW the residents are going to be sitting in their dirty diapers for extended periods of time, for several pees or poops, because that's the only way such a measure could save staff time.

This is the kind of thing that causes infections getting into bones, etc. -- because you know also, if they're so understaffed they're letting the patients sit there in dirty diapers, they're likely not very meticulous in getting them up to walk & get the blood flowing, either. Pressure ulcers + stool & urine = infection.

Patients with fecal incontinence were 22 times more likely to have pressure ulcers than patients without fecal incontinence."2

"...The odds of having a pressure ulcer were 37.5 times greater in patients who had both impaired mobility and fecal incontinence than in patients who had neither."2

http://www.sageproducts.com/products/incontinence-care/iad-risk-factors.cfm

"Incontinent" = people wearing diapers. Putting continent people into diapers puts them at the same risk the incontinent are. Getting people up to toilet is part of therapy, both in keeping that area clean & in keeping good blood flow, therefore speeding healing after surgery & maintaining skin integrity.

What kind of "rehab" is THIS?

I can't believe it's the norm, even in Texas. There must be some state commission on the elderly, state regulators of nursing homes, nursing home ombudsman, someone you can call to find out what's going on.

http://www.dads.state.tx.us/news_info/ombudsman/

Look up decubitus ulcers/pressure ulcers. A lot of people don't know anything about them & they are one of the common problems for nursing home residents. They kill, and they can be well developed before the family even knows there's a problem.

[pnwmom]

26. Thank you! This is useful information for me to refer to

as I prepare a complaint to the state regulators.

[El_Johns]

29. I'm glad you're going to file a complaint, & glad you're able to make other arrangements.

[pnwmom]

69. Thanks. This has been eye-opening, sadly. n/t

[tazkcmo]

68. Good for you and your mom! n/t

[CrawlingChaos]

50. I strongly agree with this!

Even when diapers are changed promptly there's an increase in sores and infections, but in this case, the clear intention is to let patients sit in their dirty diapers (otherwise, how is it labor-saving at all?) which is sure to do serious harm. Everything you said about the likelihood of very serious infections, as well as the importance of getting up to go to the bathroom, is so very true!

I would also worry about a loss of bowel and bladder control -- I've observed in elderly people how critical it is for bodily functions to stay in constant use (use it or lose it) in order to maintain them, and it can be a long road back, once function is lost. Putting a continent person in diapers is the polar opposite of "rehab".

Not to mention the loss of personal dignity - those issues can have a big impact on recovery too.

Best of luck to the OP with this. Maybe even think about engaging a lawyer, if need be.

[El_Johns]

56. Yes; that a facility with this policy would bill itself as "rehabilitative" just boggles the mind.

A death warehouse, to my thinking.

[pnwmom]

59. That's the thing I was worried about -- that they were teaching her

to be incontinent.

They were also surprised when they found out my sister was taking her out at the three week point. For some reason they were just expecting she would stay. So they said something like "now that we know she's leaving, we'll step up on some of the self-care."

[Squinch]

20. NO! It is not acceptable. It is not respectful to her, and it is not appropriate for

a facility that says it is involved in rehab. It is bad for the skin integrity and can lead to dangerous sores, especially in an elderly patient who is relatively immobile.

I have worked in rehab facilities and have never heard of such a thing. I have had my mother in a number of rehab and skilled nursing facilities/nursing homes for rehab, and I have never heard of such a thing.

I would try and find another nursing home AND tell the state regulators. Try and find one that bills itself as a skilled nursing facility.

[pnwmom]

25. Thanks Squinch. She's going home to my sister on Tuesday

(where we will also pay for an aide.)

I am here trying to collect information to use in my complaint to the state authorities in Texas.

I'm glad to see that this practice isn't the norm.

[Squinch]

27. Oh, good. Make sure the aide does a good skin check on her when she gets home.

[pnwmom]

30. I will!

[pnwmom]

31. This one DOES bill itself as a skilled nursing facility.

Unfortunately, I've just seen a site that ranks Texas in the very bottom of the states in the quality of nursing homes.

[Squinch]

74. After hearing your story, I believe it.

As far as when she gets home: in the skilled nursing facility, they should have had physical therapists teaching her how to use the walker, and supervising her recovery.

In my state, you can get physical therapists and registered nurses, if necessary, coming to the home once or twice a week and it's covered by Medicare.

I wouldn't ask that SNF anything, but maybe you can call the hospital that did the surgery and ask to speak to a social worker. Ask the social worker if s/he can help you figure out how to get insurance-covered therapists and/or nurses to come to your sister's home and help your mother with rehab.

They do stuff like set up modifications in the home that will make it easier and safer for your mother while she is improving, give her exercise programs to help her get her mobility back and supervise those programs, and monitor her health.

There is a big benefit in terms of good outcomes to this, so I am guessing that it is covered, but in Texas you never know.

[pnwmom]

80. Thanks, Squinch. I'll talk to my sister about this. nt

[Brigid]

23. I assume from your profile that your are in WA.

Try this:

http://www.waombudsman.org

This can't be acceptable.

[pnwmom]

24. Thanks, Brigid. Unfortunately, my mom lives in Texas

near my sister, so that's why she's in a rehab place there.

I've found the state place to complain to, however, and I will be doing so. Though I don't think it will matter in Texas. They seem to be comfortable with their national ranking of 50 in nursing home care.

[elehhhhna]

81. The Carlyle Group is buying all the nursing homes they can

so don't expect this to improve

[polly7]

32. In the nursing homes I've worked at,

maintaining mobility as long as possible is very important, even if it only involves toileting, using a walker to get there. I can understand a diaper or pad being suggested for accidents and at night ... especially if the home is short-staffed, but I don't agree with telling her to use it. I hope your mother is doing well with her hip recovery and you get things worked out. It's so hard, I know.

[Tuesday Afternoon]

33. Dignity issue. Abuse and Neglect.

[sammytko]

37. Did someone from the nursing home say this to you, or

Was it a third party, maybe your sister?

We're you upset because she was wearing Depends, and your sister told you that the home required it, that way to put an end to the conversation?

[pnwmom]

46. I don't remember exactly how I found out, because it was almost

three weeks ago. I think my sister just mentioned it, and I asked why -- since I knew Mom was using a commode at the hospital. And then my sister said it was because ALL the patients wore them because they didn't have enough staffing to help everyone go to the bathroom when the needed to. "This is a nursing home, not a hospital, so they don't have the staff."

Thinking about it, I bet this was done at the previous nursing home my mother went to several years ago. My mother was on a bunch of pain meds then and probably did have no control, at least at first. So my sister probably thought this was just normal.

At the other nursing home, my mom had a UTI that turned into a kidney infection before they finally diagnosed it. I wouldn't be surprised if it was related to the diapers.

[sammytko]

58. UTI are very common in the elderly

We found out so many things about the aging process by having to take care of my mother. At least I know what to expect.

The nurses and aides are wonderful. They can diagnose things better than the doctors.

[El_Johns]

61. They are more common in nursing homes than in the general elderly population. Partly this is

because the nursing home elderly are more fragile, but partly it's because of bad practices like making residents sit in dirty diapers for extended periods of time. That's how you get UTIs, not to mention worse infections.

[pnwmom]

62. Unfortunately, I think mom had her UTI for months before

it was diagnosed. None of the nurses or aides noticed. She had fallen and had an (undiagnosed till later) broken tailbone. A few weeks later, she began to complain of new pain in her abdomen and pelvis, and out of the blue, she was wetting the bed. So they gave her more pain meds and put her in diapers.

After a couple months of her suffering, they finally realized she had a kidney infection and when they treated it -- like magic -- that pain in her abdomen went away. So did the bedwetting.

I was sitting up here unable to do anything, because my sister had the power of attorney and got extremely defensive when I asked questions. This time we seem to be working better together. But it is so hard.

[Squinch]

76. She is going to need you, so I imagine her defensiveness will go away.

I am so lucky. I have two sisters near me and we tag teamed. When one was just too exhausted with the constant needs, she just ducked out and the other two covered.

My out of state siblings helped by doing things like finding the homecare agencies, handling some of the eternal calls about insurance and billing, doing grocery shopping through an online delivery service, calling my mother frequently so that even on days when we didn't visit her, the staff knew she was getting a few phone calls. They did whatever they could think of that could be handled by phone and internet, and it helped a lot.

But even as lucky as I was, it was still an exhausting marathon. Do whatever you can to lighten the load for your sister.

[pnwmom]

79. Right now I have the painful job of trying to figure out her finances.

I've been trying to understand some of her credit card charges and it's been very depressing. Somehow she's gotten snookered into a bunch of "free trials" that turned out to be anything but free.

One of them is from an evil place called Newsmax. And Mom is a huge liberal , so all the info they were sending her was scaring her to death. But she didn't realize she was paying them to torture her.



The worst part is when we all have to have a SKYPE call with her and the local sister, explaining to her why we have to take over now. I tried to a couple of years ago but backed down when she convinced me she was doing okay. But we don't have any choice now, and it's so sad.

[Squinch]

82. That is one of the hardest things. That and the car. But at a certain point you have to do it to

keep her safe. My mother did the same with some insurance scam.

We left my mother with a small account in her control, and a checkbook, so she felt she had some control over her money and could spend if she wanted to. But it wasn't enough to let her get herself into financial trouble.

[pnwmom]

83. We tried that. Unfortunately, she has credit cards with huge credit lines

and she's been using them to pay for pledges, etc. And only been paying the minimum each month. What a mess.

I've been sending her money every year to help her get by and it's kind of sickening to see where some of it has been going . . . . no more.

But we were lucky with her car. Several years ago she made that decision without any prompting from anyone's part.

[sammytko]

99. They did that to my mother also! Not newsmax, but all sorts of other places

It got to the point that we would go through her purse when we took her to the doctor. Throw all those things away - people asking for money etc. She would have the checks written out already. She wouldn't remember afterwards anyway.

She had bags and bags of pantyhose and bras and underwear that she ordered from somewhere - who knows.

She didn't like it when one sister was handling her accounts, but that was years ago when she was still able to go places on her own. Guess her body was good, but her mental processes were shot. Now she is okay with whatever we want to do. Only thing she says is "no operations of any sort"!

Only took about 15 years.

[MattBaggins]

48. In NY yes

The State comes in every year and knows that on some weekends there is 1 LPN and three CNAs for 40 residents. They review the logs.

[TwilightGardener]

51. Wow--I worked in a nursing home in South Dakota when there was 1 RN or LPN

and 1 aide (myself) for 40 or so residents during night shifts. Four people sounds like a dream compared to two. We made rounds to turn, change, toilet, every two hours. We'd finish just as the next two hour round was coming up--never-ending! And yet, it was a good nursing home.

[MattBaggins]

64. That would be nights here except no RN

[Squinch]

75. I'm in NY. I've never seen this. That's awful.

They probably get away with it because they don't overtly come out and say that they are making ambulatory and continent patients wear diapers. If someone actually said it to them, they would probably have to do something.

[doc03]

49. I delt with two nursing homes that my mother was in here in

Ohio. Both of them were horrible, that is always their complaint they don't
have enough staff. The SOBs charge $6000 a month and have one nurse and a
couple aids that are paid minimum wage to take care of dozens of patiants. My mother was doing fine so I thought I was safe to take a vacation. On the first night they call and tell me she fell. I come back in two weeks and she can't even feed herself. They would just come in and drop off a tray and come back an hour later and pick it up untouched. I had to make them send her to the hospitol, she was dehydratred because she had no food or water since I don't know when. I get her back in the nursing home and caught them several times not feeding her after that. It got to the point I had to go there at least once a day and feed her myself to make sure she ate and had some water. I'll tell you what if they don't have family checking on them they will just let them die. I think the SOBs should be in prison.

[El_Johns]

52. +1

[KentuckyWoman]

60. The math

168 hrs a week for full time care. Even at minimum wage just the cost of labor is a lot of money. To get and keep staff with enough grey matter to create heat takes double that.

This is unaffordable. But with our society where the patient's kids are often out of stateor like me, childless.... it's a service we need to figure out how to provide.

[doc03]

63. The math $6000 a month per patient? They aren't getting full time care

they have one nurse and one or two aids taking care of a whole wing in the home. At best
they spend a couple hours a day with a patient and that is if they have family checking on them.

[Le Taz Hot]

77. I had a similar situation with my great uncle.

After a hospital stay my aunt chose to put him into a nursing home for a couple of weeks to recoup and have physical therapy. Unfortunately, right after that I came down with the flu and wasn't able to visit him for about 9 days. When I came back I was horrified. He was emaciated, they had him drugged and he hadn't done one day of physical therapy. By the time I got there the damage to his already-frail 86-year-old body was already done. He went to the hospital, then into hospice. I KNOW that the nursing home stay is what killed him. At least the hospice was a VA hospice and they gave him outstanding care at the end.

I will NEVER put a loved one in one of those places and I sure as hell better not be put into one.

ETA: As bad as all that is, they also stole most of his stuff. Long johns, jeans, t-shirts, socks, personal items. The staff blamed it on the residents but the residents were so drugged up I found that pretty hard to believe. I knew damned well who stole them.

[doc03]

94. That's what they do, drug them up to keep them quiet

I found that out when I came back from vacation and found my mother unable to feed herself, a neurologist
had her on 3 different drugs. She didn't even know who she was.

[KentuckyWoman]

54. Standard practice. Legal. Unacceptable.

Kentucky nursing homes meet the barest legal requirements. All of which are legalized neglect and in my opinion theft. Cost $300 a day. It's awful what we accept for our most vulnerable citizens. I can't imagine Texas would be any better.

I feel for you. I too have several states between me and Mom. The prospect of entrusting her to hired help has kept me up nights a couple times. Luckily it hasn't come to that yet.

[ZombieHorde]

55. Most nursing homes are a operated strictly for the purpose

of making someone rich. This means many nursing homes will sacrifice appropriate staffing for higher profits. State inspections are generally known in advance, and those days will have a much better aid to resident ratio.

This info comes from my experiences working in several nursing homes, which also matches my wife's experience working in other nursing homes.

[MADem]

65. It sounds like the nursing home is understaffed and that's their solution.

It's a crappy solution, not to be snarky about it.

What can one do when there are no other alternatives? Watch like a hawk, put a nanny cam in the room, visit at odd hours, and get your loved one the hell outta there ASAP.

I would ask the state regulators about it, but how much regulation is there in TX? Not being snarky, I'm seriously asking....don't they do most stuff with "panels" of cronies appointed by the governor down that way?

[pnwmom]

72. From my observations 2,000 miles away, they do very little regulating in Texas.

Remember the big explosion they had at the fertilizer factory last summer in West, Texas? They don't regulate explosive materials either. This is why all the companies want to move down there, I guess, so they can squeeze out every bit of profits they can manage-- no matter at whose expense.

[MADem]

73. Yes, right before that explosion, I recall Governor Goodhair giving a "Come on down!" speech

touting the "business benefits" of Texas...

I guess no regulation is an incentive for some...!

[tazkcmo]

66. Call the authorities

after you've gone and raised holy hell about this in person, at the facility. I worked at a retirement community for 3 years and the number 1 rule was to always maintain the resident's dignity. We had independent, assisted and totally dependent living quarters and dignity was job 1.
We were inspected by the state several times a year, announced, unannounced and every time there was a fall there was a state follow up.

This is not standard practice btw. It's sheer laziness and/or pure profiteering not to mention possibly abusive as defined by your state's laws.

I am not a medical professional. Just a worker. Start at the facility and then go to the state agency that over sees these facilities.

[pnwmom]

71. Thank you! n/t

[Pretzel_Warrior]

70. no. that is unacceptable treatment.

[elehhhhna]

78. My Mom broke both hips in JUly

It wasn't required BUT nec. if she didn't want to wait forever to hit the restroom. It's gross but better than wetting the bed. Anyway, she did her rehab and is at home again now stronger than she was.

Keep your eye on the long game, and make sure the rehab is getting done.

[pnwmom]

86. But didn't that mean she was sitting in wet diapers for long periods of time?

Because if they couldn't spare the time to help her with the bathroom, they wouldn't have the time to change her, either.

[elehhhhna]

93. I get your point but they got her changed pretty quick

like 5 minutes after she'd rung the bell for an assist in the first place.
She doesn't get much of a heads up on peeing and then she can't hold it long or well...

[El_Johns]

100. Toileting IS part of rehab.

[boston bean]

84. You and your sister can demand they bring her to the commode.

Don't let them do this to her, as she will become incontinent without control if it continues.

[etherealtruth]

88. Emphatically NO

My mom had a 2 strokes in October (came home the Monday before thanksgiving). After ~ 1 week in the hospital she was transferred to a rehab facility (a super nice wing of a nursing home).

They did all they did a wonderful job of maintaining her abilities and improving her functions lost in the strokes.

I also am a former nurse (worked for a decade until my kids were born) .... most of that time was as a Hospice nurse (we had patients in the community, in nursing homes and in hospitals) ... I have never heard of this being even remotely acceptable. I honestly would file a complaint with your state if this is the case.


I am really sorry your mom is being treated like this!

[pnwmom]

89. Thank you. I will file a complaint with the state of Texas --

which, thankfully, is not my state. But I doubt that they'll care. Apparently Texas ranks 51st in the country (including D.C.) in nursing home quality. For a good reason.

[etherealtruth]

95. Oh God, I am sorry

Hoping your mom has a swift recovery ... jeeze this makes me so angry!

[pnwmom]

96. She's happy because she's being released tomorrow to go to my sister's.

For further recuperation.

So we'll all have a better Christmas!

[etherealtruth]

97. I feel better knowing this

Even though I don't actually know you or your mom ... this made me feel sick to my stomach. I am so glad ... hoping she (and all of you that love her) have wonderful holidays ... and wishing her a continued recovery!

[pnwmom]

98. Aw, thanks! I'm beginning to think for-profit nursing homes

are worse than for-profit prisons. . . .

[gvstn]

104. I would say that is not normal.

Most nursing homes are very conscious of how the place smells and are very careful to make sure patients are clean and bathed. I think it is a hygiene issue as well as the possibility of UTI. Requiring a patient to wear a diaper might be acceptable if they have diarrhea and are immobile but even then patients have rights.

Don't forget the nursing home probably has a coordinator that should be available to family. You might want to talk with that person to see if that is indeed policy. She is not incontinent and should be able to get assistance to the bathroom. That seems like a most basic need of a patient in a nursing home.

[uppityperson]

90. kick to mark to replynto later in more depth.

I am not sure if TX has staff/patient ratio or a couple other things. I will do some resaech this eve on computer and let you know what I find. That does not sound good.

[pnwmom]

91. Thank you! n/t

[Jenoch]

92. Reading this thread makes me feel grateful.

My mother spent the last three montgs of her life in a nursing home that was fully staffed. I inly noticed one aid who I thought was lazy. The nursing and administrative staff were mostly efficient and caring.

My mother had dementia but was alert. She complimented an RN on her nails. That RN came back after her shift was over and did my mother's nails.

What was interesting is that when my mother was first in the nursing home she was in the rehab unit before ir was decided that she would be staying there long term. Four months later, my father ended up in the same room to rehab after knee replacement surgery. Then, a year later my aunt was in the same room for short term rehab. It's a good thing that place was close to our home (my aunt's family were not nearby).

[Squinch]

101. Hey! How did it go getting your mom home to your sisters'?

I hope you can rest easy now that she's being well cared for.

Happy holidays, and best to you and your mom and your sister for the new year. Here's wishing her a speedy recovery.

[pnwmom]

111. Well. Sis says that Mom is getting around well with a walker

and that the home health nurse checked her out that day and she had no signs of bed sores (one of my concerns).

So Christmas was a much better day for everyone!

[Squinch]

113. I am so glad!

[pnwmom]

114. Thank you, Squinch! n/t

[sammytko]

115. Glad your mom is doing better - n/t

[tosh]

103. That seems to be the trend now.

My FIL is in this situation but we are fortunate enough to be able to afford a male sitter (daytime only, though ) who can help him
from his wheelchair to the bathroom.

A close friend of mine had this experience with her mother (same situation as your mother's, to continue rehab after surgery) - at not 1, not 2, but 3 NHs in the region - and moved her home and hired staff for this reason.

It truly sucks!

[pnwmom]

112. We tried to hire an aide for the hospital stay, and they said it wasn't allowed

for liability reasons. I don't know why my sister didn't do that for the nursing home. Maybe they had the same policy.

[Laffy Kat]

106. I'm a ward clerk at a care center.

It is not normal or right to expect a continent person to use a diaper. If the center is so short-staffed they can't help get a resident to the restroom, they are also too short-staffed to clean a resident up after soiling a diaper. Diapers increase the incidences of UTIs and cause constipation. The more the patients move around, the better; even if it's just to the bathroom, ambulation is a good thing. I'd also worry the short staff situation in case of an emergency. Good luck.

[pnwmom]

110. Thank you -- that's what I thought but it's very helpful

to have someone with professional knowledge to back me up.

[msanthrope]

107. What they are doing is below the standard of care....use that phrase when you call the

administrator and complain that the staff are making medical decisions that do not have a corresponding doctor's order...

I would fear that your mother's mobility was being curtailed in contravention of the standard of care that would encourage mobility after a hip operation. I would ask the administrator why your mother's mobility was being curtailed in this manner, and I would suggest to the administrator that this policy is a detriment to your mothers health.

And then I would complain.

[pnwmom]

109. Thanks, misanthrope. It helps to know the jargon. n/t

[Jane Austin]

108. Sitting in wet diapers

is a good way to get bedsores.

Sounds like the profit motive is too strong at that nursing home. They need to hire more help.

[LWolf]

116. I don't know

if it's common, or considered acceptable; the only relative I ever had in a nursing home was already incontinent, among other age-related disabilities, when she got there.

I know it shouldn't be acceptable, and it shouldn't happen. What's right is not what is practiced in way too many situations, though.