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Caregiving - Skilled Nursing Facility Style



This story will tell the reason the caregiver's responsibilities change when a loved one goes into a Skilled Nursing Facility, but they do not vanish.


Sunday I noticed Bill had "missed" the toilet so there was urine on the floor in his bathroom. I cleaned it up, but a little was left right at the base of his toilet - the same toilet that had a problem with the flapper causing it to run until it was adjusted. Monday when I went to see him it seemed as though the floor had not been washed. That day I also noticed he'd spilled a drink on the chest next to his bed. I picked up the styrophoam cup, but did not clean the chest - surely they would be cleaning later in the day. Tuesday I noticed the lovely bouquet of flowers we'd brought from the hospital really needed the water changed so I changed it. When I did so a couple of petals fell in the sink. Since I'd noticed the chest had not been wiped, and it seemed the floor had not yet been washed I assumed all would be taken care of later in the day I did not clean the sink out. Yesterday I went in to see Bill...he stood up and he had wet his pants and was sitting on his bed - not a recent accident either, I might add. I walked into his bathroom and dry urine was on the floor at the toilet.


Ann went into action....First stop was to advise the RN who was busy working at the med cart. She called the CNA, telling me Steven would be in directly to help with my husband. I told her I would take care of my husband - maybe he could take care of cleaning the room. Steven advised me he doesn't clean the rooms - would I like to speak with the Housekeeping Manager? Why yes, I certainly would. How about changing the bed - does he do that? Fine, he could do that. When the Housekeeping Manager came in I pointed out the few problems with the room...She called the Director of Housekeeping...He came in and was mortified - of course it would be cleaned. However, no one was there so he would SEE TO IT that the room is cleaned first thing this morning. And, oh, I forgot the soft drink on his tray - not sugar free...and then there are the two packets of sugar that come with his ice tea. I had told the RN about that before I discovered Bill was wet.


I'll be anxious to see what has been done today. I certainly hope they are able to find the time to clean his room. I informed them, rather firmly, yesterday that I am going to be in everyday. I will not allow my husband's dignity to be taken away in the manner I had already seen. He deserves to have his room cleaned and I won't stand for a room smelling of urine because it is not cleaned.


In order to "protect" Bill they have placed an alarm on his bed so that should he get out of bed someone will come to assist him. These alarms work so well - it usually takes a minimum of 5 minutes for someone to come check on the resident. I know what happened - Bill attempted to go the the bathroom, the alarm went off so he sat back down on the bed. The alarm stopped so no one checked on him. Now what? Well, what else is there to do but wet your pants???


As I said, caregiving duties change when a loved one enters a SNF - they do not disappear. I cannot change the fact that my husband needs this care, however I can ensure he gets the best care possible, his room is cleaned and he is clean. My husband's dignity will not be taken from him because he needs this care. His sweet spirit will not be taken advantage of through neglect. I will be heard!!!


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I am so sorry to hear of the problems. It can be really difficult to get good care when the patient is not able to demand anything. I do know that when my Mother was in a nursing home, the squeaky wheel method did work. These who had family who appear often and complain get more attention. My sister also did her laundry so she knew what clothes were being worn and what condition they were in. She also was able to go at unscheduled times so they did not have the option of being ready for her visit. We talked about it as managing her stay.


Keep complaining! And good luck to both of you.

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My comment from personally observing my aunt and other family members in these SNF is they all in my opinion like the personnel who really care about taking care of people, under their care, to be up to standards of cleanness.


There is no way sheets, beds, floors and the room in general should have to be brought to their attention cause it's not clean. There is NO excuse. I pray to God I never have to go into a SNF. I fully understand the reasons for those like yourself Ann who has to go that route.


I pray he get better and able to return home soon!

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I agree with you your duty as caregiver don't change, you need to keep eye on the staff such that Bill gets best care and dignity he deserves. being in hospital in itself makes you feel so hepless and that's why I think having patient's advocate is so important.




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It's ashame that it's the squeaky wheel that gets the attention in nursing homes, but unfortunately they are all so understaffed that the squeaky wheel theory is more fact than fiction. It's scary to think what the poor souls who have no one looking out for them have to go through.


When Don was in a nursing home shortly after his stroke, I once found him stark naked, laying in bed without the curtains drawn or the door closed. An aid had started a sponge bath, got distracted and never came back! All of us who've had loved ones in nursing homes can tell horror stories like that, I'm sure. Keep up the pressure, Ann. It's the only thing that works.



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I am Vi's care giver Misti, i have worked in nursing facilities for the past 18 years. I do agree with you, there is no excuse that things are not being cleaned up every day. They should have a house keeper on duty every day of the week. There are certain things that do not get cleaned on the weekends, but the floors and table are things that are cleaned every day and this is not only housekeeping's job. If the housekeeping is not around it was also my job. Most nurses do not like doing it but we had to right away. For the safety and cleanliness of the resident. There is no reason that your husband could not be placed on a bowel and bladder program, which would help with his being incontinent, or just the nursing staff laziness. Hearing about someone being taken care of like this gives the really good nurses a bad reputation, and it only takes one to do that.



Vi's care giver, Misti

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Now it's my turn. I was in a nursing facility for 5 months after I left the hospital for the therapy they provided. In my case, I was the squeaky wheel, but it didn't help much. The quality of care was not the best, but I had no choice. The therapy, on the other hand, was great.


My parents were in the same facility from 1988-94, but the care was quite good then. I made sure my visits came at different times of the day or evening, so no one really knew when I would pop in.


Sorry to say that you will have to keep on top of things at all times. Keep after them, Ann.


Wish I could clone Misti. She's 1 in a million and I am so lucky. She only works 2-3 hours a day and doesn't come on weekends.



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Unfortunately, everyone who needs to be in a Nursing home situation needs to have an advocate. I spent 4 weeks in one getting my step-down therapy. I had visited people in nursing homes years before and they smelled of vanilla which masks urine (I said masks) The place I was in did not smell of urine or vanilla because they took good care. That is the way it should be.


Keep fighting Ann. They will know they can't get away with it with Bill at least - and that's basically who you care about. If they do it for Bill, they will have to do it for all. That's the way it should be. They started with the wrong person.


Go Ann!

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You Go Ann!!!! If only we could all go with you and march in there and DEMAND better care for Bill and everyone else who doesn't have an advocate. When I was in rehab, fortunately, I was my own loud-mouthed advocate. Yes they were short staffed and underpaid - but they should have been expected to "earn" their hourly wage. The nurses I had were super, most of the aides were also. I had one aide though......I wanted to throw something at her....I literally had to nag and nag to get her to do anything. I'm sure she did a happy dance when I left :happydance:


I hope the squeaky wheel gets oiled and Bill gets treated with the dignity and respect he deserves. I'm sure that, if he doesn't, you will continue to climb up the "food chain" and get things resolved.

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:happydance: :happydance: :happydance:


Yes, family - it worked....The room was clean. The floor was washed...The sinks were washed...Bill had spilled a few lima beans on his sheet, so I changed that since there was a clean one I'd noticed in a drawer the other day!! He had a shower today, too but he wanted his hair washed again (I think they had him do it and he didn't feel like he got it done the way he wanted - he has so much hair, you know!!) He didn't remember that he'd brushed his teeth this morning, so he did that again - which was a good thing.


He was better today. He seemed more alert and said he hadn't gotten to sleep very early last night. For the first time he said he'd like to go to a "meeting" with me - but he didn't push at all. I told him we'd go out Saturday and he seemed absolutely satisfied. Now, if it doesn't rain Saturday we will be good to go! History tells me tomorrow won't be so good, but I'll take it as it comes. No expectations, no resentments about the situation I say.


At any rate, I am very aggressive as far as care for Bill. Even in the hospital I have a reputation I think - especially since everytime he goes in the hospital the nurses look at me and say - "don't I know you?"


Thanks for your encouraging words - you know I'll be looking out for "our Bill"!!!

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Ann, the best way is to find out who to talk to about your concerns. The cleaning of the rooms is one person's responsibility, nursing issues another's, activity issues yet another's. I also speak to staff wherever I see them so in the shopping centre as well as in the lodge. That way they are happy to see me, more helpful and approachable.


I find I complain less now, but seek information more. So I find out how Mum is sleeping eating etc. Most enquiries are well recieved. I also ask about updating her clothes etc and sooner or later someone gives me a list.


If this is to be where Bill will be for a while stay steady in your visits for a week or so and then gradually back off. You still need time for yourself and have to trust that Bill can stay alone for a while and still maintain his equilibrium.


I know it is hard to see them anywhere else but home, but sometimes home is not the best place.


(((Hugs))) from Sue.

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Thanks for the update on "our" Bill. Glad to hear he was having a good day - need to hang onto those days to get through the "not so good days". I hope you 2 are able to get out to a meeting. If not, there is always next week. I 2nd Sue's motion - take care of yourself - Bill is safe where he is at - so take time for you as well. Pamper yourself - then tell us all about it to satisfy all us "busybodies".

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Dear Ann--Kudos to you! When we had to put my father in a nursing home after his heart stent (sp?) operation, it broke my heart. He was so unhappy about it. The first day, as I was saying good-bye to him, I wheeled him out to the large window near where my car was parked so he could see me as I left. It broke my heart to see him in the window. It didn't get much better. My Mother had a devil of a time keeping things neat for him. She would go visit him and find his clothes were in someone else's room. The staff would move him to another room and leave his belongings in the old room. Yes, his room was not cleaned. Also, they would leave him a tray of food but he would not eat. They didn't check up on him. It was awful. In this case even the squeaky wheel didn't work. It got to the point that my Mom and I sat down together and we had individually come to the same conclusion: that my Dad wouldn't be any worse off at home. At least whatever we did, we did it out of love. By that time, he was skin and bones and we were convinced he was near death. So, we brought him home. After a few weeks, he was so much better. He recuperated from his operation and I got my Dad back. We were lucky that we could take him home.


It sounds like Bill's situation is different. Keep up your spirits and keep the staff on their toes. You're doing a great job. As some before me have said, Make Sure You Take Care of You, too! Take Care. LK

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