@mykidsgranny - So sorry to hear your news. Such a difficult time…sending hugs.
@Aekmom . How horrible for your father. (and you). Since this is a safety issue, I would speak strongly to the manager/RN. But also if you do that, be prepared that they might kick him out. Depends on the state as to how easily it is to do , but usually there is a clause in your contract that states that they can kick him out for “non-compliance with directions”.
The other thing is to ask if they have tried to hire male aides . My mom’s friend in AL got kicked out because he wouldn’t shower… he needed support and all they had were young women working there… he wasn’t getting naked with girls!! Just offended his dignity. Even though his memory was really bad, he still had a sense of self and dignity. They did kick him out because he got combative about the showers. And I always felt like it was their fault. But guy aides are hard to come by.
For the soiling, he should be in depends and his level of care should specify how many checks per shift should be done. get that in writing, then monitor best you can. They can lose their license over stuff like that. And I’d find out who/where the state office that regulates AL places is. Oregon has an on-line place you can see complaints against places.
So heartbreaking.
@Aekmom I empathize with you. My Dad has major issues with showering. When he first moved into Memory Care, 18 months ago, they would call me and complain that he wasn’t showering and ask me to ask him to shower. He doesn’t listen to me about anything so it was very frustrating. My Dad was going weeks without a shower. He had convinced himself that if he showered he would die. (The dementia logic went something like, he has gout, his brother had gout, his brother died (of alcoholism, not gout), so if he takes a shower he is going to die). They asked us to buy special odor controlling laundry soap, dry shampoo, etc… He was also refusing to let them cut his hair or shave him. He really looked (and smelled) awful. There were a lot of changes in staffing (new company bought the facility, new director, new (more experienced) staff. The doctor got involved and now he is showered twice a week. He screams and yells and makes a huge scene, but they shower him twice a week. The doctor prescribed Ativan to give him prior to showering to relax him a little. I am not sure how often they use that or if it is effective. If the staff isn’t willing to make him shower, maybe you can hire someone to come in and shower him?
State by state and facility by facility…
At Skilled Care with our facility, residents have a shower schedule - first or second shift, M - W - F or Tu - Th - Sat. If a resident refused a shower, the nurse talks to the resident. Sometimes I let them get a bed bath or a good cleaning up, but most times we get them into a shower. We do have one lady with dry skin and really high anxiety (and many other medical conditions) that we allow her to have shower once a week and good cleaning up the rest of the time - and she does stay clean.
H’s dad had to get over his modesty issue with someone other than his W helping him (when she could no longer do it). H did manage him for several showers and talked long to him - now he is allowing the caretakers to assist him. A man can put a washcloth over his privates in a shower chair.
The medications to help with anxiety can help.
Just have to get him on a schedule. Outside help can perhaps be helpful.
Some do like to stay in pajama and lounging type of clothing at skilled care, but when you go to dining room for meals (at assisted living) one needs to get cleaned up and dressed. Some of our residents have some meals in dining hall with assistance there, and some trays are in their rooms.
The ability to maintain the minimal basics. Hope you can find a way to have his care be managed. Sometimes the staff gets use to the resident doing more for themselves and don’t readily realize they need more help. Overlooking what you indicated @Aekmom may be a staffing person issue or more checking on his care needs.
High turnover with personal care attendants - maybe more so with skilled care than other care facilities. It also is how they are managed and how well they like the residents/co-workers and their personality and work ethic.
Thanks everyone for the feedback and ideas…I am not sure how Depends would work…I worry about more of a mess as they are harder to pull down and he has awful balance issues…
I wouldn’t worry about the dressing thing except he is in a t shirt and boxers
@Aekmom -So sorry for this circumstance. People have shared some good ideas. Full disclosure: such issues are hot button ones for me.
Is your father in skilled nursing level memory care as opposed to assisted living level of care? Family members often have to “tweak” their senior’s experiences in any care facility to optimize the fit and refine routines. It is a matter of degree. Regardless of his opposition to showers, your post is describing unacceptable, unsanitary conditions that the staff appear to be comfortable both ignoring and blaming on an impaired resident. This likely will be a constant battle towards ensuring that the facility meet minimal health standards. Are there alternatives? Can you hire a compassionate professional for critical times as you sort this out? That may help you discern what is unavoidable for your father right now vs how much difference the right approach can make.
My father spent about 5 years in a high quality skilled nursing memory care unit. No odors were evident, people were treated with dignity, the residents’ rooms as well as public spaces were kept very clean, and much was professionally finessed to make each resident was relaxed, well-groomed and comfortable. Lots of the them required extensive help with ADLs. Such places exist and his was a non-profit.
Additionally, it should be possible to figure out ways to have most residents dressed and all residents clean if pros with a good “tool box” are on it. If you haven’t already, try simple pull over polo shirts and pull on pants. Lands End makes some passable knit pants that allow for an easier process for your father and the staff.
To me, any medical facility indifferent to the conditions you describe is flying a red flag. My efforts would be to determine if other options exist and if so, re-locating my relative. One may become a persona non grata very quickly in these circumstances.
I have seen a place almost as you describe “up close”. In my observation, staff attitudes often track with quality of care and less than warm treatment can become institutional. It could be your father is not as cooperative as he might be if shown sincere interest by his caregivers. I do understand that some with cognitive impairment are uncooperative no matter who is attempting to help them or how.
I’d photograph and note health violations for myself, try to move my relative and then consider reporting problems to appropriate state agencies- after my relative was out. You can also review annual state reports on most nursing homes now and assess any previously documented problems.
Sorry if these ideas seem out of proportion to your actual experiences; the conditions described are worrisome to me. I have had my parents and in-laws in senior facilities of various types for many years; quite an education.
Aekmom, I so feel for you! My mom has been in the best assisted living memory care in the area, according to people who work there and have worked at a lot of others. It smells good, the residents are dressed and are involved in group activities much of the day. But there are still issues, one of which was very evident when Mom had her downturn yesterday and ended up in ICU. She probably won’t leave the hospital, but I don’t blame the facility because of the broken arm and resulting complications.
But, if my step-daughter hadn’t been on management staff there, there is a long waiting list plus the residents of the assisted living get priority admission when they need to move to memory care. Jill got us in because a room (apartment?) opened up and she is the one who oversees who is moved in. You are basically caught between a rock and a hard place because of waiting lists. People are living longer, but only physically. What is going on with your dad isn’t acceptable in any way, but can you even move him? I made friends with several of the aides at Mom’s facility, and made sure to tell them how much I appreciated them. BUT they loved my mother and doted on her (and knew she was Ms Jill’s grandmother).
You might make some phone calls and see if another facility has an opening, but I just don’t know. My heart hurts for you.
Moving on, my mother had a horrible day, very agitated, reaching for something I couldn’t see and trying so very hard to talk, but just babbling. She had no orders for anything that would calm her, so when the cardiologist walked in and introduced herself, I immediately asked her to write some Ativan. She did, happily. She has taken Mom off antibiotics (her sepsis is too massive to try to overcome), no more blood draws, no more tests, Morphine for pain and Ativan as needed for the agitation. I love the cardiologist; she suspects that Mom has had a stroke, and I think her techs who did an ultrasound saw something that caused her to come see me. We just never got around to talking about it. I will call the social worker in the morning (if Mom is still with us) and get hospice involved. She has lived for 97 years with a lot of trials mixed with the happy times, and it’s probably time for her to go see my Dad. He has been gone longer than they were married.
I’m glad the cardiologist was able to help give your mom some comfort from her agitation. Also great they are stopping heroic measures.
@mykidsgranny so glad the cardiologist was able to help you. Your mom has lived a long life and deserves peace.
@Aekmom I would buy that your father is refusing to shower or get dressed. It might be the way he is being asked, his mood at the time, change in environment, and a whole host of other things. We find that a schedule doesn’t work super well for my dad, and showers need to be done in the AM when he is not super agitated and sun downing starting at 2p. But, if he refuses, leave him alone and come back to him in about 30 minutes. Sometimes, it needs to be an aide who he has learned to trust. I don’t think a traditional memory care could handle his behaviors and the flexibility of the personal care home is really useful for hygiene issues. He is not always out of PJs, but usually is and always clean and the PJs don’t bother me. As for Depends, we found he took to them well and they are no harder to pull off and on then regular underwear.
@mykidsgranny - wishing you all comfort and peace…
@mykidsgranny - thinking of you and your mother. How fortunate she is to have your care and not be subjected to further medical procedures.
In case it is relevant, my father had trouble swallowing near the end of his life and was a bit “gurgley” from aspirating, etc. He was given under the tongue medicine to help calm that symptom (can’t remember the name); a side effect of it was some of those random movements, including reaching as you describe. I would imagine that the morphine and Ativan will help minimize that.
All the best and take good care.
I am so sorry @mykidsgranny.
I have an elderly resident on Ativan, and the small half pill still has to be crushed and put in thickening because it would get stuck in her mouth or she would cough (even with the tiny pill!).
As soon as you can get Hospice involved, the better - helps ease lots of things. If you have a choice on Hospice services, ask around…including the medical staff who have experience with the agencies.
One would be surprised how well the Ativan can help.
Working the 3 - 11 shift, my aides and I are use to the sun-downing with several residents…
They are giving the Ativan through the IV, she can’t swallow anything. I know which hospice to choose if I am given a choice. My step-daughter is a wealth of information.
IMHO you always have a choice - just let them know before they assign one w/o checking…
My FIL and SisIL wanted and got morphine under their tongue (sublingual) to ease distress in breathing.
Thinking of you mykidsgranny
I put Mom under the care of Methodist Hospice because she is in a Methodist hospital; if the hospital doesn’t get urgently overcrowded (which it is almost completely full now), she can stay in the bed/room she is in. If she has to be moved, they have a hospice residence that she will go to.
Thank you all for the care and support.
Comfort to you and your mother, @mykidsgranny.