Care facilities following standard of care donāt just āforgetā about catheters. You can talk to whoever writes orders/makes changes to see what they think about your dadās catheter and his medical progress since placement - or the charge nurse for that unit. What happens elsewhere - you just need to concern yourself with what is going on with your dad in his facility.
For skilled care and rehab (in our state) the Medical Director (who makes rounds every week, and also there are NPs to also have medical decision making 24/7 - in facility or on call) are the decision makers (gaining input from nurse manager over that unit) to decide if a resident should go off the urinary catheter, or if it is time to change out the catheter. Do not assume a person with a urinary catheter is going to have consistent UTIs. If a personās behavior has a dramatic change they check for a UTI first.
@momofboiler1 your momās situation is different than this one. My mom never had a catheter - she died of dementia but her decline at the end was very dramatic. My sisterās mother in law was in nursing home bed for 12 years with dementia (during that time not knowing any family members - she had 8 children) and I can bet she had a urinary catheter that was well managed.
There should be enough tubing on the urinary catheter for him to move around in bed; when transferring to wheel chair or to walker, the bag should be emptied and then moved before your father. Perhaps over the past weeks at home with a diaper and his sore bottom he is just instinctively protective of that area or with the dementia and not knowing the person is a caretaker or a wife/daughter is reacting in a withdrawn manner. Get feedback from staff on how he is when you are not there - you may recognize some regular caregivers on the different shifts. I have seen men with dementia who just cannot process what is going on even when you tell them what you are checking and what you are doing. One man calmly asked me āare you raping me?ā when I was checking his private area.
Anyone in a diaper in skilled care or rehab (or in the hospital) should be checked every two hours - so the diaper changes for wet/soiled diaper should be happening during the night as well ā not 3X/day. The urinary bag should be emptied at a minimum each 8 hour shift; if ambulatory or getting in and out of wheel chair more often.
You may believe he is going to do a lot better, and maybe he will.
When I was charge nurse on a rehab unit a few years ago (3-11 pm shift), we had a 92+ YO man that had come from the hospital after a series of cardiac issues. He was in a wheel chair during the day in between PT sessions, and in the evening prior to going to bed (he was continent of bowel/bladder so transfers to toilet or use of urinary bottle). His son came by and was encouraging the man to do more walking; I could see how sick the man was. I know the family is stressed with transitions on their loved one ā and they are just expecting gradual changes and gradual improvement is hoped for. That very night, he had a stroke, was transferred to the hospital through ER, and died. Again, a facility following standard of care makes rounds - in rehab each shift vital signs are checked. This manās room was close to the nursesā station (planned for sicker residents).
My mother in law did great her first week in skilled care and then dramatic decline to death the second week. As soon as she declined, DH went right back up there ā 850 miles drive each way (so he had been with her for long stretches and helped feed her the last food and drink she would take); I told BILs with this decline to plan to get there ASAP. The BIL 5 hours away sat with her for her last two days. BIL - 800 miles away didnāt drop things immediately, stayed overnight on the drive, and arrived a few hours after she died. BIL and SIL from the distance location were āshockedā. Heck she was 92, had been on major meds for years being well managed for cardiac issues, diabetes, etc. - her nearby pharmacist son and medical providers had her being well cared for/well managed. My RN DD and I (also a RN) had been there months earlier as she was recovering with severely swollen legs and leg sores (which did heal as she got better) - that is all from her failing heart and the diabetes with the sores taking longer to heal. At the end, her chest filled up with fluid due to cardiac failure.
@compmom good for you to outline exactly what needs to be done and having your mom getting best care, and scheduling your time to be there. Glad you were informed by your mother of the appointment time and got that day taken care of! Also the list of tips was great. I know you are worried, frustrated and exhausted. Doing YOUR BEST. Sending hugs.
Once her arrived, EMS was called. No one can be at the hospital with her, but my BIL was at the apartment once he was called.