Saturday, August 27, 2005

No One Should Have to Pee Themselves

Sorry for the graphic title, but I think if I....well okay let's back up a moment.

First, let me say that I think being a care aide, (or a Nurse's Aide, or a Resident Care Attendant, or whatever they may be called where you are) is an incredibly difficult job. I think generally, in Vancouver anyway, care is good, thanks to the many wonderful care aides. For the life of me, I don't understand how they get done what they have to in a shift, and have a shred of sanity left at the end of the day. To do it with compassion, gentleness, and caring is incredible.


However, if I hear one more time, as I have already three times this week about different facilities, where a care aide has told an alert and continent resident who has called for some help because they can;t get to the washroom, that if they can't hold it they should "use the diaper that is why you are wearing it," I will either scream, throw up, or both.

There is absolutely no excuse for anyone to say that . It shows a complete lack of understanding of the concept of maintaining dignity , and a complete lack of empathy. It is abusive, almost, and certainly demonstrates the power differential which is often perceived by residents, and makes them feel frightened an vulnerable.

If you hear of someone saying that to your relative ( or if they say it to you) you should immediately lodge a complaint.

To anyone who says that, I would like to put them in an adult diaper (and even the word is n ot great, but I am not sure what to use that really describes it), and have them lie in bed until they have to use the washroom, and then use the diaper, and then stay there for a few hours.

I know they are designed to be superasbsorbent and keep people dry.

THAT IS NOT THE POINT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

People should not be wearing pads, or diapers unless they have to. Every effort should be made to see if they can maintain continency or get it back if they have lost if for some reason. Personally, I think we should try to figure out why someone is losing continence. Check for things like urinary tract infection or other problems which might be easily solvable.

Now the other side again. I have heard family members lose it when they come into a facility and see their relative wet or smelly. Check first. They may have just been changed, And staff is busy. If they toilet someone, who is unable to make their needs known., that person may soil or wet themselves five minutes after the aide has left the room. The staff has done their job, but they cannot be there every minute.

Tuesday, August 16, 2005

Advice About Room Changes and Where Not to Pee

I went to see Mrs T.--one of my 98 year old clients the other day. She has lived many years in a nursing home, in a large corner room with a lovely view. She is a sweet, alert, and lonely lady, who never recovered from the loss of her husband a few years ago. Due to very legitimate changes in the home, ones that were really beyond managment control, she had to change rooms.

The home got Mrs. T a room on another floor, but the exact same size, same view, same everything, except the bathroom was changed around. They took care of all the moving expenses, and did all the work. Her family, most of whom live out of town, were aware. We talked about the moved beforehand, she chose what she wanted. It was all done right.

I went to see her after the move. She was exhausted, and cranky. "Everything is different, " she told me. "I don't know, it is just too much for me, I think I should go to sleep and not wake up."

We talked about how hard moving is. Not the physical work, but the worry. And the new staff, the change in her routine that comes with new people, even good staff. We talked for a long time, allowing her to ventilate and process what happened to her. I finally asked her what was different.

"The bathroom, " she told me. " It's all changed around. The sink is where the toilet was, and the toilet is where the sink was."

I got up to go look in the bathroom. When I sat down again, I looked at her in the face quite slolemnly for aboutfiteen secons. The I said, "Hmm. Well, I can see what you mean. You better be careful you don't pee in your sink."

She burst out laughing. "Now you're trying to make me laugh."

"I'm sorry, " I said contritely, "I won't do that again."

She laughed again. It didn't put things back, but between listening to her, and laughing with her, I hope it started to help her adjust. I will spend a lot more time with her on this.

The point is, that adjustment and change is hard on older people. A movc from one room to another in which everything is done, would seem simple. A change in the dining room would seem to be a small thing.

But they're not, when you don't have much left, in either things or energy . That's what makes eldercare so hard, and so special. That is also why the government needs to be aware of the policies and changes that it institutes, and know what the effects are. it is why staff and management needto think things through very carefully, and do a lot of problme solving before they decide to move someon's room .

Residents in nursing homes are not protected by Residential Tenancy Law. They have some protection from Licensing, and the Health Authorities, but it is not legal, and they have no recourse. They have no security. In the U. S., before a move takes place, there is a whole process which has to be followed,

We don't have that law, but we should. In the meantime, preparation and planning are essential when any move takes place. And you can object. You can read more about this in my book , "Nursing Homes: The Family's Journey ( ).

That is also one reason why you hire a Geriatric Care Manager. We can help you through this process, or other problem solving processes in nursing homes and in the community. If you are are out of town, we can be there for you. For more about Geriatric Care Management, please see our website

Tuesday, August 09, 2005

200 Years Old and Counting

The other day I stopped in to see a woman who lives very happily in a nursing home. She is 101 years old. She walks by herself with a walker, dresses elegantly, but needs a lot of help. She is alert, but a little confused about things. "My memory comes and goes," she told me. I wasn't sure how confused or disoriented she was, so I started asking her some questions. She knew her room number, she knew her children's names and her grandchildren. She wasn't sure what the year is, or even what the month or season was. But she knew where the dining room is, how to get outside, and the girls who take care of her.. She knew her birthdate. "So how old would that make you Mrs. M?" I asked her.

"Oh," she said, very seriously, "I think I am 202."

"Well," I replied, equally seriously, "for 202, I think you are doing remarkably well."

She looked at me happily. "Am I really?" she asked me.

"Absolutely,"I told her.

Stupid Excuses In Nursing Homes

Well, I just heard what could possibly win a prize for Stupidest Reason For Not Allowing Things, Nursing Homes Division.

A client of mine's mother was just discharged from hospital into a nursing home (on the first available bed policy), a rather old building where many people are still in four person rooms. Anyway, he was told he couldn't eat dinner with his mother in the dining room, because it would disturb the other residents!!!!!!!!!!!!!!!

Not "there isn't enough room." That would have been bad enough. IT WOULD DISTURB THE OTHER RESIDENTS!!!!!!!!!!!!!!!!!!!!!! DID THEY THINK HE WAS GOING TO GO PSYCHOTIC ON THEM IN THE DINING ROOM?????????????????????? DID THEY THINK HE WAS SUCH A MORON THAT HE WOULD BUY THAT??????????????????????

I constantly hear excuses from nursing homes about why they won't allow things. A lot of times, it is because they have been burned when they did. Many times they cannot do something because of staffing limitation (For example if they have a limited number of recreation staff, they can't have programmes going from morning till night seven days a week, or not if they are depending on recreation staff to do them, which is another itch I will scratch someday) But a lot of times it is just they don't want to think outside the box, or shift their system.

But, "You can't eat with your mother in the dining room because it would disturb the other residents" IS THE STUPIDEST EXCUSE I HAVE EVER HEARD.

I had to gag myself in order not to scream when he told me this. What can he do? He can call licensing, he can sit down with the Administrator. He can start a Family Council. He can call the Facility Liaison with the Continuing Care programme in his Health Authority.