Need some help as far as what to do regarding what is proper behavior from an aid at an assisted living facility, and how to proceed, if at all?
My mom, who lives alone, in her own apartment at a pretty nice AL facility, and who is starting to need more and more assistance as of late, called me on the phone tonight and was upset. Some background is that according to my mom, the staff seems to be getting more and more militant as to when she needs to get dressed for bed and instead of helping her, they will just stand there and watch offering no help. This facility did just get a new manager and head nurse, and staff is understaffed and are leaving.
So tonight, my my mom called me and said that one of the long-time female aids, came into her room (and usually an aid will come at bedtime to make sure she has on her PJ's). The aid told my mom that she (the aide) needs to make sure her diaper is dry before going to bed. My mom, on her own, had just changed the pad within the diaper, and everything was dry, so no need to do anything - and told her this. The aide did not believe my mom. Then, the aide proceeded to go behind my mom, who was standing, (with the help of her walker), and while in the living room, the aid pulled my mom’s pants and diaper down, and from behind took off the pad that was attached to the diaper, changed it, and pulled her pants back up. My soft spoken mom, recenlty diagnosed with Parkinson's was a bit in shock. Yes, they help her, but it's usually when she asks and while in the bathroom or changing, and it's just to pull the diapers up and over the hip. But not smack dab in the living room and when my mom indicated this was not necessary or called for.
Later, when another aide came in, my mom told her what happened, and this aide said we just need to 'make sure you are dry'.
My mom told me she is ready to move.
My question is…do we say nothing and tell my mom they were just doing their job? Do we tell the head nurse? Do we move? Is this a big deal? I think it is. Or are we over-reacting? We have not had a problem like this before, and I don’t want to get this staff member in trouble, but I think her actions undermines the trust in her and the staff. It just feels so wrong. Yes, my mom is old and slow, is hard of hearing, soft spoken, but this just feels not quite right and powerless. Any advice? Thank you ahead of time.
I wouldn't move Mom over one aide - but I WOULD speak up.
Speak to the Manager in private. Discuss how the incident your Mother described did not meet reasonable expectations for consent, respect, dignity & privacy.
Ask about bedtime routines. Has there been any changes to be aware of?
Keep the discussion respectful but honest. Use the aide's name (or names) if there are specific staff. Hopefully the Manager can use your feedback for training - to improve quality of care.
The staff may have "orders" to make sure everyone is dry before bed. I imagine they don't want there to be wet beds or skin break down from someone being left in a wet diaper. For example, I know that at some hospitals there could be orders that the patient be changed every 2 hours around the clock and if the aid does not do it, they get in trouble. Skin break down is a big thing and no one wants to be responsible for letting that start.
I'm sure there are many people in her AL that have dementia and aren't taking good care of their hygiene properly. It is unfortunate that your mom got lumped into that category. The aid could have handled this much better and at the very least talked your mom through what she was going to do. She could have nicely said "OK, but I'm just going to take a quick peek here and just double check. I don't want you to go bed with your pad even a little bit wet. Sometimes it's hard to tell."
I'd talk to the nurse manager about how this was handled, etc. I wouldn't move mom unless there are other issues. No place is perfect.
#1 FOCUS: communication with client; explain yourself and what you are there to assist with.
*Respect their privacy and dignity; allow them to let you know what they need. (Unless advanced dementia, etc...that's another gentle approach, but different)
*Do not rush! Remain calm and give eye contact.
*Explain what you are going to do, BEFORE you do it.
Ugh.....my heart aches over the years at the disrespect and lack of dignity provided to our aging population. I am so sorry for your worry and sorry for the feelings your mom has.
xo
Diana
OR did this happen in the "living room" of your mother's own apartment?
If the former, this is a serious violation of privacy and the aid would be fired. If the latter, the removal of the pad may indicate that the aid WAS checking and your mom WAS wet and she was changed. In the privacy of her own apartment.
We know nothing about your mom, how reliable a reporter she is.
Only YOU know that.
Nor can we know what you mean by "in the living room".
If your mother's mentation is spot on, and if there were others in the room to witness this, it is a violation of privacy of the worst kind.
So. Start with questions for Mom:
1. Were others in this public room?
2. Would these others tell what they saw happen?
If the answer to both is yes, then off to go--next step--to an appointment with the administration.
If however, your mother is becoming more confused, you may be looking at an issue of whether or not ALF is correct placement at this time or if memory care is needed. Especially if she is wet and unaware.
You mention also that they witness her getting ready for bed but don't "help". They are in this instance doing their job well. Not helping actually takes MORE time but it maintains the elder's abilities to do self care, and doesn't enable deterioration. Just whisking them into their jammies may look like help but it is actually "hurring things along".
The fact that staffing is poor and staff is overwhelmed is nothing new in in-facility care these days. Things happen. Things go wrong.
But if your mom is a "reliable reporter" and if this was a PUBLIC incident, this aid would be fired for EXTREME violation of a patient's privacy at a very high level. This isn't OK!
When you speak with administration be certain of your facts of where this happened, who was present, and who witnessed this. To me it sounds as though it may have happened in Mom's own rooms, that she was checked. That she reported. That she was reassured that they were only checking to be certain she was dry. But I wasn't there. More information gathering may help you more. Hope you will update us.
It may clear up exactly what is going on . So far you have one side of how it happened . I did read it as they were in your Mom’s own apartment . It doesn’t hurt to talk to admin about it , also about the approach the aide took .
FWIW , my FIL always said he was dry and refused to be changed . I complained that they weren’t more persuasive . They let him say No too quickly . Ended up with bedsores.
It wouldn’t hurt to let Mom get used to them checking . You may regret later if you fight this battle for her which could result in her refusing to be checked down the road, when she needs to be checked . Also ask if perhaps they were finding Mom wet at times ?
When we were trying to get My FIL to let them help him , he lied to us and said they were checking his bed and it was never wet. It was reported to us that he refused care and his bed was wet every day . The evidence was that FIL pants and pajamas were always in his laundry basket wet with urine . FIL was changing his Depend maybe once a day when he dressed in the morning . He kept saying he changes his underwear everyday .
It took months for me to get the staff to believe he wasn’t reliable , when he said he was dry or when he lied and said he took a shower. He could carry on a great conversation but was not able to recognize his diaper was wet . He kept saying he was “ independent “ and didn’t need any help at all . At first he was changing his depend maybe twice a day . But later he didn’t so often and was leaking through onto his bed and chair .
Things are not always how the parent tells you they are . Cameras will clear that up , and help you decide going forward .
Have them check her diaper in the bathroom .
Have them offer to help with her pajamas .
Also , It sounds like Mom’s pad was wet , since the aide pulled it off and put a new one on . It sounds to me as if there is now a reason that they need to “ make sure she’s dry”, as the other aide said .
Often it’s necessary for staff to say “ It’s time to freshen up , or check “ in order to get a resident to allow it .
Asking if they are wet , often does not get an accurate reply , and results in refusal to have staff help . Mom may be struggling with the fact that she needs more help .
I'm not saying that's what happened in this instance, but it's something to consider. These behaviors creep in. You think your person is perfectly normal, but they're not, and you don't realize it for a while.
Just food for thought as you move forward.
My mum had vascular dementia, but the nurses in the hospital and carers at home all maintained her dignity when assisting her with intimate hygiene care. I also asked Mum's permission when helping her to use the toilet or when getting her changed.
These things were always carried out in the bathroom or bedroom, or behind screens in the hospital. Not in the living room and not without either asking permission, or informing and checking Mum had understood (depending on whether Mum was experiencing a good day or a bad day).
I already knew the basics of maintaining someone's dignity, from Mum when she worked with either elderly patients or residents. (I helped Mum type up her college notes when she attained higher qualifications, and learned a lot about caring and safeguarding.) Mum's carers and nurses all taught me the practicalities by their example.
Obviously, a non-cooperative patient/client might need firmer handling, but that isn't the case here.
When Mum became non-responsive, the carers and district nurses checked Mum's incontinence pads while making sure that Mum was covered with the sheet. Even then, she was never exposed.
I cannot fathom how anyone could think it's okay to ignore another person's rights in this way. Perhaps the carers need better training in this particular facility.
Mom had private duty CNA's who also worked at Assisted Living places. I think each one generally had 10 or 12 residents they looked after each shift. It was a lot for them. They would have to race from one to the next resident all day long.
While I understand the aide was likely trying to do her job, her approach was not considerate of your mom’s feelings or privacy. This kind of experience can undermine the trust that residents have in the staff, which is so important for their well-being.
I believe this situation should definitely be addressed. Reinforcing the importance of empathy and respect in caregiving it's crucial. Your mom deserves to feel comfortable and safe in her home, and this incident highlights a need for better training and communication among the staff.