Management of continence

[Abysmal]

Hi all,
Sorry long gabbled post.
I’m pulling my hair out. My husband has been in a nursing home for over a year. He knows when he wants to pass urine or open his bowels but is almost non-verbal. After a recent hospital admission when he was acutely unwell he has been hoisted (waiting physio review) the dynamics have changed whereas when they were walking him he would be taken to the toilet if I asked, albeit having to wait sometimes up to two hours before they took him and invariably sometimes incontinent whilst waiting, now I have been told the staff are fed up with me asking every time I visit. Today he wasn’t got out of bed until 12 (and then it seemed a big ask) he was wet from about 11.00 when he grunted at me for the toilet, I asked at 3 if they could take him as he was starting to grunt and give me his look. They weren’t happy and this is when the staff nurse told me the staff are getting fed up. Am I being unreasonable asking for him to be taken to the toilet, he hangs on until he can hang on no more as he still despite being in the later stages of his journey doesn’t like using his incontinence pants. I keep getting told ‘won’t he use his pants’ or ‘ we’ll put him on the bed and change him’ yesterday he was placed on his bed, he was dry and clean so the staff wanted to take him back to the lounge, I kept telling them he wanted the toilet. It took 2 1/4hrs of him waiting on the bed before they fetched a commode, by that time he had started to open his bowels as he could hang on no more. Im getting so frustrated, the nurse told me yesterday I have to accept that he probably doesn’t know that he needs to go. Im not in any illusions about his condition as I have many years experience of being a registered nurse so I know each sign as it appears but while he’s got this awareness how do I manage it? Do I sit and ignore his ‘asking’ to appease the staff? what do I do as everyday I tell him to hang on and then latterly I’ve had to tell him I can’t help him he has to do it in his pants.
This is making me feel ill, where is the dignity?
If any has had a similar experience please tell me how you coped with this. If he was unaware of his incontinence I would be much happier but at present he has full awareness. To an outsider he appears far more advanced due to his aphasia and deteriorating motor skills which is making this harder.
Just to add other than this issue the home is caring and the residents are well fed and looked after.

 

[Louise7]

Hi @Abysmal my mum is in a nursing home and requires hoisting, although the situation is different as she is at a more advanced stage to your husband, wears pads, and doesn't need to be taken to the toilet. Did your husband only need one member of staff to take him to the toilet previously, rather than now needing two due to the hoist use? As there has been a change in your husband's needs since returning from hospital it's a good idea for his care plan to be updated to reflect that he now needs to be hoisted, particularly as this will also need to be risk assessed too. Could you ask for a review of your husband's care plan so that you can go through this and discuss his change of needs? If you are happy with the other aspects of your husband's care it's a shame if this is causing friction with the staff, but if they are struggling to meet the increase in needs, perhaps staffing is an issue? Perhaps a chat with the manager might be helpful, not in 'combative' way, just to explain the position and say that the situation is making you feel ill and ask how things can be improved to preserve your husband's dignity. It's a difficult situation to manage but I hope this helps.

 

[Abysmal]

Thank you.
He varied with the amount of staff, as with most people living with dementia. He usually needs two to stand, although a week ago stood up by himself as he wasn’t close enough to the table. Once he’s up and walking he generally walks with supervision of two in case he needs support so numbers required haven’t changed. He’s at that variable stage. I’ve now had a ‘talk’ about his care and the staff nurse is updating his care plan to try and fit his extra needs around the other residents. She explained that the carers didn’t understand which is why they were complaining. Still not to reflect his non-verbal cues but regular toileting might work. Such a difficult phase and until you observe it you don’t realise it exists. I never thought that his elimination awareness would still be present when he’s lost the ability to feed himself etc etc I thought it would be one of the earlier stages. But then, everyone is an individual,