Toileting needs/Pad assessment

[jomc]

Hello
Can anyone tell me how I go about getting my mother in law assessed for wearing pads full time? She is in a care home and wears pads at night, as she cant find the commode or toilet quick enough according to the staff.
However, we feel that she needs them during the day. Staff say she takes herself to the toilet....well, she does but she doesnt actually do anything in there. When she finds a toilet she walks in, and just messes about with the soap or toilet brush etc...she doesnt actually go. Twice I have visited lately and she had faeces in her pants. She, sorry for this, constantly smells of urine so I feel shes dripping or not wiping properly.
However when I have brought the subject up the staff tell me shes fine.
Can I insist? Do they carry out the assessment themselves or is it independent? Im worried if I insist they will do it but just say shes fine.

Many thanks

 

[AlsoConfused]

Which staff are telling you MIL's fine? If it's the carers I'd suggest making a written note of the occasions on which your MIL was whiffy and dirty and talking to the home's manager. If that's practical, don't announce your intention beforehand, just speak to the manager when you can show him / her the problem!

If it's the manager who's resistant, could you bring in an independent high status witness (eg a vicar, SW or GP relative) and then jointly tackle the manager? Get any necessary changes written into your MIL's care plan.

 

[jomc]

Many thanks!
Its the individual carers that are telling me she is fine...I havent yet approached it with a senior member of staff yet as I wasnt sure if I should or not, before knowing how to peoperly go about it
Thanks for replying ☺

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[nita]

Your mother needs to be assessed by a continence nurse, part of the District Nurse service. You can get in touch with them or the care home can. I would pursue this. I think I got the phone number from the GP in the first place.

 

[grove]

Many thanks!
Its the individual carers that are telling me she is fine...I havent yet approached it with a senior member of staff yet as I wasnt sure if I should or not, before knowing how to peoperly go about it
Thanks for replying ☺

Sent from my Nexus 7 using Talking Point mobile app

Hello , Have just read this & just wanted to add in all the C Homes & Nursing Homes I have worked in over many years ( as Kitchen helper but all ways out & about taking Breakfasts / Tea Trolley etc ) The Carer's all ways did a proper * Toilet round * e g before & after meals etc . You did not say in your 1st post if this was in place for your Mum-In - Law ?

A well run C H should all ways update the Care Plans as & when needed ( am talking generally here ) The company that I worked for does spot Inspections on Care Plans to make sure they were well written & had all the correct information in them etc . Snr Staff from Head Office would do the Inspecting ! ( I am sorry to go off on a ramble ! ! )


Do hope you & the Staff are able to sort the problem out & give your M-In-Law her respect & dignity back ( 2 very important points in her Care )


Grove x x

 

[jomc]

Many thanks

I have asked if they ensure she goes to the toilet frequently or is supervised at any point during the day...but again they said no, as she is classed as being able to attend to her own toileting needs. They ask her if she has gone or needs to go and she says yes/no...however she has advanced dementia and I have told them bluntly that to be honest, shes incapable of answering that question. There have been times we ask her, just to give her a sense of independence but with a view to toileting her anyway, as to whether she needs to go. She will say no but we bring her in and encourage her anyway and she, as the saying goes, pees like a racehorse! Or, she will insist no, refuse to go, and 5 mins later she has started dripping...so her bladder is def full.
I am curious as to how often, when we are not there, she is incontinent and whether this is properly recorded in her daily notes.
I have no problem with her being incontinent, thays just life unfortunately...Im not looking for a miracle cure...but I have a pronblem with someone walkig around smelling of a mens urinal

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[AlsoConfused]

It's not only a question of smell ... your MIL's health, comfort and the state of her skin are likely to suffer if her skin's left wet or dirty.

Female dementia patients in particular often go down with Urinary Tract Infections (UTIs) even if they're given the best of care with personal hygiene. Your MIL doesn't seem to be getting good care and I can't understand these individual carers seems so unconcerned about it. Good luck in sorting out the problem.

 

[Katrine]

"she is classed as being able to attend to her own toileting needs." They are either lazy so-and-sos or not sufficiently well trained if they 'class' the more ambulant residents this way. The fact that someone can walk about OK doesn't mean that they can manage all their personal care needs.

We encountered a similar attitude in the first CH that MIL was placed in. The place stank of wee and although it was obviously kept very clean the carpets in all the bedrooms seemed to have had regular drenchings that no amount of steam cleaning could cure. MIL could not find the toilet and at night there were problems that really compromised her dignity. The poor thing was weeing in waste bins, pooing in ornaments, and it was just because she did not know where to find the toilet.

When she moved from there I had to throw out nearly all her clothes and all her very expensive shoes. It probably cost about £400 in lost clothes and shoes. The staff said MIL had regular episodes of incontinence but did not put her in pads. They would say, we've shown her where the toilet is, but she keeps asking every day. Hello, resident with dementia, she can't remember what you say however many times you tell her!

At her current CH she has an en suite toilet, which helps a great deal, especially at night. She still has to be prompted to toilet regularly. The staff will prompt every hour during the day, and always before mealtimes. She has been there 4 months and has had NOT ONE single incident of incontinence. It just shows how better monitoring and management can make all the difference. What an improvement in her dignity too.

 

[Angel18]

My mother is 96 and is in a nursing home and suffers from Vascular Dementia. We are reliant on the carers to ensure that she is taken to the toilet on a regular basis as she does not always realise that she wet or soiled herself and is not always able to make her wishes know that she needs to go to the toilet, she wears incontinence pads. My mother cannot walk any more and is reliant on two carers to help take her to the toilet . I visit my mother on a regular basis and when I first see her I always ask her if she needs to go to the toilet, she always says yes and nine times out of ten you can tell by the smell that she has already gone. I am concerned that the carers are not checking that she needs to go to the toilet on a regular basis, it is not helped by the fact that my mother is partially deaf and keeps taking her hearing aids out and cannot hear or understand what the carers are saying and as a consequence will often say no when she should be saying yes and vice versa. When I have raised my concerns with the carers and the head of my mother's unit they have told me that my mother is checked on a regular basis but I have my doubts. My mother suffers from regular UTI's and this is a great concern to me as it just adds to her confusion and makes her feel so unwell. How often do you think the carers should be taking my mother to the toilet? and what is the best way to broach this subject again with the head of my mother's unit and to get my point across effectively. Any advice given would be greatly appreciated. Thank you.

 

[Scully]

"she is classed as being able to attend to her own toileting needs." They are either lazy so-and-sos or not sufficiently well trained if they 'class' the more ambulant residents this way. The fact that someone can walk about OK doesn't mean that they can manage all their personal care needs.

We encountered a similar attitude in the first CH that MIL was placed in. The place stank of wee and although it was obviously kept very clean the carpets in all the bedrooms seemed to have had regular drenchings that no amount of steam cleaning could cure. MIL could not find the toilet and at night there were problems that really compromised her dignity. The poor thing was weeing in waste bins, pooing in ornaments, and it was just because she did not know where to find the toilet.

When she moved from there I had to throw out nearly all her clothes and all her very expensive shoes. It probably cost about £400 in lost clothes and shoes. The staff said MIL had regular episodes of incontinence but did not put her in pads. They would say, we've shown her where the toilet is, but she keeps asking every day. Hello, resident with dementia, she can't remember what you say however many times you tell her!

At her current CH she has an en suite toilet, which helps a great deal, especially at night. She still has to be prompted to toilet regularly. The staff will prompt every hour during the day, and always before mealtimes. She has been there 4 months and has had NOT ONE single incident of incontinence. It just shows how better monitoring and management can make all the difference. What an improvement in her dignity too.

That is so encouraging - I am having a similar problem.

 

[Tatiana]

Jomc - reading this I was almost shouting, 'same here!!!'

MiL frequently has accidents when she's out of the Carehome, and wears pads when she's out (though our point was, well, clearly she needs something more absorbent as she's wet through and has to change her clothes?) According to the Carehome manager she's been assessed by their own continence nurse and only needs pads at night and that 'with help from the carers, she can still manage her own toileting needs'. My sister in law reports back that her Mum has been having accidents and is taking off her wet clothes and drying them on the heater. Or simply stuffing them in a drawer with her clean clothes. Or saying she's 'OK and it'll dry off' whilst tottering about hopefully. With the inlaws moving to be near us, I was utterly determined that we tackle this issue and get her proper protection for her quality of life, comfort and happiness. Husband fired off an email to the current home last night saying basically, 'she needs to wear pads ALL THE TIME, whatever she might be saying to you. And she probably needs pull-up pants at night, not just a pad, as she's wet the bed and 'not wanted to bother anyone' so she got blankets out of the cupboard and slept on the floor.' (The sleeping on the floor was heartbreaking to think about.)

This morning, the Manager replied simply, 'of course we will see to it.'

I just feel cross and upset for my MIL, I really do.

 

[Scully]

Jomc - reading this I was almost shouting, 'same here!!!'

MiL frequently has accidents when she's out of the Carehome, and wears pads when she's out (though our point was, well, clearly she needs something more absorbent as she's wet through and has to change her clothes?) According to the Carehome manager she's been assessed by their own continence nurse and only needs pads at night and that 'with help from the carers, she can still manage her own toileting needs'. My sister in law reports back that her Mum has been having accidents and is taking off her wet clothes and drying them on the heater. Or simply stuffing them in a drawer with her clean clothes. Or saying she's 'OK and it'll dry off' whilst tottering about hopefully. With the inlaws moving to be near us, I was utterly determined that we tackle this issue and get her proper protection for her quality of life, comfort and happiness. Husband fired off an email to the current home last night saying basically, 'she needs to wear pads ALL THE TIME, whatever she might be saying to you. And she probably needs pull-up pants at night, not just a pad, as she's wet the bed and 'not wanted to bother anyone' so she got blankets out of the cupboard and slept on the floor.' (The sleeping on the floor was heartbreaking to think about.)

This morning, the Manager replied simply, 'of course we will see to it.'

I just feel cross and upset for my MIL, I really do.

That is outrageous and completely unacceptable. We are talking basics here. Why can't they get it right?

 

[BR_ANA]

Some neurologist advice against diaper because lost bladder control is a simptom of which phase the dementia are.

I would talk with manager about dirt clothes, and as said before take a witness with you