Toilet issues in a care home

Discussion in 'Middle - later stages of dementia' started by Violin1963, Jul 17, 2019.

  1. Violin1963

    Violin1963 New member

    May 9, 2018
    5
    Mum, who is 88 and has Alzheimer’s, has been in a care home for 10 months now following a fall. Her memory, conversation and level of understanding have rapidly deteriorated over that time. She is able to feed herself and is relatively mobile with a frame but is having more issues with going to the toilet and particularly remembering how to clean herself up afterwards. When we visit, the times we find her in a mess seem to be increasing. She has been in bed and wet, and when she goes to the toilet herself she can’t get her clothes out of the way, struggles using toilet paper, doesn’t flush, or wash her hands and invariably we or the carers have to tend to her to clean her up. When we raise this with the senior staff they don’t seem to think it is too much of an issue, that she manages quite well most of the time and say they will monitor her more closely when she goes to the toilet. Mum is on a tablet to keep her bowels comfortable. Should we be expecting more support for her? Alternative support? My brother seems to think the staff are not dealing with the issue in a proactive way and that she should have some form of incontinence support.
     
  2. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,414
    Female
    Yes, I would expect them to be doing more.
    My mother has been in a CH for 15 months, and until recently they managed to keep her continent by taking her to the loo every two hours. So during the day she was prompted and accompanied - they do this for all residents who need it. Then at night she had a pad in case the carer didn't get to her at the right time.

    But recently they noticed that despite this, she was having accidents during the day, and they arranged for the continence nurse to visit. She now has continence pads which I think she wears all the time.

    They should want to preserve your mother's dignity, and should be more proactive about this.
     
  3. canary

    canary Registered User

    Feb 25, 2014
    9,867
    Female
    South coast
    I agree with @Sirena . Mum started becoming incontinent soon after moving to her care home and the carers used to accompany her to the toilet to prompt and assist her. Once she started having accidents she was given pads which she very quickly needed day and night.

    It really isnt fair on your mum to be left in that sort of state.
     
  4. Violin1963

    Violin1963 New member

    May 9, 2018
    5
    First of all, thank you for taking the time to reply and apologies for my delay in acknowledging that - I’m new to the forum and it’s taking me a while to work out what to do!

    Thank you for your comments. It’s really useful
    And helpful to hear from someone who has experience of these issues. I think I should speak with the manager next time I’m at the home. It seems to me that when a family member is with mum the staff take their eye off the ball more. It’s very difficult to know when and what to challenge - they do such an amazing, demanding job - but the costs are astronomical and, like you both say, they should be doing as much as they can to preserve mum’s dignity and independence.
     
  5. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,414
    Female
    It is a bit of a baptism of fire when your relative goes into a care home, you have no idea what you can expect. And unfortunately what you can expect seems to be fairly random.

    I should say that my mother is not in a 'posh' CH. I chose it because it felt very welcoming but it is certainly not luxurious, it's slightly scruffy - but my mother couldn't care less about the decor, it's the care which is important. She pays £800 p.w. and the carers know each resident as individuals and the care is definitely better than average. I hope you manage to improve things for your mum.
     
  6. Violin1963

    Violin1963 New member

    May 9, 2018
    5
    Thank you Sirena, you are quite right -
    As long as the care is good then the surroundings are less important. The CH that mum is in has good CQC rating and the staff are all lovely but because of that it can make you feel unjust challenging.
    Can I ask what level of feedback you get on your mum? Do you have to ask how things have been?
     
  7. Imstressedout

    Imstressedout Registered User

    Jun 6, 2019
    30
    It’s so difficult. I visited dad in his last carehome and he started getting very agitated that he needed to open his bowels. I called for a carer and she just told him to do so in his incontinence pads and she’s clean him up after. He hit the roof (he’s a very clean person). She obviously saw the look on my face because as Dad is large and immobile then hoisting him is a real pullaver. She made a half-hearted attempt to get the hoist. Then said someone else would have to do it. Then I never saw her again. We moved dad to a new home shortly thereafter where they get him up every day, interact with him and is regularly taken to the bathroom. Personal care is very important and I think it’s right to flag it up if you aren’t happy.
     
  8. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,414
    Female
    I know what you mean about not wanting to challenge when they are doing such a difficult job. But you could frame it as a question rather than a complaint, as in "I'm a bit concerned, what could we do to improve this". By the way, the continence team only provide 3 free pads a day (or it might be 4, can't remember), so your mother would be asked to pay if extra were needed.

    I found it odd to start with that I didn't seem to get much feedback - the only time I was contacted was if she had a fall or was unwell. After 3 months I had a review with the manager when she went through my mother's care plan, but other than that I tend to be updated each time I visit - one of the senior carers will greet me and tell me how she's been, and what activities she's been doing. That was when I heard about the visit from the continence team. If I have any additional questions, there is always someone senior in the office so I can go in and ask.
     
  9. Violin1963

    Violin1963 New member

    May 9, 2018
    5
    I sympathise with you there. Dignity is very important and to dismiss your dad like that is intolerable. Thank you for your input it’s very much appreciated.
     
  10. Violin1963

    Violin1963 New member

    May 9, 2018
    5
    Thank you Sirena, your input is invaluable.
    I’ve visited mum today and she was wearing continence pants. Mum said she needed the loo so I went in with her. She was able to pull her clothes out the way and sit on the loo but when she’d finished she just wanted to pull her pants back up without any attempt to wipe. I took over and cleaned her up (although perhaps I should have fetched a member of staff?) I reported the incident to the staff so that they knew she wouldn’t have managed if she’d been on her own and so that it could be reported in mum’s plan. They implied that if I hadn’t been there they would have followed her to her room.
     

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