(Awkward question I know.) My 95-year-old father is in MC facility under hospice care & is bedridden. He is slowly deteriorating as expected, but seems to be comfortable. He has gotten very skinny. I'm concerned that he is not being turned every 2 hours. It takes 2 people to turn & position him & my gut feeling is that, since he is being monitored by hospice, the staff of the MC do not think he needs as much attention from them. On multiple occasions when I visit & ask about it I am assured that he is being turned. However he is in the same position each time I visit. I know that may be coincidental & that he may have been turned appropriately before I got there. However, I have a sitter with him at night & she told me that she has difficulty getting anyone to help her. I have discussed this with the executive director & the nursing director at least twice & both have reassured me that the staff will help. However he has developed a skin breakdown area on his lower back, according to the sitter.

I am going to tell the hospice nurse about this so he can monitor the area. I know that this could have happened anyway, but I want to limit the damage as much as possible. In the meantime, I want the executive director & nursing director to emphasize to the staff how important it is that he be turned appropriately & hold them accountable if he isn't. Also I will photograph the area next time I'm there.

Am I dreaming? Do I need a doctor's order? I know the directors can't be there day & night, but there's got to be a way. I've purchased wedge & extra regular pillows with which to prop him. It takes 5 minutes to turn & position him, if he hasn't been incontinent.

I hesitate to get firm with them because they may retaliate. I have twice asked the directors to tell me when they can no longer provide the level of care he needs & I've been assured that they can manage. I have contemplated moving him to a different place, but in my area all the long term care facilities are sketchy & I'm sure are having staffing problems as is everyone. So would it be any different?

I guess I need some guidance on how to write an email that is firm, but non-threatening, if such a thing is possible so that they will take this seriously. I know I can't tell them how to run their "shop", but I want to do all I can to hold off the ravages of being bedridden. Thoughts?

nature73, so sorry your Dad is going through this. One has to remember at night there is less Staff at the facility for the same number of people.

It is not unusual to have emergencies where those Staff members are helping out another resident, thus turning your Dad is put on the back burner until the emergency is through.

I remember visiting my Mom later in the evening at her facility, and it was like herding cats trying to get the residents back into their rooms for night time. As soon as the residents are settled in, a few would wander back out in their pj's into the mail hallway. I remember overhearing one nurse say "Lord, give me strength".
Helpful Answer (7)
Reply to freqflyer
Cover99 Mar 16, 2022
I'm sorry but your last few words, " Lord give me Strength" reminded me of the late Ms Lisa Fleming from My 600 Pound Life, before the Paramedics came to move her to take her to Houston. Lol
If there are bedsores, please talk to his doctor and ask the doctor to prescribe proper care for the bedsores, which should include turning. Keep visiting him as often as you can. Discuss with hospice and the staff if it would be appropriate for him to be sitting for part of the day in a geri chair, propped up with pillows (it's a safe supportive chair on wheels that can be put in a lounging position, and it would provide some changes of position for him). As mentioned below, there are also mattresses that provide a massaging motion. All the best to you both.
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Reply to NancyIS

Ask Hospice if they can order a bed with an Alternating Pressure Mattress. On the off chance the staff is not changing his position every 2 hours (minimum) the air flow and the inflating and deflating of the tubes in the mattress will eliminate some of the pressure spots.
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Reply to Grandma1954

May come off as harsh but they most likely have limited staff and your gut reaction might be correct being as they are hospice your LO might not be a priority. It is unfortunate, as the social worker told me when my mom was placed. Pestering the ones that are responsible for the care or your LO does not always end well. They are human you must not forget that.
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Reply to Sighopinion

They should be taking their instructions from the hospice folks, because that's who is his primary caregiver now.

This is why I chose a hospice organization that worked frequently in my mom's MC. They all worked well as a team, and the staff was very receptive to the nurse's orders.

Your dad absolutely should have the pressure mattress mentioned by Grandma1954. (I'm surprised that he doesn't already.) Get the hospice folks to order it ASAP. The fact that he's getting pressure sores isn't really all that surprising, and the spot where he's getting it is the main place where they tend to occur. His skin is breaking down, and he doesn't have any cushion on his body now. There may not be much to prevent it happening in one place or another.
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Reply to MJ1929

My wife has the same thing going on.
In my years of life, I know I am not in control; even though I’ve accomplished much. But if difficult circumstances arise I bring it to God early in my morning and tell him my concerns, As I continue to walk in love, (for God loves all people at all times), and I figure He likes that of me. Then I wait and see ( this is also sometimes difficult). Patience is a virtue, and a good practice, it keeps us from mistakes.
I know how difficult it feels not to be able to do more. But just doing your best in love, will bring about a peaceable journey for you, bringing your light into the workers presence may even trigger them to see you understand their problems as well.
Nothing will ever be perfect in this life, but we can show love in a difficult situation, and perhaps in this you will find your direction. He (God) listens and responds.
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Reply to robertw5709
rosadelima Mar 18, 2022
Thank you for this beautiful reminder of the “bigger picture.”
Since your dad is bedridden and under hospice care, may I ask why you want him in MC and pay a private carer? Can you not do that at your home? Hospice can come to your home too, as is in my husband’s case. You save the money by not paying MC and using it to hire two carers to look after him.
Helpful Answer (6)
Reply to Worriedspouse
freqflyer Mar 18, 2022
Worriedspouse, around the clock caregivers are extremely expensive.

My Dad had 3 shifts of caregivers when he lived at home and it was costing him $20k per month, yes per month. Cost can vary from area to area. And that was just one person each shift. If Dad would need to be turn over two hours, as the Original Poster's would need, what would that caregiver do?

Chances are the grown daughter is a senior herself, like I was. There are limitations.

Better for him to stay in Memory Care where he has a village to help out.
Sounds like you are on it. Taking pictures is a good idea. There should be a social worker or a patient advocate in the facility. I would talk to the county department of human services elder abuse unit. Your name will be kept confidential. I wonder if other patients' families are experiencing the same difficulties. Maybe talk to the director as a group.

I worked my way through college as a nurses side at nursing homes. It was a terrible job. Nurses did not change linens, take care of bedsores or turn patients. That was the nurse's aides job. We were always understaffed and pressured to do tasks that were related to housekeeping rather than patient care. One nursing home had us crawling under the beds to wash the bedsprings! I understand that covid has created a shortage in medical staff in general.

I have incurable cancer and am in palliative care. Due to fatigue, I spend a lot of time sleeping. I am very aware that bedsores are a possibility for me. I am sorry you are having to struggle with this. It should not be that hard to make and follow a schedule to turn a patient and prevent pressure sores.
Helpful Answer (5)
Reply to Liztucker

A photograph from your phone will also record the time and place and can be a good talking point when needed. In the morning, (memory care) if I changed my mom I used to write the date/time/my initials on the back of my moms pull-up. In the evenings or the next morning I would check the waste receptacle. Not a perfect system, but it provided a method of tracking.

You can the photos to yourself but also have them “just in case” you need documentation. I would first verbally mention an issue to the staff, next time I would write up one of those “if you see something” notes (take photo of the note) and hand it to the unit again. Third time, I would level up to supervisor along with both incident photo and note photo. It worked for awhile till a change of staff. They were receptive to verbal but reacted harshly to documentation and pressed to have my mother moved. (I didn’t even show them the photos) I had to invoke hospice for the extra care to give my mom a little more time.

It is a fine line you have to walk: keeping peace with the staff to maintain the security of the facility BUT avoid harm to your LO in a time where there are limited (if any?) options.
Helpful Answer (4)
Reply to GAinPA

Can you get a specialty mattress either through hospice or by purchasing or renting? There are specialty, “low flow” mattresses that reduce pressure sores and he may not require as much turning. Contact a DME company, they may have more information.
Helpful Answer (3)
Reply to Beethoven13
horticulturist Mar 18, 2022
What is a DME company?
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