How do I get the staff at Dad's MC facility to make sure they are doing what they tell me they are doing?

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".

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.

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.

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.

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.

I really like the pressure air mattress. My dad was bedridden and this helped a great deal. What also helped was massaging the skin with lotion every day. Even with my mom’s wonderful care for my dad, his skin was always close to breaking down. He lived at home.
My mom is in AL and will probably go to MC (if that is the best plan). I put in Blink Camera’s that runs off the wifi of the facility. I didn’t ask, I put them in. They are movement activated. I turned off the LED so the surveillance is not obvious (that red light is distracting). The facility eventually put a sign on the outside of her door stating Surveillance. This camera has been helpful to me. She has a caregiver from 2-6 that helps her shower, go to pt and to dinner. I check the recordings every morning to see how often she moves in the night. Your dad would be a great candidate for cameras. Since he lives alone, there is not an issue of privacy lost for a roommate.
It was a game changer for me because I knew what was going on when it was going on.
I would also talk to Hospice and express your concerns. ALSO, you may need to change Hospice providers. The facility my mom is at has 2 they do business with and one is better. I used that as I searched to see if there were better ones than the 2 they mentioned to me. My thoughts for you:
1. I would put in the cameras (I use Blink but they may have better ones). They have a 30 day free saved recordings and the yearly rate is $30.00 for the year. I can hear what is being said and the recordings are saved for 60 days.
2. I would talk to Hospice on what they can do to facilitate the required care. Get a air pressure mattress.
3. I would look to see if there is another hospice and interview them to determine if they have better care. I would not tell them I already have hospice, since they may not want to have conflict with another provider.
4. I would, after the above 3 things are done, if needed, draft a letter for the director of nursing (that is the person in charge of evaluations and care) with a cc to the directors. I would fax it to ensure it is received as well as email it. This correspondence is only sent if your issues with them is proven with the surveillance. I set up 3 camera because I wanted to get all the angles and if one becomes off line, the others can pick up the slack. That has happened and I was grateful for the other camera. My mom has 3 rooms but I only have them in the 2 rooms she uses.

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.

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.

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.

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.

The only time my mom got serious bed sores was rehab and the hospital. They would change mom and never apply a barrier cream. I even offered to supply the Desodine. Can you bring your parent home for Hospice. I did that for mom and brought in people to help me. Hospice came 3 times a week to bath mom. I had the bathing early in the morning so I could sleep in. The Hospice aide would come in bath and dress mom and get her in her chair. Then text me when she was done.

My mom was independent in walking but advanced dementia (can't dress herself, needs directions to find the bathroom, no sense of time, can talk but not coherently express any needs). If a memory care unit has 15 people they have 2 staff on and a med tech if you are lucky. My mom's unit was an upscale boutique facility with 9 residents (15 max) and she had 9 falls, bathroom accidents daily, wasn't given fluids (because she couldn't ask), and she was anxious and afraid all the time because no one was there to help her navigate her time and space. It is IMPOSSIBLE no matter what any facility tells you to have 2 workers on for 15 + memory care residents who all have varying needs for care, meds, food, activities, etc. I had cameras in my moms room (approved) and what I saw was absolutely horrific. They would leave her alone for 7-12 hours without even entering her room (on camera). She had times that she fell and hours went by before someone checked on her. I believe that anyone with a loved one in memory should have a camera. If you suspect they are not following the "care plan" and your loved one has bed sores, trust your intuition. Also, I know it sounds jaded and people are recommending help from hospice companies and elder abuse but I can attest to the fact that the system is broken and it is a long road. I am currently 7 months into the attorney general's office investigating my camera footage. Also, the attorney general in my state said that they have NEVER brought a case against an Private memory care facility because they have only ever have anecdotal evidence like yours and mine is the first time it has been documented on camera. It is not considered "abuse" if they do not turn your loved one. If they say they turned your loved one, it is documented on a medical document that they did it, and you have proof saying they didn't do it (camera), then it is a felony to falsify medical documents. Otherwise it is just an unfortunate flaw in a broken system but not against the law or considered abuse. Your loved one needs an advocate when they have dementia or specialty care and you cannot rely on the facility to know what is going on with them accurately. It is sad, but it is the reality of the system that is broken and needs more regulation.

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.

To help document how often he is being turned, don't arrive on the same days at the same time. Switch your visits to various days at various times and if at all possible visit him a few times a day to take notes of date, times and position that your dad is in. If he has other visitors, ask them to also note the day, time and position of your dad. In the meantime, get an air mattress. Will help take pressure off his pressure points to help prevent bedsores. Good luck to you!

Thanks for all the responses, great suggestions, & words of wisdom. I got the pictures & the breakdown is worse than I thought. I ran into the nursing director yesterday as I was leaving & once again requested she have the staff follow through with turning & positioning. She said she would "take care of it."

Having cameras in resident's rooms is illegal in my state so that's out. I'm going to request the alternating pressure mattress from hospice.

After a lengthy discussion about my concerns, the hospice RN is delivering a barrier cream today. I like the idea of marking the disposable brief & will follow up some how.

I know that working in MC is a challenge & I'm not sure I could do it. I'm always pleasant to the staff & thank them for all they do. I have the sitter at night so that he will at least get turned & positioned during that time. And I'm going to request from either dad's primary care or hospice for an official order to have him turned appropriately.

If skin breakdown is inevitable, I want to make sure I've done everything I can to limit it. Only then can I get some peace.

DME stands for Durable Medical Equipment.

Go to the facility manager

can't trust any place but home so sad, or get someone to go alot

nature73: I did see your update from eight hours ago wherein you've stated that a barrier cream is being applied. Best of luck with this difficult issue. Pressure sores can and do develop on elders' skin. I, myself, am presently dealing with one on the heel of my right foot. How I deal with it is I don't put pressure on it for my wakeful hours (I let it float on a cushion type device). This may or may not be helpful to your LO's issue.

I used a hospice company the Memory Care worked with ALL THE TIME, and they had superb communication between them. In fact, mom's doctor was part of the hospice group as well so all the communication and prescription writing was as smooth as glass as a result. Mom was turned every 2 hours *but it's not a FULL BODY TURN as you might imagine*; pillows are used to wedge the person to the left or the right side; if heart failure is at play, as it was with my mother, she could not be turned on her right side AT ALL b/c she'd turn blue & lose oxygen. So they did the best they could with what they had to work with. The first thing they gave her was waffle boots to make sure there would be no pressure ulcers on her HEELS. I visited for many hours each day during the last week of mom's life so I was there to make SURE everything was being done properly; I never had to remind anyone of anything, actually. And, mom was on morphine and feeling no pain at all, so I was relieved to know that even if she did wind up with some skin breaking down, she would not feel pain as a result.

In reality, during end of life, pressure sores MAY HAPPEN in some instances; they can be impossible to avoid entirely depending upon how long the person is bedridden and what lengths are gone to to avoid them. Stay on top of the staff as best you can, then make sure dad is being given enough comfort meds so that he's suffering no pain. Also make sure you realize HOW the patient is 'repositioned' in the bed first, so that you know if they are or are not actually DOING it! And, if dad has any issues preventing him from being turned on one side or another. The hospice nurse is the best one to speak to about the entire matter; ask for his or her input on how it should be done, etc.

Best of luck.

My mother became bedridden and came to me with a class one bedsore from abject neglect during a “rehab” stay. Proper care turned it around quickly lucky for her. Continued improper care would have been a disaster.

Re the mattress issue, I tried one of those adjustable air mattresses for a while but ultimately had the most success buying a Twin size Serta mattress cushion at Kohls. It also helped with heel pressure.

Take detailed notes and document your conversations with notes that consistently show the date, time and the person you spoke with. E-mail is a great way to create a legal record of your communications with staff. Confirm every important conversation with supervisory or management staff by email, ie “Per our conversation this afternoon I am confirming our mutual understanding that it is medically necessary and imperative that my father is re-positioned at a minimum of every two hours and has wet pants changed to prevent skin ulcers. It is also our mutual understanding that this medical concern is being appropriately communicated to and addressed by your staff. Please advise me if you are aware of any issues in addressing this concern.”
Take photos of your Dad’s skin as often as you can with the date set on the camera and bring their attention to whatever breakdown is occurring under their watch. Your Dad has enough to deal with. There is no excuse for the facility neglecting to provide this basic medical care. Make it clear that you are paying attention and expect their care and compassion concerning your father - never mind the fact that they are likely being paid thousands with the expectation of providing competent care in return.

You are not dreaming - you are standing up for the rights of a patient who is not able to stand up for himself. I think the doctor’s order idea is good too if your doctor will help you with that. It would be an official medical record of care ordered. Failure to follow that could land them in real legal trouble if things break bad. Don’t let them try to build a case that he is terminal and already had bedsores not caused by their lack of care unless that is true. I would not hesitate to hold their feet to the fire on this. Don’t be afraid to let them see you take notes and document- document- document. I hope your Dad gets the care he needs.

Ask for a wound care consult. Besides turning him every 2 hours, he needs other things for good wound healing: good nutrition, good circulation, good oxygenation, good cleansing (to prevent or treat infections), and proper care of the wound. He might not heal if he doesn't have the other issues addressed. The proper person to evaluate and address those issues are wound care nurses (RNs with specialized education and expanded role as a nurse). They can recommend specialized beds for the doctor to prescribe to help with the turning issues.

If you are really uncertain about his care you could hire a private duty aide and make a turning and repositioning schedule for her to follow and check off. With the staffing shortages it is difficult for staff to turn every patient every hour and still complete assignments. I know how you feel but being a retired nurse, I’m also realistic. I wish you the best.

You are allowed cameras in rooms now. It is amazing how much better care my mother is getting. I have an app on my phone and I can check anytime day or night. I can also talk to her by the camera. It is a Nest camera and bought at Best Buy. You can also get an Ombudsman involved. It has helped a lot. Good luck.

First of all do not be afraid to get more than firm with these people. You have a witness who is with your father at night who says they don't come in and reposition him.
You have every right to tell them how to "run their shop" because they are getting paid to provide proper care to your father. He isn't in their facility for free nor are they caring for him free oout of the goodness of their hearts. They are making money off of him every minute of the day. Put a camera in his room and see how many times a day they are turning him.
A nursing home or MC will never admit to a bedridden resident needing more care than they can provide. A bedridden dementia patient is easy. It's the ones who can still get around that are hard. They'd love it if every bed in the MC was occupied by a bedridden invalid.
Talk to the director of the facility he's in and bring it to their attention that he's starting to get a pressure sore. Then ask them if they would better be instructed by a personal injury law firm specializing in nursing home abuse and neglect on the importance of repositioning bedridden patients and proper skin care.
They will improve the care your father receives.