Is this normal, average nursing home care?

@JoAnn and Geaton,

It is irrelevant where the nursing home is getting their money from or how much is being collected for a resident.
The source be it private cash-pay, a long-term care policy, or Medicaid doesn't matter.
A resident who is walking around with dried piss and sh*t down their legs and without a clean pull-up or diaper on is downright neglect. Plain and simple. That is nursing home neglect and abuse. The nursing home regardless of how much or how little they're getting for a resident is collecting more than enough to keep that person in clean pull-ups or diapers if need be.
Basic hygiene and cleanliness is a human right. When it is being paid for like in a nursing home or hospital and being ignored, that is a crime.
Of course there are elders who refuse to get changed or washed. Some can even get downright nasty about it. I've had many care clients like this. Never in almost 25 years of service have I ever left an elder in their own mess or without a clean diaper or pull-up.
Care facility staff often use the 'resident refuses help' as an excuse to slack off so they don't have to get the hard work done like getting someone washed and changed. Sometimes there has to be a bit of intimidation to get the work done. This sounds harsh, but a person recovers a lot easier from a bit of intimidation then they do from UTI's, skin infections, sores and all kinds of sickness that comes from being filthy and exposed to excrement.
Being nice to the staff does not improve resident care. Being respectful enough and making sure they know you're on top of your LO's care is what will get an elder adequate care in a facility.

The nursing home is supposed to provide adequate hygiene care to the residents. Adequate hygiene care is basic cleanliness. She should not have dried piss and sh*t on her at any time and should never be going without a pull-up. If she was getting a daily sponge bath and her personal hygiene kept up on, she would not be in such a state when you see her. How you saw her today is not a one time thing. This may be the first time you've seen it.
If it's possible for you and your sibling to visit at different times, you will see this occurrence often. They're not keeping up on her basic hygiene.
If I were you, I'd take pictures of this and visit a law firm that specializes in nursing home neglect. This is nursing home neglect. People usually decline fast in a nursing home. To answer your other question, no you should not be bathing her. I've never heard of a nursing home allowing family members to shower residents because of the liability. Your mother is being neglected and very likely so are the other residents. Next time you visit look around at the other residents, then follow your nose. If you're smelling piss and sh*t around the residents, then this nursing home neglecting basic hygiene care.

Ask to see the care plan. Ask also to see her daily record for the last week or two (all regulatory environments require facilities to document care provided - if it isn't written down, it didn't happen). Try not to be depressed or put off if the notes are rudimentary or hard to decipher, because the best aides I know are great at caregiving but almost illiterate - the point of reading the notes is only to get a series of snapshots of what's been going on.

You may find that your mother is telling them confidently that she can manage, or that she'll get dressed later on, and there are limits to how far we can argue. If what you observed about dried soiling on her legs or wet clothing is more than a one-off, talk to whoever wrote the care plan about trying different approaches to offering support.

Practical tips: look at how your mother's clothing and underwear are laid out, and make sure it all makes sense to her - not by lecturing her or telling her, but by going through a dressing or washing routine with her. If you're having to fetch and find, for example, then you can be sure she won't be able to do this when she's on her own and it will be worth a rethink.

I wish your mother well, and you! I hope you get many useful tips.

My comment is off-point, but I’m amazed people can afford $12,000/month. We would be ruined very quickly.

I stayed in close contact with my LO’s MC staff during “The Battle of the Bath”, and the results were as follows-

I pretty quickly learned that the staff was loving, eager to please their clients, and focused on the safety and welfare of the patients in their care.

I affirmed to management and the actual care staff that I wanted her to be kept clean, as she would have wanted to be when she was managing for herself, and I gave permission for them to be “firm” and “directive” on shower days.

When I got reports that the had been more compliant, I praised her to the skies, complimented her beautiful silvery hair, told her she smelled “delicious”, brought her fresh lipstick and face powder.

I was visiting every day, and knew that the reporting of problems at the MC was fastidious, and also knew that she’d be bruising and frightened if she was being pushed too hard. She NEVER WAS.

Then of course the Pandemic ruined everything. When I could visit again, I found circumstances to be pretty much, as far as keeping her clean, as they’d been before the lockdowns.

I’ve always had good luck with ingratiating the staff before problems arise, and also supporting the benefits of THEIR hard work in successfully providing the best
care that they can for my LO’s.

Usually the ones I couldn’t win over were not long for the job.

I realize that you “‘don’t want to complain”, but can you find some little points to praise? Can you try “firm but gentle”, and assure them that you know they’ll never do anything to hurt her, but will be insistent that she shower, with their help?

This price is the same my mom paid at nursing home, completely self pay, and I thought she wasn't getting good enough care. But Mom at least seemed always to be clean and never expected to dress or bathe herself. She was not combative and always cooperated, but that your mom refuses care is no excuse for lack of care. It's their responsibility to keep her clean, fed, and as happy as possible. You should not have to do the cleaning or dressing. Often bathing is a problem for the elderly, but they should know how to deal with it. If there is a head nurse on the floor, go to that person first and go over the care plan with the social worker. Have the doctor do an evaluation to see if some sort of mood medication will help her to be more cooperative.

You really need to let them know. This is dangerous and soon there will be UTIs and bedsores, which quite honestly can be deadly. They need to know. Bedbath includes ESPECIALLY the areas mentioned.
They may not understand the level she is deteriorating to, and they need to be informed. If you who visit so very faithfully are finding this, imagine what those seniors with no family are enduring. I would call an Ombudsman if this continues. A Nursing home could lose licensure for this.
You aren't complaining. You start with "I think perhaps the staff doesn't know, but could you enter in the care plan that blah blah blah. " I would be very nice the first time. If this continues I would document, and then tell them what I found, and that I would be reporting to State and Ombudsman if this continues. You don't have to shout, be mean, or anything else. It's just that this is NOT right and should not continue.

Not surprising. Some aids can be really nasty to residents if/when they need more care then others.

No, its not normal. There are ways to get people to bathe. No they can't be forced. Maybe she needs to be medicated to calm her down. I would have that meeting. If not satisfied with the results call the State Ombudsman.

One thing I found when Mom was in the NH was they ask "Mrs E do u want a shower?" Moms answer was "No". I told the aide the answer will always be No. They are like children in that respect. I told the aide not to ask just do. I never asked Mom when she lived with me "do u want a shower". I just said "Come on Mom time to shower" and walked her to the bathroom.

Maybe I missed where it was written, but is she in MC? What level of care is she getting? If it's AL it doesn't sound like it's enough anymore.