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The last two summers, my LO in an ALF got a severe UTI which required an ambulance trip to the hospital. In 2018, they basically got very weak, and started passing out. It must have caused severe pain and urinary retention, because when they got to the hospital and put in a catheter, 2 liters of urine were removed. They were treated with antibiotics and then sent to rehab at skilled nursing before returning to the ALF. They had to use a catheter for 6 months afterwords. In 2019, something similar happened, and again they had to be sent to the hospital after passing out.


In both cases, the ALF had noticed symptoms and ordered a urine test and ordered antibiotics. But, it seems they must have ordered the wrong antibiotic or the course of antibiotics didn't last long enough to treat the infection. The really bad symptoms came after the initial course of antibiotics had ended.


I'm just wondering if a better run facility with better nursing care could have done a better job? Should they have noticed he wasn't getting better and ordered more tests? Just curious how common this is and whether it is indicative of overall quality of care there.

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Who evaluated and treated the UTI at the AL?

In general, a urine culture (not just a rapid UTI test) should be done to determine what antibiotic the bacterium involved will be sensitive to. And there should be follow-up by the treating clinician to make sure the infection has cleared.

This also assumes that the patient is able to do some management and accurate reporting of their own symptoms.

In my experience, medical care in ALs can be very "hit or miss".
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Helpperson, for the last week or so you have written us many questions, all about an Assisted Living with which you have serious concerns. Some of the issues were about admins playing good cop and bad cop, you felt; level of care issues and costs as a problem, and problems with the Assisted Living having concerns with the acting out of the elder.
You are clearly very unhappy with the care of this Assisted Living. I am uncertain if you are POA with choice to choose another facility, but I am wondering if you might think your elder would be better at another facility?
You ask now about UTI with urinary retention. I believe you were writing us about a male. I can tell you as a nurse that retention, whether from prostate issues or other reasons (many medications cause retention, also) is a serious issues with males. IF this is the male who was also acting out, and if this acting out constituted a sudden behavior change, then the UTI could have resulted from the retention and both would almost certainly have caused some acting out, and possible real discomfort and distress. Assisted Living Facilities are often just not equipped with staff to do any real nursing care and assessments.
Antibiotics as an issue.....generally the UTI is diagnosed and treated with a broad spectrum antibiotic until a urine culture comes back after some 72 hours. Then sometimes the antibiotic is changed to another stronger one that is specific for the bacteria growing in the petri dish.
I am afraid UTIs cannot be blamed on an Assisted Living. The elder may require a different placement where there is some ongoing nursing staff, if this tends to recur. Regular assisted living aids are just in no way equipped to diagnose possible UTIs, and even retention. Some males require ongoing frequent catheterization, and this isn't for Assisted Living, but for skilled nursing, SNF, Rehab where there are nurses to do this. Often Ultrasound machines are needed to assess the fullness of the bladder.
Sadly there are a lot of issues for your elder going on I think it is time to really assess if he is placed in the right setting. Medical issues will and do occur, and really are for the most part not the "fault" of a facility.
Wishing you good luck. There seems to be just a constant flow of problems and illnesses happening for your elder, one after another. I hope things get better.
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Countrymouse Aug 2020
? We have loads of clients with in-dwelling catheters living in the community? They're managed by either the District Nurses or the Community Bowel & Bladder team (also nurse-led).
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When elders have cognitive decline sometimes they no longer process pain or discomfort signals accurately. If your LO isn't alerting staff to smaller changes then they'd only know there's a problem when things become critical and obvious to others. My MIL is in LTC in a very well run facility and she gets UTIs often. She'll wince in pain as she lets out urine. When we ask her, "Are you having pain when you urinate?" she says no. She has short-term memory issues and cognitive decline/moderate dementia. The staff can only be expected to do so much if they can't get accurate info from someone.

You asked, "...if a better run facility with better nursing care could have done a better job?" I'd say not necessarily.
"Should they have noticed he wasn't getting better and ordered more tests?" Maybe.
"... how common is this" UTIs are extremely common in the elderly.
"...is it indicative of overall quality of care there." Perhaps but as AlvaDeer noted, maybe there is more to the story of this particular facility.
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I am Alva, the AL is able to test for a UTI and can get a "doctor" to order antibiotics but as she said, its a broad spectrum antibiotic which didn't work on Mom. You really need to get a culture done to determine the infection and the proper antibiotic.

An AL is not a nursing facility its a residence that supplies aides to help with ADLs.

UTIs can be caused by many things. Not voiding completely, not drinking enough water or not cleaning well after a BM. With my Mom, while on antibiotics she was given a probiotic which was continued after the UTI was gone. Cranberry tablets helped to keep the UTI from recurring. Its been suggest on the forum that D Mannose works well to prevent UTIs.
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AlvaDeer Aug 2020
I swear by D-mannose. I take it daily and while I had four a year bladder infections going all the way up to kidney, I have had none in the decade since I started it. Funny, as I am a nurse who doesn't believe in any supplements, vitamins and etc. D-Mannose (I use Source Natural) can be got from Amazon, about. 120 capsules for 30.00 and worth a try. It works like cranberry in that it keeps bacteria from adhering to the bladder wall, but is not acidic. And works better. I have recommended to two friends with same good luck for them. Big capsules, but you can open and sprinkle on food; tastes only a bit sugary. Is in fact a simple sugar, but safe for diabetics, so not as we think of sugar. Most bladder infections in women are caused in our older years by the thinning of the tissue of the urethra which thins like all our good mucous membranes, vaginal and etc that used to keep everything nice and puffy. Because of this thinning the bacteria has more ingress into the short distance to the bladder. For men it can be retention due to prostate, medications, and etc.
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