Before beginning THIS question ~ thank you to everyone who helped with suggestions in my questions about celebrating Dad’s 92nd birthday. We just brought in burgers, fries and milkshakes ~ he didn’t say much but I think he appreciated the thoughts…
TODAY’s Question: Am I expecting too much, or is this neglect?Dad is in an assisted living, one bedroom apartment that costs $6200 a month and pays another $900 a month for extra care in ADLs - ‘dressing, toileting when needed, reminders to brush teeth, shower help, etc. I also have a once a month caregiver from the outside to come in and do a ‘spa day’ for him where she cuts his hair, and tends to his fingernails and toenails and exfoliates his extremely dry skin. I visit him three times a week - short 30-45 minute visits - to check in on him, bring him his chocolate milkshake and check his room for needed toiletries, drinks, and incontinence supplies (wipes, bed pads, tab night times and depends pull ups, etc. When I walked in last week at 2pm there was fecal material wiped all over his bed sheets and down the side of the sheets. When I went downstairs to the AL director and asked her to please go to his room to do a room check. She did, I never saw her again before I left. While waiting on her I sat next to Dad by the fireplace he was drinking the milkshake and I saw that under his fingernails there was a very dark matter - appearing to be fecal material. I was horrified, I got paper towels and hand sanitizer and tried to clean it myself. Sorry, this is so long, but that day I saw the sheets and his hands I was inconsolable, holding my father and crying and telling him that I was so sorry that he was living like this, on his own and uncared for. People asked me what was wrong because they always ‘take good care of Dad, not to worry he is in good hands.’ I was still crying and told them to look at his hands, look at his bed - it was a disgrace. A few minutes later two caregivers came by on their way off shift and apologized to ME that they didn’t notice the sheets and that Dad was at breakfast when they came on shift and that they had just stripped and remade his bed because the ‘night girls’ didnt do it before they left at 730am. I thanked them for their apologies, then asked them to look at his hands - they looked and said, oh, he needs his nails cut. I said no, he needs them cleaned because in my opinion that was fecal material under his nails, while touching things in the facility, while eating breakfast, while eating lunch and while shaking people’s hands all day long. I went back the next day and only one of his hands had been cleaned and nails trimmed. So, very long story short - read the question title: Am I expecting too much, or is this neglect?
First off, you love your Dad and want the absolute best for him. So of course you expect a lot. Why wouldn't you?
But, I experienced something similar with my mom. I was visiting her and was sitting on edge of her bed. A nurse came in and said "maybe don't sit there cause elderly people dig." Don't mean to be gross but that means they dig poop out of their anus. She didn't go into any details but I think maybe at night they do that. That would explain your Dad's fingernails.
No, that's no excuse for the staff not to clean the sheets and your dad's fingernails. But I think this may become an ongoing situation with your dad.
I was disappointed at times with the cleanliness of my mom's room when I visited and noticed times when her call button wasn't even hooked up properly. Things like that. But overall they were nice to my mom and from what I could see they were understaffed and overworked.
I would just keep making note of these things with your dad and maybe ask if they think your dad is doing this digging thing that I mentioned.
You sound like a great daughter and are doing the best you can.
But if your dad is getting dressed by staff every morning and helping with ADLs then I would see it as neglect which may or may not be intentional. I would also like to ask if your dad has cognitive issues, does he have difficulty being able to ask for help or know when he needs the help? We have had many residents who need the physical help but were cognitively intact to be able to speak for their own needs. If he has impairments that prevent him from speaking up for himself, I would take this matter to the executive director and ask for a meeting with both the nursing director and the executive director. Explain the situation and see if they can add to his careplam to do checks on his nails.
Whenever we had specific issues I would add that to the careplan and audit my staff.
If after meeting with both directors, I would monitor the situation and see if it occurs again. There are agencies to report concerns to as well if you continue to see staff neglecting his care and management isn't making g sure these tasks are followed through
If he has loose bowels check his diet. Either way, may need more fiber. All it takes is a small tsp to start of fiber stirred in his coffee or water or tea. Has he had a recent need for antibiotics? Is he lactose intolerant? If this is unusual for him, look for the reason it is happening, especially if it happens again. The food served is not always the healthiest so things happen to sensitive stomachs.
Your reaction of tears is perhaps extreme but I understand the feeling. Sometimes it’s all just too much.
Make sure he is getting the help he is contracted for. Hopefully this was a one off. No place is perfect but some caregivers are more observant than others. If it was part of their routine they would have noticed it right away. Personally I would send a note to the one who went and checked and didn’t follow up with you. Obviously after she spoke with the aides she didn’t follow up to see that they corrected their mistake. Now you know you can’t trust her to follow up. So you are doing your job as his advocate to check that they do their job. Neglect is a loaded word but you are NOT expecting too much. I probably put up with too much but each aide got several lessons from me when I found issues. If I went too far over their head, by the time it filtered down to the ones who touched my LO, much can be lost. That’s when I learned putting it in the chart was helpful and personal follow-up also needed. I was once told that it was in the chart but the aides weren’t reading the chart like it wasn’t their supervisors job to make sure they did. yeah, it can make you want to cry.
If dad lives in Memory Care, you need to have a Come To Jesus meeting with the Executive Director imo. And a care conference monthly where you can be updated about your concerns.
Best of luck to you and I'm so sorry for your situation.
I had a similar incident when my mom was in rehab! I swear that sometimes aides just ignore things they don't want to deal with. In my mom's case, her pillow case was missing, which was a clue. I found several obvious smears on her bedding and the backside of that naked pillow. She obviously made a little effort to take care of it herself or was embarrassed, which didn't help. She should have asked for help but didn't. Aide on duty was horrified when I call them to the room and showed it to him. She was in a chair at the time, but YUCK!
Before we got her daily diarrhea under control, she would try to clean up, but it was never fun to find a shoe with dried, crusty poop on it these last few years.
Things like this are a clue that your dad needs a higher level of care.
The increase for MC is almost $1500 more per month, I hadn’t thought that maybe that could be spent on a private caregiver with attention to him only ~ thank you!
As for nails, mom does not seem to have anything under hers, but I doubt they ever wash her hands other than her two shower days a week. I have not asked, but she said she has everything she needs to clean her hands, so they probably don't bother to ask her. I took a nice scented soap for her bathroom and it looks like it rarely gets used. She said she would rather use wipes, which she keeps in her drawer, but I've only seen her use them once. I don't know the usual process for hand washing in MC centers across the US, but since most other things are running smoothly I'm not going to complain.
You could talk with a nurse in charge and a director (whatever the title is for the person who is in charge of his care needs) and discuss exactly what the staff should be doing for him. $7,100 / month sounds like a lot to me for assisted living. Maybe it's a really nice place and they should be meeting all his care needs for that price.
"Assisted" Living only provides limited assistance to residents who are fairly independent. I don't think most offer incontinence care, such as changing a poopy diaper in the middle of the night.
It may be time for him to go to a skilled nursing facility. It won't be as nice in accommodations, but the fecal incontinence will be managed routinely.
Accidents can happen in assisted living, especially with incontinence or toileting issues, but fecal matter on the sheets and under his fingernails should have been noticed and addressed. That is not just a cosmetic issue. It is hygiene, infection control, dignity, and basic care.
Since he is paying for extra ADL help, I would request a formal care-plan meeting immediately with the administrator/director and care staff. I would ask for a written plan that explains:
How often his room and bedding are checked
How often toileting assistance is provided
Who is responsible for hygiene after accidents
Whether his hands and nails are checked after toileting issues
How shift changes are handled so things are not missed
Who will notify you when there is a hygiene or incontinence problem
I would also document everything: dates, times, photos if appropriate, names of staff you spoke with, and what was done afterward.
I would not ignore this. I would give the facility one clear opportunity to correct the problem with a written plan. If it happens again, or if they minimize it, I would contact the long-term care ombudsman and your state licensing agency.
You are not asking for luxury care. You are asking for your father to be clean, safe, and treated with dignity. That is completely reasonable.