I recently moved my 88 yr old mom into AL after she fell in Nov. and broke her femur. Drs decided not to operate due to her age. Anyways, she is healed from that but continues to lose mobility. Now she is losing her bladder control. I cannot really tell if she is just afraid, lazy, or truly has no control. Every time I visit her, she is saturated. The aides do wellness checks and ask her if she needs anything and she always says she is fine. Today I went there and she was changed into clothes but was so wet it went through her “fancy pants”, double layer of waterproof pads on her chair and still saturated her seat. Am I expecting too much by thinking they should be talking her on a regular basis? They told me they cannot “make” anyone go if they chose not to. Isn’t that part of it? I would think with the cost of well care it would be included. Not just making sure she takes all her meds. Now I have to haul a carpet scrubber and try to suck all that urine out of that chair. Sometimes I feel like I am still the main caregiver.
I am assuming UA has already been done and there is no infection?
ALF patients are graded usually from a level I care to a level IV care. They have an actual care plan that assesses their needs regarding all things. This care plan is sometimes kept with the medication nurse.
The cost will go up if the client moves to another level of care. Eventually a level IV isn't enough, and memory care may be suggested.
I would speak with the admins and find out how to go about discussing care plan for your Mom's increasing needs, but do know this may result in increased costs and a new level of care.
I am a bit surprised you haven't been called about this increase in care needs, but proactively you can reach out now to discuss. Make an appointment day would be my suggestion.
Here are a few suggestions:
1) M may need to wear pull-ups, even if they don’t get saturated every time. Or are these her 'fancy pants' already?
2) Talk to the AL manager about their rules, and how staff are trained to get things done even if the client isn’t keen.
3) Check the rules in other possible ALs. You may find one that works better for you.
I’m not an expert on this (yet?), so I hope that you get more responses that will help.
You are new on the site, and it would be good to check the resources already there. Click on ‘Care Topics’ at the top right of the screen, then on I for Incontinence. You will find expert articles, many old questions and discussions of other posters’ experience. Best wishes, Margaret
It is probably too much to ask for them to take her to the bathroom on a schedule. Most of these places wait for the resident to ring for them or tell then they need to go to the restroom - they aren't likely going to force them to go if they indicate they don't need to do so. With the understaffing at his rehab - my FIL - who is currently required to call for help rather than transfer alone - has had to wait longer than he found acceptable a number of times because the CNAs are all being pulled in a million different directions, when he is ready - and frequently when they are in his room he doesn't need to go.
If she is getting to the point where she can no longer toilet herself AND she is losing her mobility, perhaps AL is no longer for her. They need to reassess her needs. And maybe you need to consider that your expectations are a little too high - you said "They told me they cannot “make” anyone go if they chose not to. Isn’t that part of it?"
When I worked in childcare when I was in college and even when I was potty training my own daughters - I could take a child and sit them on the toilet - but I couldn't MAKE them urinate. I suppose they could MAKE her sit on the toilet - but that could actually lead to toilet regression or fear if they force her to go when she either doesn't need to or doesn't want to. Unfortunately this may just be a new phase. It happens. And she may need to move to incontinence underwear to account for the change.
Pain. Just too painful to get up? Especially if sitting a while. Hopefully any pain is being managed well?
Or, easier to not get up.
Control. I'll call it that - although that sounds bad, it'a reaspnable thing. To want to stay in control of our own life, own body, own toiletong needs.
Your Mom has lost much independance lately 😪.
She may not be ready to involve staff or give over control of this personal matter. Then once wet, pride won't allow her to speak up.
Mine does just this. Says no.
Then left sitting damp & stuck with her pride. Even with family, same. We've talked about it. I've said I'd rather wear pullups than be damp - wouldn't she? She *wants* to be independant & is holding tight to her control. Some small success was made in choosing the type of pull ups. More small success by avoiding yes/no choices. Not "do you want to go now?"
That would get no.
But "would like to go before your shower or after?"
Hopefully your Mom adapts to her new home soon. That she can enjoy other things she is still independant with.
What we did was set up her care plan for daily bathroom trash removal, and if there aren't two pairs of soiled briefs (her AM and PM changes) my mom is reminded to change her briefs by the staff and if she gets pissy she's directed to read the note taped to the bathroom mirror that goes into how she agreed to twice daily changes to prevent UTI's. The staff know to tell her it's the doctor's recommendation. Then she does it.
It may be possible that Skilled Nursing facility is likely OR if the AL where she is has "tiers" of care she may need more attention.
But if they "ask" mom if she has to go to the bathroom and she says "NO" they can not "force" her to go. They could word it like this..."Mary, it is time to go to the bathroom" and help her to the bathroom.
I am wondering though if she is experiencing any residual pain from the fracture? If so that may cause her to resist getting up or getting up as often as she should.
Ideally a person should have their position changes every 2 hours. If mom is in a chair or bed and pretty immobile they should be shifting her position. Getting her up tot he bathroom is one way to do this.