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Monitoring Care in Nursing Home ©

By: Clare Absher RN, BSN

Be sure to report any of the following observations or concerns immediately to the attention of Director of Nursing, appropriate nursing staff and physicians in the home where your loved one resides.

Ask to see plan of care, review carefully, make copy and ask to have it revised if not addressing all needs. Monitor during visits that staff is following care plan. Ask nursing aides actually providing care if they have seen the careplan and if it is reviewed with them regularly or when any changes are made.

Visit at mealtimes to see if eating OK and getting any necessary assistance from staff. Watch for weight loss especially by inspecting upper arms and calves. Ask to have weekly weights monitored by staff and review results noting significant changes.

Check if drinking enough water by looking for signs of dehydration. Evaluate skin tone by pinching forehead to see if skin makes a crease that is slow to disappear. Look inside mouth and lips for signs of dryness. Check to see if water pitcher regularly full and accessible.

When at risk for pressure sores (also known as bedsores and decubitus ulcers) due to limited mobility, check to see if staff following preventive measures such as proper cushioning (egg crate or air mattress on beds and chairs) or padding of high risk areas (heel and elbow protectors) and frequent positional changes especially when in bed or chair for long periods of time.

Check for developing bedsores or any signs of skin breakdown. Inspect heels, elbows, sacral/coccyx area (above buttocks also known as tailbone), upper back ear cartilage, and any bony areas such as shoulder blades and base of neck. If see any redness, press and see if blanches or whitens. If remains reddened, it may be start of a pressure sore that requires specific care.

Check for toileting problems such as onset of incontinence. Note whether staff available to assist to bathroom when needed and on a regular basis. If adult diapers are used, determine whether usage is based on need or convenience. Check if diapers changed regularly by looking for reddened, irritated skin and rashes in diaper area.

If getting physical therapy or any other special therapies, check to see if schedule is being followed. Attend a therapy session to observe what therapy is actually provided and whether progress noted over time.

Check to see if staff follows posted daily activities schedule and if residents are encouraged to participate and given necessary assistance in order to participate.