More often than not the squeaky wheel does get the oil in regards to your loved one's care in a nursing home. Families who are vigilant in monitoring signs of neglect or abuse noted below and voicing their concerns are apt to receive more caregiving attention. Sons and daughters need to be constant advocates, persistent observers, and relentless protectors of their vulnerable parents. The professional caregiving staff will generally respect a family's attentiveness and admire their devotion. Family members need to visit a lot and establish strong positive rapports with professional caregivers. Be careful to avoid a disapproving or offensive posture that will only serve to alienate the caregivers. Instead encourage a constructive team approach to your loved one's care among staff and family members alike.
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.
1. Review the plan of care.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 plan of care and if it is reviewed with them regularly, or when any changes are made.
2. Watch for weight loss.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.
3. Monitor water intake.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 is regularly full and accessible.
4. Advocate for pressure sore prevention.When at risk for pressure sores (also known as bedsores and decubitus ulcers) due to limited mobility, check to see if the staff is 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.
6. Monitor toileting and incontinence.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.
7. Keep tabs on physical therapy.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.
8. Make sure activities are readily available.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.
Clare Absher is a Registered Nurse with 44 years of experience. Most of her experience is in home health serving as a caregiver, educator, patient advocate, and liaison between families and community resources. She has also worked in acute care, assisted living, and retirement settings. She is passionate about helping families care for their elderly loved ones at home.
