If you have a loved one who is a resident of a long term care community does it seem that morning care including getting out of bed, appropriate hygiene, tooth brushing, toileting and dressing is hit or miss? If this is your experience you may be right at least 40% of the time. Research completed in long term care communities, also called nursing homes, indicates that residents who require greater than average physical care often miss morning care routines.1
I attest that performing morning personal care is time consuming. How long does it take for us to get out of bed, shower or bathe, get dressed and begin our day? For most of us this daily routine consumes up to an hour of time. In long term care communities where residents outnumber staff, this routine is even more challenging and at times one or more components of getting out of bed, using the toilet and getting dressed is missed in the morning and postponed until later in the day.
How many individuals working in long term care dread working mornings because of time pressures, performing multiple components of care and every resident requiring attention? Time and staffing indicate that not everyone can receive care at the same time especially if preferences indicate 7 a.m. is the perfect time to get up and out of bed. What about those individuals who want to rise earlier and those who want to sleep in? Is it possible to accommodate the wishes of every resident?
Resident behaviors and different responses from day to day complicate care schedules. Residents with memory loss when asked a question often immediately respond “no”. These individuals are easily bypassed relative to morning care routines because the time involved in persuading them to agree is too time intensive when a large number of residents who will say yes are waiting for care. Another resident, who may exhibit negative behavior, refuses to get out of bed and is viewed as exerting a “patient right”, thus left to remain in bed until care staff completes their morning routine and has time to return sometime not until after lunch. Thus it’s not surprising that many long term care residents spend at least 18 hours a day in bed or substantial amounts of time sitting is wheelchairs lined up in hallways or in front of nurses’ stations.
Some long term care residents (without memory loss) report that they have become “used to” not being asked their preferences. For example, rare are questions of “are you ready to get up and get going?”, ‘what do you want to wear today?” or “may I help you to the bathroom?” are rarely if ever asked. I had a client who pressed used the call button for mobility assistance to the bathroom and who was left sitting on the toilet for over an hour until care staff walking down the hallway heard her yelling for help. Other clients have been left lying in bed for extended periods of time in soiled undergarments.
Residents requiring continence care should be checked and changed every 2 hours at a minimum. This is no different from the idea of a 2 hour toileting schedule for an individual with memory loss to avoid the occurrence of accidents.
Complaints by residents are seen as a futile effort. Fear of retribution by care staff is an often expressed resident reality. Older adults also don’t want to be seen as a bother or to get staff they see on a daily basis into trouble with management. The absence of expressed concerns results in supervisory and care staff believing that resident care is acceptable and appropriate when the opposite is true.
If those of us working in the industry really care about providing care what can we do differently? Population estimates for the next 15 years indicate that the number of residents living in care communities will grow to exponentially as baby boomers retire, age and require care. Long term care staff assumptions that 40% of resident morning care routines are acceptable without verifying this assumption with residents is irresponsible and ethically and morally faulty.
If your family member is experiencing sub-standard care in a community speak up or retain a care advocate to provide support on your behalf. If you work in a care community and see a sub-standard resident care, speak up on behalf of the residents who are likely fearful of speaking up for themselves. It’s our responsibility to advocate for those vulnerable and less able.
1 Simmons, Sandra F. et al., Resident Characteristics Related to the lack of Morning Care Provision in Long Term Care. The Gerontologist, Vol. 53, No. 1, 2013 pp. 151- 161