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As a caregiver to my daughter who lives in a nursing home; when they tell me she had a suppository a few hours ago.

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Thank you for pointing out the positive side of nursing home life. I used to work the graveyard shift 36 years ago as a CNA in a top rated home. Hopefully things have changed since then. Because the conditions were terrible. Mainly for those who could not speak up for themselves. Somehow, they always knew when surprise inspection was coming, and got the place ship shape. Speaking up about the conditions put me in a hostile work environment, but there was not protection back then. It was the saddest job I ever worked. By the time my Mom was in a home, she was too far gone to enjoy any activities, so I guess I never got to see it. I don't expect CNA's to be paid $20 per hour, but perhaps a monetary incentive system could be put in place. Evaluations from patients, family, and nurse oversight could earn them some kind of bonus every 3 months. Something, anything to make them feel valued and want to do a better job. An employee incentive raffle every month for gift certificates. CNA's need to feel valued somehow, for them to want to better. I just wanted to get the dialogue going, because there is power in numbers. And this forum has that power. I'll get off my soapbox about this subject, but thank you all listening.
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You have to find out if this is correct protocol. Ask your daughter's doctor. The aides have to follow the doctor's orders.
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When a person is in a home, if they say no the aide/nurse cannot force them. This includes meds, toileting, eating, etc. A POA does not override this. Someone already said this but aides in homes are certified. They are given 8 weeks of training usually at the facility they work. Just like any job, there are good ones and bad. If the facilities have LPNs, they are the immediate supervisors. If not, then the RN. You can request not to have a certain aide take care of ur relative. These aides can have a full wing of patients. That can be 30 patients. My daughter, LPN and now RN has worked these facilities for 18 yrs. Nothing is going to be perfect.
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When a ground or pureed diet is ordered by a speech therapist there is a reason for this usually after a stroke the patients swallowing ability is compromised to such an extent that large pieces of food can be aspirated into the lungs and the resident can develop aspiration pneumonia.

That very thing happened to a member of my family. Her brother and his wife decided to take it upon themselves to bring in food and she ate it but she wound up having a crisis.

There is very little space between the larynx/ trachea that goes to the lungs and esophagus that goes to the stomach. After a stroke the automatic closure doesn't work properly ( wrong pipe in layman terms). you know that term. Anyway the same food served throughout the facility is the same just ground or pureed it was probably the TEXTURE that disgusted you. Sometimes the patient's liquids have to be thickened to a honey consistency and that means all liquids be careful with bringing outside beverages.

Please don't frighten your self about Nursing homes or assisted living. Living alone when you no longer drive or get about can be very isolating for the elderly they can go weeks and months without visitors. That would happen to me if I no longer could get in my car and attended various social functions on my own. At least your day is structured in a facility Up for breakfast at 8A your assisted to a dining room your with people for meals transferred if needed to freshen up OT/PT 9-10a crafts activities computer games 10-11:30A Dr's appointment, Hair Salon appts. Lunch is served 11:30-12:30 transferred if needed to freshen up toilet and get ready for entertainment between 2P -3P freshen up time after to get ready for supper at 5P.
A major movie, volunteers provide polkas bands, Elvis impersonators in fact theater groups put on plays, Animal antics, Casino night Bingo keno.
That's a schedule most people would envy in their golden years It's all the way you look at it and what your perspective is. We acually had a catered wedding between two resident's in the main ballroom 76 & 82 years young. So it's not that bad it's like living in a fine Hotel Laundry meals, and assistance and entertainment all provided. All depends on your condition at the time. The larger the facility the better
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It would really be wonderful if CNAs recieved six months training before they were certified. Then the quality of care would improve (I hope) In truth they recieve FIVE weeks classroom and hands on instruction. It is this short length of training and the ability to earn a little more than a burger flipper that directs many women into this job. I certainly aplaud Mary Cs praise of the CNAs and many do indeed do a fine job. The ones I found most dedicated where those working their way through nursing school. I have always felt that nurses of all grades are at the bottom of the feeding chain but like others just don't know where the money is comming from. Even if you cut the salary in half for the top administrators it wont make enough difference to pay the CNAs $20 an hour.
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Maybe the nursing home administration who are paid extremely well, could take a pay cut, so that the aides could be paid better for the very important work that they do. I'll be you that a nursing home administrator has never tasted the food our loved ones eat, to see if it was something they would eat themselves. You never see administration eating the same food as the residents. My heart goes out to the residents who have swallowing problems and have to have their food pureed. Have you ever tasted pasta pureed. I have when my mother had to eat it. It was disgusting. I'll bet the speech therapist has never tasted the pureed foods they prescribe. God help us all when we are no longer independent. I hear your cries about the economy, but something has got to change.
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OK let's pay the aides (of all levels) a starting salary $50,000 a yr, whether we can understand their English or not. how do you propose the pay increase will be covered? the US is already about 20 Trillion in debt and much more if counting all the baby boomers who will also need care. Yes all.the various aides have an important job to do, but when burger flippers are demanding $15/hr then the aides will want $45/hr, and the RN'S then want 3x as much as the aides (or more). Never mind the policemen firefighters and kindergarten teachers. There are other jobs "very very important" but someone who has completed a 6 month health aide course, or even 18 month LPN course, does not merit the same level of pay as a 15 yr veteran police officer. The country can't just keep printing more money, as it has been doing.
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The keyword here is RESPECT for the frontline people taking care of the patients, AKA Certified Nursing Assistants. IT'S NOT JUST A JOB IT IS THE MOST NOBLE AND HONORABLE PROFESSION ON THE FACE OF THIS EARTH.

They are doing direct care spotting potential wounds or patient decline &^ resolving issues that Dr's and Nurses are alerted to only by the CNAs. Not to mention bathing every morning showering every 3 days dressing brief changing, peri care, feeding transfer from bed to wheel chair, WC to toileting, 3 to 4 times per day, mouth care, foot and hand care, hair care, linens, validation therapy, range of motion therapy, turning an immobile patients every 2hours to prevent bed sores, safety, Emptying Foley caths and maintenance, Colostomy cleaning and care. bed making and changing, changing soiled clothing when needed through out the day, denture care & hair care 3 or 4 times per shift and much more then that. Blood pressures pulse and respirations CAN A DOLLAR PRICE COMPENSATE THAT KIND OF SERVICE? CNAs are the eyes ears nose OF THE NURSES AND DOCTORS and THE VOICE of the patient. They are doing what families can not will not or are incapable of doing. If the family tried to do this at home without help it would take a toll on their own health. BEING A CERTIFIED NURSING ASSISTANT IS ( NOT JUST A JOB ) OR ( A BOTTOM RUNG ) POSITION IT IS THE MOST HONORABLE AND NOBLE ( PROFESSION ) AN INDIVIDUAL CAN ( ASPIRE ) TO BECOME. EVERYTHING THEY DO IS NURSING 101 AT IT'S MOST EXTREME SENARIO. ALL THE DOCTORS ORDERS THE NURSES ASSESSMENTS AND CHARTING ALL THE LPNS PILL ADMINISTRATIONS, ALL THE OCCUPATION/PHYSICAL THERAPY WOULD BE FOR NOT IF THE CNA'S DID NOT CARRY OUT A PATIENTS ACTIVITIES OF DAILY LIVING AND CARE TO PREVENT INFECTION and provide safety THROUGH THE ABOVE MENTIONED TASKS. Not to mention the emotional support they give when the patients deal with what's happening to them at this point in life, the tears they have to soothe when patients feel abandoned by there families and or no longer have families. The CNAs emotional capacity to re-direct the patient into a more positive frame of mind in order to deal with the patient's current situation. Continuously 8 to 12 hrs a day and yet they still have their own personal lives and families trials and tribulations to deal with when they go home. Most people do no have the stamina or resilience to keep up a pace like that. I'D SAY THAT IS AN EXCEPTIONAL INDIVIDUAL WITH TALENTS MOST PEOPLE DO NOT never will HAVE. So when I hear IT'S JUST A JOB I have to enlighten the general population every once in a while.

FOOD FOR THOUGHT: What do you think would happen to our nation if these gifted individuals didn't exist or felt that it was just a job.

Mary C. RN,CWCA, CNA instructor
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Your question suggests the possibility that your daughter doesn't want to get out of bed and you want someone to force her to do something against her will. If that's the case, I would suggest that you respect your daughter's right to make her own choices.
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Ellie52, I hear you, and wish that the aides were better paid, but, if nursing home already costs $90,000 per year, most of that paid by taxpayers thru Medicaid, where is the money going to come from? I don't think being an aide is something people aspire to, as their career. It is just a job. Aides need to apply for college financial aid and get educated so they can get a better paying job. Just paying all the bottom rung workers is only going to have a ripple up effect as everything in the country's economy will just get more expensive. And I do have 3 kids, 2 in college who are working full-time jobs (janitor, and delivery person) at the same time they are going to college full-time. So Yes, it can be done. What can't be done is just pay the aides a higher wage.
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Nurse's Aide positions are critical to the people we love who are in institutions, and help with home care. The are not given enough training, they are responsible for too many patients, and they are underpaid. They, and they alone, dictate the degree of interpersonal care and compassion our loved ones experience everyday from the first words they hear to the first touch they feel. Imagine if it was you laying in that bed. Here comes the Nurse's Aid who has to get 10 people out of bed, washed and dressed and ready for breakfast in one hour. Most of them work two jobs to make ends meet, and the others are going to school and working so they don't have to be Nurse's Aids any more. I think it's time to raise our voices, so that their pay reflects that they hold in their hands, the quality of life our loved ones receive every day, especially when we are not around. Better pay could mean our loved ones have more quality of life. Sorry, the whole system frustrates me
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Unfortunately the nursing home will have the physical therapists evaluate a patient and make decisions as to what the patient is capable of. If the patients are put into chairs, there is a schedule that the aides follow. They go from room to room and put the patients in the chair for a certain amount of hours. This is after the patients have been fed and bathed so usually being transferred to a chair can happen in the afternoon. Then the next shift will return the patient to the bed. The nursing home staff runs on a schedule, so you will definitely have to speak to a head staff member for your request. If the patient is not able to get into the chair on her one, then they will use a hoyer lift. Basically it comes down to convenience for the nursing homes. They only do what they have to do, not always in the best interest of the patient and the family.
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I am a retired nursing home administrator/RN. I am assuming that you are your dtr's POA and have the right to advocate for her plan of care, which should address her need for a suppository. Since the timing of her receiving the suppository seems to be the issue, you have the right to have the RN change the time this is done. I suspect that she is getting this done on the staff's timetable which is not optimal for your daughter's well being. I agree with Carol's point that a non-confrontational mtg should be attempted first, but also agree that this current issue could be one of many. If needed, talk to the administrator or director of nursing before getting the ombudsman involved. May God bless.
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When I went to rehab which is suppose to be my respite....and found our 88 year old in bed...they thought she was bedbound, who gave them this idea and where did they come up with it? ...I do not know why they let Alzheimer's people speak for themselves, they may not want to do something does equate in my book with, let us teach them how to be bedridden, sit in a wheel chair, walk with a walker...we were getting good results with chiropractor and podiatrist with soft ankle braces. I think everything patient is not patient centered...it comes down to what can we get sued for and how are we going to stop it. Bottom line, I do not think they care if an Alzheimer's person is somewhat independent...dependent must mean more work, why do it or do I have it wrong leaving them more independent is more work? I am not regularly on this site anymore, I am wrestling with Alzheimer's disability issues...If a person has Alzheimer's disease and we all know here that it leads to death...ex. someone has ALZ and dies of a heart attack, why is it not listed as Alz/heart attack, why only as heart attack?
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I don't know the extent of her condition but I will answer from experiance. Most direct care staff in facilities are not really trained, nurses are but the staff that physically handles patients are aids. Saying that the best thing for for anyone is up and out of bed but safety first and your daughter may get injured if she is taken out of bed by staff that is time pressed and mad that they are being made to, aids can become vindictive towards your daughter which is sad but true. Find a better and smaller facility, small facilities seem to provide better care because the work load is smaller for the caregivers.
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When my husband was in rehab to get stronger after a hospital stay, staff were leaving him in bed! I got help from the physical therapy department. Staff would get him up in the morning but after lunch put him in bed. When asked if he wanted to get up he'd day , no." So he would stay in bed for the rest of the day. Their excuse was he asked to stay in bed. I replied, but he is here to get stronger. This made no sense to me. After I talked with the physical therapists, the problem was solved. chris
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I do not think you would be able to force them. I would try talking with the staff about this first. If that doesn't work her doc I would think would be able to add getting her out of bed to the suppository prescription.
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Sometimes people make the mistake of thinking the staff know best and they don't. They either don't know or don't care. I have experienced this. Try to talk to the nurse, she will help you, or explain things to you. I'm sorry your daughter is in this situation.
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It sounds as if there's more to this than this one incident of them not putting your daughter into her chair when you think she should be there. Is the care staff open to communication? Is the nursing staff capable? Are the hands-on caregivers generally good? These are all things to consider. Sometimes a non-confrontational meeting with the staff to discuss differences can do wonders.

Other times, there's a fundamental issue in that the home isn't providing good care or the family wants a different style of care for the person in the facility. If the facility is consistently a problem, I'd suggest that you talk to the ombudsman about your daughter's rights. You can find the ombudsman by going to www.ltcombudsman.org. They provide an interactive map to help you find the right contact.

I hope that this works out for you. Many of us care for adult children which can be just as - if not more - worrisome than caring for our aging parents.

Take care,
Carol
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