I found my Mom with unwashed hair and ears uncleaned at her nursing home. Any advice?

Q-tips should not be used for cleaning ears, especially by someone with dementia. It's too easy to accidentally probe too far and injure her ears. Even though people do use them, ENT doctors and technicians caution against it.

This is the VA's method ear cleaning at home:

First, wash hands before and after cleaning, then follow these instructions:

1. Mix equal amounts of hydrogen peroxide and tap water (well water must be boiled and cooled to room temp first) in a cup (VA provides one that's a 120 ml plastic cup with a cap). Liquids should be as close as possible to body temp. If too hot or too cold, person can feel dizzy or nauseous.

2. Use a syringe (you'll have to buy your own) with a flexible plastic tip; fill with the hydrogen peroxide/water mix, by placing tip of syringe in mixture, pull plunger to fill the syringe.

(Syringe is called BD 10 ml syringe, with a "Luer-Lok" tip, REF 309604)

Since the plastic cup to be filled with the mixture is 120 ml and the syringe only holds 10 ml, this is obviously for multiple uses. I think what I would do is just add 5 ml of hydrogen peroxide and 5 ml of water instead of filling the whole bottle.

3. Lie down on side, affected ear facing toward ceiling. Place towel under head. Gently place flexible tip of syringe into ear canal, but DO NOT PUSH TIP INTO THE EAR.

4. Slowly push plunger to push liquid SLOWLY into ear canal. Hold head still 5 minutes to allow solution to sit inside ear.

5. Then place a C shaped bowl or pan (like the emesis basins hospitals use) under ear and against neck, tilt head to allow liquid to drain into bowl and not on clothing as it may stain.

6. Repeat with other ear.

If ear pain and/or bloody drainage is experienced, discontinue and call doctor.

This is a similar but slightly different method of cleaning:
md-health/Ear-Wax-Removal-Hydrogen-Peroxide.html

There's also some helpful information on this site:
http://www.entnet.org/content/earwax-and-care


As to the issue of inadequate care, it doesn't sound as if the staff is on top of the situation. But I'm wondering what the patient-staff ratio is; that may be part of the problem.

How long has your mother been there? Have you always found deficiencies?

You asked what to expect from visiting nurses. As I understand, your mother is in a nursing home, so the nurses should be on staff. If your mother were in her own home, then visiting nurses would be appropriate. However, I wouldn't expect a lot from them; they generally take a more broad spectrum approach to the individual's overall health, while also focusing on specific areas of concern, especially if the home care is post hospital stay..

They will check her heart, pulse, etc., but they don't come often enough to provide more intense care. And generally they're tasked to factor in overall medical condition rather than become involved in providing care such as that which you mention. It's just the nature of having limited time and being reimbursed by Medicare.

You might want to ask for a meeting with the Director of Nursing to discuss the deficiencies you've found. I think it's also possible that they may have let care "slide" a bit because you're not there. If a family member is close and visits regularly, I think the nurses are a bit more attentive. They know they're being monitored!

But I also agree that it would be more helpful if your mother were so much closer to you.

Not sure what states are involved for you but here in Oregon what you have described is referred to as Adult Foster Care. Just this past month my brother and I visited several foster homes and nursing homes as we needed to move mom from her assisted living. In addition we queried every elder care professional we could corner on the pros and cons of both. In relation to your situation we found this: Foster homes are not required to bath their residents to the same standards as nursing homes. Here a NH is required to bath their residents twice a week - FH are not. In general FHs are not held to the same laws, documentation, standards, training, protocols, and certifications that a NH is - not by a long shot. So guess where our mommy dearest moved today?

So mom is not in a NH but rather an "adult foster care" or "board & care" facility? If that's the case, they are just not set up for doing the attention to medical details that it sounds like your mom is needing. The medication to her toenails issue, well, if she was in a NH, there would be doctors orders for the RX to be done twice a day and a required part of her mandated by medicare care plan. Right now, the staff is not required to do it or other detailed medical services. The board & cares expect the resident to still be self directed in their day to day needs & hygiene.

It may be that mom is at the point of needing a higher level of care. If the thought is that eventually you plan on moving her closer to you in another state, start looking now to do that. If she is gong to need to apply for Medicaid to pay for the NH, start to do things that make this easier. Like having her finances move to a banking group that is in both states and have her SS & retirement direct deposited to the new in both states bank account. I'd try to get her legal update by a firm who holds licenses in both states too.

If mom is still ambulatory, it is going to be easier to get her into an actual NH as in theory you can bring her for a visit to the new NH to see if they can provide the level of care needed. Also she could see a MD in your state to evaluate her & write the orders needed to get her admitted into a NH. Sometimes you just have to do what is best for them in the long term over their objections. If you don't have the personality to do this and your sister is more forceful, then let sissy take the lead on all this. As mom ages, her needs are only going to increase and be more overlooked at the place she is pcurrently in as its flat not a skilled nursing facility.

If she should become bedfast, it is going to be very difficult & expensive to move her to another state.

I'm going to label this response "it takes a village". Muther, do I recall that you are taking care of a spouse with dementia ? A lot on your plate. I'm wondering why your mom isn't in a facility closer to you. In my experience, once an elder is in a local facility, it really pays for them to be "around the corner" from someone who can stop by frequently .

With dementia patients and hygiene, I find it's a difficult road. I don't believe quips are thought to be "approved" for use, either for babies or elders these days. I would make an appointment to talk to the social worker about mom's bathing schedule and preferences.

A couple of months ago, my mother announced she could no longer bathe, as she would have to stand in the shower. Fortunately, we were able to untangle this dementia- related false thought and get her back into her regular bathing routine. However , had my sil not been a regular visitor and had we not pressed the staff to find out what was going on inside mom's head, I don't think we would have gotten beyond mom's "no".


In my opinion, talking to the nurses and line staff is fine for a to day stuff. If you want to understand what's really going on, make friends with the sw.

muther, from what I have read on the forums here, there is only so much the staff can do for a resident in a nursing home if the residents refuses to cooperate. One's parent might be sweet and smiling when you are there, and after you leave become mad as a hornet and pout if the staff says time for your bath. The staff can't wait around for Mom to finally cooperate, the staff goes onto the next resident. This could go around and around for days on end.

The long term care where my Mom resides, everything is computerized. I see touch screen computer monitors on the walls where the staff places information on the patient.

We had to hire an outside agency to get Mom bathed and changed twice a week at the assisted living. This is because we could control the companions and be sure that got done, for which we had to try a few different ones who could push her enough to get it done. AL staff does not push and will not push. It was "Mary do you want a bath now" and if she said no not only was it all over, there was no record of it. I just said "you can't take her out unless she is cleaned up".
I have been surprised at how much a care plan has to be specified for particulars such as "place lotion on arms twice weekly at 9am". And sometimes you have to pay for "add-ons' where you would think they would always be including (such as daily light tidy of room with toilet flush and light trash removal). Its been quite a learning curve.

Juts seconding what GardenArtist had to say re: visiting nurses. Don't expect a lot. Heart, BP, temperature and a few perfunctory questions is about all you'll get. While the home health aides they sent us were great, the actual nurses didn't really do anything I couldn't have done myself, but we need them for prescriptions and such.

A visit with the Director of Nursing at the Nursing home could probably answer most of your questions. It is unfortunate that you dont live closer. You really do have to be a presence to become familiar/friendly with staff and administration to know what is really going on and when. It is unfortunate and not right but when family/friends pop in often and not at regular times it seems staff are more on top of those patients.

I got Hospice on board for pallative care. Their aides did baths evey other day and RNs visited once a week and called me after every visit as well as made recommendations
to NH staff and brought in a better bed and Gerichair. It was comforting to have more eyes and ears on hand even though I was in and out every other day or so and sounds like your Mom is still on the ball enough that the word Hospice might upset her. But Hospice isnt necessarily only for the dying. She might not qualify. Your situation sounds especially tough due to distance.

I work at a nursing home, and yes their suppost to bath patients at less 3 times a week. But I know that many patient's don't like to take baths. I hear them telling the aide, no I don't want a bath. An aides can not force a patient to take a bath. Talking to the Director of Nursing or the Charge Nurses is your best bet to get your point across. They will see to it that your mom is being taking care of properly.