Just a statement - but important. My husband has dementia - but we are aiming to help him stay as independent as he can. My husband uses pull-ups. I buy them and bring them to the facility. I think it helps him maintain his dignity because he tries to use the toilet as much as he can, and these are easy to use. The LTC facility uses "briefs" which are actually adult diapers with side tabs. To me these "briefs" look and feel like they are made of tissue paper with a bulky pad in the center. Seems very uncomfortable. Once he takes the tabs off to use the toilet it is difficult if not impossible for him to close the tabs again. The other day I asked the aide to use the Depends (which I gladly supply) instead of the "briefs" to make it easier for him. Her response was "THE BRIEFS ARE MORE CONVENIENT FOR US!"
Sorry, I didn't know the aides' convenience was the top priority!
There are other examples of things being done for staff convenience...
So now it's time for you to let go of the reigns, and let the folks that now care for him 24/7 do what is best for them, as they have way more than just your husband to look after.
To me it sounds like you're still wanting to be in control of everything, which I certainly can relate to as I'm a control freak as well, but there does come a place and time when we have to learn to let go and learn to choose our battles.
And the fact that you had to place him means that you now have to relinquish a lot of the control you once had when he was still at home.
Now if you want to let him walk to the bathroom himself when you're there visiting and change his Depends while there, and do whatever else you think the staff isn't doing right, you go right ahead, but remember that the reason you placed him in the first place was because his care was too much for you.
So instead why don't you let the staff do their jobs best they can and just get back to being your husband's loving wife and advocate when you go to visit?
You may come to enjoy not having all that extra responsibility. Try it. You may just like it.
Let me put this question back to you. Why IS he there? My guess is that it became too difficult to care for him at home, or it was unsafe.
He is there to get the care that he needs because he needed 24/7 care. He isn't there to get 1:1 care.
As gently as I can say this - I think we ALL have some level of adjustment when a LO goes into LTC. Not just the LO, but anyone who has been their caregiver.
We want our loved ones to continue to get the same attention in LTC that they got at home.
You ask the question "Who are we trying to support?"
YOU are trying to support your DH. The LTC is trying to support ALL of their residents to a certain standard of care.
Is he in skilled nursing? You refer to it as LTC, so I'm assuming that it is not an ALF. SNF and memory care are generally a level of care that has a medical component, and requires the CNAs and Nurses to focus on meeting the basic needs of the residents in order to individualize medical needs. Individualized needs are met based on the level of impact - meaning say your DH has extreme food allergies - they would adjust the food they bring him to ensure that it doesn't contain that allergen. If certain residents need specific MEDICAL care, they are going to adjust for that.
But for basic needs like toileting- once a resident is dependent on the staff to ensure that happens - I think they fall into the general needs bucket and everyone gets the same approach unless they have a catheter or colostomy bag. If you DH is able to see to his own toileting needs entirely - the pull ups are fine. If the staff has to take over assisting or driving his toileting needs - they are going to use the tools and processes that work for the facility.
Yes, unfortunately in residential care, individual preference sometimes takes a backseat in some areas in order to ensure that ALL of the residents get their needs met. And often in LTC, what independence they do have does shrink because they are in a residential facility BECAUSE they are not independent any longer.
As a former CNA, how did you handle all of your patients at one time when they all needed something and you didn't have any help? Convenience is sometimes necessary when you are trying to meet the needs of multiple people at one time as quickly as possible.
If they start adjusting for your DH to wear pull ups, and his roommate or neighbor want to wear underwear or go commando, or someone down the hall doesn't like the toilet paper and wants a different kind, or they decide that they don't like the sheets on the bed, - this can spiral quickly out of control.
Its the same concept as a child care center doing diaper changes at the same time of day, and then on an as needed basis in between. Or a school having a lunch schedule.
Any time you get into institutional situations you have to allow for convenience in order to expedite the needs of everyone.
There are other examples: the rooms have private toilet rooms. The toilet is approximately 12 - 15 feet from the bed. PT claims he can walk 100 ft with a walker - but when he needs the toilet the staff "shoves" him into a wheelchair to go to the toilet room. How does this in any way support strengthening or independence?
Having "been there / done that" for years I understand expediency vs time constraints...but if we never show "Admin" that resident care / outcomes takes time and resources nothing will change. I still hope we are working to support the resident's best interest.
I think BlueEyed Girl explained it very well.
I can't tell you how many times I have failed & struggled getting pulls ups off or on my LO (when I was hands-on). Ripped them down the sides but still got faeces everywhere for starters..
Ripped them getting on, ruined.
Couldn’t lift the heavy foot.
Hurt back stooping over.
Couldn't pull up & assist with LO balance at same time (even with handrails).
When explaining all this to a Continence Nurse, she said time for the tab style, BUT, this would be for Aides/Caregjver to do. Too hard for someone to work the 'tab' themsleves (as two hands needed = increased falls risk).
Exactly as GBC, said moving to the tab style takes what independance there is.
Unfortunately this is the middle area where nothing is quite right.
GBC, I hope you can find a good solution that works for your husband.
I don’t think that the aide was being disrespectful to you or your husband. She was just explaining to you that they must be practical in order to get their job done.
The staff works extremely hard and are often shorthanded. They have many residents to care for.
I am sorry that this is upsetting for you. You sound like you are a wonderful advocate for your husband.
But I can still see it being problematic and time consuming if the person is not really able to participate. Many residents need someone to keep a hand on their shoulder to steady them or they can't sit long enough for all of that to transpire or stand long enough to pull the pull up and pants up.
Unfortunately - residential care does have the drawback of losing some individuality - which is sad. They aren't always able to do things the way they want to for one reason or another.
If OP can share this trick with the facility and they are onboard because her DH actively participates - that would be fantastic.
But that trick would never have worked with someone like my FIL, even when he was still able to do a lot on his own, for a variety of reasons.
And all of this assumes that he is still toileting himself. I guess that was my other question. To what level is he genuinely participating?
I know it looks simple when an average size nurse sits on a toilet, lifts her foot up for the CNA/Nurse to put it over her feet. But my FIL could barely lift his foot up and holding it that long would have been a no go. He would have ripped that thing in half before it was on.
If I'm reading the original post right, husband is able to go the toilet (perhaps with a bit of assistance). No doubt it's easier for CNAs to just roll him back and forth in bed, installing a new tabbed brief and being on their way. And I don't doubt for a second that the CNAs are horrifically overloaded and dealing with chronic understaffing.
But if husband is being kept in bed rather than helped to the toilet for the sake of convenience/efficiency, that's a problem.
I honestly don't know what the path is to paying CNAs better and upper admins (or shareholders) less as a means of ensuring sufficient staffing. In the US, the term "customer" is taken seriously (though no doubt the facilities prefer "patient," a less empowered position). Maybe if enough people make noise something will change? Or maybe the complainers will just be dismissed as jowly entitled shrews.
You might ask if the issue is the pull-ups or the having to get husband to the toilet. If the latter, you are on stronger ground, because there are important benefits to movement/ getting out of bed (reduced risk of bed sores, maintenance of mobility, etc.).
Good luck.
Or they could learn this one simple hack
https://www.agingcare.com/discussions/how-to-change-a-pull-up-without-removing-pants-and-shoes-473747.htm
Lealonnie nailed it in my opinion - if your DH is able to manage his toileting needs on his own - it wouldn't/shouldn't matter what type of incontinence underwear he is wearing. But if the CNAs are having to assist him with changing them regularly - it does become important what type.
I recognize that dignity is important. And I can understand why a person would prefer the pull up vs the tab. But that being said, if you can imagine - in a facility with let's say 100 residents - it's a good bet that AT LEAST 50 of them are wearing some kind of incontinence aid. The number could be higher (in a SKN) or lower (in an ALF) but the concept is sound.
Now imagine that you are a CNA who is responsible for let's say 10 residents during your shift. And you have to assist them in showering, changing clothing, changing incontinence briefs, getting other things adjusted (say a CPAP, or help them with their phone, or if they have an accident or get sick, or if there is an emergency).
People already complain loud and long about how long it takes a Nurse or CNA to respond to a call bell/buzzer. It would make sense as to why they would want to make sure they find convenience and efficiency where they can.
It takes twice as long to change a pull up as it does a tab - because of the clothing. If the pull up is wet, they can rip the sides and toss it - sure...but then they have to take their pants and shoes off to put a new on one, and then put the pants and shoes back on. Instead of just pulling the tabs, grabbing a new one, putting it on and closing the tabs.
That amount of time saved isn't as much about convenience for them as it is for the residents. If your DH is the one waiting for them to come because they have to change someone in a pull up - that means he is having to wait even longer to get help.
CNAs focus their attention on the resident they are working with at any given time. But in their heads they are hearing all of those other call buttons going off.
Yes, your DH's dignity and wants are important. But when someone needs help, the CNAs need the most convenience they can get to help everyone in their care.