Agitation and incontinence in long-term care

My mother and mother-in-law are in long-term care, and as a volunteer in that facility I have spent many hours on the floor observing and advocating for residents. I have had to repeatedly suggest that the agitation that staff members were reporting in my mom was possibly due to a urinary tract infection. Because of the inconsistency of care, I would suggest this to a nurse who was working that day but not the following day, and then I would suggest it again to the nurse on shift the following day until it was finally investigated and treated, and the agitation would disappear. It might have been a good idea to mention this often-overlooked cause of agitation in long-term care.

As chair of the facility’s family council I found another of my concerns, regarding so-called aggressive behavior in residents, echoed by other family members. Sometimes reported aggressive behavior only happens with a specific staff member, and yet it gets recorded in a way that makes it seem to be an ongoing problem. I discovered this when I overheard a nurse talking rudely and harshly to my mom, who was generally a congenial and gentle soul. Upon further investigation I found that it was only this nurse who had reported my mom as being aggressive. If these reports had been investigated further I think it might have been found that other residents were being reported as aggressive when the problem was actually the staff member.

I am also concerned that BC has the highest use of drugs as a form of restraint. As family members we have seen this many times. Most often this is done because of inadequate staffing levels and the resulting lack of time for behavioral interventions. Groups in our community have tried to get local physicians to come and speak about this problem at a meeting, but we don’t even get the courtesy of a reply.

My last comment is about urinary incontinence in long-term care in BC. Many people entering a facility in our province are put into diapers, not because they are incontinent but be­cause they cannot toilet themselves independently, and inadequate staf­fing levels mean that there is often no one to take them to the toilet. If they do get taken to the toilet they are sometimes left there for an inordinate length of time. 

I have heard from families in our facility and, as a member of the Vancouver Island Association of Family Councils, from families of residents in other facilities on Vancouver Island that staff will instruct residents to “go in your diaper” when there is no time to take them to the toilet. When you put that together with the fact that there are no minimal standards for bathing in BC, the cost in skin care and dignity is very high.
—Ann Zanbilowicz, MA

Ann Zanbilowicz, MA,. Agitation and incontinence in long-term care. BCMJ, Vol. 55, No. 6, July, August, 2013, Page(s) 275 - Letters.

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