How do I get across to the bath aides to keep my mother covered during her bath?

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How do I get across to the bath aides to keep my mother covered during her bath?

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My mom is in a small ALF. She’s end stage Alzheimer's and has hospice. Hospice sends a bath aide 7 days a week. My mom is bedridden so she bathes her and changes the sheets everyday. I appreciate that she is being kept clean but one thing really bothers me. I’m allowed to have a camera in her room so I observe how she is being bathed. The aide will come in very early in the morning, wake her up then start to take off her gown. My mom is still sleepy from her medications and fights to keep her clothes on. Then after she removes her clothes she starts washing her whole body and doesn’t cover her up or dry her right away. Leaves her naked and wet as she turns her from side to side to change the sheets. Her bed is under an ac vent and she’s cold!! So many times I’ve asked them to please keep her covered at all times. My poor mom looks so uncomfortable and struggling to keep herself covered with her arms. Every bath aide she’s had does the same thing. I’m so fed up. Don’t they get training? How should I handle this?

Assisted Living Bathing Caregiving

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When my husband was under hospice care in our home and completely bedridden, when the aides would come to bathe him, he always wanted 1 bath towel to cover his top half and 1 to cover his bottom half, as he was always cold as well. Now of course I was always here to make sure that it was done the way he wanted, but honestly there is no reason they couldn't do that as well. I would call your hospice agency and ask to speak to your teams supervisor, and make your wishes known. They are there to serve you and your mom, so that shouldn't be a issue. I'm sorry that thus far though it has been. Good luck.

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When the CNA from Hospice had to start giving my husband bed baths she was VERY careful about how she did it. And this in my/our home. She would start with him completely covered. She would expose only the part of the body she was washing at the time when she was done and that part was dry she would cover it back up and move to another part of the body, exposing only that part.
Even when we were bringing him to the handicap bathroom down the hall, I would get him into the shower wheelchair and she would make sure he was covered with either a sheet or a throw before we would leave the bedroom.
I would talk to the Care Manager of the Hospice Team you have and request that she be covered.
I also suggest that when the Aide comes in she begin talking to your mom and begin to get the items she needs before talking off her nightgown. This will give mom a little bit of time to wake up.
The CNA that bathed my Husband would also talk to him the entire time and tell him what she was going to do before she did it so that (if he could comprehend) he was not surprised about a movement or touch. (I did the same thing before Hospice was even involved, I think it calmed him just having the conversation. He was always calm and compliant.
If there is a way you could be there when the Hospice aide comes to give mom a bath that would be great.
Have you talked to the aide about how you would like her bathed?
Is there any possibility of moving her bed away from the AC vent? The beds are not affixed to the floor so moving them should not be a problem.
If you have talked to the aide and your request has been ignored I would call the Team Manager.

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Unfortunately I can’t be there. I’m babysitting my granddaughters full time so the parents can work. I visit my mom after I leave their house. I have written instructions and I asked the AL staff to speak with them. It bothers them that there’s a camera in the room. Too bad. Thanks to the camera I know what is going on. If they do their jobs properly there’s nothing to worry about.

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As the previous answers indicate, there are better ways to handle this. Just being suddenly awakened with bathing is cruel, the not covering up added to it is wrong. Please speak with the employer of the aides, request a different time and better attention to keeping her modest and warm. If you don’t get a favorable response know that there are choices in hospice care. Your mom is blessed to have you looking out for her

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Thank you!

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I have steam coming out of my ears. If these people were on my team they'd get a piece of my mind - and my line manager would rip them each a new one.

From "Skills for dementia care" from the Michigan Coalition for Dementia:

2.8 Recognize that every person has a need for:
• Relationships with others
• Inclusion (being part of a group)
• Occupation (having things to do)
• Individuality (feeling unique)
• Dignity
• Feeling secure emotionally
• Privacy
• Intimacy and touch
• Socialization (being with others)
• Meaning
• Physical comfort
• Meaningful activities

So - don't these people get training? I'm sure they do. Whether or not they are given the leadership that reminds them to make it part of daily practice appears to be a different question.

I'm too cross just now to find the right words to suggest you might put to the manager - in your position I'd be too apoplectic to speak.

Does your camera record these images? You might make an appointment to see (or Zoom, or MS Team, or whatever) their manager at hospice, ask them to observe what you've seen, and tell them you'd like to hear their comments.

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This REALLY infuriates me! After my mom passed away and I was her live-in caregiver for a year, I took a CNA class and hoped to join a local hospice to "give back" in Mom's honor and for the hospice's CNA wonderful care.

We are taught to bathe one area of the body at a time, keeping the remainder of the body covered and dry and warm and to maintain the person's dignity. Period. To force a person be essentially all-over naked and wet violates training and, I have no doubt, the standard procedure for the facility. This is offensive to me on so many levels.

The only thing I can--almost--understand is the aide trying to get your mother bathed before she's fully awake. Most facilities don't have enough aides and there's just no extra time. Since this is a small ALF I would hope they'd wake everyone, if needed, than return later when the client is more awake.

I'd get photos or video of these occurrences for documentation, then meet with the DON (Director of Nursing) and complain like crazy, then threaten to contact the State. Even if the aides are overwhelmed, the clients deserve--AND NEED--to be warm and dry and to allow them their dignity.

Side note: The ALF where I took my practicals had a fluid schedule and allowed the elders to sleep until they woke up (aides often checked on them), then they were assisted with dressing if need be, bathed, and wheeled to breakfast, et al. This facility was Native American-owned and their clients were treated as the honored elders that they were, which was SO beautiful. How the aides performed and how the elders were treated should be freakin' national standard.

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Yes!! The Native American people treat their elders with much respect, also the elders are the ones who pass down their history to the next generations.

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This is very unusual, to be frank. We were, as nurses, always taught to guard the privacy of patients. Bath blankets, which were like flannel sheets, were always used. You need to speak to hospice about what you saw. This is NOT OK, and the aids just got "caught". They will be spoken to at once I would imagine. There are many reasons to use this. Comfort, privacy, dignity, warmth. This is NOT OK. Call Hospice today.

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I heard a co-worker of my YB's (he's an EMT) once refer to a client as a 'sack of meat'. I guess I was in a mood--but I barely knew the guys and blew UP at him.

In fairness, he was pretty young (21?) and elderly people 'grossed him out'--so he should have been in a different field.

I don't CARE how old you are, how demented, how sick, everyone has the right to be treated with a level of dignity. I know what I said to him resonated, he actually didn't last long in the field.

I remember having my babies (c-sections) so I wasn't allowed to shower--the nurses were SO GENTLE and made the bathing experience so pleasant and comforting. At no time was I exposed to cold air--I was covered completely in a very warm, wet blanket and then parts of me were slowly uncovered and washed and then recovered. A backrub follwed this bed bath and a fresh gown and I felt so much better. I always had long hair and they even made the effort to wash my hair.

Yes, it took about 5 minutes longer to do my bath than if they just dumped a basin of tepid water on me--but it was a sweet and gentle gesture.

I've had to bedbath DH many times and while that is a whole different dynamic--I used the method the nurses used and he would always feel so much better. Even if it were just a 'bath wipe' bath, we took it slow and gently.

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Why 7 days a week? Normally with Hospice its not more than 3. Does she really need a full body wash every time? Can they not just wash under the arms and make sure her butt is clean? The AL aides should be cleaning her up well after each change though. Can they not turn the AC off while bathing her?

I would ask that they show up after breakfast. I did this with the "in home" agency Mom had for therapy who also handles Hospice. Explain that the aides wake up Mom. She is one disoriented, and two frightened. Not a good experience for her.

If this does not work, you have the right to change Hospices. And I would tell them that. They make money off of Medicare.

My husband does not agree with me on this...telling agencies when a time is not convenient for me. I figure my home and I have a right to dictate the time convenient to me. With my Mom, she did not wake till 8am. It was get her up, get her dressed and feed her breakfast. If I woke her up, she would be disoriented. The agency wanted to be here at eight for therapy. I said No, 10am would be better. Because after I got her ready, I then got my shower and dressed.

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I was wondering the same thing about seven days a week!

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My mom is in a hospice house and they allow her to have covers while she is bathed in bed.

I would absolutely follow through on this. Call the hospice organization and explain or better yet offer to share the photos from your camera.

This is why I love when cameras are allowed. Pictures don’t lie!

Best wishes to you and your mom.

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In the medical field, the bath aide has committed assault and battery.

Going back in time to the strictest interpretation of assault and battery,
one cannot even touch the person/patient without permission.

Having Dementia or Alzheimer's does not take the patient's rights away.

How you handle it?
Follow the advice of others, change the hospice company.

It is not your role, and especially during this difficult time for you and your Mom, to even consider educating the aide, correcting the aide, or changing aides with the current hospice. Current hospice has sent out an unqualified aide. Report them to the Ombudsman for the home and the hospice company if that will help you.

Refuse anymore baths until a qualified staff can give the bath.

You are exactly right, this is not okay! And not okay for your dear Mom.

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Perfect answer regarding changing hospice organizations.

This is done all of the time. We recently changed organizations because we love a particular nurse who works with mom.

This nurse loves mom but she was interested in working with the other organization. She told us the name of her new hospice so we switched to it.

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So rude and unfair! So sorry for you and your mom.

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Show a management person the camera video so they understand what you're talking about. It will be difficult to bathe anyone in a bed or in a bath because you're only warm when the water is running on you, but there should be a way to put a sheet over part not being washed to contain some body warmth. Ask them if there is a better way to do this so that mom is more comfortable.

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I'm sad that your mom has to go through this day after day. When mil was in our home on hospice, the CNA was so very respectful of her privacy. And when my husband was recently hospitalized, the CNA there was also respectful. In both instances, mil and dh, both were kept warm and comfortable and chatted a bit before beginning the bath. As others have said, you definitely need to talk to someone in authority or consider a different hospice agency.

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Talk to the administration of the ALF or the agency that provides the bathers. Let them know what you have witnessed. This is not the way I was taught to give bed baths as an RN. The supervisors should address your concerns promptly.

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This happened with hospice in my mom's case. One of the few things I didn't like. I ended up getting some terry cloth material and making her a short robe with snaps on each side - and the aide STILL took it off and left her lying there naked. I wish that I had complained earlier about it and I would say for you to let them know that it's not acceptable.

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Thank you so much for your responses and support. This is the thurs hospice I’ve gone through for different reasons. And all three had bath aides do the same thing. The first one was at home, I told them not to bathe her and I did it myself. The second one I had huge problems with, including them sending male bath aides which my mother did not like and they would disconnect the camera. I immediately changed hospice. Now this one which started off ok but I’ve had to get on them about over medicating my mom at night and now the bath aides.
I will get it straightened out or I’m dropping hospice altogether. They’ve caused me more stress and aggravation then the help they offered.
thank you all.

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Im sure the bath aide does so many baths that she has forgotten she has a person ,a human being and they have feelings and no matter that the patient has pride and dignity and the aide needs to be reminded. If the early hour is not working then call the home care and ask the hour be changed. Put your compliant in writing. If that doesn't get the changes you want and need report to APS ADULT PRITECTIVE SERVICES..You may ask the aide to do other chores while you bath your mother. They can help with running errands, light housekeeping, cooking a meal. It iss hard to bath someone covered up or to change the lines yes there is some dignity lost. Keep the ac off during bath time. Rearrange the room so the ac is not directly on your mother put a screen between the ac and bed. Your mother deserves all the dignity they can give her. Fight for her be the advocate you are the eyes and ears for your mother so report , advocate. Good luck and God Bless

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An aide - or anyone assisting an elder in need - does not 'forget'.
They do not care.
Yes. Good idea to report HOSPICE to APS. And, tell Hospice what you are doing. They will not like that and will address the issue immediately. Good idea.

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Call the Supervisor and if you have a Camera like I have a Nest Camera and I can talk thru it.

Leave a Big Written Sign saying keep mom covered while cleaning.

I would only have them clean her up 2-3 times a week as you know she doesn't like it and she can't be dirty, just wipe her bottom area off if she's peed herself just like you wipe off a Baby's bottom.

Also see if the Vents can be partially closed.

It's very chilly to be wet and naked, it's a wonder she doesn't catch a cold.

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Or worse, pneumonia.

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They seem to forget that they're bathing people, don't they? I had a similar problem with nurses at the hospital and aides at memory care changing my mother's diapers. The doors were wide open, people were wandering in and out, and while my mother wasn't able to speak at that point, she had always been very modest. I cringed for her. I realize it's just a chore to them, but our parents deserve a little privacy and dignity.

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This sounds like the aide is being deliberately cruel. How could that person not notice your mom's distress? I have my own horror story about an aide. My grandmother was in the hospital with a broken hip and the aide forced her to bend over a tub naked claiming she needed to wash my grandmother's hair. Shortly after that my grandmother's mental health deteriorated to the point that she had to be put in a nursing home. The aide claimed my grandmother insulted her by using a racial term. All the hospital did was move the aide to a different floor. They apologized profusely but my dad should have sued them, and the woman should have been fired. There are people out there who delight in hurting others or they just don't care.

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Not all aides are CNAs. Some are just that, aides. My wife is at home and anytime I get a different aide, I watch them and show them if they are doing it the wrong way( I am self taught by watching nurses and CNAs care for my wife through her many hospitalizations, rehab stays and LTC stays.

I have bought long full body with bath towels to use as covers while they are bathing her. I make sure there is enough for one a week in case of a washer or dryer break-down. (This has happened several times and after a week, I had 17 loads of laundry, 2 were from my teenage son and myself and the rest were my wife's)

Call the hospice agency , ask for a different aide, time and attitude.

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You are correct about aides. Not all are certified. Some have taken care of LOs. The one woman I had for Mom to bathe her had the experience but not the certification. I think with agencies though, they should hire CNAs only. Or at least, put their aids thru some type of training.

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Hello,
Since they aren't following your instructions I would go to the agency supervisor and let them know that they aren't following your instructions. And to send you someone who's more compassionate towards your mother that their behavior is unacceptable and disrespectful to you. If you don't get immediate results I would go over the supervisors boss until I got satisfaction. I have done it. This person is being deliberately mean. She sees but she doesn't care.

I too had a camara in my mother's room. When I saw something that I didn't approved of I candidly explained what I thought was best in that scenario. What I did was showed my mother's aid how I expected my mother to be bathed.Then I observed and assisted if you can. The aids are obligated to follow your instructions. And explained why it's important that your mother could get pneumonia be kind. You have all the right to have expections. I put a portable heater in my mother's room and the room had to be warm before mom could be bathed after her bath and clothed her they could turn it off. You can turn off the ac before she is bathed.

Also why is she being bathed everyday and her sheets changed its not necessary. My mother was bathed 2 times a week and lotioned down ( every Thursday and Monday) sheets changed at the same time unless they got messy.

You must take a stand for your mother! I didn't allow anyone to do what they wanted to do towards my mother. Don't be afraid you are your mother's protector, and advocate. The agency will understand your concern. So many parents don't say anything. I wish you well.

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Agree - my first thought was why bathing 7 days a week? This is actually (unless for sanitary reasons (BM/Urine all over the body) not recommended as it can led to skin breakdown, 2-3 times a week is the MOST I would allow. Use proper hygiene wipes for the private areas and a true "bed bath" is usually not necessary. A nice warm "bed wipe down" or "refresh" as we called it is much more soothing - face/neck, hands, feet, lather up in quality lotion and my Grandmother was much more content than with a full "bath"

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My mother spent the last 90 days of her life in a nursing home. It was horrible. Her relatively mild cognitive decline turned into full blown dementia by the end. She needed help being fed and they would not allow family members into the dining room claiming "HIPPA privacy" issues, which was an excuse. I observed the dining room from outside the building and when they were supposed to be feeding my Mom, they were ignoring her and setting the food in front of her and going off the chat with each other. Then they wheeled her back to her room. I went to her room and she was delirious, literally. I demanded the nursing supervisor come in and examine her. She had been consistently losing weight because the aides were not feeding her. She was perfectly capable of eating and she did so with assistance. I was livid. Also, I happened to be there during bath time for residents and found they were undressing the residents in their rooms and just wrapping a sheet around them and wheeling them down to the "shower room". It was robotic to them and they would often talk to each other and never to the resident. They'd "hose them down" and rewrap them in the same sheet they brought them to the shower room in. The shower room was freezing. I know this because at the end I stayed with my Mom 24/7 so I could see exactly what was going on at hours after "visiting hours". It was beyond cruel. To those who say, well they have a lot of residents to bathe, I get it. But the moment you forget you're job requires you interact humanly with human beings, it's time to pack it in. No one should be treated like a piece of meat. Oh, and this was a supposed 5-star Medicare rated nursing home.

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Thats horrific! Your poor mom suffering unnecessarily and how distressing for you. I don’t understand why anyone goes into this field if they have no compassion for the elderly. We know it’s not for the money. They can earn more working at Walmart.

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Proper way is to use a bath blanket ( those are the soft thin blankets at med centers ) and only uncover what you are washing then use towel to dry and move on - for example - uncover wash dry and recover one arm , then the next etc . Should start with face and work way down - skipping privates and bum - those are last . This is how it used to be taught - although also nowadays they sometimes use the wipes instead of soap and water so might be slightly different . Speak with the aide or with hospice nurse - their whole purpose is supposed to be to alleviate suffering not cause any.

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The caregiver providing the bath must use a bath blanket. Bath blankets are a staple of hospitals and nursing homes and have been forever. This is a google definition: "Bath blanket is a flannel covering used to prevent chilling when administering a bed bath."

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They sound like they are underpaid and doing what is easiest FOR THEM to get the task done, you and your mother's feelings and thoughts be damned!
The ALF probably is grateful your mother is one they can scratch off their list as they can force the care and any complaints onto Hospice. WHich is where I would be going first, and demanding a new aide that is trained and respectful to tend to your mom. Not to mention considering a rearrangement of furniture so her bed is not below the a/c vent. There is absolutely no reason to wash and dry someone limb by limb, keeping the rest of them covered. IT's an outrage and assuming this person knows of the camera in place even more horrendous. Go to the top and let your complaint filter down. And if there is no change I'd be looking for another hospice program or AL facility. You might want to also get some guidance from your local long term care ombudsman office, and drop a hint to those at hospice that if the matter is not resolved to your satisfaction ASAP, you will be filing a complaint with the state! It's not just for your mom,but for the rest of us god forbid that may follow in her path.

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I am going there this afternoon. I’ll find out when she was there and move her bed. You’d think that I was asking for something so outrageous instead of what they were trained to do. I’m asking for respect and dignity for my mother. And the AL staff wants hospice there so they don’t have to do it.

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Discuss with Hospice management, IMMEDIATELY.
I'm hoping that you did this already - before asking us. What did they say? do?
Request another aide, someone more experienced.
Stand there and watch what happens and show them how to cover up your mom for her dignity. These aides should know this already - or they should not be employed by Hospice.

Aides - and all Hospice workers - should be more than adequately trained to do their jobs. This is not acceptable.

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I complained to the AL staff and told them to tell her to cover her and put a pillow under her head instead of leaving her hanging. The next day she did what I asked but I noticed a change in attitude. This morning I checked the minute I woke up. No one in there at 7am. I watched until 10am. Then I noticed her gown was different so the aide was there before 7am! Wow so early. Tomorrow I’m checking. Setting my alarm. A 6am bath is not going to work for me either. If that is what is happening I’m going straight to her boss. So fed up with these people.

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I am so sorry - I too have seen both sides as well - such beautiful care and then the this is a routine trauma to someone. As we all know it’s probably one of the hardest parts someone has to go through. I the very first few months of moms stroke I saw her body treated both ways. It’s one reason why I took her home - when she finally got stronger and began to recover she was and still has trauma over the times she was not treated well. Baths are still the hardest part for her because of what she went through on the times when she wasn’t cared for as she should have been. And yes this 6 am bath stuff - is another reason she is at Home with me. It takes time for them to wake up and sometimes get oriented with their surroundings. I understand for some it may work but for most elder it does not work - at rehab they would do 5am changing market before the 7am shift as well as in the hospitals - it makes zero sense to me and fires me up more than anything.
I also agree that bathing 7 days is not good for skin integrity. Smaller “pit stop” wash ups with 2x a week full baths would be so much better for your mom.
You could also post a note with clear instructions and tape it in her room somewhere? Provide some things that are hers in her room to be used specifically for her (I know sometimes it was hard tracking down towels sheets etc when I would bathe mom on my own). I brought my own stuff as a back up.
Wishing you the best of luck to get the care your moms deserves 🙏🏼
She is blessed to have you.

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Ncl007: Imho, that is an UNACCEPTABLE hour of the day to be bathing an elder when they are still in sleep mode. It is NOT like a hospital where nurses come in at all hours of the night and early morning hours for blood draws for example. Also the fact that your mother is left unclothed and shivering needs to be addressed to this individual's supervisor STAT before she contracts pneumonia.

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Well today she showed up at 6:45am. Woke my mom up and started to remove her gown to bathe her once again. Not covering up. My mom throwing punches, upset. When she was done, my mother said something like she’s wants to go home. She answered her, that she was never going home, that she was staying there with her, a prisoner! I couldn’t believe my ears. Needless to say I called hospice, spoke with a director there. She’s changing the aide and the time. But her biggest concern is that I have a camera there. So she was going to look into that to see if I could have it. I told her AHCA already okayed it, so did the owner of the Alf. It’s completely visible to everyone. She’s in a private room and I’m her DPOA. That seemed to bother her more that they could be watched. The last hospice was actually unplugging the camera while they were there. Even though I had full permission to have it. I’m so fed up with hospice. They have caused me and my mother so much stress. I’m getting ready to get rid of them altogether.

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Long term care ombudsman, NOW. Tell them what you've told us. My hair is standing on end.

Uncovering and handling a person without that person's consent is assault.
What that aide said was emotional and mental abuse. [Not to mention - B1TCH!]

And I'm not failing to take into account the time pressure the caregiver is under - she probably has 15 minutes (maybe even less, awful but possible), whereas I get 45, but then I also have to get the client transferred, showered, dressed, mobilised, medicated and breakfasted. And there she is, snuggled under the covers like a little demented squirrel, one beady eye on me and absolutely no interest in starting the day..! It STILL isn't okay to bully her.

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How do I get across to the bath aides to keep my mother covered during her bath?

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