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My mother is 98 and has been in a nursing home near me for 8 months. There are several nursing homes in my area. My sister and I placed her at this one because it seems to be the consensus around here that this is the best one, although it is not fancy at all and is an older building. However, I have had many friends place their parents there, and they have had little if any complaints. A lot of the staff have been there 10+ years and seem to be very patient and caring. The administrator has lived in the area her whole life and has been working there at least 20 years.


Mother has had incontinence problems for at least 5 years now and has been wearing adult pull-ups on a regular basis. For a while she was able to handle toileting by herself for the most part, sometimes with assistance from the aides at the assisted living facility where she previously resided. After a bout with pneumonia and being hospitalized for a week, she was not able to walk and we placed her in the nursing home. She does have a private room with her own bathroom. She is not happy about not being able to have the door closed, but I understand this is a policy meant to insure her safety.


She has fallen a few times since being at the nursing home because she tries to get in/out of bed or into the bathroom and onto the toilet by herself. So far she has not hurt herself. She has been told to use her call button to summon assistance, but yesterday she tried to get into the bathroom by herself without calling anyone and she fell trying to transfer to the toilet. My sister thinks the reason she didn't call for help is that when she does do that it takes too long for the aid to come. I go there every day and spend a couple of hours, and when I'm there I have noticed that it may be as long as 15 minutes to get help. My sister thinks this is way too long. Since I am there every day I can observe what usually goes on, and I don't see anyone slacking off. They are always busy doing something. Needless to say, the other residents there are quite mobility challenged and need assistance also.


Should we be pressing the administrator to get someone to my mother's room more quickly? This is our first/only experience with a nursing home, and we're not sure exactly what we should be expecting.

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At our little nursing home there would have been a response within 5 minutes, although this was often just someone checking in to see whether there was an urgent need. If it was not then we would be told they would be back as soon as they were finished with xyz.
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I think it depends on the staff to patient ratio and what time of day it is. Most facilities in the states are understaffed and have a large patient to caregiver ratio so 15 minutes doesn’t sound too outrageous to me. For someone who needs to use the toilet, it’s a very long time. But unless you move her to a smaller facility with a smaller ratio, I don’t think you will have much luck in finding a faster response time.
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I would have a care meeting and point out that she is falling because it takes to long, ask how it can be dealt with so that she isn't falling and potentially getting injured as a result.

15 minutes would be the very outside of acceptable time for answering a call button.

I would also ask straight out what the company policy is about the time allowed to answer, they all have some criteria for this.

It is always okay to ask questions and it is always okay to ask how things can be improved when they are causing potential injury. They don't want a fall with injury because they take to long to answer requests for help, those are the things that cause lawsuits and the government getting involved.

Let us know how it gets resolved.

Always be kind and understanding when speaking with the care providers, if it needs to escalate to get results use the proper channels, in writing and copy the entire facility hierarchy and then you go to the ombudsman and the state board and on up. The idea is that you are part of the team that provides care for mom and we all want to provide the best care possible.
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Looking at this in another way...

The best way to deal with this might be for your mom to be on a toileting schedule, i.e., taken to the toilet every 2 hours.

15 minutes is too long to wait, but at certain times, say mealtimes or during shift changes, it might be difficult for staff to respond more quickly.
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Jo123456 Jan 2020
We tried suggesting a 2 hour potty schedule ( when MIL was in the nursing home), but apparently it is not in the vocabulary anymore.
It took a lot of meetings and a lot of our attempts to “fumigate/disinfect” the room before we could walk down the hall without a gas mask.
Unfortunately that was not soon enough to save the chair we bought to help MIL stand ( not that she used the function).
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15 minutes is way too long when you need to get to the bathroom! How long does it normally take, though? Was that delay exceptional?

It's a tricky issue; but there is another point you raise that I think is important.

Your sister believes that your mother didn't press her call button because your mother didn't expect anyone to answer promptly. That's possible, of course; but I'd be suspicious that your mother didn't press her call button because it didn't even cross her mind to do so; and if that comes into it then no matter how many times your mother is reminded to ask for help, and no matter how quickly the aides would respond if called, your mother is going to be off on her travels to the bathroom before anyone can get to her. Watch out!

The solution to this problem is pressure pads under your mother's mattress and armchair cushion that will alert staff when she gets up. Because of - sigh - "deprivation of liberty safeguards" these alarms are sometimes controversial: check what the nursing home's policy is.
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NancyO132 avatar
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NancyO132 Jan 2020
It is possible that she just didn't think about the call button. Her short-term memory is terrible at this point. Sometimes she will remember something I tell her and sometimes she won't. That is one reason I'm not sure what the situation actually is when I'm not there. She has been known to be a little disconnected from reality at times.
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What does the call button look like? My mother with MCI and short term memory problems wouldn't/couldn't use the panic buttons on the security system to summons help - either the little pendent around her neck or the larger wall mountable button. Those buttons just were not part of my mother's life during the years she was an active adult and following cognitive decline she never could remember to use them. Mom still understands what she reads, so I printed HELP labels and pasted them to the wall mountable button. She will push the HELP button.
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At Moms NH the “expected” time was 10 minutes, but in reality it could be faster or slower depending on what chaos was happening at the time. Her place had silent call lights...when the resident pressed the button a light would go on outside her room (no actual bell). If no one responded to turn it off after 10 minutes her aids pager went off. If after 15 minutes it’s not turned off the LPNs pager goes off. And up the ladder. I would suggest talking with the nursing director to see what is procedure there.

Its tough when the resident is semi-mobile or thinks they are. Or can’t remember to press the call button. Or can’t find the call button. Mom was blind in one eye and eventually both, so she was given a really big round call button. It was flat and probably 4” in diameter. It was grey (what moron thought grey was a good idea?) so I put green duck tape all over it so she could find it, but she still would forget to use it. At Moms NH they could not use the motion detector bed pads. (They were ok in rehab but not the LTC for some unknown reason.) So when she was in bed we would tuck this big green call button by her legs so it would send the signal if she tried to get up. Not ideal but better than nothing. Perhaps you could investigate a different button if that would be more obvious for her.

Getting your Mom on a toileting schedule may help. That way the call button is just a secondary tool. She may already be on a schedule that’s just not obvious so you need to find that out too.

When I was there (daily) if she had to wait much more than 10 minutes I’d be in search of an aid, especially if she said it was for #2. And no, there were no slackers, just incredibly busy and understaffed. I tried to help them as much as I could.
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NancyO132 Jan 2020
All your answers are very helpful. My sister is coming to town soon, and she will talk to the administrator and the social worker. She is better at confronting people than I am. I am the one that has to see these people almost every day, and I actually consider them friends at this point. They have tried to cater to mother quite a bit. I know my mother, and when she wants something she wants it now so I know it's not easy--especially when there are 30 other people wanting their issues attended to. My mother is an R.N. and was a nursing instructor in her former life, so anything that is done differently than the way she thinks it should be done (i.e., the way it was done 30 or 40 years ago) draws her disapproval.
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All your answers are very helpful. My sister is coming to town soon, and she will talk to the administrator and the social worker. She is better at confronting people than I am. I am the one that has to see these people almost every day, and I actually consider them friends at this point. They have tried to cater to mother quite a bit. I know my mother, and when she wants something she wants it now so I know it's not easy--especially when there are 30 other people wanting their issues attended to. My mother is an R.N. and was a nursing instructor in her former life, so anything that is done differently than the way she thinks it should be done (i.e., the way it was done 30 or 40 years ago) draws her disapproval.
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Frances73 Jan 2020
LOL My Mom is a retired RN too and is very critical of the nurses when they don’t live up to her standards!
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Nancy I've often heard it said that doctors and especially nurses make the worst patients 🤣
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NancyO132 Jan 2020
I don't doubt it, and "patience" is not one of her long suits, either.
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It seems too long from your mom's point of view. Does she have a walker to help steady herself?
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NancyO132 Jan 2020
She is in a wheelchair. There are rails along the bathroom wall to hang on to, but she needs someone to help her transfer from the wheelchair to the toilet.
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It would take the caretakers in the facility where my mother was anywhere from 5 to 15 minutes. We think there were times she couldn't remember to use the call button but there were also times that she forgot what she needed by the time someone showed up. We know the people who worked there worked themselves to death and were not ignoring her and we just had to come to terms with things were what they were. We stopped having the energy to get upset and knew it did no one any good, plus many times, we were wrong about jumping to the conclusions we jumped to. My quote for the year ended up being-It is what it is. I said that a lot!!
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Have you considered a portable toilet? If she is able to get into her wheelchair could she also Moche herself to the toilet? Just as a stop gap for emergencies.
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Five minutes is a reasonable amount of time to wait. Yes you should be pressing the administrator to get someone in their sooner. My mother is also in a facility because of my siblings. I am able to take my mother home with me but some of my siblings would rather see her in a facility. I am here with her 9 hours a day. I see the things that don’t get done while here. I can only imagine how it is when I’m not.

when I am here, I do her care. She says the aides on the floor are too rough. It’s not that they are rough. She likes to take her time and they need to stay on schedule.

Don’t be afraid to speak up when you see something that needs to be addressed. Just today at lunch I took pictures of the sparse, stale sandwiches they received for lunch and I went right to the director. I am starting a committee at her suggestion to make sure the food is improved. They welcome any thing you can do to help them improve. If they don’t, contact your local senior center social worker.

If we don’t speak up for our parents and all the residents who’s families
can’t or won’t , they will continue to get substandard care. I know my mother always made sure I was well cared for and now it’s my turn to give back to her.
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Honestly, she probably ought to be in diapers, especially since she's in a wheelchair. My mother was in pull-ups and fell in her new nursing home trying to get to the bathroom alone, and they made the decision to put her in diapers to lessen the accidents and allow my mom to stop worrying about them, too. They let her know that she was wearing underwear to catch any accidents, and eventually she just used the diapers. They take her to the bathroom every two hours, but she's essentially incontinent now, so it's more of a diaper change than anything. She doesn't know that, but she's less stressed about getting to the bathroom on time, and she no longer tries to get up to go alone.
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cwillie Jan 2020
Uhm, usually when we refer to pull-ups we are talking about incontinence products, and in the industry briefs are the traditional tab style diapers (but many here will yell at you if you use the word diaper).
But I agree that anyone who needs to wait for assistance should be using some type of incontinence product "just in case".
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We ran into this same problem in assisted living in Maryland. Dad can’t get up by himself - requires assist - and when he needed to toilet he’d push his button and wait. Mom (88yo) doesn’t have a lot of patience and would try helping him herself. She’d complain about having to help — which was stressful to her — and the facility complained about her helping — because of the risk to both of them. But their wait times were too long. The ED always said “we are fully staffed,” and maybe according to state standards they were, but I’m convinced that the corporation’s algorithm that determines staffing was wrong (insufficient). Or maybe it’s just the way it is, because I’ve seen a lot of similar complaints online about all different facilities. The facility definitely had a “window” (10 minutes, maybe?) by which an aide had to get to the resident and check in, or an alert would would be sent to the computer system. But that’s a long time to wait when you have to pee or poo. It was also hard for mom when she needed meds for an upset stomach or a severe headache; she’d push the button, wait for an aide to show up, say she needs meds, wait for the med tech to show up, say she needs meds, wait for the med tech to get them, and so on. Sometimes dragged out for 45 min. This is unacceptable but the ED wouldn’t do anything about it.
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The problem with incontinence is the urgency. When she has the feeling of having to go, she does not have 15 minutes to wait. (Consider yourself VERY lucky if you are getting a 15 minute response - my mom's experience at several different rehabs varied from 30min to an hour and resulted in adding a diaper to the mix with instructions for her to just go to bathroom in the diaper because it is easier for everyone....horrible).
One thing you might try is to set an alarm for her about every hr or two (depending on how often she usually goes) and tell her to press the call button when it goes off even if she doesn't need to go yet. By the time they get there and move her to toilet, she should be able to empty something from her bladder.
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my2cents Jan 2020
Need to add this - the facilities have certain 'expectation' response times. I found that the call button does the timing (if you try to call their hand on poor timings). They bypass the call button timing their response by stopping in, turning off call button, and telling patient they will be right back....which never happens in a timely manner - yet the response will show they answered call in just a few minutes. - Have also learned that many drive through fast food places use similar system to evaluate the store and the employees. They bypass system by taking your money and then asking you to pull out and get into a line off to the side. They got credit for delivery of food in a few minutes while you actually waiting 10-20 or so minutes. Wmart used to base productivity on cash register being in use. Checkers found ways to bypass that - wise employees were noted for how busy they were, the ones who didn't get the info appeared to stand idle for periods of time.
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It seems to me that if the resident is paying $9000 a month or so they should get the call button answered in 5 minutes.
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I think 15 minutes is reasonable at least in assisted, maybe nursing care is different. If you want faster response the only way to get it is one on one care. We've done both. We found the one on one care was not a good fit for us. It's exorbitantly costly and with no real oversight. We feel like mom gets much better care in an ALF even if she has to wait when she pulls the call button. My mom's ALF is wonderful and they do sometimes take up to 15 minutes particularly if it's meal time and they are busy feeding (and then changing) lots of residents at once. The facility is well staffed, way above guidelines but the reality is - it is not one on one care. They also know my mom is not a call button pusher so they generally respond quickly. I know they have some that call over and over and over. To their credit, they do patiently keep responding.
When my mother had a stroke and was in rehab she had the same situation with the bathroom. It's stressful because they frequently have urgency and are told they have to wait which panics them and then they just try to do it on their own - and then fall. It's just a recipe for disaster. But the reality is there's no facility that has enough staff that someone can come running every time. Maybe try some incontinence protection "in case" they don't get there in time to alleviate her stress. I like the idea of a toileting schedule as well but it may not help if there's still an urgency issue.
As far as the nursing home, are you happy otherwise? If that's your only complaint I'd say you're in a good place. If it's one of many issues, then you need to talk to them. I am also at my mom's facility every day and the workers are definitely like family to me. It's not perfect but I am happy with her care and when issues come up I just talk to them. Sometimes they will explain why they do things a certain way (and it will make sense) or have suggestions of their own which are often very helpful.
Best of luck
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NancyO132 Jan 2020
My mother was in an ALF prior to going into the nursing home. It was her inability to walk after a bout of pneumonia that put her in the nursing home. She was already using adult diapers even in the ALF for "in case" protection. The reality is that now she is for all intents and purposes mostly incontinent, especially with urine, but she still wants to get to the toilet anyway. If she weren't wearing the diapers I would be more concerned about the response time. That is where my sister and I are sort of butting heads on this. She knows that mother is in diapers, but is behaving as if she isn't. I am just trying to navigate between her and the staff at the nursing home because I am in fact very happy with the nursing home.
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Urgent bowel movements cannot wait 15 minutes. Speak to the Ombudsman. Or best yet, perhaps your mother should wear protection/diapers? You do NOT want her to break a bone at 98 years of age.
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NancyO132 Jan 2020
She is wearing diapers at all times. She has been doing that for at least 3 years now, even before she came to the nursing home.
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Edit - I see that she is in diapers. Please excuse.
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NancyO132 Jan 2020
No problem! After reading the answers I see that was one vital piece of info I should have put in the original question. I suppose my real question would be concerning how long the response time should be for a person in diapers. I think she is really bothered by the fact that she has trouble with incontinence and thinks that she should be going to the toilet when she gets the urge, but the reality is she has not been able to make it to the toilet on time for quite a while---even when she was still able to walk. I just feel like I'm between a rock and a hard place trying to make her content.
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Nancy you'll think me very odd but I don't wholly agree that the diapers make a difference.

If your mother knows that she wants to use the bathroom, it is totally unacceptable to leave her waiting because after all she can wet her pants in comfort. So diaper or no diaper, is she in fact incontinent? Is she aware of when she needs to "go"?
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Another reality of dealing with a NH is the understaffed issue. Many just dont staff adequately, or they have trouble attracting qualified people. When we were looking for a place for my dad (before he got into VA), first thing i always looked at when I arrived was how much staff was in line of sight, to include maintenance.
When we would find one where the halls were empty, we turned around and left. Your request for a few minutes for then to respond is very reasonable.. but like anything else, in most cases $$$$ drive the business, regardless of what you may be paying. Not trying to be negative, it’s just something I’ve noticed and it really is sad. Best wishes...
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You say your mom's been in depends for 3 years and could not make it in time, even before she was in a wheelchair. Her brain was already broken about the time it took between noticing the urge and reaching the bathroom. So no, she will not be able to summon someone to get her to the toilet in time.

Since you are happy with the nursing home in other areas, I think this is one where you let it go. Perhaps your sister would like to hire a private sitter who can help your mother get to the bathroom during the day. Your mother and sister are being unreasonable if they think that she should be able to make it in time with help that has to be summoned from far away when mom could not make it when she could walk.
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Having just recently helped with my husband while he was seriously ill in re-hab (nursing home) we came up against the bathroom thing. I found it was so much easier for the CNAs to tell them to use their briefs. Yet, it becomes a matter of dignity. Whether to lay there and use the brief or be put on the toilet is a matter of dignity. But the way the help in nursing homes are set up, they are not able to assist patients in a timely matter to get to the toilet. No one is more overworked and underpaid that help in nursing homes. I don't remember anyone slacking or not running running running.
My husband was finally getting better and having to call to have a brief changed rather than getting to the toilet. When I got him home under my care giving, I found we were "potty training" again and it took us about 6 weeks to train his urination and bowels. I'm not at all sure what the answer is. Sometimes all the lights were blinking in a hall and indicating that they had been waiting. It's the design of the system, and those that didn't have loved ones assisting were destined to wait and loose dignity. There is humiliation in having to have someone to clean up after an accident or instruction to "use your brief".
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When my mom was in rehab in a nursing home we experienced this also. They get there when they get there. It sounds awful but they are so short handed at times. If a person isn’t available at that time there isn’t anyone to attend to her needs.

It’s really frustrating for the residents. It’s equally frustrating for the aides. All I can say is that it’s very common. That is why they live in diapers.

The diapers get changed when the aides reach the room. There is no way to predict when that will be. That is what I observed. It’s hard. I’m sorry your mom has to wait. It is hard to see that they don’t receive care at a quicker time than they do. It really doesn’t matter how many times that call button is pushed. My mom pushed it repeatedly.
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I think the hardest adjustment for the person newly admitted as well as the family is too accept that this is group living where others have the same or more extensive needs than your mother. That being said, I would say 15 minutes is a reasonable amount of time to wait. However, if she's waiting to press the bell until she us past the point of having to go then 15 minutes may be too long. Toileting schedule, maybe?
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Nancy0132: This WAS my mother - waiting too long to get to thr toilet and then created messes on the bathroom floor and toilet. I was "dancing" while cleaning it up because I had to use the toilet.
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unfortunately that is probably the standard. My parents complain when they have to wait but I have explained the facility is short staffed and people also call in sick especially at this time of year. The most important thing is how the nurses treat her when they get to her and they it isn’t always 15 minutes.

my Mother is now chair bound and is in diapers. My Dad is able to go himself. It must be hard for your Mom to be dependent like that. My Mother is beside herself
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