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Don't anyone tell me I CAN do it. I know I can do it with more care and empathy than the current aides, but it will generate stress for me and remember I'm supposed to keep my BP low. We switched mom from the seroquel anxious to prescribe MD via Hospice, to the local medical system she has seen an MD in prior that has a care at home program. The MD was out a good week ago and put the referral in to the wound care nurse who came today, One of the heels is quite significant and rough for me to look at much less consider bandage changes to. I confirmed that those aides mentioned too many times prior are in fact state tested nursing assistants, but that makes me all the sadder considering their behavior and work. I had a nice chat with the hospice nurse the other day and came up with a couple things to possibly help the issues at hand...i.e. the face towels sort of got laundered out of rotation and were replaced with regular sized bath towels from Walmart which are cheaper/thinner. That way mom has more coverage. But the bed bath I do not believe is still being done as it really should. ANd no I didn't open my big mouth because I sense the nurse was reporting what I told her to the team leader. I also got a basket/hamper for the soiled stuff. It appeared in spite of nearby papertowels that excess protective cream was wiped off their hands onto the sheet (but I am sure I would be told it came off of MOM). Today a mess was left in the small bathroom of dirt spots and hair from mom that they I think could have cleaned up and a grocery bag with used disposables left open and hanging off the bed rail. Who is supposed to be helping whom here? And so with them being STNA's it falls within their job to do bandage changes but I do not trust them or want them doing that for mom. I was rather overwhelmed with the sight of the heels, and it would be a stressful challenge for me. I only take comfort in knowing I am sure I couldn't do it worse or with less empathy. I do not trust them to follow proper sterile like procedures. So I'm guessing Medicare might cover it but would say since mom is in hospice care, hospice should tend to it, but then we're back potentially to the aides. Wondering if we might pay privately for the care at home program to send a nurse to do it? Anyone have any experience with any of this??

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gdaughter,

I am so very sorry that you are struggling with this situation. Don’t worry, I will NOT tell you to treat your mom’s heel sores yourself.

I really feel that a wound care nurse needs to be handling this situation. I don’t think that I would be comfortable having her aides doing this job. My mom was on hospice. She had one bedsore in spite of wonderful compassionate care by the staff. Mom was 95. Her skin was breaking down.

The aides were terrific at mom’s hospice house. They did a good job bathing her. She was bed bound the last month of her life. I respect people who know their limitations. The aides would tell me that they weren’t comfortable treating mom’s wound on her backside. They would make a call to the nurse. The nurse would come out to treat it. Sadly, it never completely healed. It was painful for mom. They gave her pain meds. She was dying. We wanted her to be as comfortable as possible.

It’s really hard watching our parents decline, isn’t it? I feel your pain. It hasn’t been that long since my mom died. She died at the end of April.

I understand about your blood pressure and anxiety. I had mom for 15 years in my house. My blood pressure was sky high. I wish that I could be of more help. You’re in a very difficult situation. You will be in my thoughts and prayers. Many hugs sent your way.
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gdaughter Jul 2021
I thought I answered you!? But it doesn't appear to be showing up? Anyhow perhaps it is posted somewhere else in this list of questions and responses?
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Hospice has specialized would care nurses that they should send to address any pressure sores. Once an evaluation has been done and a Care Plan developed the CNA's in some cases can carry out the treatment and wrapping of wounds. The nurse that visits weekly is also able to continue the care as indicated. If it is a deep wound the Wound Care nurse would be involved as well. But this is all part of Hospice and caring for the patient so Medicare will cover the care.
Any problems that you have with the Nurse, CNA not doing what you asked them to do (if it is reasonable, and within their scope) you should be able to ask them to do if it makes your job of caring for mom easier. You can call Hospice and ask to talk with the Team Care Manager and discuss things with her or him.
AND please know if you are not pleased with the care you are getting, if you feel that they are not following through you have the right to contact another Hospice and interview them and they can help transfer mom to another Hospice.
the staff should treat you and mom with Respect and Dignity. And they should not leave medical waste or "contaminated" items out. Make sure they have a hamper and a covered trash can they can use to put items in.
Before you pay privately for a Wound Care person discuss the problems with Hospice and ask what the ramifications would be if you did do that.
Also just out of curiosity.....
There are 2 types of Hospice. FOR profit and the other is NOT for profit. That might make a difference.
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gdaughter Jul 2021
I had a nice chat with the understanding nurse last week, and I think (with my consent) she relayed some of my issues/concerns back to the team leader. ANd yes, totally agree, as I at this point cannot trust these current aides (2 come at the same time to do routine personal care at least on week days) to do something as specialized as wound care/bandage changes, if I am forced to deal with them in that role, I will not hesitate in engaging with another hospice organization. THIS is supposed to the best. We do have a local long term care ombudsman, and I will touch base with them, but I have no idea which program is the best. As far as I know this current hospice is NOT for profit. And yes, having worked for a non profit agency some 30 years I get the difference. Heck, Gram, the lofty Cleveland Clinic (I'm in Cleveland area) claims to be NON profit if you can believe that, and yet here I sit with a $3K+ bill for what wasn't covered when I was taken in for the emergency aorta dissection last fall....Not for profit but they will squeeze the last dime out of every living soul who crosses their threshhold while evading property taxes in every city they have a building by claiming their non-profit status. But that's a story for another day....Stay tuned all....and keep those prayers coming:-) Hugs and love to all....
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I’m so sorry for all you have been through - it is so hard to learn all the ins and outs and I have found like you that many places do not make it easy for us as family to learn - hence why this is such a great place to share and learn.
Any time we spent in skilled nursing rehab - acute care or hospitals the CNAs were never allowed to change moms wound care bandages.
They always had to go get moms nurse - moms nurse wound have to be the one to have eyes on it so she could report any changes and she had to be the one to apply the new bandage.
I would ask for either a wound care consult or if their has already been one then ask to see the orders on how it is written up to be treated. If a wound care consult was already done then I believe they follow the case and have to do daily/weekly check ins (depending on the type of wound) to follow and or make changes if needed. Either way ask to see the orders so you can see how often it is suppose to be changed - who has to apply and make progress notes in regard to it?
We have wound care for moms arm in home right now. In home health nurse check it once a week and wound care specialist comes once a week to see if any changes need to be made and how it is progressing (I do all the other dressing changes the other 5 days (but that is because we are at home) and I can call or report if I need them in between those 2 check ups.
Moms wound was not healing so our wound care nurse sent us to the wound care center and the Wound Dr was the one to write up the new orders to be followed. My home health has to order me those exact supplies and treat it under those orders given by the wound care Dr.
Im not a nurse so maybe one of the nurses here can give more insight on whom can change dressings but in my experience it has been only the Nurse who can do so.
Again - request to see the orders for it - some dressing changes may be every few days or every day - some dressing are made to not have to be changed daily unless soiled some can stay on for several days and are meant to do so.
Also do they have anything else protecting her heels? They usually provide things like air boots and I would also ask hospice to order her an alternating pressure mattress this will help her heels as well as her whole body from pressure sores.
Prays for you to get some answers and good communication from her drs and hospice that may help you feel better.🙏🏼
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gdaughter Jul 2021
Thank you so much for the empathy and understanding....it is dreadful that they seem anxious for our "business" and yet we are being led into a dark hole where info we may benefit from is deliberately withheld (or at least that's how it seems) to the detriment of us and especially our loved ones, while they are looking out for their own bottom line$. This has got to change. WE should have a legal right to this information, on who does what or is legally allowed to do what, where to report complaints re care issues or concerns. SO mom was seen dear god, was it only yesterday? BY a WOUND care specialist nurse coming from one of our two competing sources of medical care in our town, the visiting MD program. It was the initial visit by the MD who discovered a weepy heel and put the referral in for this specialized nurse who took pains to show me how to cut the bandaging material to make a "cup" and change it, She was a nurse practitioner. She said she would be back out but thank goodness I started taking notes because I just can't keep all the players and details straight...but regrettably I did not note when the wound care nurse would be back. The HOSPICE nurses, there are two who rotate every week to ten days. The directions left by the wound care nurse say the care is to be done 3xweek+as needed, but make no indication of who that person will be. I think they expect hospice to provide the care as they are established as care providers, and that's what concerned me...that we would be back to the aides I do not trust in general to provide that care. Their actions speak loudly and I fear they would not follow the proper protocols and risk my mother to infection, not to mention their less than caring ways and not potentially being as gentle as they could. I will try hard to hold my ground and insist on a real nurse to do this, as well as pursue more diligently getting clear info on what we are entitled to have covered. Amazingly the nurse showed me pictures of the air type boots and endorsed my idea of putting a pillow on top of a pool noodle to raise the legs up a bit more. We do have the pressure mattress in place. So often it seems like there is a game being played here with one agent passing the buck to another. I feel like a pawn in it all. For now I feel like I am on a scavenger hunt in search of the "plum smart" juice one suggested and some ointment for the heels which someone said hospice SHOULD (?) provide, but I was told to find it in the baby aisles and it is called A&D cream/ointment but to get the one withOUT the zinc. Still wondering to myself why not the precaution of an antibiotic ointment...but who am I to question them? There are no air boots, in fact I was asked if I had any because of my stay in the hospital last fall...I was never offered them on my departure though I recall they were used for a bit. I'm sort of thinking like you, that if indeed the bandage changes were going to be done by these two current aides I will STOP it, not allow it, and request either a change in aides or I will switch agencies so we are sure to have new people to work with. I suppose I shouldn't be, but I just remain surprised that so much of a burden for important care is placed on untrained, unskilled family members. ANd wonder who is liable if a professional is not keeping track? It's like they don't care if there is a subtle change that isn't reported, almost like, well hey, they're gonna die anyhow. This is so not what the hospice programs are supposed to be....
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CNAs should not dress wounds. They are not trained medically. CNAs do the dirty work so LPNs and RNs can do the nursing. They have maybe 10 weeks of training. Certified does not mean they do what nurses can do. It means they have passed a training course and in my State are Certified by the Nursing Board.

Woundcare is a specialty. My daughter did it for years in rehab/nursing facilities. She now is now a Unit Manager of a Woundcare clinic in a Hospital. They know what to look for. With my Dad and open sores on his heals while in Rehab, my daughter saw dead tissue when she looked at them. Those bandaging him did not note this. The DON was made aware and Dad better cared for.

I am with Grandma here. This is a question for the Nurse in charge.
You may also want to approach her about what are the duties of the CNAs. You have made them aware where the laundry room is, ect. Is it not part of their duties to clean up after?

Do you have a trashcan nearby that soiled depends can be put into. By the bed, in the bathroom? If in the bathroom, and seems the bathroom is close, why are they not using it? I bought a small flip top trashcan with a flip lid I lined with a trash bag. I put one of those stick ups in the lid.

I too would not appreciate what these aides are doing. I would question if they are certified. I have a friend who has never been certified and she cares for people. She even worked for Visiting Nurses because of her experience. I would, one more time, talk to the Supervisor. Tell her what you are finding. Then ask if cleaning up is one of the aides duties. If the answer is NO, then you will just have to make things easier for them. As u have already done, a hamper for the towels, now something to hold dirty depends.

I wasn't there for Dad's home hospice. Mom was in a NH. But I did have an aide for homecare. She was able to bathe Mom in the shower but I do think towels were left for me but her soiled diapers were put in the trashcan provided. I was so happy that she was showered and dressed that clean up didn't bother me.

You have a right to question. But you may have to except that these aides are lazy. Our Hospice was associated with a Hospital and did ask for donations. That I would not give in your circumstance.
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gdaughter Jul 2021
See my responses elsewhere and to Momheal1 below....thank you for all your info, I believe what you stated is also true in our state of OH as far as training and certification. Lazy is not the exact word...I think it's just a job for them, something they may have been forced to train for or lose benefits elsewhere? I don't want to jump to negative conclusions. BUt I see what I see, sense what I sense. I too don't care so much about popping in the garage to dump the bag of soiled disposables out. I just think they could at a minimum tie a knot in the bag to control the odor. Usually it all happens so fast not much escapes, but it's just the considerate thing to do. I think the lack of consideration and respect is what so much doesn't sit well with me, and seeing their sloppy ways, I wouldn't ever trust them with wound care. They are an accident waiting to happen health wise. YEs, around here so many grateful people put in the obits donations suggested to: and hospice is the big taker. But no way imo. Maybe I was naive and that combined with their poorly explaining the expectations of family from the beginning. But I have felt much stress with their involvement, which is only tempered by the burden relieved by the depends changing help and personal care which dad and I are not capable of doing IF mom would even tolerate it. But that is no excuse for them not doing it according to procedure/protocol. thank you so much for your info and perspective. IT helps.
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Yes, hospice will treat them, and they'll be covered by Medicare.

My mother has been in hospice since January, and she's had a pressure sore on her heel the entire time. It's a ghastly thing to deal with, and under no circumstances should you attempt to treat it. I help Mom's hospice nurse with the wound care (by holding Mom's foot while she treats it), and trust me, you don't have access to any of the medications she uses on that thing. Mom's heel looks like a moon crater, but it isn't infected nor is it wet and soggy, and that's what's important. No matter how much empathy you have, you absolutely should not mess with it.

If you don't like the hospice company you're using, fire them and hire another one. I did that with my dad's first hospice company. I hired another one, THEY notified the first company that they were being replaced, and the two companies coordinated together to switch out all the medical equipment in the space of 45 minutes. My dad merely had to be switched from his hospital bed to his old bed for that time, then we were able to get him back to bed with a minimum of inconvenience.
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gdaughter Jul 2021
Thank you so much for the wise guidance. The glimpses I had of mom's wound is that it is...very hard to look at kind of bad...to the point I wonder if I was hooked up to a BP monitor if just looking at it wouldn't raise my BP....YEs, if we cannot get the prescribed bandage changes done by nurse as the wound care nurse noted, by hospice, we will be changing, which may be a good thing in general, but I will not allow those current aides to do any bandage changes. My concerns have already been noted after observing them and considering the lack of respect, and dignity show form mom or our home furnishings and environment, it shouldn't come as a huge surprise. Not to mention as someone else did, the wounds should have been noticed and reported before that MD visit from a competing health care system.
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Dressing of open pressure sores requires nursing qualifications. I'd be surprised if the aides were allowed to do it. We're certainly not, in spite of having had skin integrity training.

Have you been told how often these dressings should be changed? I suspect it's not as frequently as you think (which might also give you the heebie-jeebies, I appreciate, but there is method in the madness).

More to the point, positioning - do you have the means to keep those heels clear of the mattress surface without applying excess pressure to other points? Frankly, this ought not to have been allowed to progress - though I'm afraid I might be adding fuel to the flames by saying that.

On the plus side, let me tell you you certainly CAN'T do it. Out of the question. What you can do is report any lifting, curling, clumping of the dressing; any further areas of skin breakdown; any seepage, odour; any redness/breaking in surrounding skin.
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NeedHelpWithMom Jul 2021
That’s correct, CM. Mom’s nurse changed her bandage once a week. It’s not a ‘daily’ changing. Mom’s nurse said that the medication had to remain on the skin for an extended period of time to work.
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Found it! - this is what I was looking for, it's a version of the skin integrity leaflet I was given after mother was discharged from rehab.; it includes various checklists and templates for record-keeping for both family caregivers and visiting professionals. If you can't open the link I'll have a go at copying and pasting the sections, just let me know.

https://www.shropscommunityhealth.nhs.uk/content/doclib/10791.pdf
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gdaughter Jul 2021
thank you!
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ME TOO (about WOUND care NURSE) and thank you for not telling me I can do it. Listen, a number of years back, with some difficulty, but loads of support from my beloved vet, I took care of one of my pups who had an abscess on her belly. We only had theories as to how this ever developed, but it did and needed care. IT was a challenge for me, but it was me or very expensive bills, so Joan helped guide me through it all, and my pup, bless her heart, was capable of feeling the love and gentleness and let me do what I had to...but even with her she had a say: she objected to the suggested warm compresses so we just did 2x a day dressing changes by my very gentle hands, and in combination with a med known to be good for vet skin infections, we healed her! We had even at Joan's suggestion, trekked to OHio State where they had no help to offer. Back home, gradually this literal hole began to shrink up and the drainage continued to diminish....from the size of a draining orange, down and down it went until the opening went from a quarter,, to a nickle, to a penny and then dime, to vanishing! Just to say I have dealt with rough stuff when essential...but I think this is really pushing it, considering the other stress I am coping with. ANd what if I am alone in the task and mom becomes...well, challenging, could kick around...heck, it was enough just assisting the nurse as I could holding her leg up so she could wrap the heel easier/quicker.
At this point it is my understanding that the hospice house facility is only used for very particular situations and often expected to be paid for not necessarily covered by Medicare. I wouldn't doubt with someone always watching over others of lower status so to speak that the care would be better.
Yes or yes, bless you for acknowledging how hard it is to be the one in person to see the decline. I guess I am blessed to see the flipside of my very active 104 year old father thriving. I am so busy trying to survive and do what I can for mom especially, and taking care of my pup who is the world to me, that I don't have time to feel for dad's pain which he must have...they will be married 72 years in a few weeks (oh and how will we acknowledge that?) and I can't imagine his going to bed of late without her beside him which all happened so suddenly it seems. I don't even want to take my blood pressure because a high reading will stress me more! ANd SHHH...I have been honest with the surgeon, but I am not taking the damn meds. That creates considerable stress for me as I am one of the worlds worst pill poppers. It also generates stress to see the bottles and watch the clock and have to have my life scheduled around the dosing. I have NO YELLING yet to connect with the assigned cardiologist, yet note I was under his roof for over a week and he never saw me either. I would be open to considering a patch but I guess BP meds in patch form are rare or have issues of their own. Trying to eat things higher in magnesium and potassium. Thank you for your love and thoughts and prayers...and the hugs. Means the world to me. Another stressor is the lack of support from my only out of town sibling. It was really hard after all I have done for our folks, to have her incorrectly conclude I had a heart attack, and that it was my own fault...in fact when she moved some 19 years ago, (can it be?!) her parting words were if mom and dad needed help, to put them some place, as I was entitled to a life of my own. SHe feels no sense of family,or need of family or obligation to those who have helped her. That's just not, for better or worse, me. I could never turn my back on my parents. OK I think I will get some clothes on and go see if I can find the A&D and a pool noodle....thanks again....
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Gd, it is quite difficult to break somebody's leg no matter how ineptly you change the dressing on her heel. The same is not true of inadequate training in moving and handling. A Hoyer lift is a very good idea but do not underestimate the care required to use it safely.

Do not touch those dressings - do not lift and peek, do not roll down to see the layers. If there is seepage (as opposed to staining), place a disposable bed pad under the affected foot and call the nurse.
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Gd Stacy means that wipes are covered as disposables when disposables are justified by taking the person out-and-about; whereas if the problem is merely an Everest-sized mountain of laundry in your house then you're on your own.

Yes?
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When my Mom broke her arm I took her to the ER. They asked her all kinds of questions and put her in a room. Mom was the only one there. Nurse walks by and says "put this on her" A hospital gown. I said I didn't feel comfortable in putting it on her because she broke her arm. The nurse got snippy and I said "well you are the nurse" she came back and said "yeah guess I am". When Mom was in the AL I did nothing that was the aides responsibility. The facility got paid well for Moms care also that nurse at the Hospital.

If you are uncomfortable doing anything don't do it. Let hospice provide the people needed to care for Mom. And I would check with State law if an aide can do bandaging. From what you have said so far, I would not trust them. They need to know what to look for.
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