“Just Go in Your Diaper…”

“Just Go in Your Diaper…”
"Just go in your diaper…"

“Just go in your diaper…”

My good friend’s mom fell on the Chicago ice in zero degree weather.  She called out for help and no one answered.  His mom was literally laying on the sidewalk in Chicago with a dislocated shoulder and a very bruised hip.  She was lucky to have her cell phone in her pocket, but at 93 years old could not figure out how to call 911 on the flip phone.  Then she was double lucky to have her wireless house phone to actually call 911 for help.

So my friend flew from Seattle (Home of the famous Seahawks) to Chicago to go help his mom.  What a burden for an adult child to be responsible for an aging parent who lives across the country.

The mom’s doctor highly recommended a rehab community and said it was excellent.  My friend checked his mom into the rehab and went back to her house to sleep.  Well, the mom ended up calling him at 4:00 AM and said, “Get me out of here!”

This is what happened…  When the mom hit the call light to go to the bathroom, a very pregnant caregiver appeared and said, “I can’t lift you, just go in your diaper.”  Later, when the mom hit the call light again for some water, another caregiver appeared and said, “You still have water left in your glass, drink that first.”  Then she just walked away.

In the morning, when the mom complained to the head nurse, the result was angry excuses.  So the mom called her doctor and heads started to spin at the rehab.  The administrator came in to apologize and then the head nurse suddenly became nice.  The mom was told that she would never have to be with the two night caregivers again.

Unbelievable.  It’s hard to imagine that a 93-year-old mentally sharp senior had to shake up this Chicago rehab community.  I wonder how the other residents faired with this “motley crew”?

Please share your successes, failures or comment below to join the conversation and interact with other senior living professionals on what is currently being effective to increase occupancy on a nationwide basis.

Diane Twohy Masson is the author of “Senior Housing Marketing – How to Increase Your Occupancy and Stay Full,” available at Amazon.com with a 5-star rating.  The book is required reading at George Mason University as a part of its marketing curriculum.  Within this book, the author developed a sales & marketing method with 12 keys to help senior living providers increase their occupancy.   Masson developed this expertise as a marketing consultant, sought-after blogger for senior housing and a regional marketing director of continuing care retirement communities in several markets.  She has also been a corporate director of sales and a mystery shopper for independent living, assisted living, memory care and skilled care nursing communities in multiple states.  Currently, Masson is setting move-in records as the regional marketing director of two debt-free Continuing Care Retirement Communities in Southern California – Freedom Village in Lake Forest and The Village in Hemet, California.  Interestingly, this career started when she was looking for a place for her own mom and helped her loved one transition through three levels of care.

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56 Comments

  1. 1st – Great info. coming! Not directly in field but did buy 5 of your books for giveaways to Marketing directors. Thanks

    If you ever do a piece on dementia residents wandering, you might want to notice our watch that is a perfect answer to prevention of consequences. I don’t necessarily mean to name it but to allude to this type of device as available.

  2. Thanks for the blog post, Diane. I experienced similar “horrors” with my father’s rehab stay during recovery from a short-term illness. Unfortunately stories like these are still not “relics of the past”. Our residents deserve (and are paying for) better service and treatment. It all speaks to respect for, and preserving the dignity of, the resident. I ended up moving my father to a different CCRC where he fully recovered. In the long run, I believe a competitive market rectifies issues such as these.

  3. Thanks for that Dianne. Sometimes families hesitate to inquire further perhaps because their relative is suffering from lapses of memory or some confusion – even mild and intial demetia can bring confusion and some doubt but I do agree its necessary to let the facility know that something may be awry. Tactfullness and courage needs to go together.
    Siah

  4. Always know who the long term care ombudsman is for the facility and remind those caring for your loved ones (or not caring for your loved ones) that you will contact them.
    It’s a sad situation for all of us, but we need to be proactive. When we are not present, it is truly hard to imagine what is happening day to day.

  5. I am a mobile hairstylist who predominantly services our Senior Citizens in their homes and I hear more and more of these stories. Seems like these nursing/rehab facilities hire people who aren’t sympathetic to seniors and treat them all like they are senile!! I had a situation with a newly opened facility here in Chicago back in 1985. I found that the employees of the facility had no formal training as to how to handle these delicate patients. I had more training from the hospital upon the discharge of my mother on how to take care of her than these employees receive who are responsible of taking care of many patients. Shame on the owners and administrators of these facilities, they should be held accountable for the actions of their employees. Maybe if the staff were paid more and received formal training, they’d treat the patient better. Sadly, if things aren’t turned around quickly, our generation are the next ones to be placed in these facilities!! Scary isn’t it?!

  6. The woman in this scenario faired very well. However, many times residents are afraid to complain for fear of retaliation. In Tennessee, residents and their families are encouraged to contact their local Ombudsman for assistance.

  7. Elder Care Professionals

    Oh my – where to begin! First, the pregnant caregiver should likely have been assigned to desk duty – and there is absolutely NO excuse for a bad attitude on the part of the next person who answered a call light. And the statement: “Just go in your diaper?” Really? More importantly, no one, repeat no one, should ever be treated in this manner regardless of age or reason for hospitalization – but ah, I preach to the choir, correct? Inservice education, better communication between staff and administration, imbedded philosophy of care that is lived by staff – so many suggestions – do you know what transpired with this situation? What improvements were made? Thanks for sharing this…
    By Stephanie Sanders-Badt

  8. Elder Care Professionals

    I cannot tell you how many times I have hear a staff member say this to a resident. It seems if they do not understand the meaning of dignity. Personally, as an independent caregiver who goes into facilities and see more and more disrespect for the elderly, I hear a lot of things spoken by CNA’s that they probably do not intend for me to hear. I’m not sure inservice education will do the trick. How about just start firing those who treat the elderly with such disrespect, facilities quit covering up for the employees ( I hear it all the time) and let a revolution start where we pay the people who care for the elderly a more decent wage where we can hire people who have high respect for these individuals, and they do their utmost to keep their jobs because they cannot go to a fast food place and make the same wage? Folks, something needs to happen. We baby boomers are going to be there soon and I think we have all seen enough that we do not want this kind of treatment. I have seen employees that look like they have not bathed in week , talk down to the residents, and not answer call lights for over 15 minutes. Always an excuse.
    By Carol Horned-Dering

  9. Elder Care Professionals

    Every time i hear a coworker say that. I cringe, then say to them …would you wantvyour love one to be told that and treated that way. If they arr still able to tell you they need the bathroom then take them so they can maintain a level of dignity.
    By Louise Mackall

  10. Elder Care Professionals

    A resident under my care was told this by the Hospice agency brought in to provide end of life care to her. Needless to say, the hospice employee was invited to leave, the hospice contacted and that particular employee not allowed to return.

    Staff in the care facility where I was admin were trained well, and understood caring for their elders with dignity, compassion and grace, so it can be done.

    Statements of this nature and others of its kind are grounds for immediate dismissal as they show that the employee is not capable of providing the level of care required by the given resident.

    Pregnancy is very hard for the caregivers, the CNAs, the aides… however, it was not viewed as a reason to not perform all aspects of the job. This is an area where corporate “policy” can be less than understanding, or admirable. The corporation governing the care facility to which I am referring did not allow any lightening of duty for a pregnant woman.
    By Edith Gendron

  11. Elder Care Professionals

    These are all great comments – offered with compassion and care – and the only thing I might add is that “company policies” vary from community to community. We had a policy that women who were in the later stages of their pregnancies would float to desk duty in another part of the house – and this was successful because of our cross-training methods. Many of our line staff were cross-trained in several areas – this had many benefits and staff retention was improved.
    By Stephanie Sanders-Badt

    • That is an excellent policy Stephanie. I wish that all corporate structures in our profession would adopt that policy.
      By Edith Gendron

  12. Elder Care Professionals

    My mom was in for “rehab” at a facility in South Jersey in 2007. This was due to a fall she had and fractured her fibula. When she asked for assistance to te bathroom she was told the same thing. I didn’t find tis out until I visited her and she said she had to “go” and i said i would get someone to help as I did not know her rehab status, and she said, “it’s ok, they told me to just go in the diaper”. She was 94 and alert but that brought her down completely in a few short months!!
    By Veronica Smith

    • Elder Care Professionals

      Veronica, I am so sorry your Mother had that experience. In Florida, that type of response is considered abusive and reportable. I’m not saying it doesn’t happen in Florida, but there is specific recourse if it is reported to the Adult Protection Service, or to the licensing agency (in this case, AHCA).
      By Edith Gendron

    • Veronica, thanks for sharing what happened to your mom. It’s is so tough being a daughter and an advocate.

  13. Elder Care Professionals

    What is the value of being able to safely get out of bed and go to the bathroom in the middle of the night instead of waiting for someone to show up? Just one of the many benefits of Friendly Beds in allowing a person to “help themselves”- safety, independence, self-esteem, strength conditioning, being able to reposition yourself, bedsore reduction, comfort and general quality of life.
    By Joe Vosters

  14. Elder Care Professionals

    I’m so sorry this happened to your friend’s mom.Thanks for sharing this story, in my opinion this is a form of elder abuse. Is this the normal standard of care?
    By Karen Whiteman, MSW, PhDc

    • Thank you Karen and no it should not be a standard. Many states consider it abuse.

      • No, it is not the norm, nor is it accepted or condoned. It is difficult in some settings (where training is not valued as it should be, where wages are horribly low, etc) to eradicate poor training or unprofessional notions on the part of staff (including licensed staff).
        By Edith Gendron

  15. Boomers: Aging Beats The Alternative

    I’m sure something like this happens all the time in many SNFs. Low pay, too much to do and jaded attitudes. It’s a sad commentary.
    By Lorie Eber

    • It upsets me, because it so wrong!

  16. Boomers: Aging Beats The Alternative

    We had my mother in law in one for rehab and could not get her out fast enough. Luckily for her we were able to pop in unannounced multiple times a day. We sat down with the administrator to go over all of the issues but nothing changed. That is why I am such a big advocate for the smaller Personal Care Homes for a long term solution. I really feel for people who do not have family who can/will advocate for them.
    By Kathryn Watson

    • Kathryn, I agree. I feel this is such a huge need for an expanding niche market – health advocates. Families need to be taught their rights, what to request, require and how to stand up for their loved ones, or how to hire a healthcare advocate to help step in when the family is far away, or out of town. I’m sure there are certification programs to ensure these advocates are properly trained in specialty areas – Parkinsons, Alzheimer’s, etc. and bonding, etc. that should be required. This does exist, right?
      By Susan Finch

      • I agree with Katheryn Watson, the smaller personal care home is much more personable. I interviewed six before deciding on one for my dad and he loved it there. I and my siblings agreed and we felt good with our dad being there. You can go and visit anytime and check in on your loved one! I highly recommend Caring Hands LLC in Houston Tx. Madonna Thibideaux is the owner and she has over 35 yrs in the industry and will make you feel right at home. Our loved ones and seniors deserve our best!
        By Jesse Hernandez Sr.

      • Susan, a Geriatric Care Manager can offer the services you describe but at a cost. For those who can afford this and for families who live far away from their loved one this is something they should really look into.
        For families that are unable to absorb this extra cost I have partnered with social workers and nurses who have a need to educate and give back to the community. They offer help to my clients giving information that is beyond the scope of my training and expertise. I have also partnered with attorneys who offer free workshops to educate families on the legal needs of the clients.My placement service is no charge to the family as the community will pay me a referral fee.
        By Kathryn Watson

  17. Boomers: Aging Beats The Alternative

    Have heard healthcare is rife with such heartlessness — especially among the CNA workers [I was in rehab after my second stroke]; Like Steve’s post above, I think accurate reporting and broad exposure may help fix this monster of a problem…
    By F. Todd Winninger

  18. Many people are telling me that if they heard a staff person say this, they would be fired!

  19. Boomers: Aging Beats The Alternative

    When my mother in law was sent to a SNF for rehab we had to sign a paper saying that we would not record or video anything in the room. we were not allowed to put hidden or exposed cameras in the room. This was a huge red flag for me!! They said it was for the patients privacy but I do not buy that. What is your opinion on this? Should you be allowed to put a camera in the room of a loved one who cannot advocate for themselves?
    By Kathryn Watson

  20. Boomers: Aging Beats The Alternative

    Cameras in a home are one thing, in a host environment, I can see why they would not be permitted. True, nothing to hide comes to mind but I think they have the right not to have camers on their premises- unless they are their own.

    Re. the “go in your diaper” that is a matter of staffing ratio to residents. A GCM can be helpful as an advocate. Hiring an aide for one on one care will get the person to the bathroom sooner. No matter how fabulous an ALF or SNF, or hospital is, there isn’t one to one care.

    I’ve heard ALFs having residents use walkers when they can ambulate independently and safely. It becomes a management and liability issue.

    For an individual’s dignity and what they are chareged it would be expected to have enough staff to attend to needs within a reasonable response time. It just doesn’t always occur. Every resident needs a hired or family advocate to let the facility know, they have someone — so make sure so in so resident is properly cared for.

    It is what we all would demand for ourselves.
    By Sherry Picker MSW

    • Regarding video “granny” cameras in a patient’s room: Check the laws of the state. The place you are citing, disclosed (prior to admission, I hope!) that they were not allowed. However, photographing the patient (only, being sure not to include staff or other patients) would be difficult to enforce.

      Some facilities use cameras themselves to be certain that staff are not violating rules, regulations and patient rights. Some places will allow them in some areas only.

      It all depends upon the polices and the laws of the given state.

      I will tell you this. There was a family who was being told by their loved one (Mother) that staff were beating her at night. Mother had a dementia diagnosis and was not believed by staff. The family took their complaint through the chain of command. No one would listen. The family snuck in a hidden video camera, and sure enough, staff were literally beating her at night when they put her to bed. They were doing it because, “they didn’t like her.” The Nursing Home Administrator, DON and all staff who were assigned to the particular patient were prosecuted with the NHA and DON being found guilty. The NH ended up closing.

      So, from my perspective, cameras are important tools that should be used while preserving the dignity of those being filmed.
      By Edith Gendron

  21. Boomers: Aging Beats The Alternative

    I think the problem is that culturally we do not place much value on older adults. Many see them as throw-a-ways who are no longer contributing to society.
    By Lorie Eber

  22. Unbelievable comments! Thanks for sharing…abuse to seniors needs to stop

  23. Licensed Nursing Home Administrators of America

    In Texas telling a resident “Just go in your diaper” is considered abuse, the state has written the tag, and I’ve written the POC.
    Might seem or sound funny but it’s serious and joking about abuse is not tolerated in Texas!
    By Paul Chaisson, MBA, LNFA

    • Paul, great comment and I was sharing this with others. I wonder how many states have made it abuse?

      • Licensed Nursing Home Administrators of America

        The details I dealt with close to 10 years ago. A bed bound resident had to go to the bathroom and a CNA informed a resident that the lift was being used at the moment with another resident. If you have to go that bad “just go in your diaper” and we can clean you up in a few minutes. The resident didn’t appreciate that comment, called it in and we were cited for verbal abuse.
        By Paul Chaisson, MBA, LNFA

        • Thanks for the details Paul. As more Boomers arrive at our communities, the demand for greater service will increase. Verbal abuse will not only be intolerable, but Boomers will text photos or make videos and up load them to You Tube.

  24. Licensed Nursing Home Administrators of America

    Thank you so much for sharing this Diane!
    By Kelsey Loushin, LICDC-CS, CDP

  25. Licensed Nursing Home Administrators of America

    Unfortunately, I fear the reality is that this type of behavior is common. It’s the “squeaky wheels get the grease” approach to care. I cared for an aunt with dementia and mobility issues in my home until I could not do it any longer. She now pays over $5600 per month for the privilege to receive sub-par care if no one is watching. It is my opinion that if you have a loved one in a care facility, no matter how good that facility is supposed to be, someone needs to be an advocate for that person and their best interests. Not all staff do their jobs well when no one is looking.
    By Valerie Clause Nosek, SPHR

  26. CCRC’s – Continuing Care Retirement Communities

    The same thing happened to my Mother can so relate. It is not fare. There should be more compassion.
    By Gina Rosse-Westra

  27. Long-term Care Industry Professionals Group

    Thank you for sharing this story Diane. Shocking and heartbreaking to think what others may have endured at the hands of a few here. Thank goodness for the spunk of this 93 year old who gave voice to the poor care provided. Complacency and neglect is what so many of us fear in placing our loved ones. Thankfully there are better options where staff embodies compassion and heart. Our family went through several facilities before finding the best fit. I’m filled with gratitude for the loving care and quality of life they provided my grandmother during her end years.
    By Kelly Hunt

    • I am glad your grandmother found a good place. My mom is in a good place too. These stories of abuse shock me.

  28. Long-term Care Industry Professionals Group

    “Go in Your Diaper” degrading and appalling to the competent patient. Rehab is supposed to be the transition between the hospital and home. This is where we are trusting that the patient will be brought to the optimal level of wellness and rehab by assisting them and doing when they cannot. Part of that would be assisting the patient to the bathroom or bedpan, not go in your diaper, it not only defeats the purpose of rehab but puts the patient at risk for UTI and in some cases pneumonia.
    I had this experience professional and personally, my mother 83 years old and a nurse who worked right up to an illness that occurred in May. My mother taught CNA. And home attendants how to properly care for the patient. In the rehab center dignity appalling call whatever you want, but I heard an aide tell my mother to “Go in your diaper I will clean you later” So first being the nurse I assisted my mother to the bathroom and back to bed. I then spoke to the nurse who this was really not a big issue, but when I went after the DON and the Administrator not only an issue but a Quality of Care issue. (You have to use the right language, reportable care, infection facility acquired UTI) shame but that got their attention. Apologies okay admit your wrong, but if I didn’t advocate for my mother who would have? What else could have happened? These individuals QOL is unknown enough to deal with why should their dignity and pride be effected? We are to build them up not break them down.
    By Mary Doherty RN/MSN

    • Way to go on advocating for your mom. Amazing how she could be a great teacher to CNA’s and when she needs care…her worst case scenario comes to life.

  29. Long-term Care Industry Professionals Group

    Another great observation from Diane!

    This story represents a “wrong” that presents itself on so many levels it’s tough to begin. From the staffing of an obviously pregnant nurse unable to perform the “essential functions of the job,” to the “dignity” issue as well as the clinical prohibitions, it is a sad day for our industry—but we ALL know it happens all too frequently.
    By Michael Coler

    • Thanks Michael, if enough people speak up, these wrongs can end. We can only hope…

  30. EMR for Nursing Homes

    This is so sad that seniors have to experience this and I know it happens everywhere. I almost wish there was a way for the caregivers who say this to have to experience what it is like to “just go in your diaper”.
    By Jane Bohn

  31. EMR for Nursing Homes

    This is a sad story, no doubt. But I believe the important thought to take from this is “How do we prevent this type of behavior?”
    The usual cattle call in-service doesn’t engage enough staff in a meaningful way, and in my experience, there is very little management training for supervisors.
    As an administrator, I made it a point to be in the building to observe all 3 shifts at unannounced times, and to listen to the residents.
    Using role playing with smaller groups of front line staff has also proved effective. being put in a wheelchair,with a limb or two tied down,vaseline on your glasses,or dried beans in your shoe while you are talked down to and having pureed foods shoved into your mouth will open the most jaded eyes to the residents perspective.
    Teaching weekend and night supervisors to verify that proper care has been given and interviewing residents to get feedback will also result in better care,and less complaints.
    I believe those in health care who don’t embrace the customer service model will be out of business sooner or later-and they deserve to be.
    By Charles Lewis

    • Charles, you gave the best response on how to end this nightmare of abuse. Your role playing techniques are excellent. I still remember my dementia training about 10 years ago. They had me put on: goggles with vaseline smeared on them, ear phones with pounding music playing, small rocks in my socks and giant gloves on my hands. The goal was to navigate my way from one side of the assisted living community to the other. It was impossible. It opened my eyes and taught me a lesson in compassion for those with dementia. None of us really know how dementia residents are interpreting their world.

  32. Long-term Care Industry Professionals Group

    I cannot imagine what an Administrator or a DON in this type of building are thinking. Rehab, custodial care, whatever, that is not an acceptable response. If staff do this to one patient, they do it to more than one. Adverse outcomes would seemingly begin to show in skin integrity issues in the facility. I do not know how this sort of poor care by staff would not begin to show itself. I know that we have all been surprised by our staff, but I would like to think that is the exception and not the rule. Those sort of caregivers belong on the abuse registry in their state!
    By Michael Hotz, LNHA, CNHA, FACHCA

  33. Elder Care Professionals

    Wow. Incomprehensible. How does dignity get thrown out the window so easily?! Thank God, she had her wits about her to raise hell about her mistreatment. Thank God, her doctor advocated for her as well.
    By Barbara Worthington

  34. Long-term Care Industry Professionals Group

    It is difficult to hear that residents have to experience this type of impersonal and dehumanizing response from staff who generally choose to work at a nursing home because they care about people. As a long-term care surveyor, I see many care givers who are customer-oriented and person-centered. However, there is often one or two residents identified during a survey who have “fallen through the cracks” of quality care despite these care givers. Most often they are the residents who cannot or will not speak for him/herself, and often they are without family or friends who will speak for them. “Adverse outcomes” are often chalked up to being unavoidable due the complex medical conditions many of the residents in nursing homes have rather than due to poor care systems. It is unfortunate that “reportable” poor care occurs, but I think the cause generates more from the hierarchical organizational structure and institutional culture of the traditional long-term care system rather than from a few “bad apples” in the care giver group. Many well-meaning care givers provide the best care they can provide within the traditional system, but the traditional structure and culture generally does not empower care givers to problem solve as a team and make spontaneous decisions that are responsive to the unique individualized needs of each person. Using your friend’s Mom’s unfortunate situation, just as an example, let’s say the pregnant care giver would have assisted her to the bathroom instead of responding with purposeful “complacency and neglect,” but her solution to “go in your diaper” was the best she could decide within the traditional system that “assigns” her to a group of residents who she doesn’t know because her assignment rotates every month, and that instructs her to “make rounds” but Mom’s need was “out of turn” with the routine rounds, and that promotes hierarchical silos in which staff typically respond with “that’s not my resident” or “that’s your job” when asked to help outside of their responsibility. The long-term care system needs to wholesale embrace transformation of the traditional structure and culture to one that is person-centered rather than institutional where residents have permanently assigned care givers, the assigned care giver and resident drive the daily routine, and care giver teams are empowered to problem solve and support each other.
    By Peggy E Williams

    • Peggy & Diane,

      I agree, in part of the training that I have developed for Long Term Care Dual Eligible in the community the Care Manager shadows a nurse in a nursing home. After that experience I have developed as part of the curriculum case scenario’s for this type of population if they cannot past the test we give a 2nd opportunity to shadow again if they fail then we don’t take to the next level of training. This population of care manager must be able to think critically and out of the box. If you don’t not only will the health plan go broke, inappropriate care will occur, hospitals will be filled with admissions that could have been handled in the community.
      By Mary Doherty RN/MSN

  35. Long-term Care Industry Professionals Group

    When teaching interior design for senior communities, a very effective technique is to have the students spend the day in a wheelchair, so they can experience the conditions themselves and incorporate it into their design. When designing facilities for the blind, one is blind folded. This is the most memorable experience I had as an interior design student. How about adopting this method to the care givers in the Chicago nursing home? One day of wearing a diaper themselves, and you’ll never again hear “just go in your diaper”
    By Shifra Mendelovitz

    • What a great idea Shifra! We also advocate to have nursing spend a night in the hospital to fully experience what it’s like from the patients perspective (what is overheard? what the environment was like? was I able to sleep?). This brings great awareness and empathy.
      By Kelly Hunt

    • Love this Shifra! Maybe it should be mandatory?

  36. Long-term Care Industry Professionals Group

    Personalizing the experience is a great way to encourage person-centered thinking and practice.
    By Peggy E Williams