Waking up care home residents every night is cruel

[Greenfingers12]

I've been doing some agency work in some and incontinent/immobile residents have their pad checked/changed every 2 hours throughout the night, or are repositioned in bed.
Some of them slept through but many of them woke up. Plus hourly room checks which sometimes wake them up even if you're quiet.
I know that the pad changes and turns are to protect their skin integrity and avoid pressure sores and so on.
I just feel bad that they have to be woken up several times every night, I'd hate it if someone did that and it must make them exhausted.
Don't know what the solution is though.

As you say, I don’t know what the solution is. My mum is in a care home, immobile and doubly incontinent and I fully expect she’s woken up through the night, but I don’t know what the solution is. The only saving grace to me is that my mum won’t remember being woken due to her dementia.

What used to enrage me however working in hospital was the practice of waking and washing and dressing confused or less conscious patients - or those deemed ‘all care’ and washing them at 4.30/5am. We were told off if we hadn’t done at least 3-4 washes a shift. I think in the hospital I used to work in, that practice is still carried out now unfortunately despite it being flagged up dozens of times over.

It depends what is in their care plan but if done in a dignified manner then it is better than having a ungradeable sores and getting sepsis xxx

2 hourly does seem very frequent for overnight. Do they have air mattresses? My understanding was that they minimize having to move the person as much (I may be wrong). What do the residents themselves think? Do they have capacity to decline if they don't want to be repositioned? Are the pads full before they are changed or are they changing every time? Sorry so many questions you don't have to respond just things to think about! I suppose the positive thing is that the care home is being proactive about minimizing pressure sores!

Agree every 2 hours seems excessive. Surely once or twice a night would be ok provided they are regularly repositioned during the daytime hours?

As someone has already said, pressure sores are worse than being disturbed during the night, and they can always be encouraged to have an afternoon nap. I think 2 hourly rounding is too frequent though. 3 - 4 hourly should be okay if their skin is intact.

I was very unwell in late pregnancy and spent some time in ICU, and then stepped down slowly to a single room. I was sleeping badly anyway, and when I asked whether they could rearrange the overnight visits so that I wasn't woken at 4am for monitoring, there was absolute consternation. I'm not complaining as the care I got was magnificent, but even when I had nothing to do but sleep around the clock, being woken in the middle of the night was still really hard to deal with.

Yanbu in your feelings but sometimes it's just neccessary. It's the same in hospital. Certain things have to be done.

It’s not ideal of course it isn’t but sometimes there is no option.

ds has medical needs that involve overnight care, some of that care can be a bit flexible to timings but there are times medication has to be given at a set time day and night. Thankfully it goes through his feeding tube but sometimes it does wake him (and I always get the joys of a 2am alarm!)

When I gave birth I had covid and the baby suspected covid (wouldn't test him) and I was woken every 2 hours for him to be checked and he was a brand new baby so it felt like every time he went down they would come wake us.

My experience of my nana who is in a home is they’re sleeping a lot in the day too and if it’s to prevent sores then it’s probably justified. Obviously not ideal but id be more annoyed and upset for my nana if she was left in a wet bed for several hours.

Id struggle if I was woken every couple of hours if I had work every day but these guys don’t really have plans for the next day.

Yes I agree 2 hourly is excessive. It was pad checks every 2 hours, and they started bed baths at 5am!
Some homes do hourly room checks.
I just feel sorry for them. However I know it's to prevent health problems which could be fatal.

True, they can sleep in the day too. However depends how quiet the home is!

Pressure sores are very difficult to treat and are very painful so I can see why they are doing it. Old people’s skin is thin and fragile and they would get sores very quickly if not checked regularly, particularly if they are incontinent or immobile. Well done to the care home for taking their responsibilities seriously.

What mattresses are they on? If a standard mattress,2 hourly is good practise for immobile people or 4 hrly on a pressure mattress…..if they aren’t using the latter and the person is long term immobile,they probably should be on a pressure mattress as you’re right 2 hourly turns can be very disruptive considering how little some older people actually sleep. Needless to say most people being nursed at home don’t get moved this often…am surprised they have the staff availability in the care home!

Yes most do have airflow mattresses (think that's the name!) Yes, there have been some who refused and/or tried to hit us if we did anything so ultimately cannot force them.

I disagree that 2hrs is too frequent. If you’re sitting on a chair without moving, it takes less than 2hrs for what you’re sitting on to go completely numb. Special mattress can help but no substitute for rolling over

Sores are incredibly painful,it’s cruel not to do everything you can to avoid them

I doubt you are in a position to do /say much but yes I would question them still being turned twice hourly but there may be specific reasons in the care plans for certain clients . I think checking pads so often is also ill advised at night, if the client has confusion/dementia they may well be very scared by this. It’s always a balance and I hated the lack of person centred care when I worked in care homes.

Day time yes, night time no….and there are other factors around good skin care that are important too. Average stay in nursing home is around 18 months and being woken too frequently in the night is not necessarily any better for an individual.

Yes, my mum was nursed at home with no overnight care (daytime carers were excellent and pads changed regularly) and I wonder whether this contributed to her developing a grade 4 pressure sore and it wasn't just being bed bound. She died from sepsis as a result of the sore.

Would depend on advice from District nurses. If someone developed a grade 3 sore it would meet the safeguarding threshold and a safeguarding social worker would be considering neglect if the care plan and professional advice wasn't being followed. There will be waterlow risk assessments in place which will look at the severity of the risk and the mitigation would need to be necessary and proportionate

Pressure sores in immobile patients are very difficult to heal and the risk should be taken seriously. I agree a big effort should be made not to wake people though.

I don't think you can do anything with those. Apart from be as gentle as you can to try and not disturb. But, you can only do what you can do, if people wake up, they do. It sounds v hard x

I think every 2 hours might be ott but depends on the person's needs I guess. But 5am to get people up and bathed is just too early. Where I worked, we started getting people up at 8 unless they were wandering and hungry e.g - dementia care. Sounds like they need more staff for the early shift.

This is institutional abuse unless it is the person's choice

This was done every morning in an elderly care ward of a hospital I did night shifts in 20 years ago now.
I was told by the permanent staff that ''Sister demands it''
I complained about demented patients getting woken up at 4 30am every morning, got out of bed ,washed, dressed and sat in chairs ready for the day staff coming on at 8.I was told that as I was not permanent staff it was none of my business
I am retired now from nursing, but shocked to learn this is still going on.