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.

Yeah, between 5 and 7am they had to do something like 7 bed baths.

What is? I'm not saying we wouldn't see to them if they wanted to get up earlier or indeed if they wanted to stay in bed longer that was fine too, we wouldn't wake anyone up deliberately unless, like some, they were likely to need their bed changing and a wash due to incontinence and or removing pads etc. No one was forced to do anything but the general idea was to help people prepare for the day from the start of the 8am shift.

That was in reply to Louisetopaz21

Pressure sores don’t care whether it is day or night. If an immobile patient is left for too long, they will get pressure sores, so such patients need regular turning day AND night.

To be honest I think sometimes getting people up early is fine. When my Dad was late stage dementia he was got up, washed and dressed by the night shift before the day shift came in at 7.00. He had no idea what time it was and found getting up distressing. This meant night shift had plenty of time to take it slowly and gently that the day shift wouldn't have as lots of others needed helped.

That's fair enough, all down to the individual resident and their needs. But obviously there has to be some structure to the day as much as Is possible.

Being woken every two hours all night and up at 5am to be washed and dressed sounds like a form of torture to me. I hate being in hospital so much for this reason, woken a lot at night, up too early and they only come around about 6.30am. I always go home at the earliest opportunity.

I’d take it on a case by case basis but generally 2 hours is excessive. I’d do comfort rounds during the day 2 hourly but at nights, my patients are left to sleep. Pad change late on the shift before bed then first thing in the morning. It’s rare for me to find a completely saturated pad or bed. Modern day pads, especially the pull up ones like pants, are incredibly effective.

I was agreeing with you getting people up the crack of dawn to meet the needs of the service rather than the person's

It takes 20 mins for a pressure sore to begin in an elderly person.

2 hour turns are very normal in care homes.

elderly people do sleep a lot during the day, probably because they’re woken so frequently in the night

When I worked on an elderly ward it was two hourly turns, day and night.

I’m a nurse and I agree although we ‘need’ to to present pressure sores it seems cruel. Personally when I’m bedbound and doubly incontinent I’d rather a pressure sore and swift death from sepsis than years or two hourly turns and constant crying and confusion.

Waking people at 5am for washes is sounding like institutional abuse.

Yes, some people may need turning every 2 hours but a blanket policy for everyone, which includes waking them up, despite being on airflow mattresses, speaks to an absence of individualised care and making policies for the benefit of the care home not the person.

2 hour turns may be fine for a short admission in hospital but not for the rest of your life.

Absolutely no-one being cared for in bed at home by their families is having 2 hrly turns 24 hours a day.

I’ve been a carer all my adult life and this is a sign of a good care home. Despite using an air flow mattress, an immobile person needs turning every two hours. Once a pressure sore is detected the flesh underneath has been deteriorating for some time, this is very painful and difficult to heal and can result in sepsis and death. I don’t agree with doing personal care at 5.00 am unless someone is already up and wandering. I suspect this is to help the day staff with an extremely busy morning getting people up for breakfast but still feels very cruel 🫤

Surely a good number of those issues could be fixed with tech?

We have owlette socks for babies. AI baby cameras that detects faces, breathing, movements, cries, coughs etc...

We've got bed wetting sensors for toilet training toddlers.

So we've got all the constituent parts that would mean no interruptions needed for the residents other than those that physically need to be rolled. Or where a sensor has indicated something needs to be checked.

Some elderly people’s skin might not breakdown for hours, but some breaks down in an hour. So, on average 2 hourly isn’t excessive.

There’s a body of research that supports 2 hours as the minimum time needed to reposition an immobile person with fragile skin and poor circulation. Plus, it’s uncomfortable to remain in the same position for too long when you can’t reposition yourself.

Pressure sores can develop incredibly quickly and can be so difficult to heal, often they become infected. I’m actually really impressed that your care home is diligent with the turns and pad changes. Urine can also break down the skin very quickly. So you and the staff are to be congratulated on doing a brilliant job of looking after your clients.

Of course this doesn’t include changing soiled pads when needed.

Residents are only prescribed/ allocated a certain amount of pads a day so carers definitely won’t be binning dry pads as they are scarce 😕

It takes 20 mins for a pressure sore to begin in an elderly person.

All my patients are on hybrid mattresses and I do a full skin check and settling so everything is fresh for bedtime at 10pm. Plus I'll do obs then (acute care). I put them on a side at that point. Then at 2am I do obs if required, check the pad and if dry just slip the pillow out without waking them. At 6am it's a full change and reposition and morning obs. 4 hours is the maximum I would leave someone in the one position but we can cluster care and make minimal disturbance during the night and keep lights low.

I can see the 'it's cruel to wake them' argument but I remember nursing someone at home who's family didn't wake during the night and wanted him sitting up during the day but didn't want a hoist in the house so were dragging him to the chair. Their intentions were so good but he was left with a necrotic sore that you could place a fist inside. Also it's incredibly rare that people sleep through 12 hours, they sleep through the day so often up early doors.

I had a similar experience during pregnancy. They'd wake you a couple of times for monitoring in the night and then the lights would go on and breakfast and morning drug trolley at 6am. Such a restful atmosphere!

An infected pressure sore that will not heal is worse than being woken and turned every two hours, @Highdaysandholidays1 - that is why nurses work so hard to try to prevent them. If a patient not able to turn themself over in bed, and they are left in one position all night, it will not be long before they get pressure sores.

@SDTGisAnEvilWolefGenius I'm sure you are right. I'm just reflecting I hope I don't make it that long, it sounds horrific. Sleeping all day, being turned all night, constant danger of sores. Honestly, old age is cruel.

I agree, @Highdaysandholidays1. I lost my mum recently - she died following a fall, but up to that point, she had been living pretty independently - she had some support from carers and my sister, but basically was still caring for herself, and while I miss her, I know she would have hated being completely dependent, so in some ways, even though it was sudden and a shock, it was better for her this way.

This sounds horrific. Wtf would you check pads so frequently at night? Surely they can stay for 6 hours? This sounds like a nightmare to me. I honestly didnt know :(
Id hate his. Do they not have a choice in the matter?
This is my fear now , sigh

Urine soaked pads left next to delicate elderly skin will cause skin to break down, and that will get infected so easily - and because old people’s circulation can be poor, it will be difficult or impossible to heal it so they end up with an open sore.

Plus who wants to be left wearing a soaking pad for hours on end?