Memory Care and Skilled Nursing

[Anonymous]

Family member has dementia and a catheter but keeps pulling it out and getting sent to the ER for reinsertion. Skilled nursing can come but not at short notice. Memory care place doesn’t have a bladder scanner to check for issues and is primarily unskilled nursing.

Financially we can’t afford 24/7 supervision.

Anyone dealt with this?

[Anonymous]

If you’re looking for a facility, you spend down assets on care then go on Medicaid. But be careful on how you are spending their money now. There is a five year look back period and if you violated Medicaid rules, there will be a period of no coverage between the time the money is spent down and the time Medicaid starts. It’s that issue that makes it hard to find a spot.

[Anonymous]

https://www.ncbi.nlm.nih.gov/books/NBK482270/#:~:text=Diapers%20and%20mesh%20underpants%20can,when%20appropriate%20for%20extra%20protection.

Use Standard Preventive Measures
All patients with Foley catheters should include a properly placed Foley stabilization device as well as additional observation by staff if patients appear confused or agitated. Do not use a Foley stabilization device on suprapubic catheters.

Reposition the Foley Catheter Under the Thigh, Tape and Cover it
In higher-risk patients, reposition the catheter by directing it under the thigh and then taping it directly to the skin without a gap. Leave no space under the tubing or the catheter for the patient to use his fingers to grab it. Being unable to encircle the catheter and tubing makes it much harder for the patient to secure purchase on the Foley and pull it out. The catheter needs to be completely secured with tape, starting almost at the level of the meatus and continuing as the catheter is secured underneath the thigh. Then wrap a large, wide elastic bandage around the patient’s thigh, completely covering the tape and Foley catheter. TED hose or similar anti-edema leg wraps may also be used to cover the Foley catheter and tubing. These measures should obscure the majority of the Foley catheter, making it even more difficult for the patient to get his fingers under and around the catheter as both the wrappings and the tape would need to be dislodged first. This delay will often give staff sufficient time to intervene. Additional tape or a plastic roll also may be used to cover the wrap if additional security measures are desired.

Use a Diaper or Mesh Underwear with Pads
When in place, these coverings make it a little harder for patients to reach their catheters as they will have to get past the diaper and padding to grasp and pull on the Foley. This is particularly helpful when used together with the decoy catheters described below.

Add Decoy Foley Catheters
Decoy catheters are a greatly underutilized resource and are particularly useful as they are not only effective but can be immediately initiated by nurses for any patient identified as being at risk without waiting for a specific physician’s order. The decoy catheter can be taped to the upper thigh or just over the diaper and secured sufficiently to prevent easy removal with simple pulling. If it comes off too easily, the patient may lose interest and go looking for the real Foley. Benzoin or similar adhesive agents can be used to help fasten the tape and decoy catheter more securely to the skin or over their pants/diaper. Multiple decoy catheters can be used if necessary to keep confused patients occupied. This has proven to be a very simple and effective technique for protecting Foley catheters from even the most persistent patients who seem determined to pull out their Foleys traumatically.[6]

[Anonymous]

Hospital put mitts on my father to prevent him from pulling out all kinds of tubes. He HATED them but it did work.

[Anonymous]

Thanks for the info. I shared it with the memory care. I wish we could do mittens but they aren’t allowed because they are a restraint.