Thread: Bladder infections

My dad is in a care home and is incontinent my mum goes to see him every day and most days she has to ask for him to be changed as he is soaking wet he keeps getting bladder infections could this be due to the fact that he is sitting in his own urine, just wanted to be sure before I complain. Thanks

Thanks for that

I'll point out some problematic areas in care homes, if you don't mind, as any number of things could be a factor in this. Firstly though I would say that frequent incontinence (dribbling) is a result of a urine infection rather than a cause of one.

Just in addition to what flyingdoc has said, I would encourage your mum to speak to the charge nurse or matron to see firstly if they are aware that he is consistently wet, and if there are any particular reasons for it. Ask if she can look at his care plan too, if she hasn't recently viewed it, to see what they have in place to combat his continence issues.

There may be a reason behind it. One of the main issues in today's nursing care are patients right to refusal. Not the right itself but the interpretation of it. A patient refuses to be changed, a nurse/carer cannot physically force them to do so. They can persuade but if the patient is not willing, they cannot force. I have seen it so many times, relatives expecting nurses to be able to "make" a patient comply. (I'm not saying this is the case here) Unfortunately the reality is there is a very fine line between gentle persuasion ("Mr X, you must be very uncomfortable in those wet clothes, how about we get you some clean clothes to put on. I'll help you if you like", - gently lead "Mr X" to a place of privacy where he can have a wash and change) and abuse, where a patient refuses point blank and will not move, a nurse or carer cannot physically "take" them to be freshened up, This can be considered elder abuse and a breach of a patients right to choice. I have seen it many times where a family are blissfully unaware of how patients react when they are not around. (Again not saying this is the case here.) However, there is also a very fine line between right of refusal and neglect.

Another common issue is funding. In some care homes, only a certain amount of incontinence pads are allocated to each patient per day, and are based on the need of the patient and it can be very strictly adhered to. Depending on the level of absorbancy, a pad should last a certain amount of time. The longest lasting pads SHOULD last twelve hours, however they rarely do. In any case, whether or not pads are in use, a patient who is incontinent should have assistance with toileting, regularly. Pads are designed to assist with keeping a patient dry, not act as a makeshift toilet. Most pads will "lock" urine in, however similarly to a baby with nappy rash, a pad which is not changed when the wetness comes to the surface and is left against the skin can cause all manner of problems, in addition to being uncomfortable.

If it gets to a point where a patient refuses or other problems cause the incontinence pads to soak through in short spaces of time, then there are other ways around the problem, as flyingdoc mentioned, other aids to incontinence they could try. Perhaps your mum could discuss these options with the charge nurse or matron.

Or it could be a case of as flyingdoc pointed out, lack of time. There are ratios of staff to patients in care homes and staff are usually working at the minimum number of staff required, and struggle to keep "on top" of times.

Another problematic area in nursing homes can be lack of permanent staff. If there are regularly agency nurses hired to make up the numbers, and there is a high turnover of agency staff, this can also become an issue. An agency carer who doesn't work there regularly will not know the patients as well as the full time staff will, they won't know their routines, whether they are continent, incontinent and have to be guided by the permanent staff.

One of the most problematic areas is a high turnover of permanent staff, period. When this happens, new staff are regularly recruited most of whom have little or no experience of working in the care sector (I'm talking about carers, here not qualified nursing staff). Some of which don't realise the importance of the "small" things, some of which frankly don't really stop to think about it. This is one of the main reasons it was decided that all care staff should be trained to SVQ/NVQ level in care.

Another issue that is happening in a lot of care homes (and I am NOT being racist) is overseas workers being employed in them. Some in their own country are trained nurses, but have to do an adaptation course before they can practice in the UK as a nurse, but there is nothing stopping them from working as care assistants. I've seen extreme language barriers here in some cases. Also, depending on the country the worker comes from there can be a huge cultural difference about the manner in which care is carried out.

Those are some reasons. However, reasons are not excuses. Your dad is in a care home because he needs 24 hour care. If he is not receiving that care for whatever reason, then it needs to be addressed. They cannot stop your dad from being incontinent but they can help to combat the effects of it, and they should be ensuring to the best of their ability that he is not left to sit in wet clothes. I would echo flyingdoc again that your mother speaks to either your dads keyworker, the charge nurse or the matron. All too often, they are unaware that a patient has been sitting in wet clothes. However as your mum has regularly had to ask for him to be changed, then you would think that they are aware that it is a problem and addressing it should be incorporated into his care plan and his evaluation.

You can also find inspection reports on the nursing home to find out if similar matters have come to the attention of the regulators during their inspections. Here are some links to the regulatory bodies:

ENGLAND: National Care Standards Commission England, NCSC , care regulation

SCOTLAND: SCRC - Scottish Commission for the Regulation of Care

WALES: CSSIW | Care and Social Services Inspectorate Wales (CSSIW)

Hope this helps.

Thank you so much for that its a help I will ask her to look at his care plan.
He doesnt refuse to be changed he says very little and has dementia as well.

I was extremely interested in the comments made by ErkinPNP. I don't think the issues raised are exclusive to care homes; they happen on the elderly care wards in our hospitals too.
If a patient has dementia, at what point can you judge that you have breached the individual's right of choice? I'd worry that this was used as an excuse by a care home for neglect.

Men get bladder infections as a result of a chill or possibly linked to a prostate problem. Bladder infections result from bacteria that cause an inflammation of the bladder's inner lining.

From this infection he may get a Kidney infection also, so he may need some anti biotics to get him through this. Best get the doctor to get him checked out, especially the prostate area.

Originally Posted by Sali

I was extremely interested in the comments made by ErkinPNP. I don't think the issues raised are exclusive to care homes; they happen on the elderly care wards in our hospitals too.
If a patient has dementia, at what point can you judge that you have breached the individual's right of choice? I'd worry that this was used as an excuse by a care home for neglect.

They are not exclusive to care homes at all. The OP related to a care home, but the issues can and do happen in any care environment. Personally I think there are several manners in which a patient can be persuaded to consent to allowing assistance with personal care, particularly if a patient has a form of dementia, dependant on the stage the dementia is in. Physical force is not acceptable. Gentle persuasion is, and there are many manners in which gentle persuasion can be used. It's simply a case of getting to know a patient and learning what they respond best to. In offering assistance to any patient there are several factors a carer has to stop and think about.

*The manner is which they offer assistance
*The enviroment in which they ask if the assitance is required
*The tone of voice used
*Body language
*Assessing if there are any "triggers"

One of the best forms of training for care staff is person centred care, particularly, but not exclusively for care staff who have little or no experience in the care sector. Seeing the world from the eyes of a patient is very educating and interesting.

Originally Posted by ukaviator

Men get bladder infections as a result of a chill or possibly linked to a prostate problem. Bladder infections result from bacteria that cause an inflammation of the bladder's inner lining.

From this infection he may get a Kidney infection also, so he may need some anti biotics to get him through this. Best get the doctor to get him checked out, especially the prostate area.

I did mention Bacteria Flyingdoc, i admit the chill part is wrongly worded there. Symptoms do include feeling a chill.

Why rant, simple mistake ?

ErikaPNP
Person centred care sounds ideal and what we should strive for in our care homes and our hospitals. Empathy is lost in targets and budgets.

Everywhere is going the same way Sali. Anything that is government run is obsessed with targets which are never really a true reflection anyway as people strive to ensure the targets are met which means quality gets lost along the way.

It's a terrible shame, people become nurses because they want to care for others. I bet half the young students who sign up don't realise what they are actually going to end up doing is far from what they expected.

I watched that dispatches programme about the NHS and I was very saddened to hear the upset in the nurses voices as they talked about how obsessions with targets and lack of staff were having such a dire effect on patient care. They have all these fantastic nurses there who want to spend time with the patients. It always reminds me of "A nurses reply" poem, in response to the patient's "What do you see poem" have you read it? It's very moving.

I read the poems Erikapnp - they moved me to tears.

Well said - it's a crying shame that the Govt and DH don't listen more to the front line staff.

Our management accept that we have closed too many beds and shed too many nurses....but won't do anything about it, it's all steam ahead for foundation status (coz the alternatives are too grim to think about according to mgmt).

ErikaPNP - have you ever thought of applying for the post of Chief Exec of a Trust? I think you'd do an excellent job.
I 'm glad that the patients (and their families) attitudes have changed. My parents generation thought that 'doctors knew best' and never challenged the medics, which I think led to them thinking they were God and beyond question. There are still many with that attitude working in the healthcare profession. Perhaps the reasons that people complain more now, is because there is more to complain about. Staff shortages cannot help but lead to poor care. However, I agree with you about the nursing training. I haven't been impressed by what I've encountered. You also cannot teach compassion. I have a sister who trained as a nurse before it moved from the classroom and she shares my views.
As for hospital infections. My own hospital regularly carried out a deep clean of the wards and the patients were not given a second thought. Thrown in wheelchairs without slippers or dressing gowns. Yet the doctors always (and I mean always) never wore an apron as they moved from bed to bed. I made a comment about this once, but the nurses said they were fed up with trying.

Hi Davey,

Have just read your blog and would like to congratulate you on the dedication you show to your mum. Hope things have continued to improve. It's time the government showed some recognition for folk in your situation.

I hope my lads turn out as caring as you.

Best wishes x