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Pads, Tools, and How to Use Them Effectively © Everything you need to know and hoped you'd never have to ask! |
The In-Charge Stage of Incontinence Care
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Your person is now wheel chair-bound and bed-ridden. |
Tools and Products needed for the In-Charge stage of care |
By the time your person enters this stage of care they will be wheel-chair bound and bed-ridden. The lower functions of the brain are now affected and general physical health begins to erode.
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They will not be able to move without help,
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They have lost the ability to grasp, make their needs known or assist in any of their care.
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They will lose weight and become very frail. Their body will begin to curl into the fetal position because the muscles that straighten limbs will no longer work in opposition to those muscles that bend and pull in the limbs.
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Their skins will be subject to rashes, pressure points, and bed sores because of inactivity.
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They can be and should be moved from bed room to living space when possible.
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Diapering and Bathing is done in bed or in a shower chair.
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It is important to move them out of bed during the day and keep them in the stream of life in the house the same way it is important to keep a new born close. It is part of nurturing. By the last few weeks even this is unimportant.
Tools and Products Needed for This Stage of Incontinence Care
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Bed Pads. Same product as in The Taking Charge Stage list. Place the bed pad across the bed under the torso and place a thick terry bath towel over it. Make sure the pads are double sided flannel. This will hold the pad in place on the sheet and hold the towel in place as well. You don't want these materials bunching up under the body because that can induce pressure points which evolve into bed sores. This will serve as a draw sheet which is explained below.
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Wash cloths
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Lotion, Bag Balm, cold pressed castor oil (for external use only)
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Two plastic dish bowls, one for the wet and soapy wash cloths, and one for the used washcloths.
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Plastic high top garbage pail bags
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Briefs and with inset beltless pads to catch over flow of urine.
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External catheters. This product was originally developed for men to use in place of internal catheters and they work very well at disposing of urine so that they aren't laying in urine soaked pads for any amount of time. They attach to the penis with a condom like device attached to a hose, attached to a bag which collects the urine. It is important that the bag is lower than the body so that gravity moves the urine into the bag and doesn't back it up into the bladder. This made the last stage of care so much easier on both my husband and myself. There were fewer diaper changes per day and I didn't have to worry about what the urine was doing to his skin if I didn't discover it soon enough. I totally rejected internal catheter as being too invasive a procedure.
I see that there is also an external product now available for women. I have no idea how well this works. Since a female's anatomy is so different the logistics of design must be difficult. However, even if it works a little it will save on the amount of urine your person is lying in before the diaper can be changed. I just don't like the idea of an internal catheter. There is so much danger of infection and your person won't be able to express the pain that accompanies the symptoms.
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Latex gloves
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Lotion, lubricant. I used cold pressed castor oil which puts a solid shield of lubricant on the skin acting as a buffer between it and the body waste. Castor oil has long been known as a healing agent in the Middle East and is widely used in homeopathic medicine as a healing agent on the skin. "Bag Balm" which is now available in Cosco as well as numerous drug stores and department stores is another healing agent that presents a very good buffer between skin and bodily waste. It is often used by new mothers treating diaper rash. In any event, use something.
Like everyone in the last stages, Tom has his boughts with diaper rash. This is no simple matter with an adult in the last stages of AD. It is very important to keep on top of this. My hospice workers were amazed at how quickly castor oil cleared it up. My sister had tried everything including doctor's prescriptions to clear up her twin's diaper rash. A elder from the Onondaga Tribe south of Syracuse suggested Bag Balm. The diaper rash began to improve immediately.
It is also a good idea to keep the skin on the entire body lubricated with lotion. Light massage helps promote good skin condition and circulation.
Important note: Make sure your hands do not have any of this lubricant on them when you close up the brief. The tabs will not stick if any of the lubricant gets on the diaper surface.
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Place the plastic bowl containing the soapy wash cloths and the water soaked wash cloths within easy reach of your person. The other bowl can sit on the floor to receive the used wash cloths.
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Slide a plastic garbage bag under the torso and over the pad/towel combination. I've tried other water proof sheets such as cut up shower curtains and table cloths and the garbage bags work the best. They are slippery enough to slide under the body without disturbing your person very much.
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Undo all the tabs on the front of the brief.
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If you are dealing with urine only, you can remove the pad entirely, slide a new pad into place under the body, wipe your person with a damp cloth, pat on some lotion and close the tabs of the brief.
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If you are dealing with a bowel movement, fold the front panel tabs into the center and roll the center panel in towards the body from the top until it is down by the crotch. Use the pad itself to wipe as much of the bowel movement as possible. Fold back the side panels into themselves.
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Use the baby crib pad/bath towel combination as a draw sheet. It should be in place under the torso of your person and this should be part of the regular bedding. This combination will absorb any run over of urine without betting the sheeting wet, is comfortable under the family member and is more easily laundered and changed than the entire sheet is.
It also acts as a draw sheet. By holding two corners on one side of the bed and gently raising it in the air it will gently roll your person on to their side. Make sure they don't crash into bed rails or smother in a pillow.
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Remove the used pad, also wiping up as much of the bowel movement as possible. Discard it into the pail.
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Using soapy wash cloths, clean the bottom area and between the legs.
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Rinse with the wet wash cloths, dry and apply lotion, or what ever lubricant you choose. Wipe your hands.
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Take a clean brief, open it up so that the panels are flat, hold in place on the body with your hand while you gently roll the person back onto their back.
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Repeat the process of washing and cleaning the front of their body.
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Pull the front panel up through the legs and attach the tabs.
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Then deal with the clean up after they are wrapped in warm covers.
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I do not recommend that you keep them in sweat pants or pajama bottoms once they become bed-ridden. Trying to pull down and pull up clothing not only takes a toll on the caregiver it takes a toll on the family member. You can keep them covered and warm with bed covers.
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100% cotton turtle neck knit shirts are the easiest to get on and off and they offer warmth to the family member.
The external catheter was very helpful during the last months of Tom's care. I meant changing fewer diapers and insuring less chance of diaper rash and other skin problems.
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The bag was hung on the bottom rail of the bed rail
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Because the condom I used did not have a sticky interior to hold it on his penis, I used surgical tape making sure it wasn't too tight to impede circulation.
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I tried the condom with the sticky interior and to tell you the truth it must have been invented as a source of torture. It caught on his hair and we had a nightmare trying to remove it.
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The condom lasted a day or two before needed to replace it. I made sure that he was washed thoroughly between condoms so promote healthy skin tissue.
By the time Tom reached the last stage of care he was surrounded with pillows to keep his elbows, arms, legs, knees, ankles, heels from rubbing on the sheets. This can also cause pressure points and evolve into bed sores very quickly.
I still brought him into the living room and placed him in a recliner, also propped with pillows.
Tom was still bathed in the shower, using a shower chair nearly every day. He was so light my aid and I could carry him in. I held him under his arms, using my body to hold as much of his weight as possible and she held him under his knees. After washing we placed him back in bed and then dried and dressed him.
Tom on his sea green flannel cloud
Refer to "Incontinence" for a complete list of subjects
regarding this phase of caregiving.
©2000