Caring for a Loved One in a Nursing Home: Labeling Clothing

There are several options for labeling your loved one's clothing. Pictures help tell the story, so enjoy!

Write on the Clothing

The quickest easiest way to label is to use a Sharpie or a permanent fabric marker. I have personally used a Pigma Micron pen and a Sharpie for my father's clothes, and both have been successful.

Not long ago Sharpie came out with some markers intended for permanent writing on fabric called Stained by Sharpie. These work even better than regular Sharpies for permanent marking on clothing.

Regular Sharpie markers do eventually fade with washing. It's easy enough to re-write on the clothing, but you must remember to check.

This obviously only works well for lighter fabrics using a darker marker.

Write the name in a location on the garment that is inconspicuous when worn, yet fairly easy to find. If the garment is dark, you can write on a light colored manufacturer label. Usually there is some margin space on these labels.

Writing on the garment is my preferred method for labeling white socks. I write the name on the bottom of the sock around the arch. Dark socks are tricky.... that's another post.

Writing on the garment is always a good "fall-back" labeling technique. This is why I keep a Sharpie in my purse at all times. You could also stash one in your loved one's room if there's a convenient place.

Custom Ink Stamps

A social worker at my father's facility highly recommends a military clothing stamp. The military requires all clothing to be labeled and they have developed inks that really stay.  I have no personal experience with these stamps, but it seems like a really good idea.  As an employee of a facility, the social worker purchased a customizable stamp where you can change the name. I'm not sure where you can get such a thing, but as you know....you can buy just about anything on the Internet!

You can get a custom clothing stamp made - several companies offer such a product.

Custom Labels

I don't have personal experience with purchased iron-on or sew-on labels. Many boast iron-on for simplicity and permanent adhesion, but honestly, I'm suspicious. The laundry in a nursing home is so harsh on clothes I would be afraid the adhesive would deteriorate. Knits could be problematic because the stretching could cause the adhesive to detach.

I would imagine sewing them on would be just like sewing on the homemade labels, without having to press under raw edges.

Fortunately, they aren't expensive and you can get a lot of them for a little bit of money. A web search on "clothing labels" will lead you to many options, as plain or as fancy as you like.

Homemade Labels

I like to sew, and my sewing machine is always at the ready, so I don't mind making my own labels. The easiest labels are simple rectangles of white cotton (or cotton-blend) fabric with raw edged folded and pressed under, and stitched to the garment by machine using a zig zag stitch. I write the name on the label using one of the markers mentioned above. I usually make up a bunch of them at one time using scraps of white or light-colored fabric, then sew them on as Dad acquires new clothes.

A good dimension for a homemade label is 1.25" x 2.5" (raw, before edges are pressed under.)

Label with Hand-Written Name
(name blurred for privacy)

Label with Edges Ironed Under

Position the label and pin to garment. If you don't want to pin, you can always use a washable glue (like Elmer's).

The zig zag stitch is a good choice because you don't have to be as precise in sewing around the label, and it has a little "give" to it. Much of Dad's clothing is knit with some stretch. I usually sew the label on near the manufacturers labels.

Label Zigzag Stitched to Garment

I usually use white thread on the top and a thread in the color matching the shirt in the bobbin, so the stitching is not too obvious. Here's how it looks on the back (outwards facing, when worn).

Appearance of Label Stitching

Sure, it's noticeable when you're looking for it. If I was picky I could touch the white thread with a marker to conceal them. In this case, it's the back of a pair of athletic pants and it won't be seen when Dad is sitting. When standing, his shirt will cover it.

Tips: 

Spray starch or Mary Ellen's Best Press Clear Starch used when ironing helps the labels retain their crisp pressed edges.

On polo shirts with knit collars, you can sew the label on the collar itself on the inside, a little above the seam where the collar is stitched to the shirt. The fold of the collar will cover up the stitching in back. On T-shirts, I usually sew the label on the strip of fabric that covers the seam between the shirt and the ribbed neck opening.

Homemade labels do not work well for super-stretchy items like socks, though.

For shirts and pants, this is my preferred technique. The labels are easy to find and easy to read. Plus, it shows that someone put in a little extra care for their family member.

Caring for a Loved One in a Nursing Home: Laundry

Many nursing home facilities offer laundry services for the residents. Usually the fee is quite reasonable and using the service is a great convenience for the family. In my experience, the laundry service currently costs about $1.00/day.

Some families prefer to do their loved one's laundry. That's fine, but be advised that there are dozens of other things that need to be done to care for your loved one in a nursing home. Using the service can lighten the load a little. And, you won't have to worry about if Mom or Dad has enough clothes for the next few days.

Labeling your loved one's clothes is required. There is no way the laundry service will be able to remember whose clothes are whose - it all looks the same to them.  I advise labeling with the last name, rather than a room number, because room assignments can change. Names will work for any laundry service, no matter how many times Dad moves - within the facility or to a new facility.

The laundry service will label clothes if asked, but this is one thing that I don't think is worth the cost. Really it's not that much of a burden to do.

Understand that when laundry is done in this setting, they are interested in cleanliness and efficiency, not special care of delicate fabrics. The laundry detergent is probably cheap industrial strength, and they wash in warm and hot water. They probably only separate whites from colors, and that's it - no wash-and-wear, no delicate cycle, no cold water hand-wash. Everything goes in the drier and they run the drier on hot. Like, really hot...to dry faster.

Laundry Tips

It is important to select durable clothing that can take the laundry wear-and-tear of the nursing home laundry service. Here are a few tips:

• Cotton clothing is at risk for shrinkage, even if the cotton is pre-shrunk. In my experience T-shirts generally hold up well, but 100% cotton sweatpants, slacks, and shorts tend to get shorter. Shrinkage continues to happen over time. 
• Colors will fade.
• The heavy-duty laundering can cause labeling to come off or fade beyond recognition. 
• It is a good idea to check the labeling every so often. 
• Keep delicate or special care items at your home, and if you want your loved one to wear that nicer outfit for an event, bring it in right before it is needed. 
• Before the event, talk to the staff, and let them know your loved-one will need to change clothes for an event. 
• Allow plenty of time to do the change. Then have them change back into everyday clothes as soon as it is convenient. 
• Take the worn clothes with you for cleaning, so they don't accidentally end up in the laundry and get ruined. (Remember to bring a laundry bag, in case an accident happens while Dad is wearing his suit.)
• Anything can end up in the wash.
• My father's shearling leather slippers were put in the laundry once. Shrunk them terribly and bleached the color out! Fortunately, they survived, and with repeated stretching, they are wearable again.

In my next post, I will share my experience about labeling clothes.

When a Loved One is in a Rehab Hospital: Part 3

Useful Things

As I've mentioned in previous posts, Rehab Hospitals have the basics, but there are some extra things I found particularly useful when coordinating Dad's care.

Whiteboard
Yes, the facility already had a whiteboard in each room! In my Dad's room it was located nowhere convenient, there was no pen, and no one looked at it.

I bought a whiteboard decal at Staples (here's the one I bought). Cool - I didn't have to do anything to the wall to put it up! I stuck it on the bathroom door in Dad's room because it was right opposite the head of his bed. He could see it easily and the staff could see it easily.

I bought a dry-erase pen and some stick-on Velcro. I stuck a strip of the loop part of the Velcro on the bottom of the whiteboard and stuck a strip of the hook part on the pen. Voila! Instant communication system.

I used paper towels to wipe it off. And you know what? Alcohol foam makes a great whiteboard cleaner. How convenient!

Sometimes I wrote inspirational or funny quotes, Bible verses, and jokes on the whiteboard. Sometimes I wrote reminders for Dad (e.g. "3 days til the Baseball Game!"). Sometimes I wrote requests or general information to the staff:

• Please have Dad ready for his doctor's appointment tomorrow by 8:30 am. Thanks!
• Dad could use a haircut - can you schedule that with the salon?
• Dad's laundry needs to be done. He needs clean clothes for the weekend.
• Visiting with family in the Dogwood room (2:00pm)

When I had Dad out of the facility (e.g. attending the doctor's appointment) I'd write something like:

9:00am: took Dad to doctor's appt. Should be back around 10:30. My cell number: Lauren, Mr. N's daughter.

I signed those notes so they knew whom Dad was with. You never know if the nurse on duty that day is brand new and doesn't know you.

The staff commented a couple of times to me that they loved my white board decal. It really helped them remember to do certain things for Dad.

The Visit Bag
I kept a tote bag ready with stuff I frequently brought for Dad, and every time I went to the facility, I brought the bag. At home if I thought of something I needed to bring or if some mail came for Dad, I just put in the in the bag right then. Then, as I was leaving to visit Dad, I didn't have to think about what I had to remember to bring.

Some examples in our bag: the book we were reading, the newspaper, the shaving kit (in a separate smaller Dopp kit bag - I didn't need it every time), and ointment I was applying daily.

Stuff to Do on My Own

Sometimes when I visited, Dad was busy with therapy. Sometimes the aide was cleaning him up and dressing him. Sometimes, he was in the bathroom (which takes a long time when you aren't very mobile). I tried to have something pleasant to keep me busy while waiting on Dad. I figured I might as well enjoy myself while waiting, otherwise, I might get mad about "wasting my time."

Mostly I checked email or played games on my iPhone.

iPhone

More about the iPhone: specifically, the camera on the iPhone.

Other family members enjoyed seeing picture of Dad (on Facebook or sent via email). They wanted to know how he was doing and a picture really helps. I also humbly suggest that they liked seeing a few pictures of me with Dad and Dad with Trixie (my pup).

We have the technology, so why not?

I could also show pictures to Dad on the iPhone. I took some shots of my dog throughout my stay, so I'd share the latest Trixie picture with Dad, when I had a new one. Or the house with the huge snowfall on it! He really enjoyed that.

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What other useful things do you bring when you visit?

When a Loved One is in a Rehab Hospital: Part 1

This post is about a rehab hospital for physical rehab, not drug addiction.

I spent the last several weeks in Virginia caring for my father, who had a brain injury after surgery. He remains in a rehab hospital, which is like a skilled nursing facility (SNF, also called a "snif") except that patients must participate in about 3 hours of therapy a day.

The types of therapy are Physical Therapy, Occupational Therapy, and Speech Therapy. Not everyone needs all three, but my father does. Physical Therapy (PT) concentrates on basic physical skills like walking, balance, getting in and out of a car, climbing stairs, etc. Occupational Therapy (OT) often works with PT and concentrates on activities that a person needs to take care of themselves, such as combing hair, brushing teeth, shaving (men), etc. Speech therapy (ST) concentrates on talking, swallowing, coughing, and some cognitive skills.

In the case of my Dad, he lost the ability to swallow safely and is currently being fed by a feeding tube in his belly. We didn't want to him to get the tube, but it came to the point where he had no other way to get adequate nutrition. The problem with his swallow is that the muscles in his throat and soft palate aren't completely closing off his trachea when he swallows. That means he inhales whatever he is trying to eat. Then he coughs - but he may not cough out everything and wind up with pneumonia. Not good.

I learned a lot while I supervised Dad's care and visited the rehab hospital. I thought I'd share some of my knowledge with the blogosphere. When this happens in your family, you may not know where to start, and you may be afraid that you won't know what to do.  My tips may not answer all of your questions, but maybe you can find a few gems that work for you.

Communication Among the Team

Our healthcare system cannot communicate within itself well. As your loved one's advocate and spokesperson, it is in your best interest to make sure communication happens correctly. Here are things you should know:

• Do not assume that team members talk to each other. If you tell the physical therapist something, don't expect the nurse, the occupational therapist, the care coordinators, or anyone else to have been told. 
• Expect to communicate with each team member the same thing individually.
• Remember that nurses and aides work in shifts and every day your loved one may have someone new assigned. So, you'll have to tell them, too. 
• Confirm and reconfirm. If they schedule a test for your family member, verify the date, time, and location. If it's an outside location, call them yourself and verify they are expecting your family member. 
• Expect to have to ask twice or more for something for your loved one.
• You don't have to be mean or rude about it. Your care team is very busy and has a hundred things on their minds. They forget. They get pulled aside. They get involved in the latest emergency.
• When they do follow through, thank them. Tell them whatever they did really helped (example: "Thanks for giving Dad a shave! He looks great!"). 
• Coordination of Care:
• Don't expect anyone to know the "big picture" for your loved one. Most team members are focused on a certain aspect of their care. There usually is a care coordinator assigned to your loved one who is supposed to do that, but they usually are responsible for an unrealistically large number of patients. They would like to develop and carry out a personalized care plan, but it just doesn't happen the way we would like. 
• As your loved one's advocate, you have the best view of the big picture. Use this perspective to establish goals in your mind about what should be accomplished, then direct the therapy to meet those goals.  
• Example: you will probably be driving your loved one somewhere in the future. Make sure Physical Therapy enables your family member to get in and out of a car - increases strength, teaches them the steps to get in a car safely, and practices it with them.
• Not everyone at the facility knows up-to-date information about your loved one. If something changes, you might have to prompt for changes in care. 
• Example: When my Dad first came to the facility, he really couldn't get out of bed on his own. Upon arrival, his dietary needs were assessed by a dietitian who set the number of calories he needed to maintain his weight and support his bodily functions. That established how much nutrition he received by his tube feedings.
• Four weeks later, Dad had improved significantly and was much more mobile. As a result, he was burning more calories walking around the facility and working harder in physical therapy. However, no one reevaluated his dietary needs given his increased activity, and the calorie intake remained the same. He lost weight - not a good thing for Dad, as he's pretty thin.  I had to request an updated assessment by the dietitian given his improved mobility. 
• A few days later, I asked to make sure it had been done and he was getting more nutrition. Just covering my bases. 

The facility where my Dad is located is actually pretty good. They have the right goals, the maintain the place well, and the employees are generally caring, conscientious people trying to do the best for their patients. However, the system interferes with providing the kind of care we think happens. If you want the best for your loved one, you will need to watch for potential oversights and act accordingly.