The short answer
Staff usually ask visitors to step out during bathing and changing to protect the resident's privacy and dignity, and sometimes a roommate's. But privacy is the resident's right, not the facility's. If the resident wants you there, or you are the resident's legal representative and it is appropriate, you can ask to stay. Either way, you can ask the nurse for a skin check with you present, ask for the latest skin and wound records, and watch for warning signs.
Why staff ask you to leave
- The resident's privacy. Residents have a right to privacy in personal care. Many residents prefer family not see them undressed.
- A roommate's privacy, if care is being given in a shared room.
- Facility habit. Sometimes "please step out" is simply routine, and sometimes it is used to avoid scrutiny.
When you can ask to stay
If the resident can make decisions and wants you present, the resident can say so. If the resident lacks capacity and you are the health care agent or guardian, you can ask to be present or to see the skin, keeping the resident's dignity in mind. Close the curtain and ask that the roommate's privacy be respected. If staff refuse, ask why in writing and raise it with the director of nursing.
Practical ways to check on the skin
- Ask the nurse for a skin check while you are there. A nurse can look at the high-risk areas (tailbone and buttocks, hips, heels, ankles, elbows, shoulder blades, back of the head and ears) and tell you what is seen.
- Ask direct questions. "Is there any open area, redness or dressing anywhere on her body?" is harder to deflect than "How is she doing?"
- Ask for the latest weekly skin assessment, Braden score and any wound measurements. Residents and their representatives have the right to see the records within 24 hours.
- Attend care plan meetings and ask about skin every time.
Warning signs you can see without undressing anyone
- A dressing on the heel, hip or lower back, or a new air mattress or heel boots that appeared without explanation
- A strong odor, or drainage on sheets or clothing
- Pain or wincing when the resident is moved or sits
- The resident left in the same position for hours, or in a wet brief
- Fever, new confusion or loss of appetite, which can signal an infected wound
Do not remove dressings yourself. If the resident agrees, photographs of a wound taken by family with a date can be useful later; avoid capturing other residents. The facility must notify the resident's representative of a significant change in condition, which includes a new or worsening pressure injury. See bedsore stages explained.
The rules behind this
- 42 C.F.R. § 483.10(h) (privacy)
- 42 C.F.R. § 483.10(g)(2) (access to records)
- 42 C.F.R. § 483.25(b)(1) (pressure ulcers)
Related questions
This guide provides general information, not medical or legal advice. Rules change; confirm current requirements with the facility, the New York State Department of Health or a professional. Attorney Advertising.