Great lengths for short nails

Toenails grow approximately 1.6 mm a month, or about 1/16 of an inch. My mother, a beautician, taught me to keep them short to avoid them from becoming ingrown. Others have had to shorten them for me since I became disabled at age 19. When I lived on my own, my caregivers kept them the same length using an emery board every two weeks.

At my first nursing home, I had to see the podiatrist. Like all the other residents, I had to lie in bed and wait for him, sometimes for an hour. Back then, I was private pay and felt $100 for toenail care was excessive. I asked the nursing director if I could forgo seeing that the doctor since I am not diabetic and if a nurse or aide could trim them instead. She agreed. I did not see the podiatrist again even when I went on Medicaid.

When I moved here, and my toenails went untrimmed, I asked an aide to trim them. I was not told I had to see the podiatrist. Some of the aides enjoyed using my battery-operated nail drill or one of my colorful emery boards for nail care. I saw the podiatrist only when the aides did not get to me. Some residents complained the podiatrist did not visit often, and I hoped I would not need to rely on him.

Last fall, I was frustrated because the aides were not shortening my toenails often enough. I talked with the nurse manager, and she told me to see the foot doctor. Coincidentally, he came the day my friend, Beth, visited for an outing. There were 20 plus residents waiting. Beth thought I would be allowed to "ditch the line." Wanting to leave, I asked Beth, a registered nurse, if she could file them later, and she agreed. Beth commiserated because Medicaid only pays for her 90-year-old, diabetic mother's toenails to be trimmed by a podiatrist every 12 weeks. Since her mother wanted them trimmed more often, Beth does them.

After choosing my friend over the podiatrist, I asked the nurse manager if a nurse could shorten my toenails monthly, and she agreed. I understood management wanted the podiatrist to trim them because he has liability insurance. However, I feel an emery board is safe.

For a while, a nurse trimmed them monthly. At the end of February, she said she would have the podiatrist trim them that afternoon. I asked the aide with the podiatrist's list if I was on it, and she said I was not. Thinking I would not be able to see him, I went back to my room. The nurse came and told me to see the podiatrist anyway.

I waited while the podiatrist finished the last three residents. When it was my turn, he announced it was 3 p.m. and was leaving. The aide assisting got the nurse manager who reminded the podiatrist of his contractual obligation and advised him to shorten my toenails.

Somewhat embarrassed, I headed into the room. The podiatrist gave my toenails a cursory trim. I asked him to smooth the edges with the drill, as the other podiatrist had done, but he said he did not have one. Instead, he picked up a dilapidated, cardboard file and whisked it quickly over the edges.

I asked how often Medicaid paid for a resident toenail trim and was surprised when he said every nine weeks. I told him I had never let my toenails go that long without being shortened. He tersely replied, "If I need to trim them more often, you will have to pay my fee out of your pocket."

I realized he probably had no idea how powerless I felt. I could not afford to pay his fee. I knew if I had to wait nine weeks for his return, they would be 3.2 mm longer, uncomfortable and definitely need a trim.


Topics: Clinical