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My 96-year-old mother will be going to a memory care facility with skilled nursing. She has dementia, falls a couple of times a week and is ADL dependent. We are thinking of hiring additional help for her in the NH as we can only visit a few hours a day. We are thinking of 4 additional hours of outside help per day. I am looking for advice on what is the best time for the hired help to be there. Thank you.

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Definitely the facility admins and nursing staff are the ones to help you here. They would be the ones to tell you what hours they are the most taxed and in need of help for their own facility. Each caring facility has its own mode of operations.

Call the admins at your facility and ask them when the need is greatest. They would, I would think, be so glad to discuss this with you. Otherwise speak with trusted personnel you already are familiar with when visiting.
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Check with the facility. Many have restrictions as to hiring a caregiver for a resident.
Many facilities require you to hire from either a specific agency or from a list of pre approved "vetted" people.
Where has mom been living up to this point?
If she has been living with you or a family member you or they are the ones that know her "schedule" and when she needs the most help.
I honestly would wait and see what added help she needs. 4 hours a day is a LOT of extra help and you may be paying someone to watch mom sleep, eat and watch tv. I also think having someone with her will lessen her relying on facility staff and possibly making friends with other residents,.
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elisny Apr 2023
Limiting selection of private care givers looks to be illegal under:
42 CFR § 483.10 - Residents' Rights

(f) Self-determination. The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.

(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, plan of care and other applicable provisions of this part.

(2) The resident has the right to make choices about aspects of his or her life in the facility that are significant to the resident.

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I would work something out with the facility, via the Care Plan, to ensure a resident has providers to their liking and agreeable (reasonably) to the facility. If the facility pushes back, it is possibly a kickback situation - and I would get a lawyer involved pronto.
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I spent over 5 years caring for my mother in a nursing home. I have good knowledge of the law and have seen much.

First, to be clear - you said you can only visit a few hours a day: Presumably that is due to your restrictions, not the nursing home (the law requires immediate access for family 24/7 - among other rights to visitation),

42 CFR § 483.10 (f)(4)
(ii) The facility must provide immediate access to a resident by immediate family and other relatives of the resident, subject to the resident's right to deny or withdraw consent at any time;

Secondly: The nursing home is required to provide sufficient care -- see regulation below. However, this is typically not the case, and is unenforced by regulators, including the CMS.

42 CFR § 483.24 Quality of life.
Quality of life is a fundamental principle that applies to all care and services provided to facility residents. Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care.

It is quite individual as to when additional help is most useful. Typically, I was with my mother from 1 PM (for lunch) until 9:30 PM. Mornings were the most active, and well staffed, even on weekends. The worst time was late afternoon and early evening - management gone, lots of residents needing or wanting assistance for dinner and getting ready for bed. IF you can be there during this late afternoon, early evening window, then I would suggest after lunch for a private aide -- for activities.

Best to you.
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I considered doing this, but since I was dropping in at different times during the day, I came to realize that most of her needs were usually covered.

When she went to hospice care, the coverage was even better.

So I held off.

Unless you are seeing some specific periods of deficit care, I’d hold off.
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I hired 4 hours (1-5 p.m.) that would enable mom to have 2 meals and the most help when she was more awake. She sleeps in but is more aware in the morning. My caregiver for her gives her washups every day and applying lotions, puts lubricating eyedrops in and warm compresses, reads to her while she is enjoying the compresses, showers and fixes her hair, walks her to the meals; she also does laundry because “Loosing/got lost” items seems to be a problem. Mom has done very well with this schedule. We did have 2-6 but that wasn't so good because the meals were not served after 2 p.m. The caregiver reports to me and sends me a text every day (normal day, slow day, mom more confused day, good day). I got lock boxes from amazon to keep the eyedrops so no one could get to them and drink the drops. The continuity of care for mom has paid off. Mom has a dependable person 4 hours a day 7 days a week. The staffing at her place is unpredictable and the best ones are not always assigned to my mom. Pro: she is safe, I have eyes on her with the caregiver and mom is content.
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Why do you think they won't have adequate staffing? She isn't even there yet.

Go ahead and hire a companion for her if you want, but talk to the administrator first to get a sense of how that will work within their organization.

As to what time, at what time are your mother's needs the greatest? That's when you have the helper in there with her.
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Tandemfun4us Apr 2023
according to the Admin and Director of Nursing, my mom would not need any additional help……but then I got to meet other family members and found that they were there because their loved one wasn’t always toileted well or wiped/cleaned and the best personnel were few in number. I am glad I have someone for the 4 hours. Yes, sometimes mom is extra tired and sleeps but my person still can do a bed bath and massaging lotion into her skin keeping her from pressure sores. Mom is aware of her hurts and enjoys the warm eye compresses. The admin tell you what they want you to hear and if you ask about a short staff day, “it isn’t their fault”. I was glad I didn’t listen to them about not having a daily caregiver. Other residents family members have “poached” my 2 caregivers because they saw how clean/loved/and well treated they cared for my mom. The admin actually approached my main caregiver because of the increased needs of some residents and the inability of the current staff to adequately meet the needs of the resident. It has been good but frustrating because of the demands on staff but I know this can be a high turnover job so the consistently of care for mom with a private caregiver has been less stress for me and better care for mom. My caregivers are very loyal to me and only took on more work with the understanding of their new client that Pat comes first!
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I would cover as many meal times as you can. Below mentioned is 1-5 because their parent slept late. It depends on your mom's schedule and when family can help. Can family cover one mealtime? Does mom have trouble with sundowning? Check the meal schedule with your facility.

When my dad was in rehab, speech therapist worked with him for breakfast, I covered lunch and because his sundowning was very bad the sitter came 5-9. That worked great for him.

Good luck to you!
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I would go for swings. 3 to dinnertime. There are less staff generally on swings, and that time is when most sundown.

Before doing anything, tho, stand back and observe your own facility’s staffing needs.
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my First thought is how much is she awake during the day? 4 hours seems excessive. I agree with other posters , talk with administrator, and find out how brings go..
If you’re visiting a few hours a day, plus your hiring care, what art you paying the memory care for? Take a wait and see approach.
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As Peggy Sue stated meal times and staff changeover are the best times. Many times when mom was in rehab at assisted living/memory care places. She was not even woken to eat. Forget it, if they need help using the bathroom at staff changeover times no one will come. You could scream bloody murder if you fell and no one would respond on changeover. My biggest concern is meals and choking.
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bkoropchak123 Apr 2023
My biggest concern is: isn’t the “care” facility liable for providing safe and humane care? As we pay more and more for facility care there seems to be more concerns over quality of care. Twenty years ago my mom was safe and was very well cared for after requiring total care at 87 until she died at 99. Bed rails kept her safe from falls from her bed.
Today my 91 year old sister is in a very expensive locked memory care unit. She has fallen out of bed at night but laws prohibit any kind of bed rails to prevent this. Yes, I know of prior problems with bed rails that preceded these laws. Most responses suggest adding private pay staffing which are financially out of reach for many families.
Although I’ve read that these facilities are responsible for assuring safe care, I’ve also read and been told that these responsibilities do not include providing care that the facility determines are too expensive.
Residents are discharged when care needs are too costly to the facility and the families cannot afford to hire private pay extra caregivers. Thus - a no risk/no cost situation for facilities.
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