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Moved ALZ dad from a NU to a MC this past Wednesday. As reported, found out the NH had not being giving my dad his seizure med for a whole month due to a clerical error. Now in three days at Memory Care: Went 30 hours without fluids as they did not have the Thick It and everyone (MC, NH, hospice) was all pointing fingers at each other as to why the orders were not in place. It could be any, but I would think in the meanwhile, the MC would not let him go 30 hours without fluids. He is supposed to have nebulizer three times a day. First MC said they equipment had not come from hospice. Finally did last night. Today they said they had not received the nebulizer meds from pharmacy. I called pharmacy to ream them out only to be told they indeed delivered it three nights ago, at such and such a time, and signed for by a certain named nurse. So they confirmed they had it but could not find it. Finally they found it. They said his neb time was at eight to night. I said the heck with that, he is supposed to have it three times a day and he has not had it for three days, do it now. I called the hospice nurse who called the MC to raise hell (hospice is a godsend) and finally they did it. He was supposed to have a thickened ensure type drink with meals, and they always claimed it was coming from pharmacy that night. Yet the pharmancy told me today they made very clear to the MC that it would not be available until Monday. So I have been with my dad at meals all the time trying to assure he eats OK as in the past he would have a supplement drink to add if he didn't eat well. Its tough enough to watch my dad fade away the way it is . The reason you pay money to a facility is to have the peace of mind your LO is being taken care of, but I feel I am the only one making sure of this. Maybe this is just normal with all facilities, especially in the early days and you need to advocate. I was mad at the SNF we took him from, but looking back, they were probably not so bad. Am I just having bad luck or is this typical for places?

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In my opinion, there's absolutely no excuse for not having Thik-It or providing similar support for someone who needs it. Nor is there an excuse for not having the nebulizer or 30 hours w/o hydration.

Even worse, the staff should have been working together instead of blaming each other.

I don't think this place has the capability to manage what I assume is a dysphagia diet. Nor does it seem able to work together to solve problems. Bad, bad signs.

I'd start looking immediately for someplace else, while also addressing the mismanagement situation with the administrative staff.

Is this a memory care unit, with outside hospice treating, i.e., who's responsible for the screw-ups?

I assume you're documenting everything?

This is NOT typical. Although I've had good facilities, not so good, and completely awful facilities, I was fortunate enough to have a few days to pick one which turned out to be better than I expected for the last 2 stays. In the future, I'll always use this one; it's a Catholic run facility, and better than any I've experienced.

If you're by any chance in SE Michigan, PM me and I'll give you the information on the great facility I've just used.

I'm sorry to read about the problems you're having; I can understand your frustration. I would be livid!
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We all have had nightmare experiences with our LO in facilities but it sure seems like you’ve had more than your fair share. And your poor dad! I think it’s time you went to the Administrator of the facility. Take along notes of what you’ve told us about all the missteps you’ve seen in Dad’s care. Be polite but firm and let them know this is NOT acceptable. Insist on a meeting within the next few days. Force them to make time for you. You can also meet with the Director of Nursing. It’s time to get the executive staff involved. Let them know you’re watching and making notes of all these incidents. Make yourself very visible at the facility. Get to know the nurses and aides. Let them know you’re not going away. Good luck and let us know his it works out.
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A couple of things, Karsten;

Use Hospice. Call the Hospice Nurse and outline the issues--pureeing, lack of Thick-it, dehydration, nebulizer and ask THEM to figure out why those three things, any ONE of which might have killed your dad, weren't in place when dad arrived. Ask specifically if they think this MC is displaying an attitude of "he's on Hospice, it doesn't matter what we do or don't do". Ask Hospice Nurse specifically if s/he thinks you should move dad back to NH or elsewhere.

Find out who Director of Nursing is. Sit down with her/him first thing Monday and say you'd like this situation to work out, but these are the ways in which her facility has dropped the ball. What corrective actions will be taken to assure that there is accountability and re-framing of staff. Include the bully patient on this list. Think about if you feel safe leaving your mom, as a visitor, alone with this guy.

If DON is not shocked/horrified by these lapses and makes excuses, make arrangements to move Dad immediately. This was a mistake we made at mom's very first AL. If the DON is busy pointing fingers, or worse, blaming you, you want to move on.

Call the State Ombudsmen on Monday and report these lapses.
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Karsten,
I feel badly for you, as I know how frustrating it is to expect things to go smoothly
Is this MC a single location, or part of a nationwide chain?
What level of nursing do they have on staff ?

There's no doubt the physical facilities are more pleasant than a nursing home, but hearing they don't have thick it and the puree isn't smooth is surprising

Mom has been in a dedicated memory care for over 2 years, feel free to private message me if you like
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Barb, my reaction that the DON is an LPN was also Oy! as well, but I would add an OMG! And she supervises RNs? Double OMG!
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Further thoughts...do you have a phone that's capable of taking good, clear photos? I think I would start taking them, just in case you have to support the statements you'll be making on the lack of minimally acceptable care.

I think I'd even be considering finding a quality video system and hiding it somewhere in the room. I have a feeling more is going on than what you see when you're there.

You might ask the hospice worker what other facilities they cover, and if they would recommend any of them.
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Posted too early....Just wanted to add .......

One of the first things I checked into about my dads AL was how long the various ad min folks, Director of this and that, had been there. In this particular place most had several years. And they were honest about turnover in the lower ranks.

Not a good sign if you have a different director or head of nursing every few weeks. That usually means the corporate office is treating all employees like crap.
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...it may be how it is but I refuse to sit back and watch.
This is messed up! Is this what I have to look forward to? I'm only 55 but dread my future.

Good luck Karsten!! I'm happy your dad has you!
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I remember one evening while at my Mom's long-term-care, Mom and I were sitting in the common room and it was around 8pm. The nurses and aides were racing about trying to get the patients into bed.

One time I heard one Aide say "Lord, give me strength" and then I realized why. As she and other Staff members were working their way down the hall getting folks into bed, some of the patients had been in bed where now out and about in the pj's wandering the hallways. It was like herding cats.
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oh yea, I told the hospice SW if I should be reporting this to the state ombudsman. She said she and the hospice nurse were already discussing this with their management and thinking of doing it themselves. I am guessing they may now wait until the care conference.
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