Oversight of caregivers who live in areas distant from long term care facility.

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My sister and I both live over 1000 miles from the facility where our mother is a resident. Unfortunately, because of her mental decline, an evaluation conducted by the state forced us to place her in a Behavioral Unit. She has visitors but they are elderly and not able to understand medications and laboratory results. The visits are important to her and we want to avoid transfer trama.

The facility is a for profit institution which raises an immediate red flag, but we had no choice because the facility had one of the few behavior facilities in the state. To provide us better oversight we have taken the following steps. In the event our mother passes, her body is to be sent to the county coroner for autopsy. The final decision to actually perform the autopsy is at our discretion, but the facility has no way of knowing what our decision will be. We request a full copy of all medical records be faxed each month and maintain on ongoing database of laboratory results, nursing notes, doctor's orders and the date medications were ordered. Since our mother is not competent to make informed decisions, we are to be notified regarding any changes in medication or critical laboratory values by phone. We retain phone records and cross check the facility notes to determine if notification was received. Recently, we have noted that their records indicate we were notified, but in fact we were not informed. Whatever the reason this represents falsification of records. This has been brought to the attention of the State Health Department and an investigation is ongoing. We make regular calls an ask polite but direct questions about her medical condition, when we hear phases "she had a really good day" our response is thank you, but revert the topic to what were her blood sugar results and has her balance or gait changed in the past two weeks. The nurse often sends our calls to the LNHA (lisenced nursing home administrator) who has finally learned that we love our mother but we want facts not platitudes. We initially tried the ombudsman but found they often have a 10 year relationship with the the LNHA and are not without bias. In fact the ombudsman's response was "they don't like you because you ask more questions than other families and take too much of their time" our answer was they should hire more staff, but of course that means the CEO and LNHA may have to take a pay cut. We can't sue them because of binding arbitration, but we can file complaints and alert websites, AARP and other organizations. What do other's think about this approach.


You are doing an amazing job of keeping track of her. Just be sure you praise the facility when they get it right. Yes, there will be glitches along the way, but overall she is in a good place with friends able to visit. If they feel too oppressed, they will toss her out for one reason or another. Always have a backup plan.
In my opinion, you should move her to closer to you. I say this in a loving way.
Have you looked into hiring a Geriatric Care manager? They are expensive, but they can get the answers you need. Or do you have a smart friend who lives maybe 50 miles away who would accept $100-$200 to go and ask questions in person maybe once a month? Look for someone who has just finished caring for their own parent or spouse, who would already know what questions to ask? Or a diabetic who knows their stuff about A1C etc. I think boots on the ground would make you feel more comfortable. Good luck; you are doing a good job.
I want to thank you for sharing what you do. My turn is near and I need someone that like you so i know where to start. My father may not be able to continue in this way and I will have to take over

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