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My sister expressed some concern that my encounters with the Nursing Home staff are going to have them running for cover. I honestly don't set out to be confrontational, but it seems like every time I have a question instead of a simple reply I get some variation on "this is the way it's done, trust us". While I can't fault the quality of mom's basic daily care I have seem with my own eyes that I can't trust them in some areas, so I get drawn into a discussion that quickly becomes confrontational. Adding to the problem is the total lack of a space to ask my questions in private, pretty much everyone from the doctor on down seems to conduct their business in the hallway (not really surprising as the only office space available is on another floor). They clearly are not used to being questioned and immediately get defensive, I feel as though I have to justify my concerns and push back, how can I stop this dysfunctional cycle??

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You are standing up for the rights of someone you love dearly. The Nurses or Carers don't have the same connections as you. They are just doing their job and, some of them need to be questioned on some of it. Just carry on, keep questioning anything that you don't agree with, or don't understand. I have been through this type of thing myself with my mother when she had her stroke. Don't worry about your their reactions, you are speaking for your Mother. Sadly, my mother died 4 months later, but I am glad I kept defending her and queried anything I thought was wrong. After all, the Staff meant nothing to me personally. Few of them showed a caring side to them., and my mother was unable to make enquiries or to stand up for herself.
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And Send, it's all in how you speak up. They can't 86 you for caring.
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I agree with send - don't give them their excuse for not doing their job - especially do not open with it when you are going to follow with the issue you are concerned about. It's like saying "here's my list of circumstances of when it's okay for you not to treat my mother well or not do your job".
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It hasn't been a good weekend

If I had the time, I would consider forming a family council as it would be the forum for folks to grumble over the petty issues and then identify the top three issues that are commonplace and really do need to be addressed and if not the ombudsman gets contacted
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Unfortunately, when promoting or prefacing the "understanding and sympathetic" position, all most staff hear is you giving them an understanding pass on providing your Mom the best standards of care, imo.

I am not a good communicator, so will yield the floor to the more experienced who have actually been to the "Care Meetings".

I am not someone who would accept sub-standard care, and would more likely be banned for speaking up at all.
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I'd like to get across the idea that I understand and sympathize with the reasons for some things without conceding the point I'm trying to make....

"I understand that weekends and evening shifts are often short staffed, what can be done to ensure mom doesn't miss her bath too often?"

"Unfortunately mom can't remember anything that happens, I know I can't expect the psw's to take time to update me about what mom is doing every day, do you have any suggestions to help us to keep abreast of her activities or needs?"
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Excellent wording of your concerns!
Fact finders sit in the middle, but others cannot hear or see you.
Not sure about the use of "I" statements, what about using the formal name of the patient/client (your Mom),
example: "Mrs. Willie has always expressed a strong desire to be changed and clean at all times."

Or, how is this:  Let's cut to the chase....
"If anyone blends a sandwich or tries to feed (Mrs. Willie) anything you yourselves would not eat, you will be hearing from me directly on the heels of the Ombudsman, and will have hekk
to pay".

me bad.
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Cwillie, your kind heart and innocence is showing. There was room at the table, the bully came late and had her own seat, perhaps thinking her opinion WAS the only opinion. Shortly after her arrival, verbal fights broke out. One would not need to hear due to the scowl on her face. Only 2 joined her at the end of the meeting.
The second most powerful position IS the one at the other end (of a rectangle table), it is said by the referenced article's author.
My best position is not to go to any meetings anymore.
If it all can be avoided.
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I've been practising my "I" statements. I feel

frustrated
unimportant
overwhelmed
unappreciated
disconnected
resentful
dismissed
left out
.....oops, can't use any of those!

We have decided that this will be a fact finding mission and we will let the meeting proceed according to their agenda and sit back and hear what they have to say, I will have to bite my tongue if they start handing me BS. My one main point is summed up as

"If I have a question or I see something that concerns me I'm not sure of the proper protocol to bring it to someone's attention, I often feel I am interrupting your work."
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My preferred spot is at the bottom of the table, or directly across from the leader but not too close. (lol)
If I were at your meeting I'd want to sit close enough to your neighbours at the separate table to hear what they were saying without aligning myself with them.... was there not enough room for everyone at the main table, or did they feel excluded and that their opinions had no place there?
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"Where to sit at a meeting...the 4 power positions".
This should help you be heard and not ignored.

I want to be the b*tch seated to the immediate right of the leader. .... ......cannot believe I am saying this.

Unconsciously, in a meeting of neighbors with strong opposing views, I sat next to the leader. The bullies and haters actually started a new table and talked amongst themselves, without giving input to the issues at hand.
Not really success when everyone could have been united for the cause.
It's about the best care for Mom, right?
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There was something I read about where to sit in a meeting...similar to a job interview (which a care meeting is not). Maybe someone else knows the psychology of this technique. However, I am sure if the leader and staff line up on one side of the table and you and possibly sis on the other, that is not good. Sitting next to the leader maybe?
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Well, er, um, "I think" avoiding being labelled a "b*tch" or even a "witch" is overrated. If doing what hubs needs to get him the best care is going to have me accused of being (insert any bad name here) a b*tch, then bring it on.

Sometimes, if "I " have to be nice in addition to obtaining a good outcome....then "I" think "I" will explode.

Thank you Rainmon for the book reference-maybe I could be nicer....
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Also - if you're a reader, I highly recommend the book Seven Habits of Highly Effective People by Stephen Covey. It's an older book - late 1980's but back in my HR days it was considered the gold standard on how to communicate with people to get them to do what you want. It was a bit dry for me as I'm not big on self-help books so I got it on tape and listened to it in the car. I ended up so impressed with it that I did buy a copy to have as an at-fingertips reference.
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Lol, cwillie, my problem was that I always knew what I SHOULD be saying but that wicked temper I inherited from both of my parents - often left me with my foot in my mouth.
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Wow Rainmom, can you come with us to our care plan meeting next week? It's something I should already know, using "I" statements vs "you" statements is psych 101, but after living in isolation with mom for so long I'd totally forgotten. I need to practice, practice, practice.
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Cwillie
It's terribly frustrating isn't it?

Since mom can be a handful I go out of my way to be nice to staff - not necessarily admin - when I bring treats I bring some for them - I order in pizza or get burgers when they seem to be having a bad night but there's so much turnover in staff or they're rotating ones to different residents it's a constant challenge

Last night I arrived at the hotel California around 8:30 pm - tired from work - a new evening nurse and a new CNA - CNA came over and was going to take mom to bed - she wasn't tired plus I just arrived so I said no worries I'll put her to bed tonight but would you take her tinkle while I get something from the car - when she returned I asked if she was wet - she said just a little so I assumed she'd changed her - nope she was drenched clear through to the towel and seat cushion on her wheelchair -grrrr

When we went to mom's room another resident's walker was there and her roommate was in bed so I take the walker upstairs to return to its owner - her name was clearly marked - while I tried to be nice both the new evening nurse and the noc nurse got my frustration especially since mom has struggled with one UTI after another but I'm sure this scene will play out again and again as it has before

Unfortunately I have seen residents die from a lack of response when someone is struggling to breathe - one even had a personal caregiver who tried to alert the nurse there was a problem- she was turning blue

Short of being there everyday there's not much more we can do sometimes
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I think it also depends on which staff member you're talking to. See if you can form a good relationship with some of the staff members - the ones you can rely on to give you an honest answer and to listen to your concerns without becoming confrontational. Definitely not the ones that say "this is how it's done" and leave it at that. You want to find the staff member(s) that take the time to explain to you *why* it's done that way, or that listen to your reasons why you think it should be done differently for your Mom. Elder care is not a cookie-cutter situation - every elder is different and requires different handling. What works for one patient doesn't always work for another.

We had one CNA who annoyed the heck out of me. She started right off the bat by being condescending with Mom when she first arrived. On the first day in the NH, this girl came in, leaned right into Mom's face and spoke very loudly and slowly, and in a sing-song voice, like she was talking to an infant. Mom was completely put off by that, and so was I. This same CNA insisted on cleaning Mom's abdominal skin folds (she was very heavy) while she was seated on the toilet - making it difficult for herself and painful for Mom. Her folds were very heavy and more than one skin tear was caused using this method. I kept telling her that she needed to lay Mom on the bed for this process, as it was much easier to reach the bottom of the fold that way - cleaning in a seated position on the toilet not only makes it impossible to clean all the way to the bottom of the fold, it's just inviting more bacteria into the folds. I mean...she's sitting on a toilet, for goodness sakes, while you're cleaning an area with irritation & broken skin. Seriously?! The CNA would just look at me like I had two heads and go on with what she was doing. The other CNAs all did it the way I suggested and agreed that it was easier both on Mom and themselves. I finally had to go to the administrator and request that CNA not be allowed to deal with my Mom at all.

You have to advocate for your loved one - that's a fact - but finding staff members that are truly devoted to their job and willing to listen and act on your requests without seeing you as confrontational is the secret, in my opinion. It's a sad fact that many staff members in the NHs are simply there for the paycheck and don't truly care about their charges. I knew exactly who those people were, and I knew who the ones were that truly cared for my mom - the day she suddenly collapsed and died unexpectedly, there was one particular CNA who had to be sent off the floor, because she couldn't stop crying. I knew she was one of the good ones.
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Lol, I am sooo not the right person to be giving it a shot at answering your question!

My mother always use to say to me "you catch more flies with honey than vinegar". She was also, no one to talk!

Unfortunately, it has been my experience that when I take the "honey" route - I usually get blown off. Maybe because I'm a big boobed blond people tend to talk to me like I'm an idiot when I'm attempting to be non-confrontational and nice. That almost always pisses me off and I start spewing the vinegar.

However, I have learned a few things in my attempt to treat people nicer than my mother did (sorry, someday I might also learn I don't have to continually take jabs at my mother). This is what I've learned as an advocate for Rainman, my mom and myself.

When urgency isn't a immediate factor - I try to give a "heads up". "Nurse Ratchet, when will you have a few minutes in the next few days to talk with me?" This shows it's important enough to you that you want a specific time and her undivided attention - and that you are not having a knee jerk fit about something that just happened. Next - when actually having the conversation I try not to jump to the point, instead I usually build to it - but don't start by giving them an excuse. Wrong - " I know how very busy you all are here and I know my mom can be a handful...". Right - "With this currently being cold and flu season, I am concerned about my mothers cough - what have you noticed". That's also getting their input right off the bat, making them your team member not your enemy. I also try to avoid statements that make it look like I am documenting. Wrong - "three of the last four days mom has been in a soiled diaper when I got here." Although, this can be a very effective tool - appearing to document if they start making excuses or try to blow you off. Then I again ask for their opinion "why do you think this is happening?" Then - them coming up with a solution "what can we do next time to ensure I'm notified right away if mom appears sick?" If they don't have an answer at that point - I ask for another time to met - again, if time allows. "Why don't we both think on this - when can we met tomorrow with a solution?" People respond better when they come up with their own solutions. That does not mean you can't say "Im not sure that will work...". And lastly, I always thank them - "I appreciate you taking the time to discuss this issue with me - I'm sure we both have the same goal here - the best care for my mother." This also keeps you on the same verses opposing team.

I know that sounds like the long way to make a point - but if it works AND it keeps both you and your mom on their good side - and therefore more likely to treat your mom well, isn't it worth it?

Last minute tip - stick to one issue at a time. Dumping stored up issues will make them think you are being overly picky and demanding. 
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IMO, the staff need to realize that your mom's care is the most important thing in your life right now. And even if they are NOT on the ball, they need to learn how to be empathetic and make things right, when given the opportunity. This would distress me as well, if they don't seem to get it.

Keeping notes is good. I'd use them to lay out my concerns when you have your team meetings. When I ask questions at my LO's MC, I usually get the response that things were done according to the law or policy. They seem to have a handle of it. Still, some things confuse me.

Is your mother on Hospice? Is that an option? Would their services help put more eyes on her?
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My most recent confrontation was a question about mom's health; despite being deemed fit enough to be allowed to leave her room when I visited she seemed in distress, coughing with literally every breath, mumbling and groaning. When I asked the rpn/lpn if her lungs had been checked recently she sent me to talk to the aprn. (Frankly she could have pulled out a stethoscope right then and there and reassured me but chose instead to not reply, and this cover-my-own-a$$ is what I am seeing too much of.) The APRN, instead of reassuring me that she had been checked started quoting me statistics from the Health Unit, that mom had passed the 5 day quarantine and would likely have a lingering cough for a long time, and to trust the team to keep an eye on her. Sorry, but "the team" knew mom was sick 2 days before I found her ill in bed last week and nobody seemed inclined to proactively do anything about it. And I've also posted about the total lack of infection control protocols when senior staff leave for the day and over the weekend, none of which makes me inclined to "trust". All I wanted was some reassurance and I found myself having to defend my lack of trust, at which point I chose to end the conversation. I know I'm only seeing mom for a small slice of time and maybe she is just fine the rest of the day, but how can I know if nobody will talk openly?
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SUCH a good question.

I find that it's much better if I do this stuff in a care meeting (I know that you are having trouble getting that scheduled because of your sister's lack of response; I would just go ahead and schedule.

Yes, every facility has THEIR way of doing things. And I think that we, as advocates for our parents, can respect and understand that. And understand that our parent's care is NEVER going to be as customized as it might be at home.

I look at this the way I look at school for children. Yes, if you home schooled your child, you have total control and you can customize. And if that's what you want, and you don't have to work, then so be it.

I think that having my mom in a care center gets her better health care than I could ever give her, plus she gets some socialization. And I don't have to worry about the fact that she's with one or two caregivers who I have to supervise. And I don't have to give up the privacy that frankly, my husband and I can't live without. We live in just 1000 square feet.

So for me, the choice was pretty much a non-choice.

Make a list of what is bothering you and sit with it. Are they life and death problems? What are the biggest barriers to your mom's quality of life? THOSE are the important issues to talk about at a care meeting, not on the fly, in my opinion.
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