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My mother has recently been put in a nursing home following a stroke last month for rehabilitation. My sisters and I have already had a meeting with the facility regarding her treatment plan and I brought up several of my concerns about her care or the lack of care she is receiving. My sisters seem to think we are not allowed to have concerns or bring up the problems that are happening every day. There are three of us and we each go up every day, throughout the day individually to see her. The care isn't there and we are there every day. Not keeping her arm elevated, the heat was turned on in the room and her blankets and sweater were still on her. It was about ninety in the room, I got someone to turn it off and they had no idea who would have turned it on. Both women in the room can't get out of bed. My mother can't even get covers off of herself. I just need to know what are the procedures to follow to see if this can be addressed without my sisters thinking they will tell my mother to leave because we have concerns.

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Advocating for a patient's best care marks you as a concerned relative. Complaining tends to mark you as pest. Concerned relatives are taken more seriously than pests.

Take care of each incident as it arises. At the care meeting bring up only the things that happen repeatedly. The thermostat thing doesn't need to come up at the meeting, unless it happens repeatedly.

Mention what you like at these meetings. "Mom really enjoys the meals," "Both PTs have been so patient with Mom."

You will probably learn the attitudes and personalities of staff. There was one nurse at my mom's NH, for example, whose grandmother and mother had both been in the facility and who cared deeply about the quality of service and the NH's reputation. Even though he was seldom on my mother's side of the building I'd bring concerns to him if appropriate. "Bill, my mom didn't have her teeth in. This has happened twice this week. Are there some new aides just training in?" And I knew he'd be bringing this up with staff, making sure the right people knew. (He wouldn't have wanted his Granny to be without her teeth for a meal!)
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Lhershey

What does the agreement/contract that was signed say? It should mention steps to take if there are issues.
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There is the right to complain - and in the sense of "speak out" that is everybody's right, nay responsibility - and then there is the approach to developing a relationship with the rehab centre or NH that will actually achieve the results you want. Namely, good care taken of your mother.

You and your sisters both want the latter, of course; you just have different beliefs about what might work, and in their case a fear that "complaining" will be counterproductive and may even lead to your mother's treatment being worse.

My late aunt, a doctor, remained convinced to the end of her days that if you asked a nurse for so much as a glass of water the staff would take it out on you for "causing trouble." My aunt's attitude used to drive me to drink (and I don't mean water). How can people possibly put things right if they don't know there's anything wrong?

The trouble with rehab is that the patient necessarily arrives there in a bit of a state and necessarily isn't there for all that long. Which all adds to the challenges the facility must overcome to give their patient the best possible care.

Always be polite.
Always be reasonable.
Always be clear about what you want them to do, exactly.

Review your expectations as you learn more about how the facility works - how many patients per staff by day and by night, what needs to be done for each patient, how long it will realistically take a member of staff to respond to a call and so on. For example, did it matter who turned the heating up? You got it turned down: good. That's what was needed. If you're really anxious that some clown might flick it on again, put a post-it by the control saying "not over 80! :)" or whatever. But don't waste energy trying to track down the culprit.

Separate the things you would like for your mother into Essential, Important and Nice. Then you'll know what you have to jump up and down about, and what you can mention in passing.

There should be a communication book, a journal, a noticeboard or something like that in your mother's room, is there? That is where you note and initial anything amiss, like the arm not being elevated or the room temperature being excessively hot; and don't forget to add bouquets as well as brickbats - "loved having her hair washed", "favourite dessert tonight."

Since the three of you are visiting every day, there is a lot you can do between you to help your mother and take pressure off the staff. Are you there at mealtimes? Ask if you can learn to help her with eating (there may be important issues around swallowing and choking - don't just charge in there without asking). Don't be too proud to wipe down a table or take out trash, and *don't* ask the staff to do things you can perfectly well do yourself. If it needs doing, it doesn't matter who does it.

Show the staff that you have a good understanding of how much work is involved in caring for post-stroke patients and be willing to roll your sleeves up, and you'll find them much happier to discuss issues with you and take your concerns on board.

It's the sort of relatives who march in and bark orders, or who do nothing *but* complain, or who expect perfection and instant results - they're the ones who make the heart sink.
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Lhershey, If she is competent, she speaks for herself. If she is not, then whoever signed her in is usually the contact person and may also be a health care proxy. Nursing homes will rightfully ask for a single point of contact; this is one person, to avoid conflicting demands from family members.
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Diverting a bit from the original question but still on the subject of dealing with staff, I had planned to share this anyway. I was met with some "surprise" responses when I asked the Admissions director for a copy of the admission dox which Dad signed this time, on the day after admission (my off day).

The Director and another staff told me, not in a challenging way but just relating an issue type of manner, that they didn't provide copies b/c they aren't obligated to. I merely told them Dad was entitled to copies, and they complied, in a somewhat confused manner. But I decided to look up the federal statutory citation in case I have any problem getting them again (another item on the "to do" list).

This is the first time this has happened, and this is the 4th time at this facility. I have no idea why they now feel they don't need to provide copies of documents that a patient signs.

If this happens again, I might have to raise the issue that a patient and family can't abide by the terms if copies of the documents aren't provide ... No one can be expected to memorize dozens of pages of terms. And refusal to provide a copy might affect the "informed consent", as patients are rarely given time to read the entire set of documents.
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We had ongoing issues with communications with the staff in mom's nh, wnere she was doingvrehab and eventually became a lomg term resident. After several failed attempts to improve the situation, we had a meeting with the social worker, don and administrative head. I pointed out a grave miscommunication of medical information and asked why my next call shouldn't be to the Joint Commision and the Ombudsman.

We set up a system by which i communicate issues to SW; i copy the DON.

You need to find out how their chain of communication works, and how they want you to convey issues to them.

Make sure you differentiate between medical issues ( arm raised), and temperature control, which may be based on patient request.
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Just remember that no facility can ever meet the needs of all the residents 100% of the time so pick you battles and be prepared to let the minor stuff go. Not elevating her arm if her therapy requires it is something to fight for, the heat in the room may not be (remember that what is comfortable to us is not necessarily comfortable for others, mom and her room mate are old, ill and immobile and either of them may have complained about feeling cold at some point)
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Absolutely! My sister, father and I raised issues when my mother was in rehab for therapy and recovery from a fractured femur. My sister was a nurse, so she addressed the medical issues; I addressed the legal ones. We discussed them before a meeting, outlined our concerns and possible courses of remediation, then met with the staff (which tried to intimidate by overwhelming and outnumbering us).

It will help if you propose options and solutions. Also, if you have a meeting, position yourselves not together but at strategic places around the table, or in such a way that each of you can make eye contact with the staff. Believe me, there will be "eyes on" each of you at a meeting. Be prepared.

I still have to do this for some aspects of my father's current rehab, at a facility which is top notch and at which he's rehabbed 3 times before. It's easy to become annoyed, but I have to remind myself that communication isn't always the best, nor is the attention needed, especially when the patient is determined to prove how strong he or she is and conveys a nonspoken message that help isn't needed that much.
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Don't think of it as complaining but rather Advocating for someone who can't speak for herself. As long as things are said in a non confrontational way, I believe it IS the role of family/loved ones to make sure things are the best as possible. The examples you have given are fair discussion items. Personally, I would address them on the spot rather than waiting for a meeting.
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