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My dad keeps arguing with the staff at the nursing home about my mother's care. It's always something physical therapy or getting her on the toilet. The physical therapist told him if you didn't like it maybe he should look into going somewhere else. I know the director of nursing is fed up with him for constantly insisting she be on the toilet. She can't stand she can't communicate she's a handful to try to get on the toilet or into bed or to do anything. Can the nursing home tell us to take her somewhere else?

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Louise, the physical therapist's response to your father's concerns was very unprofessional. We are finding here in our part of Michigan that nursing homes are seriously understaffed. We rarely see family visiting residents at the place my grandfather is at now, but when we do, they are almost always in the process of trying to track down staff and advocating for their family member.

The compassionate and competent staff members are on the same side as their patients and their families. The people that are most likely to snap and be rude are ones that should not be working with infirm and dependent people. The fact is that these places do not have enough people to do the work, and the workers who bear the brunt of the work -- the CNAs -- are often working a second job because this work pays so little. It is truly heartbreaking that both the patients and aides are treated so poorly.

Is your dad being abusive to the staff or is he just distressed because he feels your mom's needs are not being met? As you know, it is really a loss to see a loved one in that setting and it takes awhile for everyone to adjust. If this is out of character for your dad, he might be burnt out and the stress of seeing your mom in that setting might be too much. If he is there everyday, it might help to encourage him to take a day off and let him see your mom will be all right if someone else takes a turn visiting.
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I wish health care personnel were/could be on a 1:1 ratio so we could accommodate each patient at the moment they need assistance. As an RN that previously worked in Geri/psych, I had 10 patients and one CRNA. I would be changing a diaper/toileting a patient and hear a patient in other room call/scream for help. I physically couldn't be in 2 places at once. I'm sure for the family member of loved one yelling for help and not immediately being assisted is frustrating. It happens a lot so I understand why your dad is angry. Sometimes it takes more than one staff member to help toilet a patient. Patients can be assaultive and I've been hit and kicked while attempting to care for a patient. Although family members need a break, if at all possible we always allowed family members stay even off visiting hours if they wished to always have a person to constantly be in same room to immediately tend to needs. Another option is if your dad could hire private duty aid to sit and help with toileting. If your mom is a two person lift/assist that aid sitting with your mom may have to wait for a staff member to be free from tending to other patients to help. Nurses have other responsibilities, passing meds, wound/skin care, arranging for tests, entering labs into computer system, calling doctors for medication/admission orders, admitting new patients interviewing family/patient during admission, monitoring behavioral changes, documentation of all of the above and more. We generally try to do our best but we can't immediately be there if we are involved with caring for another. I personally avoided the complaining family member but continued to do best I could. Your dad could make appointment with social worker to discuss a transfer to another facility. Sorry to say, but if complains and is abrupt and demanding to staff, staff will be relieved to not deal with complaints if your mom is discharged. The phone would ring sometimes and secretary would answer it would be a family member known to be difficult. I sometimes told secretary I could not take call because it would take up time that was better served taking care of my patients. Your dad is angry because he loves your mom. That's beautiful. This won't last forever. Good luck.
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You should contact your local Ombudsman to advocate for your mother and strongly encourage Dad to back off. Ombudsman are trained advocates. That's what they do - try and get the best possible care for residents in long-term care. Their services are free. Please contact them.
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I believe she could be asked to leave. But I imagine they would take other measures first. They would bar him from visiting. They would talk to him and tell him to cool it. Most likely if they have a resident who is paying in some way they will try to keep them. Money talks whether it is my medicaid or self pay, they will put up with a lot. Did your family sign a contract and see any rules when mom was admitted. Surely they have rules that have to be followed.
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It sounds like a meeting would help. Between the PT staff and the staff of the rehab facility. It should probably include the nurses, CNA's if possible and a Social worker. Your Dad and at least one other family member so you can get the whole picture as well as potential outcome and what your Dad is doing to hinder progress if there is any.
I understand what your Dad is going through I went through the same thing with my husband a few years ago. It took me 2 months to get a seat riser for the toilet rather than a small rickety commode that had been placed over the toilet for the resident in the next room. Difference was the resident next door was about 5'5" and 100 pounds soaking wet my husband was 6'4" and 260 pounds. While the commode was stable for the next guy it shook like a leaf when my husband tried to use it. I won't get into the 100's of other problems. But there is a difference in advocating and being obnoxious or belligerent.
Tell your Dad the old adage is right...You catch more flies with honey than vinegar.
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''we don't see things how they are; we see things as we are''..Meaning we all have our own opinions.and feelings..the patient; the partner; other family ;doctors...and ALL must be heard by someone who is actually not involved with that particular patient..and feelings and situations can change on a minute to minute..so it is an ongoing process
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I complain all the time about things I am not happy with at my husbands NH....no one has ever told me to go somewhere else...on the contrary they look into the problem and it gets corrected. However I go to the administrators, not the workers....if a CNA is not properly taking care of him I first talk to his nurse, if that doesn't correct the problem I go to administrator....they always assure me I have every reason to complain if there is something that I don't like or agree with ....I don't scream and holler..I just go in with a humble attitude....they are extremely good at addressing the problem...even have opened their eyes to some that needed to be let go.
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A valid reason apart from having every right to see his wife, and his wife having every right to see her husband, do you mean?

If he is violent or abusive, then the staff could take steps to have him banned from the facility, yes. But they are more likely to ask him to remove his wife, and that indeed is the primary concern of the original poster. In any case all the poor man is doing is questioning the care his wife is receiving, and the correct response to that is to explain and reassure - not to chuck him out on his ear for his temerity.
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unless he has a valid reason, yes he can get kicked out. not only can he get kicked out but they can ban him from the entire facility.
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Yes, that's the sort of lift I had in mind. You can adjust the angle of tilt because there are three sets of loops at the back, so the person can be more upright or more reclining. There are also two different ways to fix the thigh straps to keep the person's knees together or not, according to a) what you're using the hoist for and b) how much muscle tone the person has (knees not together is safer if the person is prone to slipping or tipping forward).

I suppose from wheelchair to room to bed to commode to bed to wheelchair and back again would take that time, yes, on reflection. I guess I hadn't really added up in that way before. I used to transfer my mother last thing before "bed-time", and in the whole performance of that, washing, teeth-cleaning, bed-making and the rest of it I lost track of time.

I also ignored the two-person rule. This was partly to do with reality - there weren't two of me, and if you think transferring somebody on your own is heavy going all I can say is try changing the bed on your own with the person still in it - but also because of at least two occasions when the frankly dangerous actions of professional aides, trained and qualified, made me insist they stop what they were doing immediately (I very rarely challenged our HCAs, or felt the need to). One of them would have had the hoist tip over - she was yanking on it to get it over a bed cable - and the other hadn't got the sling straight and my mother's torso was heading for a 45 degree angle to the right. I consulted the government's Health and Safety Executive's reports on the use of hoists in care settings to check what the main causes of serious accidents were so that I'd know what to be neurotic about. And although these reports are in Civil Service speak and therefore don't call anyone a moron, when you dig down accidents are caused by people not paying attention, not using the equipment properly and in one case having the spatial intelligence of a woodlouse. I suspect, too, that quite a lot of the inattention comes from pairs of aides chatting to each other instead of concentrating on what they're doing.

With practice you should get good at it, like a choreographed routine. What matters though is whether your mother is aware of continence issues or not. If she is at all concerned by it and is willing to persist with transferring, then the benefits to her sense of self, skin integrity, infection prevention and just simple hygiene make it worth the effort.
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Wow Louise - this sounds miserable for all and I'm surprised that the nh isn't just trying to change her in bed

How do you feel the staff is performing ? How does the facility rate by Medicare? If you are uncomfortable then are there alternatives ?
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I was looking into using a sling to help with my mom and I have to say the way they are transferring her sounds crazy, they make special sling for toileting that allow you to pull down their pants while in the sling (you can watch a youtube video about them). This place is obviously not set up to toilet those who need assistance and prefers to use diapers.
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They can no longer use the lift that is a padded strap across back & under arms. She slips her arms out. They use the hoyer lift, a sling you sit in. It takes 45 minutes because they have to lift her out of her wheelchair with the sling put her into bed to take her pants. off put her back in the sling to hoist her over to the toilet let her sit there for 10 minutes then lift her off toilet in sling, clean her up shift her over the bed lower the lift put her pants back on lift her back up again to put her back in her wheelchair the whole process is very time consuming and to me it seems like a lot of pressure being put on her body in the sling.
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Does anyone experienced with lifts know how they determine when to continue the lifting to a toilet, if the patient does not use it when lifted, but only goes in the diaper? Do they go through that process several times a day, even if it produces no results?
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The other thing - which is harder if your patient is non-compliant, I agree - is that getting the sling straight along the line of her spine when she's rolled on to it is vital. Otherwise when she's lifted she'll be uncomfortably tilted to one side, and it'll be no surprise that she doesn't like to be transferred.

What's taking them 45 minutes? I'm liking the sound of this NH less and less.
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Louise, what do you think your father understands about your mother's current state and about her prognosis?

It sounds as if someone - you maybe, but a counsellor or support worker might be better unless you'd rather do it yourself - needs to sit down with him and have a gentle but candid talk about realistic expectations.

By the way. I do have experience of transferring using a hoist. And I have to say that if your mother is left swinging around with her butt hanging out then the two aides responsible should have the same done to them to see how they like it. Respecting the person's dignity is paramount, and it's a matter of technique and considerateness. A lot of blushes can be spared with just a little thought and some deft placing of towels.
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Louise210, is your father mentally sound? Is he capable of processing his wife's condition? I ask, because if he's not able to do that due to some of his own cognitive decline, then, you may have unreasonable expectations of him. If he is able to process it, then I think I might explain her condition in detail and also explain that the staff are doing the job the way the doctors want and the way that is best for his wife. ( If she is not aware of her surroundings, I would imagine the lift would be quite frightening to her.)

And if dad continued to be pester the staff, then, I'd have to insist that he only come at certain times to visit when you or another family member could be there. You are Healthcare POA, correct? Are his questions polite and curious or loud and demanding. That would make a difference.
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Oh Louise210, my heart breaks for you and your Dad. It seems he's just not ready to accept that she may not be coming home, ever, and is putting the blame on everybody else, which is understandable since the've probably not been apart in over 50 years!
I know that when my Mom was going through post Cancer recovery, and staying with my eldest sister, Dad was still at the MIL apartment attached to my other sisters home, and he himself had such a dreaded disease process that required the assistance of this sister. My Mom then went through 6 weeks of Radiation therapy, and it was thought that it would be best if she continued to staybon through this with eldest sister to aid her in her rest and recovery. My Dad, while able to visit her there every day, missed her so much, it was heartbreaking, although he definitely understood, but he began a sort of downhill spiral, and we soon realized that he absolutely must stay there with her, even though it was a lot more work for eldest sister. We all (the other 5 of us) rallied around her and helped out and we got through it, plus we got an aide in, to help our Dad with his ADL's, getting up, dressing and breakfast every morning. I can't imagine being separated from my husband after so many years, but sometimes its not a choice.

I'm sure you've already spoken to him about this, but gentle reminders is all I can suggest at this time. I'm sorry this is so difficult for you both!
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PT has stopped because she can't follow comands. If you try to assist her to stand or toilet she swats at you. They labeled her as incontinent. She doesn't indicate she has to go. Much like a baby's face you can tell she's going. They have to use a lift & the toilet process takes about 45 minutes & requires 2 aids. If you have ever watch the lift to toilet a person process. It's not easy & basically you are hanging in the air with your butt hanging out. When she is put on toilet she might go but then 5 minutes later she goes in her pants.
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Freqflyer
Do you think your mom was aware of the cutback in time your dad was with her?

My mom has a bad summer cold and was already asleep when I got to her facility last night - albeit in her clothes - I didn't want to wake her just to out her into a nightie but I stayed 2 hours in case she woke up and needed help until her overnight sitter arrived - although she woke calling my name I stayed at the doorway and let the sitter get her ready for bed - felt badly but didn't want to make her more upset by seeing me and then me leaving - although more frustrating that the baby monitor had fallen into a drawer in the wellness center and staff couldn't even here she was calling for help ....
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I remember back when my Mom [97] was in rehab due to a head trauma fall that put her into accelerated dementia... Mom could no longer remember how to walk much less stand up....

Anyway, my Dad didn't quite understand what was going on and my Mom would tell Dad that she walked for 20 minutes that day.... of course my Dad believed Mom had walked, and he kept wanting me to get Mom to get out of bed so that they would walk. Same with whenever Mom wanted to use the bathroom... [sigh].

Thank goodness my Dad was a quiet reserved man, didn't give anyone any problems. But it took over a month before Dad realized that Mom won't be walking :( He still had hopes she would come home and everything would be like it was before that last fall. Once that hope was gone, Dad cut his visits down to a half hour each day. He really didn't want to remember his wife in that condition.
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That's a very good explanation Veronica91. I think that family members want the patient to hang in there, rebound, and recover, but it's not possible sometimes. I suppose that it's just too painful to accept a dire prognosis when it comes to the love of your life. I can't imagine it.
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Very difficult to accept that a loved one is not going to get better. Many relatives take the "if only" approach. Eat more, exercise, get out of bed, socialize, take the medications, do hobbies, the list goes on and on.
What people do not realize is that their loved one is not giving up and waiting to die ( although this may be the case) they are simply experiencing a progression of their condition and are content to simply be left alone. They have probably accepted their new really and are not able to change the inevitable so accepting this for the loved one is a great love and kindness if there is no hope of improving their physical or mental condition.
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I wonder if your father understands your mom's physical condition. Does he really understand that with her dementia, she may not be able to move the way she used to? And that her control of her bowels is no longer fine? I wonder if her failing to meet his expectations is being translated as to failure of the NH staff.

What if the therapist or whoever is in charge of her therapy or care were to go over her abilities and explain what she is no longer able to do. He may have in his mind that she might catch on if they spent more time with her or explained things better. And we know that dementia patients aren't really able to learn new things, so, if she is declining, he may have to be told specifically so he can adjust his expectations.
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I agree. You don't have to bow and scrape to be professional.
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As i said, given my experience with the therapists at my mom's nh, i imagine we would be referred to the social worker or DON to discuss the issue. ESPECIALLY if the person doing the complaining was elderly and possibly compromised.
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Oh I can Babalou, if someone constantly berates me for not doing my job right (even though I know I am) then that would probably be my response too. Maybe not the first few times, but you can only bow and scrape so much.
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I agree wiith CM; I CAN'T iimagine an employee of my mom's NH saying that to a family member or client.
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The physical therapist told him if he didn't like *what* maybe he should look into going somewhere else?

Even overlooking the childish petulance of that response to your father's concerns, whether or not the PT was being reasonable depends on what your father objected to.

My late aunt was very much of the 'oh don't complain you'll only make things worse' type. It used to drive me nuts. If there is a problem, say so. Say so politely, say so to the right person, and before you speak up have a clear idea of what you expect to be done about the problem. And if the NH can't cope with that kind of constructive approach and still gives you backchat, then maybe you should be looking for somewhere else.
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Do you have any funds available to hire a sitter for your mom for a couple of hours a day ? This would give her some 1:1 care and give your dad some rest as well

Nursing homes and rehab facilities are tough places to be and generally are not comfortable for visitors to sit in hard chairs - I found having a sitter with my mom from 4-8 pm each day until I got home from work made a huge difference
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