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My Mother is currently in a nursing facility which will probably be long term because of her age a dementia. I am with her practically every day after work assist with dinner - while I was there yesterday I nearly triped on the floor because it was cleaned up of crumbs - I had to ask for someone to sweep the floor and it got so that I said give me the broom I'll do it - I cannot complain about all of the aides as they are wonderful but a few I noticed will do only so much and that is it. I love to say something to my Mother's social worker about this and a few other matters but I'm afraid if I do there will be repucissions. Has anyone had this kind of a problem - if so I need some advice on how to go about speaking up and not stirring the pot!!

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It's really a shame when we have to be worried about our elderly loved ones being treated poorly because we've complained about something but this is a very real concern in the world of nursing homes. It may not be universal but it certainly happens. When a particular family or family member irritates the staff it's their loved one who pays for it through neglect and unprofessional care. I've witnessed it myself and have been shocked at what some aides are allowed to get away with.

You have to pick your battles very carefully. Find someone in management (like the Director of Nursing) you can talk to but decide first if that person is someone who is going to be discreet and professional before you get into anything.

If your mom tells you things that the aides are doing to her you can't take her at her word because of the dementia. A lot of "neglect" goes on in nursing homes but it's become standard practice. Sitting someone on the toilet for example. An aide will sit a resident on the toilet and leave them there while they go and care for someone else. Also, a resident may sit around in sopping wet pants for hours before they are changed. Our parents can't advocate for themselves so this is what happens. If a resident is in bed and would like to get up the aide may forbid it (I've seen this happen). Especially if the resident is a difficult transfer. Aides don't want to get people up and down all day long so if someone wants to get up and it's not close to a mealtime the aide may refuse.

Tread carefully. Be extra-special nice to the aides. Choose your battles carefully. It's a shame it has to be like this but this is the way it is. I'm sure there are some exceptions but being a nurse and having patients in nursing homes I've seen this over and over.
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thank you so much for you concern.
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If your biggest concern is crumbs, she is getting excellent care. We got a number of complaints from Mom, but she recanted quickly for the Head of Wellness. She made us look really stupid. It was all attention-seeking lies. So keep your eyes open and take her stories with a grain of salt.
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Pick your battles.

Most of the aides are doing a good job you say -- celebrate that! Thank them. Be nice. :)

Crumbs on the floor? Probably a battle not worth fighting (unless it is a symptom of overall neglect of cleanliness). Be friendly about your offer. "I'd be glad to sweep up this mess before sometimes slips on it, if you'll tell me where the broom is." That would normally get turned down and inspire the aide to see that it gets swept immediately. But if it is one of those days when they are swamped, do it yourself cheerfully. Lots of people volunteer to make the days brighter for residents. Consider it your little bit of volunteering.

Save your complaining for things that directly impact your mother's health, and be sure you are on solid ground. Note dates and times. If Mom says "I rang the call bell an hour ago and no one has come to help me" realize that 10 minutes can seem like an hour if you are waiting for help. Mom isn't lying but her perceptions might not be accurate.

If possible, vary the time of day you go there. Once in a while go in at lunch time, or before work in the morning. It is good to get a broader picture of care going on.

My 3 sisters and I each visit Mom in NH 2 to 3 times a week. She has visitors every shift throughout the week.. (I've even stayed over night a few times when she was having sleeping issues.) Among us, we know all the regular nurses and aides, and even the building maintenance guy. We compare notes. We agree that the staff does an extraordinary job. We are all pleasant with the staff, thank them, and I've brought treats in for each shift. When problems do arise, it is easier to resolve them together.

For example, Mom pulled out her catheter more than once. When I saw Mom in bed with no bottoms on I did not yell, "You idiots! Why are you giving her easy access to the catheter tube?!" Instead I said, "Hmm. Do you suppose she would not grab her catheter tube so much if it were covered up?" The young aide thought I was brilliant. She got out the pajama bottoms and put them on mom, and then wrote a big note about it and put it on Mom's bulletin board. Problem solved. Mom always had bottoms on and never took out her catheter after that. Yes, we could complain about that shameful lack of common sense, but all we wanted is the problem solved. And it was, with warm fuzzy feelings all around.

Pick your battles. And if possible, fight them with good will and humor.
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(Jeanne, I think you're brilliant too.)
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With many years of experience under her belt Jeannie has the best approach, that way face is saved all round.
It is also important to remember that staff in healthcare facilities are often highly unionized so one had better not be seen doing another's job. Those crumbs for example fell under the care of "housekeeping" Think of it the way things are managed in a hotel. If room service brings you something and you need another cup of coffee he will jump to your request but if you tell him the light bulb is not working he won't get you another he"ll call up maintainance. That's just the way it works. if your request is not ultimately taken care of of course talk to a supervisor but try the nice way first then work your way up.
Everishlass paints a different picture and of course she is entirely correct but even then try and see both sides of the picture. Many of the aides work this very low paying job out of necessity not for the love of nursing. they may be older and just plain tired and have health problems but as long as they can drag their aching bodies to work there is no hope of disability and at the other end of the spectrum there are the young single Moms who go home after the night shift get the kids ready for school,snatch a couple of hours sleep then work a few hours at another job then back to the NH for another night. Be friendly get to know your aides and don't sit there like a statue when they are struggling alone with your loved one. offer to hold her arm still while they struggle to get a B/P when she won't co-operate. So it takes Mom an hour to eat the aide does not have an hour but you do. The aides have minimal nursing training so you can not expect the same level of expertise an RN would provide. By all means be warm and fuzzy but be watchful and pick your battles.
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It's very hard work, there are good hard working honest people in this field, but that has not been my typical experience. Overall I've found the best aides to be working with Hospice groups, but it depends on which group too.

My dad was in two difference nursing homes while he was recovering from surgery that went very wrong and he needed care beyond a hospital stay and beyond what I could provide at home. One nursing home was filthy, the poor people were kept lined up along the walls all day, my dad was bedridden and on a drip 24/7, he wanted to be there because it was closest to his home, I would show up every day at different times to check on him, he'd be soaking wet almost every time and I'd have to find someone to change him, I moved him to a better facility within two weeks. The second nursing home was much better but not great, they got him up in a wheelchair so he could wheel around, but they put everybody to bed at 7, not the end of the world but it was obvious it was their routine to make their work easier, keep everybody in bed, as a result dad ended up with a huge ulcer and gangrene on his foot from pushing himself around in bed, this was not treated properly and he ended up very sick from it. Active seniors don't want to be in bed for 14 hours.

His health has improved greatly, he's living with me now, so then we have the home health aides. First the companies have a hard time finding good people and it seems to be a back up career when there is no other work for some. We've had four in my home for my dad in the last six months. I've talked to others in my area who've had just as many for their parent or grandparent and no one can find anybody truly professional at the field. I've hired a health aide through a reputable company to work in my home for my dad while I go to work which is part time. Per the contract with the service they work for, they're suppose to bathe, clean his living space, do his laundry, cook his breakfast and lunch, give him his meds, transfer him when necessary. By contract even if we only need them for an hour, the aide has to be here for four at least, since we pay for four hours, I have the health aide do these chores for dad. Four hours is a long time. So one aide asked me how to change my dad's diaper and a week later dropped him on the floor when transferring, she didn't know how to do anything, and made a mess of his living area, she's gone. A second aide knew how to do everything and did a good job, but wouldn't unless you stood there and told her what to do as it needed to be done, as soon as I'd leave for work she did nothing. The third one did work and help dad, but she smelled like an ash tray and beer and dad said she cussed all the time after I left which he did not like. The forth one who still works for us, does a great job in comparison to the other three, she does her work very quickly to get it done and then spends two to three hours sitting on my couch watching tv. She goes through paperwork in my kitchen, bills, shopping lists things like that and has outright asked me questions about my private paperwork at my desk. She's great at keeping everything organized, but believe me it seems there's an added price to be paid when you have someone in your house who seems too good to be true. This woman tries to finagle anything she can out of us to get more than her hourly wage the company pays her. It seems the thought is if you or your parent can afford to hire a health aide or you have insurance to cover it, then you must have money. She's spent hours working on my dad playing on his sympathy about how little she gets paid, and how she just can't make it on that pay, she tells him this with her new car parked on my driveway, my car is fifteen years old. She's told us over and over "my other family I work for gives me things and lets me leave as soon as my work is done, they just go ahead and pay for all the extra hours I don't work". She tried to get dad's house from him, and tried to get him to finance it, did not discuss it with me at all until she wanted to see the house. I was beyond angry, but found it hysterical because my dad's house is actually going to be condemned, so I said sure, you want to see the house, let's go. She backed off. After this my kids set up a baby monitor in dad's living area so they can keep tabs on things while I'm at work, and the health aide knows it too. So now she's pressing more on getting her work done really fast so she can leave and get paid the extra hours anyway. I don't mean any offense to any nurses or health aides, hired caregivers who do good honest work, this is just our experience, so just saying and venting.
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My Mom was in a nursing home for 4 years. We made sure to have different family/friends drop by at different times. We spoke regularly to all staff members to thank them and make sure they knew how appreciative we were of their work. This was kind of expensive but we bought the staff lunch once a year. My mother loved the attention when staff thanked her. We also got to know the Director a little. When we did have issues, we brought them to the Director of Nursing and she was very responsive. As others have said, we picked our battles. Being involved is the best way to protect your family members in a nursing home.
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Your fear of repercussions is what has made relatives of the elderly silent and uncomplaining for decades, even when there is much to complain about.

I have made it a practice never to be silent when conditions in hospitals and nursing homes are not up to par,. So far, there have never been any repercussions.

Let them know you are observant and caring and that you will not tolerate second best for the care of your parent.

Always make your complaint to the highest level of personnel you can find. Knock on the door of the director of nursing; tell the visiting physician; tell the facility administrator. Do not be afraid.

Where cleanliness is the issue, and it often is, then have the chief of the facility visit the room with you and ask whether they would tolerate such conditions if it was their parent.

In practice, the higher up the tree you go, the more positive action will ensue.

My wife has been in three SNFs over the past three years, for post-surgical rehab.

I took her out of two: one because she had hit all her milestones set by her orthopaedic surgeon, and the second because it was filthy and uncaring.

The third SNF was a wonderful,caring place where she was treated like a queen. I told them before agreeing to have her stay there that I had taken her out of two others and explained why. I was told, "Give us a chance. If you feel we aren't caring for her properly, then at least talk things over with us before you whisk her away."

It was a very positive experience for her. If you are in Arizona, I can provide the name of the SNF. I recommend it without hesitation.

Please do not be cowed into silence. Let them know you care and they will also care.

Good luck.
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When I was working (as a hospice RN) our organization only hired LPNs to work in patient's homes and their work was regularily checked. If there was a need for more help than we could provide we maintained a list of aides who had previously worked satisfactorally and offered this to our clients if they expressed an interest in hiring privately. No aides were actually recomended but no one made that list if we had not been satisfied.
So if anyone has an interest in hiring an aide you can contact your local hospice and ask if they maintain such a list. Senior day care and other agencies and often churches can put you in touch with people who like to do this work. it is of course up to you to do interviews and background checks but you will probably find people who do this work for the love of it not because they are desperate. Often retired nurses may do this during the summer and go south for the winter. Also if you find a good caregiver they can often reccomend others. If you have a good aide in a NH and need help at home they will often be willing to pick up a few extra hours.
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Sounds like the home could use a few good housekeepers to me. When I had to do my 16-hour working shifts to get my humble STNA certification, we students noted a housekeeper who had plenty to do shooting the breeze when she could have been cleaning resident's bathrooms (which were crummy). The aides can't do it all. These places desperately need all the honest help they can get. If I end up having to stick my mother in one, you can bet your booty I'd probably be cleaning her and her room up myself and not being afraid of offending anybody in the process. I'd know the first names of the housekeeper and aides. But they don't have enough good ones nor do they pay them well enough.
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Write a letter of commendation mentioning the names of the good aides, thanking them for the wonderful job they are doing for you're Mom. Give a copy to the D.O.N. and the nursing home management. That sets the ground work for the complaint you make later for the ones that are not doing a good job with mother. That keeps the pressure off the ones that work well. My wife is CNA, she often complains of people she works with that don't care to do a good job and they are every place, in every facility. It makes the ones that care work harder to care for others to pick up the slack for those who don't care. Where she works they have a star program, people write complements on the star and get appreciated and its displayed where everyone can see it. The problem is when a complaint comes in all are blamed, that is a fact of life, By setting up the complements first you will have built a good relationship with the good ones even though all will be blamed. Then those that are slackers will have respect for you and at least do a good job while you are around.
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Lots of good advice here!

Be sure to compliment the good aides and if you can bring yourself to do it, find something good to say about the less than good aides

Sometime in my career I attended a brief seminar with someone who taught the "How to win friends and influence people" course. We had to meet a stranger, ask questions about him or her, then report to the group all the good things we discovered about this person.

It was a bit daunting at first - it takes a while to get to know someone well enough to comment on their personality, but with "say good things" as our mission, that was our focus. I actually found it a lot easier to do than I expected.

So, make finding good things to say about the unenthusiastic aids your mission. Ask about them personally - that alone is probably something that doesn't happen often. They're not well paid, expected to be available on demand for multiple patients, and have jobs that a lot of people wouldn't want to do.

Get to know them as people as well, then make a point to ask about their families, their interests, etc.

This part of your caregiver role is the Diplmatic one. Your role for your parent is just as important as the roles Hillary and now Kerry play. Take the approach that it's not "if" you can get through to the unenthusiastic aides, but HOW to get through. Turn it into a mental and personal challenge.


My father had a very good aide at the rehab facility when he broke his hip. I detected a Russian accent, did a little bit of research and then greeted her in Russian the next time she came in. I also thanked her in Russina. She was elated! She taught me a few more words, remembered Dad the second time I brought him there, and was a really top performer.

Bring food. Pretend that you want one of the less than enthusiastic aides to have it; he/she will probably tell you they can't accept any kind of gifts, so suggest it be put in the staff kitchen. That's what we did. Believe me, they remember patients whose families bring food!

There might be some staff who just can't be reached, but if you try your best, at least you've made the effort.

If after all is said and done there are still problems, you might try asking the aides if there's anything you can do to help, after sharing that you've observed how busy they are and how hard they work. Maybe it will work, maybe not.

I would be careful about complaining though, remembering that these aren't easy to fill jobs, have no career path, and are very difficult emotionally and physically.

If you do feel you have to complaint, forget the SW and go to the DON or other high ranking administrative person. You could approach it as that you've noticed such and such, don't want to make a complaint and wonder if there's anything you can do to help this person without it affecting his/her employment records. That approach might work more than just complaining.

Good luck.
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Being an aide is probably worse than housekeeping and pays about the same.
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I agree about picking your battles. If she had bruises and welts then complain. Crumbs not that much. If you would say something, keep it sweet about the crumbs. Sweet but assertive.
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If crumbs persist, you could make a point by bringing in a couple of pigeons. :)
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Our next step is likely to be a NH and I am scared. I have heard so many horror stories. I know I will put it off til it becomes absolutely necessary. However many of you have (sorta) put my mind at ease. Some very good advice about being nice and getting nice in return. Once again Im so happy to have found AC and all you guys. God Bless
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Not all NHs are the same. Shop around and Google, read reviews. If still worried go and see admissions directors and Directors of Nursing and explain your concerns.

If they cannot satisfy your proper worries, then look elsewhere.

If anyone is close to Mesa, AZ, I know of an excellent NH that I will happily recommend.
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Call the number given at your mom's Nursing facility for the omsbudmans. File a complaint with all your concerns and the investigate. Also call the Elder Law Attorney's and they will guide you.
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FYI, the Nursing Home Compare site at Medicare.gov has a lot of detailed information about nursing home inspections including how well they perform in terms of staffing levels, chronic infections, residents' mobility and overall ability to care for themselves, and other measures. However I do not believe these reports are reliable because the NH my dad is in right now has fair to good ratings in most categories but somehow it earned an overall rating of 5 stars. Frankly nothing could be further from the truth. We have an ongoing problem with the CNAs not changing him frequently enough which has led to huge open sores on his rear end. Just yesterday my mother got there at 4 pm and found him in bed with no clothes on except an overflowing diaper which they had put on him 22 hours earlier! The nurse told my mom that they hadn't gotten him out of bed all day becomes his rear end was too infected and sore for him to sit up in a wheelchair. So their alternative was for him to lay in bed in his own filth for 22 hours? Really? And this is hardly the first time something like this has happened. When my mother asks the CNAs to help her get him changed they either completely ignore her or tell her it's "not his turn yet." That is not 5 star care by any stretch of the imagination.
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If you are just starting the process of choosing an NH I strongly suggest you try to find out from family members of other residents what they think of the NH that their loved one is in. Although I don't know how to do it, the best way to judge a place before committing to it would be to spend 4-5 hours in the dining room or common area to get a sense of the CNAs treatment of residents, how the nurses and CNAs interact, how smoothly things go at meal time, how responsive they are when a resident asks for help, and the overall sense of the place, good, bad, or a little of both. I wish I had don't this before we placed my dad where he is. We were working with a Geriatric Care Manager who recommended this place to us. She was generallly well meaning but apparently unaware of what life is actually like in there.
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Violet, is your father finally getting treatment for the bedsores? There's no excuse for the conditions and treatment you describe. I hope you're taking action to move him elsewhere? And DOCUMENT, PHOTOS, DOCUMENT & PHOTOS!

You're right about the Medicare ratings; they're based on certain standard criteria, but there's more to evaluation of a facility than that. Still, it's a measure of some factors, and I did rely on it to eliminate some facilities when I was looking several years ago.

The one area which I accidentally but completely overlooked was the staff to patient ratio, especially at meal time and thereafter.
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GardenArtist, thanks for the response. There is a doctor coming to see him tomorrow mid day and my mom and I will be there. I have taught my mom how to take pictures with her iPhone and she is also taking notes during every visit. We are looking for another place for him but he is currently "Medicaid pending" and we've been told that he can't get in anywhere else while he's in limbo.
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Violet521 - bed or pressure sores are an absolute deal breaker and they constitute wilful neglect. When my wife started getting red patches on her buttocks and back I called in the RN and explained to her that if they did not disappear soon the NH would be involved in an expensive lawsuit.

I never make any bones about the level of care I expect her to receive and I don't care who knows it. In fact, it has been my experience that the more people know what you expect from them fro your loved one the better and higher the standard of care they receive.

Relatives and caregivers must NEVER be complicit in neglect by failing to make complaints [most NHs have forms for that express purpose], nor for expressing your dissatisfaction at the level of care received or the standard of cleanliness of both the patient's body, the patient's bed, and surrounding area, nor of any rudeness, disrespect, or of any neglect, however slight, that your loved one, their patient, suffers.

If you have to raise H*ll in the place to get your loved on treated right, then do it. If you feel unable to do so, then contact your state ombudsman and complain loudly to them.

Let your voice be heard, let it be heard often, and make your ;ploints in a bold, courageous, and proper manner.

If that neglect persists, report the facility to the nearest police officer or station for serious 'elder neglect.' It is a crime.

The more light that it shed in these places, the better will be the level of care they offer as routine.

Independence Day is looming: make your stand and demand your rights.

Good luck and don't forget to complain to the Director of Nursing about the conditions your father is being treated to, tomorrow! Then, let us know how you got on. You can always call the local TV station and newspapers to highlight your concern and let some light in this dark place.
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Stand up! Speak up! And never back down! When you know you are right and they are wrong, they also recognise that and will move themselves to set things right.

Do not be fobbed off with excuses. Demand immediate improvements.

Consult your state ombudsman.
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When she went into the nursing home you were given information to contact the dept. of health and human services, there is a number that is a 800# to call and leave an anonymous concern, but then they can not get back to you, but you can ask them not to use your name and if you are there everyday you know of others who there is no one to advocate for them. please do something as there are so many who have no one! There is also in each area as I do not know your state to call the ombudsman/woman to mediate your concerns.
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I didn't have a chance to read all the comments here, but there seems to be a lot of good advice. I would like to add that if you have concerns about how the nursing facility is treating your mom contact the Ombudsman Supervisor for that facility. In accordance with the Nursing Home Care Act, the facility has an Ombudsman Supervisor assigned there. His/Her name and phone number should be prominently displayed at the facility. If not, call the state Ombudsman office (Aging Services) and talk to them. Long Term Care Ombudsmen are advocates for residents of long term care facilities. They are there to make sure the residents' rights are being upheld, receiving dignified care in a respectful manner. Ombudsmen have the right to investigate complaints. Confidentiality is always at the forefront of all complaints.
Good luck.
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There should be housekeeping staff that clean the facility. Resident care is more important. I know aides and usually very busy. If the facility overall needs cleaning then I'd be concerned, you have to pick your battles. You can speak with your local long-term care ombudsman if you feel there are some major issues in the facility.
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Gee, teena1...All I can say is "Stir the pot" as much as you need, but be helpful to the staff. My mother has been in the nursing home since 2003 and I've seen it! Both positive and negative results. I've seen caring nurses and lazy cna's. I can't stand to see them standing around shootin bull instead of checking on a resident. I really flipped when I observed a large pressure ulcer on my mother just from sitting in her wheelchair a lot. It actually lit a fire under me as to deciding how much more I needed to be there, and not to mention what else I did to get more attention for my mother. She is healing slowly and I've learned a lot out of this. I offer my help while they change her, and helping her to get her food down, and they DO like that. I've made my complaints to the director and I make sure I say THANK YOU to anyone involved in her care inspite of how pissed I've gotton. I still would go nuts if I had to care for her at home. Its only a matter of time before God takes her home so I try to make her as comfortable as I can with their help. Bringing food/snacks to the staff is a nice idea to show appreciation.
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@ 2muchpain:

Pressure sores are UNFORGIVEABLE. They are signs of studied neglect, and make an inroad for infections.

Speak up now, and do not be afraid. In the English Law system there is a position called, "Next Friend." A Next Friend is appointed by a family member to speak up for the interests of anyone at risk whether in or out of a nursing facility of any kind.

I do not know whether this position exists in the American system, but if it doesn't then it should.

Regardless, get a bold, courageous, even an opinionated fearless friend of any sex or age to go with you and to speak out for you when you see such appalling neglect.

Never be afraid to make waves, and never be afraid to drop the provocative term, "Lawsuit" into the conversation.

Neglect in cases like these are elder abuse crimes and our loved ones are entitled to the full protection of the law in alleviating them.

I wish you well in your mother's future care.

Not all staff are careless, lazy, neglectful, but some are and they need to find different employment. They are suited for cinder sorting at the local gasworks, but should never be left to deal with people. It is not their vocation. The cinders will not mind their neglect or laziness.
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