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My aunt is in a skilled nursing facility and I find it troubling that when an aide realizes she needs new socks or underwear, she must communicate through the head nurse who talks to the social worker who calls me. Does anyone else experience this? Any solutions on how to reduce communication steps or speed it up so she can get those holey socks replaced quickly? I'm only able to visit once every 3 weeks or so, so I can't monitor as much as I'd like.

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All of those steps should only take a day or two at most, are you finding it is longer? I'd make a point of asking about anything she might need when you are there - ask the people on the floor doing the actual care because those at a desk haven't a clue. If you are concerned that you personally can't get things to her then look into places that offer delivery to the NH.
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When my mom was in a facility, I asked the nurse if it would be possible to “stock up” on things for my mom. They had recently remodeled and had a bit of extra room, so I was able to make up a box of necessities for her, labeled it all and they kept it at the nurses’ station.
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Alium, did you inventory her possessions when she first moved in, and check them when you're there? Admittedly, she could need something in the interim, but you could try stocking up ahead of time.

I think the chain of command is just the method established at this facility, and that might not be a bad idea b/c then there's a path to follow if something isn't brought in. Otherwise, the staff really wouldn't know who may or may not have told you about the new needs.

Are you keeping track of what's needed the most? That could help identify what to stock up on.

You could ask if a list of needs can be posted on the closet door, or someplace similar, and one person be in charge of contacting you instead of going through 3 people. I have a feeling though that this is a fairly rigid place in terms of communication and procedure, and that the admins will stick with the methods already established.
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Remember, use her Personal Needs Allowance if u don't already. The balance in included in the spend down amt that you do not want to exceed.

If you are allowing facility wash her clothes, make sure they are returning her socks. My Mom had 15 pairs and only has 2 or 3 pairs at any one time. Why? Because they have to be matched and it takes time.
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