So this will come as no surprise to any of you, not even me, but is this just another example of something that has no solution?
When signing mom up for AL, we were shown a monthly calendar of activities, told she would shower twice a day, etc. Of course COVID is a convenient excuse why there have been no activities since she moved in (Jan of this year) and probably never will be activities again. She has not showered since moving in, except when she was in the nursing home for a month-long stay. She "washes up" in the sink , but won't get in the shower. They don't make her, which I sort of understand, because it would be a battle and they can't manhandle her. Lately I've been taking wipes over there and encouraging her to clean herself with them. She doesn't smell and her clothes are always clean (until yesterday when I went and she had the same outfit on that she was wearing Friday and I think she's had it on for the last four days).
Anyway, the only way she gets her hair washed is if I tell them my sister is coming to cut it and then they will take her in the salon and wash it. WTH? I thought it was assisted living?
They have a hairdresser that comes every other week and charges $22 for a shampoo and style. So I have started paying for that since I know it makes her feel better and I can't take her anywhere with greasy hair. So on top of the place receiving nearly $6k per month, I have to pay for her medicine (through their pharmacy), Ensure, Depends and hair washing. It's a real racket.
But that isn't even my biggest complaint. All she does is lay in bed all day and barely gets up for meals. Because there is nothing to do! No reason to get out of bed. The only thing happening there is 3 meals a day and a snack or two. She is not eating all her meals anymore. We are all trying to visit and call more, but she won't answer her cell half the time (why is getting a "home phone" so much drama?). I went over yesterday and found Little League on TV for her, because thank God that is one thing she is interested in and at least she can sit up in her chair and watch it. But really! Is COVID going to be the reason the place is understaffed and not having activities forever? Is this the new normal? I assume all of them are the same and Mom is already in the nicest one we can afford.
I am tempted to put her back on Hospice because at least then she would have more visitors - the nurse, the chaplain, etc.
I just think there are things they could do there w/o having outside people come in. I'm just aggravated, y'all, and I am venting.
It's like they have us over a barrel, they know we can't afford to pay someone at home all day and night (still no activities but more than where she is now) plus the whole caregiver scheduling thing, and they know all the places are the same, so they can do whatever they want. It's just very sad. Her doctor mentioned putting her on an antidepressant, and I told him she is depressed because there is nothing to do! If you can change your situation, that should be the first choice before taking a drug, but I guess in her case, we can't change her situation.
And worst of all, none of this is going to change before I am 87! What in the world am I going to do with myself then?
I'm happy to hear you speak so highly of Interim Healthcare. They must have really cleaned up their act. I worked for them years ago and they were a right piece of sh*t in those days.
If you continue to put up with what ever is going on, you continue to approve their idea of “care”.
You also can do a spend down. She would go into a NH but you would not pay for meds., etc.
Now my mother is in the same home. I have hospice, physical therapy and occupational therapy (doing toileting). Hoping she gets more attention. By the way, a hair appointment is $45.
I was going in cleaning everytime I went. Finally after cleaning the bathroom floor I complained about the hygiene. Now her room is very clean - at least what I can see. They still fail to change the chucks on the bed. You just can't win.
Luckily I have a great hospice nurse who fights some of her battles. My mother is 96 with mild dementia and a lot of falling.
Why would you allow your mom to go eight months without a shower and not give her one yourself? There's a whole staff in the place and it's their job to do the showers and they'd help you.
Of course there's an increased risk of falling with age, but a care facility doesn't have walk-in showers? Or use bath benches?
Your mom could have gotten serious problems from not showering. Like skin infections, fungus, UTI's, skin breakdown, and sores.
I know that it's hard to get a resistant senior's care done sometimes because I've done this line of work for near to 25 years.
There are times when you have to take a firm approach and maybe even be somewhat intimidating. I've had to. A person recovers from hurt feelings a lot easier than they do from a UTI or skin breakdown sores.
Covid is just the cherry on the cake of excuses AL facilities make about why they take people's money and offer next to nothing in return.
No place EVER showers a person twice a day or even once a day. If the place your mom is in advertised that I'd report them to whatever government agencies would listen.
I worked at what was considered a higher-end AL. Here's how the services like hygiene assistance work.
An aide comes in and asks if the resident wants to take a shower or wash their hair. If the resident says no, they walk away.
An aide comes in and asks if they want to change their clothes or eat. The resident says no and they're left alone.
Assisted Living facilities are not nurseries. They are not in the business of coaxing or begging, or making deals with some senior to take a shower or change their clothes the way you sometimes have to do with children. The staff is not going to have a fight with the senior to get them to take a shower or change their clothes either. Many of the residents I knew wanted to shower and change their clothes, but wanted to have a fight about it first. It wasn't my job to fight. So if they refuse hygiene assistance, they stay dirty and their families had to come and help them.
You say your mom has nothing to do and is depressed. AL facilities have an activities director who plans activity for the residents. If your mom isn't interested in taking part, they're not going to force her. They're also not going to plead with her or try to coax her into taking part.
AL facilities are a rip off. To save a few bucks start supplying them with the medication your mom takes. Go through a pharmacy that accepts her insurance. They will have to accept it if you stop paying her pharmacy bill. The nursing home my father was in tried pulling this as well. I'll let you in on one of the secrets of nursing homes and AL facilities. Their pharmacy is accepting and billing every resident's Medicare and secondary insurance, and they are all being paid by it. The bills you're getting for mom's drugs are just extra money for them.
Request that Medicare and her secondary insurance send you some statements, You will see that they are paying for her meds.
I simply refused to pay the nursing home's med bill for my father. I told them he has five different insurances for prescription medications, so pick one.
I still get bills for him from the nursing home pharmacy. I either throw them away or I write 'Return To Sender' on the envelopes.
Assisted living is for people who need some help with ADL's and who may be forgetful that might need reminding and a some help about things like meds or hygiene maintenance.
They are not for people with dementia or mental illness that has advanced to the point where they will beat up an aide instead of taking their shower or changing their clothes.
A person in that condition belongs in a nursing home, a memory care facility, or a psychiatric hospital. Assisted Living is not the place for them.
1: Assisted Living is just that Assisted Living. They cannot force the resident to do anything. They will ask if the resident wants to do the activity, they will provide the medication and manage the medication but cannot force the resident to take it. They will ask if the resident wants a shower or offer assistance but they cannot force them to take a shower. Unfortunately that remains on you as the family member to ascertain that your family member is doing so. At least in IL you will not find any AL that will force a resident to do anything.
2: the cost is way reasonable. Most ALs offers services and charges a la carte, meaning the resident is charged in tiers depending on level of care; how many medication visits your family member needs, 2 morning and night? 3 morning noon and night? Does the resident require supervision visits over night? All that is considered on the price. Hair cuts, outside outings, are all extra.
If your mom needs more supervision than basic medication management and engagement she is in the wrong type of facility or you will need to hire a private caregiver.
Also the pricing is some what malleable as well, but it has to be done prior to move in. You can negotiate the pricing prior to move in including move in charges. 🤨 as if we did not have enough to worry about 😝
Best of luck to you and yours
i do think all these facilities are using Covid-19 and difficulty finding staff as an excuse to cut back and save $$…. Gov’t handouts $ and groceries
making everything worse .
you should however be able to schedule visits … even if they’re not allowing residents outings. I would start looking for suitable places … this time making sure she gets level of care and activities promised.
also nobody’s going sit and keep mom company … you need to do more .. also look into private hire companion couple hours/day …
good luck ..
My son works in AL in Pearl River New York. There are activities for seniors there.
There is activity (Recreation) director. My son is a musician and plays piano there for seniors. They love him, he also leads activities, such as Bingo, exercises every day, sing-a-long, arts and crafts. It is true that the facility is understaffed, all of them are, but there are activities. Think about switching AL for mom.
Also, my son tells me that stuff complains it is very hard for them to wear masks
for 8 hours a day, they get dehydrated and take frequent breaks, on top of that a lot of stuff refuses to work more hours, that are offered by the facility, because of mandatory masks. Pandemic is a big factor, talk to the facility manager. They must bring in entertainers and hire part-time recreation stuff. Otherwise switch AL for mom. Sleeping or staying in bed all day is not good for mom. She must move around and be occupied. They should interest her and involve her in something.
most these facilities are already set in the cut back mode using COVID
as excuse !!!
If you don't like what is going on then talk to the facility Director / Manager and find out why things are not happening that are not covid linked. Why they are not showering her or washing her hair, why she cannot have a line phone, why no one pops in to see how she is, or why they cannot turn on TV when they take her a meal.
Social activities are more difficult with covid around, but presumably they restrict visitors and the chance of infection entering the facility. So these should get back to normal - ask.
Do you provide her with puzzle books, jig saws, does she knit/sew/crochet, does she like any other craft activity she can do?
It sounds as though you should be talking to the Manager of the home, not asking here. And thinking of things you could be providing for her to do if she is capable. An edged tray makes doing puzzles easy and can be put aside without losing all the bits. A few simple provisions can give her something to do until more social activities can be started up again.
Failing this you can always move her.
I agree that your loved one should have better care. If you can not get the standard of care your expect - at least the basics - then please, please, please consider other options.
This pandemic will pass or become part of our daily life and the short-staffing will change. Make plans for yourself since the "day of needing care" will come sooner than you realize.
It is basically the same as what you're saying. A lot of their time is spent sitting
in a room with a TV. When she first moved in, there were 2 woman who did the activities. One worked during the week and the other worked every weekend.
They actually worked 8 hours a day. They were great.
A new manager started and a lot of workers left because of her. She was eventually let go for not being qualified! At that point, the damage was done and it has not been the same since.
It seems like everyone is looking for a way to sit most of the day. It doesn't matter
who you talk to they give you excuses.
This is a small place with a max of 16 residents. They do let them all go to the dining room for meals, so I don't' know why they can't have activities there. Not sure if it's the rules (MD State Dept of Health) or if it's because they're understaffed, which they are, or because they can't get anyone to come in and do the activities - everyone is hiring here and no one wants to work.
Something I forgot to mention is that she really only had two friends at this place (since it's so small there is not a lot to choose from) and one of them died two weeks ago, which only leaves her with the other. Of course she is still in the denial phase of grief - she acts like (or maybe really doesn't?) she can't remember who we are talking about when we bring her up, but the main thing is she now has one less person to pal around with and talk to. Mom likes to walk laps in the hallways, but not by herself and the remaining lady doesn't like to walk. So she's back to doing nothing and laying in bed all day. She will get another bedsore if she doesn't get up.
I guess I need to give her a little more time and then I need to look into the only two decent nursing homes around before I have her evaluated again. By state law, she has to be evaluated every 6 months or whenever returning from a hospital stay. She moved in as a Level 1, but after returning from hospital and then nursing home, she is at Level 2. So last time was in March. I will ask when she is due again. Should be September, I would think, but who knows how they count. And if she goes to Level 3, the $ will be gone even sooner, so that is a factor.
It is a good point to move her while we can still private pay to get her in the door somewhere and then transition when the $ is gone. She won't want to go to a NH because she can't have a private room there and they close to visitors much faster than ALs here. With COVID, I might never be able to visit again. The two decent NHs here are both closed to visitors due to COVID. I think that would be worse for her. So I just feel like I'm stuck.
There is no activities director. I think during the day they have one manager on duty, one med tech/CNA and that's it, other than the cook. Sometimes they have two med techs/CNAs. But that's it. Once since she has been there, someone painted her nails, which was very nice. But that is the only "activity" I have ever heard of happening. The calendar on the wall still shows October and due to COVID, I doubt anything on there ever happened.
When people get older they lose a lot of friends. So your mom is probably very depressed and grieving over the loss of her friend in a place that is disconnected from her former life. Go easy on her. In a larger assisted living facility there would be a larger group of people to get to know, as well as in a nursing facility. I don’t know the specifics about dining where my brother is as he gets almost total care and eats in his room.
We’ve found very little restrictions where my brother is. But at two other place visits were by appointment and weren’t always honored. They were busy earning their 1 star ratings. So visiting seems to differ between facilities, though of course who knows what the future holds.
Ask are there any conversations about this in their meetings - have they done nothing to bring in and offer any activity and thought outside the box?
I think the activity schedule can be changed many different ways. I have no idea of the set up - or how excessive rules are as I think they vary everywhere.
Different wings of the facility can have set days that are provided to them in chairs or wheelchairs at their doorways playing games (and the activity director is in the hall for all to see) - having entertainment from their doorways but with groups. Play bingo for small prizes from small groups in doorways or spaced apart - have a dessert or cookie decorating day (even if delivered to their room) and arts crafts painting canvas competitions - if they don’t have outdoor space they should install a tent or ours chase a pop up tent - (every week the time and day can change for people to participate or sign up for) and each day certain groups go outside for a small cookout - movie popcorn on a screen outside or outdoor activity - have them plant seeds and let them grow flowers - there are plenty of ways to come up with activities that maybe each sections has activity week or day and if they have to be downsized or done in smaller sections. But a year plus later they haven’t come up with different ways for different levels of people to have some sort of activities to participate in and look forward to then I would talk to someone - and make your own suggestions and say exactly what your wrote above and even talk to other families. Again these are basic things - but they can be changed for each level of care and offered.
I hope you do speak with someone as I hate to think that places haven’t found ways to still provide joy and activities to those in care places.
Maybe it is time for a move to either NH or MC
Talk to the executive director and express your concerns and ask why there are no activities going on, etc. Vent to the ED who can actually address these issues although coming here is a huge help for most of us 😁.
If you move her to memory care, there is a higher level of care and attention paid to the residents there, although they also can't force showers on the non compliant. Dementia tends to make the sufferer refuse to want to bathe, in many cases, which creates problems for all concerned. I'm lucky my mother hasn't had that issue yet......shes had 1000 others, God knows, but still agrees to at least 1 of her 2 scheduled showers per week in memory care.
Anyway, speak to the ED and the nurse in charge to see what they think about where your mom would thrive best. I know how difficult and frustrating all these things can be between the AL and the non compliant mother, it's all mind boggling sometimes. You have my sympathy and I'm wishing you the best of luck with a difficult situation
I have no idea why they said showering 2 times a day would be done. Unless a person is VERY active I do not know many people that shower 2 times a day. (When my Husband was in rehab I found out to my surprise that the State standard and requirement is 2 times a week) You might want to check what the State standard is where she lives.
And they can not "force" her to shower, participate in any activities if there are any. They can not force her to eat a meal or come to the dining room.
I think she needs a higher level of care and supervision than she currently has. If this facility has a Memory Care unit I would ask that she be evaluated again to determine if she she should be in MC.
if she is in AL, she is expected to be competent and cognitive enough and able to do most ADL type of things on her own with assistance on occasion from staff. So can she do her ADLs or recognize what she needs to do to get her day going? If you were to ask her what’s on the activities schedule and when, could she answer you correctly? If not, she not suitable for AL, she needs a different higher level of care.
An issue w AL, is that if a resident flat does not want to participate in activities or go down to have a meal, that’s their decision. It’s assisted care not oversight care. The AL is not going to force her. That they provide for meals is in the contract. If she won’t get dressed appropriately and walk down to the dining room that’s on her. They will deliver a meal to her room but expect there to be a charge for this if it’s every day and most meals.
I suggest that you have a needs assessment done for her.
The AL should have someone they can refer you to for an assessment. It’s usually a duo of a geriatric RN and a SW. Please realize if it shows she needs a NH or MC, the AL will require that she moves out. If this AL has a NH or MC that is a sister facility, that should make it way easier to have her move.
6k is somewhat on the higher side for AL. But if it includes medication management (daily delivery of her meds to her in her room & oversight that she takes them as per script), then 6k seems ok.
If the assessment shows need for skilled nursing care and if she will run out of $ to afford it, I’d look at facility that have Medicaid beds in addition to private pay. This way she can segueway from private pay to Medicaid when she becomes impoverished plus you do not have to move her again, perhaps a yr or two from now when she is much more frail and lots less cognitive. If right now, it’s the situation that she is NOT paying herself for this AL, but it’s you and your siblings who are AND you realistically cannot afford to do this for years & years, please pls pls stop and get her assessed for NH and find her a NH who has open Medicaid beds ASAP and get her into it as “Medicaid Pending”.