Mom has been in a memory care facility for 4 months. We struggle with the lack of compassionate care by this facility. Seems they put people in CNA positions who don't understand how valuable the compassion side of dementia care can be. Mom can be very sensitive and will not participate in activities. She won't watch TV read or do anything. Her ability to comprehend is pretty much gone. When we are not there to visit she sits in her room and gets depressed and begins to cry. Sometimes she won't go out and eat meals. If only the staff would come in and check on her more often. Just maybe sit down and chat with her for a few minutes. That's all it would take. There is only one CNA who delivers that level of care. Most of the others would rather sit in the common area and take care of personal items. We have had meeting with the managers, but not much seems to change. Unfortunately there are not many other choices in the area. Just not sure the management in this facility puts the quality
of care above the bottom line. We as her family worry 24-7 about her care and rarely feel confident she is receiving the care which was discussed in our initial meeting before choosing this facility. Couple questions, any suggestions to get mom more interested in participating in activities? Second, how do we tackle the compassionate side of care in this facility?
When encroaching dementia caused us to find a facility, we found that although she was also a sensitive and reticent resident, consistency was the most important factor by far, in increasing her comfort level in her new surroundings and helping her to adjust.
Her caregivers focused on small positive behaviors and ignored or de-emphasized negative ones.
After AT LEAST4 months, she started to come around. I remember a day when “the group” had made a chocolate cake together, and my tiny aunt was having a large piece with a glass of milk when we came to visit.
We were thrilled when she “shooed” us out so she could enjoy her cake in privacy!
If as you’ve noted, you mom’s “ability to comprehend is pretty much gone”, is she really reacting to the degree of compassion in her care, or is she just attempting to figure out where she is and how she fits there. Can you tell?
Early in her stay, my LO would cry and ask for her mother and sisters (all deceased), and we enlisted the services of a behavioral geriatric psychiatrist, who conferred with her every few weeks and offered her small doses of medication to help her balance her moods.
Ours was a very good MC setting, and we knew it would be a tough path for her to find. Ultimately she did come to find a level of peace and contentment.
I hope you and your dear mom will find the same.
The one we chose was A) well-run and well-staffed. If a facility takes into AL too many who need MC, is a mistake which may cause CNAs with a heavy, w/c bound, incontinent elder who should be in MC to call in more help from other areas. Or to be "tied up" in care in one room. We could watch all of that.
B) there was a decided difference in how the staff treated elders and whether that was because they were better vetted or not, I cannot know.
My brother died less than a few years in care, but his care was so marvelous, and the care of his ex-partner for years after his death when he was in the MC area was stellar as well; this man had no family in the state).
I complimented the admin so frequently. This kind of care starts at the top. They always said that good care was their mission, and someone not interested in that should not attempt to work for them.
If you are considering a move, if there are choices, I have three suggestions.
rA) be honest in your own assessment of you mom, and whether at this point ANYTHING will help
B) ask if you can make visits in the way I did. Spend some hours observing if you have more than one choice.
C) Be realistic in what you can expect in the sad end of life "satisfaction" you can expect from mom, and in abilities of LTC facilities to hire enough quality people.
I sure wish you luck.
That being said, I'm going to assume that you have seen with your own eyes the staff sitting in the common areas taking care of personal items (I am assuming on personal phones or computers or tablets) and know that they are not doing patient charting for example. I know that in my FIL's rehab facility we have seen CNAs and nurses sitting in common areas (because they all share office space) with phones or tablets and it can appear that they are doing personal tasks when they are actually doing work tasks- and we've been able to tell because the electronics that they are holding have been labeled for use by the facility.
Additionally - we have seen issues with staffing in the facility that he is in for rehab - that is also a Skilled Nursing Facility that offers Memory Care and Assisted Living options. They are struggling, at least in our area, to keep staff. Many elder care facilities in our area are hiring. They are practically begging for help. And as a result when we visited last week, there was just one nurse on shift for his floor, and two CNAs. and that one nurse was covering two floors. That meant she was covering 32 patients, with the help of 4 CNAs. While that doesn't mean they can't show compassion, it does mean that they don't really have the time (or even the energy) to spend more than the bare minimum amount of time with any one resident doing what they are required to do before they have to move on to the next patient, if they are going to get through their rounds before they have to get their charting completed and start all over again. When they are short staffed at all, that means that the CNAs and nurses are basically doubling up on what they normally have to do, so they have even less time.
I'm not making excuses. Its hard to see your loved one not getting the attention that you feel that they need, and that you would give them. And especially when the attention that they are given is not done in a kind and compassionate way. If you feel that they are being unkind or directly hurtful, I would certainly bring it up with the head of nursing or the administration. However, sometimes, people just have different personalities and they may just be the type of people who execute their jobs and nothing more. Maybe not the ideal people to work in that particular area, but clinically they may be amazing CNAs and nurses.
As far as the activities - is there something on the schedule that you KNOW she always enjoyed before she went into memory care? Something that maybe you could be on site to take her to maybe the first time and encourage her to attend on her own? If she loved to read, maybe get her audio books and maybe set them on a timer to play at certain times of day?
If you continue to be genuinely unhappy with her care, as PeggySue suggested, that may not be the right facility for her. But a word of caution - don't go into it expecting the level of care that YOU would give her. You are never going to get that in any care facility. I know you know this intellectually but sometimes it is hard for people to actually come to terms with. She is never going to get one to one assistance and attention. If she chooses to stay in her room all the time, there is only so much they can do to encourage her and they won't force it with her. Because they have however many other patients that they have to provide basic care for first. Then if there is time left over they can dig into the more personalized types of care. It's nothing personal, it's just about time and ability to get everything done in the amount of time they have.
However, someone coming to sit and chat with mom now and then might NOT be all it would take to cheer her up.
Dementia patients mourn the losses they’ve endured. It isn’t unusual for them to be sad and depressed. If you were to lose your mind, your memories, your executive function, and if you were looking at gradually losing your ability to walk, swallow, and other functions that keep you alive - would a chirpy aide at a facility who popped in once a day to discuss the daffodils blooming be able to take away your sadness and anger? I think not.
Maybe she needs antidepressants or anti anxiety meds. Maybe she needs time alone to process her feelings. Maybe she’s adjusting in her own way.
As for activities, those are what we THINK they want because that’s what we, normal people, would want. The person with dementia isn’t like us. Their brains are broken. They might not give a flying fig about bingo or pasting pictures on a piece of paper.
You are most likely to get closer to personalized care if it is a small independent dementia home or a board and care. It will cost half as much.