Father-in-law (95) with moderate dementia and living in skilled nursing facility. Concerned about the level of attention in facility. Any advice?

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My father in law fell and broke his hip (he's 95 with lite to moderate dementia). He had surgery to repair last week and is in a skilled nursing unit at the assisted living center where he lives. We are concerned that the level of attention is very low and are considering hiring an assistant to be with him when we are not. The questions are numerous and may seems simple but none in our small family has gone thru this (no spouse, just a son and a daughter):
- are we hovering too much (neither of us have children so no experience there)
- are our expectations of care to great?
- should we consider moving him?

With his dementia, he does not remember his fall nor the surgery. He tries to get out of bed. The shilled nursing unit refuses to put rails on the bed, saying that would be a form of restraint, which they cannot do, based on licensing only as assisted living. We're at wits end without knowing what to expect.

any thoughts?

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he may need a higher level of care - and if transfer to skilled nursing or an acute inpatient rehab is not a good or viable option, hiring a one to one sitter for when family can't be there is what they are suggesting. bed rails are also for helping get in and out of bed - if the person can operate them they are not necessarily a restraint but could function as a reminder, and they CAN place thick soft mats on the floor and use an alarm. The pain of another fracture should be preventable, and worth preventing, really!
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Could you elaborate about your concern that "the level of attention is very low"? Do you mean nursing attention, aide attention, therapy attention?

Typically PT and OT are given daily, perhaps 45 minutes or so, depending on the number of patients and therapists. Given your FIL's dementia, he may not make as much progress as someone w/o dementia would.

The issue of hiring someone to be with him could be problematic if that person is to act on your behalf. Would this person be granted HIPAA authority by your family (assuming you have in place the legal authority to do so), and/or to make decisions on your behalf? The staff may find this intrusive and offensive.

Your FIL also would need significant downtime to rest and recover from a serious operation. Having what amounts to a fulltime companion may make him feel he needs to be social with that person, and that would interfere with his rest and recovery.

What I would alternately do is establish a better working relationship with staff and administration to get the level of care you seek. Itemize your concerns, document, and ask for a care meeting to discuss these issues.

Explain what you expect and discuss whether it's realistic, and if so, how to achieve it.

Failing satisfcation with the results of the meeting, you could consider moving him, but would need to review other rehab facilities to ensure you don't encounter the same thing.

As to the other questions, it's hard to answer because the questions are so vague. I.e., what ARE your expectations, and how much are you "hovering", and for what reasons?

I am confused though about the issue of restraints. I can understand that the AL section wouldn't use restraints but he's not in AL; he's in the rehab section. I'm not current on this and stand open to correction by others who are, but it's my understanding that rails can be used with permission of the family. However, there are serious concerns about their use for someone who might accidentally become caught between the rails.

If they're only licensed as an AL facility, under what authority are they providing rehab?
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He's in rehab and they say they can't do bed rails.? In my experience, ny and ct, if there is a reason, they can do bedrails. If he needs bed rails to keep him safe, then ask what facility he needs to be transferred to. Call the hospital he was discharged from; they clearly did not arrange an adequate level of care. This is so not your problem. Discharge didn't do their homework.
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