Mom has been in memory care for just over a week, and I think the staff are getting tired of me already. I have changed/laundered urine soaked sheets four times already (her room stinks of pee), she has fallen 4-5 times already, I consistently find her with no bra (I have provided cami's for her to wear instead, at a nurse's suggestion), wearing stained clothes, and I am pretty sure she is not being put in deodorant or brushing her teeth. I am having trouble keeping up with my own life at home with my 80 year old dad, as he wants good care for her, but is emotionally immature and doesn't want or know how to take any responsibility for these things on his own.
I have talked to staff, and they just snark at me: "we are understaffed... we did this and this and this... it's the other shift's problem." The head nurse is good, but she manages things from afar, and I just can't be there 100% of the time. That's why I put her in care!
I am going to go in and talk to her head nurse today, and we have started hospice care, but I would appreciate any and all suggestions about dealing with this. I'm not even sure what to bring up without sounding like a "b***h" because I'm addressing things as I am there, and nothing is changing.
I was finally able to talk with the nurse in charge of the ward yesterday, and she assured me that what I was seeing was NOT (capital letters NOT) normal or considered acceptable for her floor. She is doing regular surprise inspections, has called out the staff for both attitude and behavior where appropriate, and assured me that the staff not doing their jobs to provide at the MINIMUM basic human dignity for her residents will be written up, at least.
I'm less worried about falls and laundry and and and, now that I have the charge nurse's reassurance. So now I wait to see if she follows up... Things are very different over the weekend than during the week, so now that staff is being on a higher level of watch, we will have to see...
Thanks for updating us.
My only thought is what is the #1 issue that is driving you batsh*t crazy? (And you don’t even need to share it here, just think about it.) Can you fix that one, then go on to the next? Bite-sized pieces instead of attacking the entire giant.
Often they forget they can't walk unassisted and try to get up out of a chair or bed without assistance. They forget they need to push a call button or request assistance to transfer. Most facilities are no longer allowed to use bed rails for fear of things like entrapment or injury. It's next to impossible to keep a person who wants to get up or tries to walk from falling unfortunately when they are memory impaired.
My FIL had been driving a scooter for years (10+) and got the forward and reverse hand controls mixed up and injured the CNA that was trying to assist him because he wouldn't let her help him (or listen to her).
Its hard. When my FIL got to the last few months, he was getting out of the bed and trying to go to work at the grocery store (he hadn't worked in a store since he was 15). They finally had to lower his bed to the lowest setting and put mats on the floor to protect him. And eventually because he was so agitated they had to medicate him to keep him safe.
Falls are awful. They bring with them cumulative issues and often collateral damage. Often when disoriented (like the first week in a facility) the number can increase because they are more agitated and trying to understand where they are.
It's a lot for certain, but also not entirely shocking unfortunately.
Her teeth. I was told she would not brush them. Weird she did when she was living with me. "Do you put the toothpaste on the brush and hand it to her?" The answer was no. My thought, "really your the aide and you did not think to do that? I thought to do that and I have no training in caring for someone" I would think its commonsense. Deoderant, for my Mom it was a must.
Is there a way of putting a couple of bowls of vinegar high up where Mom can't reach them. I had to do this and within a couple of hours the smell started to dissipate. I left them there for 2 days and the smell was gone.
The spills on her clothes, Moms AL did not allow Bibs because of dignity. So she always had spots on her tops.
I went to my Moms room one day to find that she had a #2 accident in bed. The aide just thru the comforter over it. I did the laundry. That I went right to the Nurse about. All that aide had to do was strip the bed and put the linens in a bag and put out the door for the laundress. Then remake the bed. I was told even though I did Moms laundry, soiled items went directly to the laundry. With the sheets not being changed, I think that is something to complain about.
If there are things in her care plan that are not being addressed - yes absolutely a care plan meeting is acceptable to discuss. But just keep in mind what we have said, some things are reasonable, others may not be reasonable to expect even if its in the care plan.
With my FIL, we got to the point where we were ok with him getting his clothes changed when he would allow it, which averaged out to about every other day - or when he really soiled his clothing of course.
Is she wearing incontinence underwear?
I'm really not trying to make light of any of the issues. I really do understand the concern. It's not easy adjusting to the fact that there are 100% things that are not going to happen the way we would like.
Sometimes you have to choose the "hill to die on" things and just let the rest go. Not dealing with medical issues, injuries, things like bedsores, those are hills to die on. Laying in urine soaked sheets all day - absolutely.
The laying like a vegetable. That's a hard one. Because they can offer a million activities....and she may choose not to attend a single one and prefer to lay like a vegetable or stay in her room. My FIL did. His facility had so many activities - some that we thought he would enjoy. The only time he left his room was for PT/OT. He had meals brought to his room. He sat and played on his phone or watched tv all day. He REFUSED to join any activities. Even gospel singings and church services, which he liked.
You can't help your dad with this in all likelihood. It took my SIL MONTHS to actually stop trying to call over there every day because FIL was calling her and telling her that they weren't providing care. I finally begged her to stop because she KNEW that what he was telling her was not the truth.
Your best bet is to come up with that "non-negotiable" list - keeping in mind that there is a good possibility that a single CNA is responsible for your mom and potentially 7+ other residents within a given shift. Something I always like to use as a good example - my FIL was a VERY large man - over 300lbs. And was nearly bedridden/immobile when he went into facility care (it was the reason we had to move him). When he would soil himself, it was at least a TWO person job - so a CNA from another area would be asked to help. And completing that task - could take upwards of 45 minutes to an hour. That means that during that 45-minutes to an hour - everyone else was having to wait for their needs to be met unless it was some kind of medical emergency that the nurse responded to.
That is a daily issue for the CNAs especially - so few of them and so many people to help. And it takes time with each resident to achieve whatever they walked in the room for. And like the other residents, my FIL often had to wait for his needs to be met while others were tended to.
Your dad has to understand that she is getting the care she NEEDS, and she is taken care of. I likely wouldn't share your concerns with your dad. And if he talks to her, gently remind him that she is not a credible witness.
I get it, its hard when you want your loved one to receive the best care possible. But in facility care they also are not really allowed to force their residents to do things - and they can't wait around for extended periods of time until the resident is ready to do the required task. Brushing teeth is important absolutely. But if the resident does not want to do it -they can only stick around for so long to wait to see if they will change their minds. Same with bathing or toileting.
You know that you can't be there 100% of the time. But you also have to realize that THEY are physically there 100% of the time but not focused on your mom 100% of their time. That's the drawback of facility care. You are exchanging sourcing out the tasks to a 24/7 facility -but they are not going to get the level of care that you personally would provide. The only way to get that is to hire a private caregiver to spend some time with her each day.
If you talk to the facility - I would address the most important issues. Deodorant is not a requirement. Falls, as long as they are taking any precautions they can....cannot be prevented -especially if mom is getting up on her own. They would happen no matter where she is. Stained clothing - ask if she is refusing to change her clothes. Perhaps those clothes give her some level of comfort and she doesn't want to change them. Urine soaked sheets - unfortunately unless she pushes the call button to let them know -they aren't going to know about it until they come into the room - and often it takes two CNAs to change them unless the resident is out of the bed. So it sometimes takes time for it to happen. And you may be arriving before they have made that level of rounds.
Ask questions - be careful not to sound like you are making accusations. She has been there for a little over a week. We were asked not to even COME to the facility for 2 weeks after we moved my FIL to give him time to settle in and adjust before we visited. The first few weeks are hard for everyone.
You aren't a "b***h" at all. But you will have to make some adjustments into the level of care you are expecting her to receive because she is not on a 1:1 ratio and won't have someone checking her every few minutes to see if she needs anything. And if she balks, they aren't going to argue with her, they will have to move on to the next resident who needs their care.
As for the timeline on bed changes, I have been in there mid to late afternoon most of the times I have gone to visit since she was moved to memory care a week ago. TWICE I have walked in to them changing the bed mid to late afternoon.
You are wanting a perfection that is no longer going to happen. You will be frustrated, and so will the facility. But you need to understand this.
If you think you can maintain 24/7 odor-free, fall-free, stain-free care for your mom and your dad, then take her home. Because it won't happen here.
I understand that you are advocating for your Mom. THAT will go one of two ways. Either the place will be frustrated with you and that will be taken out on Mom and you will be told that "perhaps this isn't the right fit for your mom and you should take her somewhere else"
OR
You will see some changes because staff will be told by admin "We do not want THAT woman in our offices again; SEE TO IT". And mom will get a bit more care and others will suffer the more for it.
There is no perfection in facilities caring for our elders, just as there is no perfection in the rest of our lives. I am so sorry. I truly understand your frustration. But you are attempting to make perfect something YOU cannot yourself control, and something they cannot control either. It's all very tragic. But it is more and more, as we live longer and longer with more and more tragic qualities of life, a "norm".
She isn't cattle, she is a human being.