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My great aunt and uncle, both 84, live in another state and recently moved to an assisted care facility. My great aunt has set up everything to this point and doesn't feel that anything is going well in the home. My great uncle hasn't been given a shower or sponge bathed in 6 days. He has a catheter and wraps that should be removed and changed daily. He was getting physical therapy and that abruptly stopped. Her toilet stopped up and when she went to tell the staff, they laughed at her and told her she would have to wait for maintenance and who knows how long that will be. She also said that call lights go unanswered, money has been stolen from her 5 times (approx $250), and when she speaks to staff about things, they will say that they will come down to speak to them and never do. She had some personal items in storage and was told that they couldn't be stored anymore; she didn't know what to do and then she was told that her things are in a "garage somewhere". My great aunt is the POA for my great uncle, and she believe that their exector has POA on her as well as my great uncle. I have called the POA and left a message, but haven't heard back from him yet today. My great aunt told me that she hasn't told the POA much about what's been going on. She also told me today that she went to a museum and had lunch with a friend. It seems like she may not want to bother others, or tried to check out for a bit and do something fun, but I'm very concerned that my great uncle is going to get an infection from lack of care. I'm not sure that she's comprehending everything or able to keep it all straight as far as the home, insurance, doc appts, what level of care my great uncle is supposed to be receiving vs. what he is getting, etc. They have no children and the closest family is my mom and I (3.5 hour drive away). They have been self sufficient till now and I believe my great aunt was just doing what she knew to do, but I don't trust that she can make the best decisions anymore. I am driving there to visit them tomorrow (Saturday) and staying thru Monday. I want to be as prepared as possible to help them through this. I've looked up some questions to ask and things to be on the lookout for. Are there more specific ways that I could help them during this visit, and also from 3.5 hours away? I do not have POA.

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I guess I feel like I have to do it now because I'm here. Tomorrow will be my 3rd day here. I called the Executive Director this morning (Sunday) and expressed 3 things: no baths/showers for now 7 days, the hour wait time for bathroom, and the 40 minute wait time for bed. She said these things are unacceptable and she would make sure that he would get a bath today and a shower tomorrow.
He did not get a bath today. The Executive Director and another higher-up person (sorry, it's late) both ensured me that he would. I've gathered everything into a bullet pointed document to take tomorrow. The POA may not be able to make it because I just found out today that he lives 40 (!) minutes away. He tried to get my great aunt to come to another facility close to him that he personally knows is great, but she wanted to stay within the city.
I honestly don't know the alternative options. I've been working on them to understand that even if this place changes, it won't most likely in the time that they live there. It makes more sense to move on and spend their money in a place that actually likes people (seriously, that's been my impression of this place) and I can see her slooooowly coming around, but it won't happen in this trip I don't think.
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How long exactly have they been there now, Leah?

Express *everything* that's concerning... woah. What, all in one go, in one meeting, verbally? I wouldn't. "And seventeenthly, Mrs Manager, ..."

Write a list. Bullet points. You will, depending on how the conversation goes, be giving this to the manager as a baseline sitrep to be referred to at some agreed future date for comparison, to gauge progress.

More to the point... for a negotiation to work, you have to have an option. So. What are great aunt's and great uncle's alternative options?

Also, you really do need to do this in concert with the POA. Any further news of him?
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OK, so it's worse than I was expecting...

There are so. many. things. I'm overwhelmed.

They both told me today that yesterday they called for my great uncle to go to the bathroom. They waited an hour. I witnessed my great aunt calling to put my great uncle to bed tonight. We waited 40 minutes. They're given a pendant button and were told it's the same as calling, so after 40 minutes my great aunt hit the pendant button. Within about 5 minutes, three people came. A nurse, an aide, and a manager. My great uncle asked the one lady if she was a manager, and she responded yes. The nurse goes, "why, you got something to say Bob?" The aide said the nurse's name under her breath, like telling her to simmer down. The manager then said she would come back to check on them. I stayed for another hour after that and she never came back. What would have happened if I wasn't there???

My great aunt told me that that same nurse has yelled at her on more than one occasion. She also said that she feels she is calling the nurse's station for too many things. When I asked her what she's calling the nurse's station for, she responded with, "well, asking for Bob to go to the bathroom, asking for his ointments, asking for him to be put to bed." Who is making her feel like she's calling too much for the bare freaking essentials?!

That's scratching the surface. My great uncle wasn't bathed today either and when I got to their room at 4pm, there was a pungent, nasty odor.

I'm just......can anyone give some guidance as to how best to handle this? Tomorrow is Sunday so it's iffy who will be there, but I'll track down whoever to get this taken care of. I'm also here on Monday so there will be more staff then. My plan is to find the highest person on shift tomorrow and show them the paperwork my great aunt has that clearly states 5x sponge bathing per week and a shower on Monday and Thursday, and inquire about the wait times for bathroom visits. Then whenever I can get the director/main admin person, express everything that's concerning. Is this the best way to go?
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Leah (my own much-loved great aunt's name, by the way), especially if he is of a similar vintage to your great aunt and great uncle, the POA friend may be coming to feel that he has bitten off more than he can chew. There is nothing more stressful than having responsibility without power, and your great aunt's lack of co-operation may be making his life quite difficult. Not suggesting you should ask him that directly - he'd just say oh no no, everything's fine, and clam up - but be open to cues that he might secretly long to hand over to someone else; or at least share the supervision.

Will you be meeting him together with your great aunt?

I think Medicare's supposition that catheter care will be handled by family makes less sense when the "family" is 84 and unused to providing hands-on personal care. It's not very nice for her, true, but more to the point it's dodgy for your great-uncle - if the site gets infected it could easily become quite serious. It's no task for unenthusiastic amateurs!
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Just one thing to be aware of ... sometimes these care centers are not staffed over the weekend the same way they are during the week. Look at posted schedules of activities to get a more complete picture.
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Thanks so much for the responses!

The POA is a long time family friend. I have never met him but I was able to speak to him tonight and got a little better picture of what's happening. We're going to meet this weekend to further get a handle on things. I do feel that he's a good person (in as much as I can gauge from a phone conversation) and is acting in the best interest of my family members.

So apparently the POA has been there for much of everything. He often and consistently visits and offers assistance to my great aunt. She declines help and is rather private, so he isn't privy to all the information that could help him make better decisions with and for her.

Example: she won't share their finances in any way with him, but struggles to balance her checkbook. He offers to help, but she declines. He then suggests she make an appointment with her accountant, and she says she called but she can't get in for weeks.

He feels his hands are tied in that if she won't share info with him, he isn't able to make accurate decisions, so he's doing the best he can with what he does know.

Great uncle has lymphedema and congestive heart failure. The lymphedema is bad enough that he has wraps that have to be changed every day and he can't get into a wheelchair or walk without assistance. There may be other things that I'm not aware of and I'll find out more tomorrow. Great aunt is completely mobile with no significant health issues.

As far as the museum/friend visit, one of the things she really wanted was to stay in the area they previously lived in so that she could easily access events and stores she likes. Her friend probably came and got her for their outing.

Thanks for the HIPPA form tip- I'll look into it tomorrow. Also that Medicare thinks family can take care of catheter things; my great aunt did say that she was told she can clean the area but feels she shouldn't have to. That makes more sense now.

I feel much more equipped to handle this! Thanks so much!!
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I agree. If Aunt didn't request services and pay for them than employees can't do them. Not sure if a CNA can do catheters. Who did them before the AL? Medicare feels family can be trained to take care of this. The nurse would have to do it and again, if not paying extra it won't be done. You pay extra for bathing. Mom got 2x a week I had to pay for 3rd. Hopefully the POA was involved in the contract between Aunt and AL. If not, he needs to review it. If AL is not performing the tasks that are being paid for, then it should be brought to the administrators attn. If it continues there r agencies who can be contacted to file a complaint with. If Aunt is lke my Mom, they except what they r being told. A clogged toilet is a health problem. A CNA is capable of using a plunger. I saw the main RN and administer try to unclog one. It may be a "While the cat is away, the mice will play" thing. She needs to report her problems to the Administor.
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Are you certain this is nursing home or are you confusing with Assisted Living? If Assisted living, then they probably arent bathing, changing catheter, etc for uncle unless aunt has paid extra for that type assistance. Maintenance should be included and toilet should’ve been taken care of as part of their service.

If this is a nursing home, then uncle should be getting full skilled care. If aunt is competent she can come and go as she pleases.

Good luck with your visit. Agree with other posters. Take notes, names and discuss with aunt what issues she is having, Etc. If aunt is POA for uncle then other POA over aunt has no authority at this time unless aunt has given such permission and authorization to other POA to make decisions on aunt and uncles behalf. You and mom should probably discuss with great aunt this POA chain of command; hopefully you trust this person as well.

Certainly any POA would want to know what’s going on and may not even be aware of these issues you mention in email. One possibility is that great aunt isn’t telling POA and only complaining to you, or POA isn’t listening to aunt, or POA is ignoring.

Either way, it’s a good idea for you to visit and observe and see if you find same issues with staff or find uncle is not getting care and attention needed.

It’s very hard long distance. You have to depend and trust your gut when you visit and look out for things such as:
Is staff attentive
Does place smell
Is place inviting and organized
Are residents just placed in one area with one staff member
Is place cheery and bright
Activities appropriate to resident
Are residents engaged, content
Suggest having a meal or two during your visit - gage food quality
Does resident have clean linens, towels
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1. Keep an open mind.
2. Take notes.
3. Keep calling the person with POA - which is who, by the way? Any relation, or a lawyer, or what?
4. Be incredibly nice to any members of staff you're introduced to. Note their names, tell them yours and that you're looking forward to getting to know everyone. Hold off on any complaints until you're very sure of your ground, keep this as a fact-finding mission.

You may not have POA but you don't need it to compile information and speak up. If things really are as awful as some of those incidents your aunt mentioned, there are formal channels for complaint which anybody can use; but obviously it would be better to go about it methodically.

If the worst came to the very worst, is there a similar facility near you and your mother?
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Leah, what are health issues of your Great Aunt and Great Uncle?

I assume it is your Great Aunt who is telling you all the things that are going wrong in the nursing home, correct? Does she by chance have any memory issues? Why I am asking is that residents of Assisted Living or of Nursing Homes will tell "stories" to get attention if they have dementia.

Example, your Great Aunt going out to visit a museum then having lunch with a friend??? Unless the nursing home had a field trip, which I don't see happening.

Chances are both of your relatives are getting good care but if it makes you feel better having boots on the ground to see for yourself, you can help correct anything that is amiss.

Oh, I just remembered, I hope your name is on the HIPAA forum, so that you would be allowed to ask questions of the Staff as to the health of your relatives. 
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