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Aides rotate, some care, some don't.


My Mom is 93, legally blind, has dementia, has disintegrating hips. She just suffered a catastrophic fall and is bound to wheelchair, cannot feed, dress etc. she is continent. There is no way for her to get their attention for bathroom or anything else. I go and help her eat 2 meals a day and visit but always have to check everything like did they put adhesive in her false teeth, is she wearing her underpants or did they put her in diapers etc. can't ever take a day off. No one to manage aides on weekend or holidays. Aides are not accountable. LPN are not team players. No respect for residents. What can be done to fix this?

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Federal standards require certified nursing homes that provide Medicare and Medicaid services to have a full-time director of nursing (DON), an RN on duty for 8 consecutive hours 7 days a week (this may be the DON), and one RN and licensed nurse (either an RN or LVN/LPN) for the two remaining shifts.
If the aides are unsupervised, notify the Wisconsin Health Dept.
To use the toll free number to file a complaint dial 1-800-642-6552.
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Both CWillie and FF addressed a phenomenon that I thought of immediately while reading your post. Once the staff knows you'll be there on a regular basis, they can begin to rely on your supplementing the care needed.

There's really a delicate balance to this; if I came too often, I began to physically and emotionally wear down, and also saw that the staff wasn't doing as much as they should. When I backed off, some things still didn't get done. And the discharge instructions noted that I visited "occasionally". What??

It's as if you "can't win for losing."

What I have done is address specific issues with the staff, and if that didn't work I went to the admins, not with a complaint but rather with a question of how to work out specific issues. I always mentioned the fact that the staff was supportive, but just couldn't address everything. I added that I saw things from a somewhat different viewpoint since I was more familiar with my father's needs.

The approach was that we're all in this together; how can we work out solutions that benefit everyone but don't overtax the staff?

Soooo, I asked, how can we get together on these issues to work out solutions that address everyone's needs? I won't say that it always worked though; the nurses in these facilities don't have the same outlook as nurses in a doctor's office, on hospital floor duty or in ERs. That has to be recognized.

You can try this approach, and if the staff's attention and attitude don't improve, then raise the issue with the admins, again emphasizing that the staff is spread thin, so how can these issues be addressed?

I've also found that if the patient can "hit it off" with the aides, the attention improves. So start conversations with them, ask about their interests, their family, etc. One of my father's aides at his last rehab was a weather buff. They ended up in a nice discussion of cloud formations.

Back in 2012, one of his aids was Russian. So I got out my Russian text, refreshed my memory and greeted her in Russian every time I saw her. That made a world of difference. And she began to teach me more common words in Russian, so that enhanced my meager knowledge of that language.

So, try to find a common ground with them.

And bringing goodies doesn't hurt either. After 2 stays at an excellent facility, but with a somewhat lazy nurse (who I also heard complain about one family that was demanding), I've decided to send follow-up cards thanking each group for their support. I might even drop by during the upcoming holidays with a basket of goodies.

Maybe that nurse could benefit from some complements instead of criticism. That's my hope.
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I agree with cwillie, if you are at the nursing home the Aides will put their attention to the other residents who don't have someone there to help. As for meals, my Dad's caregiver would drive Dad over to the nursing home to visit Mom and the caregiver would help feed Mom the lunch in the main dining room. The Aides were happy that the caregiver was there to help as the Aides then could help the residents who were bedridden.

Otherwise, my Mom was getting the best care possible for her condition [major head trauma from a fall that put Mom into late stage dementia]. The Aides had Mom in clean clothes and Mom always smelled like she had a bath. The Aides were around Mom 24 hours a day, so they knew her routine.... I didn't. Thus I put my trust into the Nurses/Aides and let them do their job.

I never complained about anything. But if there was an urgent "question" the Staff was more than happy to give me answers. There was equal respect.
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I've had my mom in respite care twice, the first time was only a week and I could visit every day, the second time was for two weeks and I was out of the country. I lose my temper with mom and am struggling with her decreasing mobility but the nursing home was 1000 X worse, everything you have mentioned and more. When they reach the point where they are both physically dependent and mentally withdrawn they are totally at the mercy of their caregivers, whether it is family at home or staff in a facility.

You just have to trust that on the whole the care is good enough - not the best, but adequate. If you didn't feed her someone would, as long as your care plan details that she needs assistance. She will be in diapers because it takes two aides to toilet a wheelchair bound woman and they have a whole lot of them there and they can not possibly do it any other way. She will be changed on a schedule, not necessarily whenever she is wet or soiled. Her basic needs will be met.

Your constant presence there is a signal to staff that you are picking up the slack and they will come to depend on that so it is a two edged sword, they won't pick up the pace unless they have to. Try to step back so they will step up, let the little things slide and concentrate on the little extras that only you can do. I know it is hard, it will take some time for everyone to adjust and find the rhythm of the place.
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Oh Mareva, your poor mother. What a difficult situation for both of you. Family members and spouses so often feel as if they have to be with their loved one in a facility hour after hour, day after day, to ensure their loved one is being taken care of. I've known so many people who have been in your situation. Of course we don't want to leave our loved ones to a staff that is indifferent if not downright neglectful. Some people move their loved one to a different facility only to find the same problem.

There is no easy fix. It's a systemic problem that is pervasive throughout the long term care healthcare system. Staff shortages create overburdened workers which leads to residents not getting what they need when they need it and it's the same in almost every facility. Nursing homes pay barely above minimum wage so they don't attract the crème of the crop in healthcare although it's been my experience that there are gems to be found among nursing home staff. Dedicated, respectful, and compassionate employees can be found in every facility.

Some families believe in bribes like food and other little treats for the staff hoping that in treating the staff well will guarantee their loved one will be treated well. The downside to this is that the staff rotates around and you're frequently dealing with different people each day unless your loved one is in memory care. They tend to have the same staff everyday.

Some loved ones, like you, like to be with their parent all day everyday to make sure their parent is being treated decently but not everyone is able to do that. Some people work or have family commitments and other obligations.

Family members don't like to complain about the staff to a supervisor out of fear the employees will take it out on their family member and not treat him/her well.

It's a broken system. Low wages, high turnover rate, poor morale, staff shortages, not enough aides for all the residents, etc.

But it's not all bad. There are good people out there. People who are dedicated and care about the people they take care of. Unfortunately, I think they're the exception and not the rule. Or maybe I'm just being cynical.
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