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She has stage 4/5 vascular dementia with level 1 care at a facility. I requested recent blood work because it has been a long time since she had seen a doctor outside of the hospital and requested physical therapy to help her with strength. The facility's offsite rounding doctor ordered blood and it took me 3 weeks to get the results, which showed showed her to be anemic, (her upper body stays extremely cold even with the room being 78 degrees, main reason for my request), her cholesterol was very high, she's on blood pressure meds and had a stroke 1 year ago, which is why she's now in AL. Plus other areas were high which I have never been able to get an answer as to what those issues were. The only treatment for her by the doctor was placing her on a low-fat diet, but she picks her own meals daily and nothing has been put into place in regards to her diet.


I have also been trying to obtain a copy of her home health care plan from the medical director despite numerous requests, (she doesn't even have one) so I had no idea until I received an explanation of benefits that she was being seen by a nurse. She is on her 2nd month of treatments.


Should we be responsible for taking her to a doctor when needed for general health concerns/issues or is this something the medical staff should be overseeing if they have a local MD that rounds weekly for residents who choose to use him? I'm not sure what is normal. I just know I can't get responses to questions, medical concerns without much prompting and I have to initiate treatment for anything I know is not normal. Nothing is brought to my attention when some of her issues have been very noticeable but never addressed by any of the facility staff. Am I expecting too much for the staff at the facility be responsible and more communicative and proactive? I have not pushed or raised a stink yet but it's become extremely frustrating especially for the amount of money being paid and this facility came highly rated. She has been there for 90 days but so far everything else has been good!

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You are within your rights to call a Care Conference at your mom’s facility. You are entitled to one every 3 months but you can call one at any time. Write down all the questions you have and take them into the conference. Request the presence of her nurse, aide, social worker and therapists. The Director of Nursing was present at some of my mom’s as was the dietician. Take notes on what they tell you and give them a few days to implement your requests. Then follow up. Don’t let up until you get satisfactory answers.
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if i was you !!!!i would shop for another nursing home 1st off check make sure insurance cover it.. & then i would ask them if what you are going thru is going to be a problem if so move on ..also you could ask a hospital maybe even where you might go to for a home they could help ..my mom was in a home & they told me had to have a POA = POWER OF ATTORNEY ..so the next time she had to go again asked for one at the hospital .. some place's are rotten they run things to there benefit not the patient so get a better one i would do it right away ..i think there doctors are quacks my self ..my mom was never to have a pill that controls the bladder !!! the home had got some but never give her them cause she had a catheter so she never needed one & they would not give her vitamins ..i believe they do help big time so what ever she has google what to get in vitamins ..they do not care about there health you see that now so shop ..they will never change so get to work good luck
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also 1st take her to a doctor let them examine her !!!!!!
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Ahmijoy gave good advice. Answer is, you have to fight for your voice in the care of your Mom. I watched my Mom receive inferior care medically. There is an attitude toward Alzheimer’s care that defeats me! I kept my Mom home and later still, in home with hospice. Another example within weeks following my Mom’s passing was the loss of our Uncle. My Aunt kept saying to the caregivers and doctor at the facility that his cough recently sounded different, he’s not eating much or drinking and their response? “Hewas in dining room today” He had not! Within 2 days of this conversation he was rushed to the hospital near death. Severely dehydrated, pneumonia from possible aspiration and then he was gone. I had ultimate respect for the medical world until I had to navigate it. My knowledge is now, these are a bunch of burned out professionals that not having a cure to offer just placate and move on. Advocate, advocate and advocate some more. You are your Mom’s ONLY protector!!!
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I agree - ADVOCATE! Request care conferences and hold the facility accountable. I now use the facility doctor mainly to get referrals to specialists - I had had enough of my Mom being their 'bread and butter' (direct quote from facility physician!). I have also called in the Ombudsman and the State when my concerns were not being addressed. Advocate!
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Unfortunately i think being a doc at a nh can be on his gravy train.

After my mil died the nurses told me they called the doc but he wouldnt come.

When he sent me a bill i sent it back with a letter telling him he'd better never contact us again.

I think he got a clue ... but if he cared i dont know. We never heatd from him again.
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I didn’t realize assisted living facilities could be so nonchalant about medical care! At Moms NH I get bloodwork results on the 2nd day, and review them with the nurse practitioner. I have her cell phone number. Care conference usually every 3 months with dietitian, charge nurse, therapy. In the immediate future I would suggest you take Mom to her her regular doctor, or at least call and review her bloodwork with him/her, or have you ceded all medical care to the facility? If so, you need to be in their collective faces.
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High ratings don't mean much nowadays. If these come from a questionnaire filled out with staged questions to end in a high rating.

It is not unusual for a Nurse Practitioner to see AL residents for doctors visits.

From what you stated, I would be looking for a new facility while I found out what was going on and why is she not receiving the paid for care. I personally think there is so much fraud in these places. It's a, which one is least awful kinda situation, unfortunately.
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All states have different regulations and laws for what services are required at skilled nursing care and assisted living. So, I can't speak directly to your situation. HOWEVER... this is how I see the situation.

Short answer - yes, you need to be involved and keep track of everything that matters. As others have said, advocate!

Long answer -

Assisted living was (theoretically) designed for people who need physical help but they can manage their own affairs. In reality, many people in assisted living cannot manage their own affairs, and the senior and the facility rely on family members for support. What if an older adult doesn't have a family member willing and able? They can hire an advocate or a geriatric care manager or a private case manager. People often don't think it's necessary but it really is....here's why:

Assisted living is very good at day-to-day, moment-to-moment needs, but not so good at the big picture. They can get your loved one to breakfast in the morning, but they may not be able to detect that she hasn't eaten more than 25% of her breakfast over the last two weeks, for example. This is partially a consequence of having shift workers, partially a consequence of an overloaded staff, partially a consequence of the priorities and education levels of the workers (no offense intended - they're doing what they're paid for - getting Mom out of bed and to the breakfast table reliably). Theoretically the nurse or the social worker should review records and pick this kind of thing up but rarely does this happen. It's not until it's an emergency does it get attention.

When our loved ones enter senior care facilities, we really want to believe that everything will be taken care of. The facility certainly doesn't want to point out that it relies on families - it might lose the sale! Once your loved one is a resident, then you come to learn this aspect of senior care facilities. Having an interested and active family member is required.

If they were to provide that level of service, it would raise the price which would also cause them to lose a sale. As a result, regulations are needed. Some states put in lots of regulations and then have to deal with and pay for enforcing them. Other states let the buyers beware.

As you can tell, I've thought a lot about this.
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Lauren bond is spot on. Many of the responses refer to NH, but lollilove states her LO is in AL. They are not the same thing!
While convenient, medical staff at AL is not the same as having an off site doctor. Even then, it may be hard to get info from a doc unless they have a great staff.
Find a good geriatric MD for your LO and take them to appointments yourself. Have AL get orders from doctor. AL may prefer you use their doctor cuz it is easier for them, but this way you have an independent third party who is responsible to you!
Have doctor include orders for special diets and regular checks for BP, etc. Then AL has to follow up. However, be prepared that if your LO has needs that exceed what the AL can do, you may need to move them to Memory Care or NH.
Good luck to you. I am dealing with the same thing.
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Lollilove is mother in Assisted Living or Nursing Home? Thought it was AL. AL focus not medical . Different rules, level of care and staffing. Family still has larger role in resident medical care in AL. Although some AL say they will transport to appts, often this falls upon the family. Some AL now taking more medically complex residents than in their scope of care(or keeping resident who becomes more medically needy)
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Might also depend on what state she lives in. Different states have different regulations for assisted living. In Alabama, they wouldn't help Mom with a band-aid, and my sister oversaw all of her medical care. In Massachusetts, honorable mother-in-law uses the rounding doctor, who is quite good, and who has referred her to outside specialists. He comes every other week, and his NP or PA comes on the off weeks, so someone is there weekly, if she needs a consult. On-site nursing staff handle her meds, which is included in their basic charge (in Alabama, med management was extra).
Size matters. Honorable M-I-L is in a smaller facility, where they notice if she doesn't show up for a meal, or if she's not demonstrating the "usual" pattern. I agree with the others, though, it helps that they know she has family nearby who want to be and are involved.
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Nursing Homes/Skilled Rehab facilities are regulated by the Federal government via Medicare and Medicaid while the Assisted Living facilities are regulated by the individual states.

Look under "Health and Human Services Department" for information regarding the State Regulations for Assisted Living for the state that your Mom lives in.

I have some websites that describe the services provided by Assisted Living facilities (Copy URL and Paste onto your browser.)

https://www.assistedlivingfacilities.org/resources/services-provided/

https://www.after55.com/blog/assisted-living-vs-nursing-homes/

https://www.caring.com/articles/how-assisted-living-facilities-determine-levels-of-care
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Judysai422 Jul 2018
Great resources. Thank you.
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I always go with mom to any app't - this is so I know what her full issues are & if she is hospitalized then I can answer questions in a timely manner not wait for the facility to get around to it - I then quite often email the info to my sister who is back-up POA in case she needs it & COPY MYSELF - I have a folder for those - I put name/contact info of dr as well as results of app't so I can access everything within seconds
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My mom's AL doesn't even have a Doc on staff. It's a good thing that I always planned to continue to supervise her care. There are a couple of nurses who "notice" things but nothing comes of it. And now the facility has cut the hours of the nursing staff so we're losing the best ones. They can get other jobs with full hours that enable them to pay their bills. I was completely misled about what we were going to get in AL, but it was the only place that Mom liked. After four months of fighting with her I was just happy to find a place to which she would move. So, yes, you always have to advocate and be in charge.
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I'm not sure what brought this question to the forefront, I hope lollilove is still checking in!

Lots of the answers are about nursing homes which is a whole different level of care. Assisted living is a place for those who can manage on their own with some assistance, you are very lucky if you find one with a doctor who visits more than once a month and with more than one RN available for the whole building. In my experience anyone with medical needs beyond the very simple must arrange for them to be taken care of off site or find outside providers who come to the facility.
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The one thing I wouldn't get meds for is cholesterol. Statins have been shown to contribute to Dementia. Another med they give is Welbutrin. This is a gigantic pill you take 4 to 6 of. Problem with it, constipation. And what are they considering high. 200 and under is good. Really, at Moms stage one med she doesn't need.
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TO ALL IF YOU FEEL THAT YOUR LOVED ONE IS NOT GETTING GOOD CARE GET THEM OUT ASAP & FASTER DO NOT BE PUSHED OVER WITH THEM !!!!!!!!
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You must advocate for your mother. If this is a top notch facility, then you must request answers to all of the questions you have stated here. You have a right to know!
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Thank you all for your responses!! My mom is in an AL and is getting good care but I agree i need to be more involved with day to day health needs to be sure nothing is being overlooked. Her husband isn't really very much help as he has a new "friend" and is extremely healthy so can't / won't understand and feels her "dementia" is more of a mental problem and is just trying to manipulate him. I can guarantee this is not the case! So, as you can see I am trying to do what i can in addition to dealing with a husband who's not much better but only 53. I appreciate the support and advice!!
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