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My folks are currently in an independent/ALF hybrid (apartment style). Things have been fine through this lockdown until my father's dementia took a turn. He qualified for visits from a hospice nurse through Medicare, but now the hospice nurse is saying he needs a night nurse (due to disorientation, confusion and falls in the night). My mom is physically disabled and can only press call button for assistance but that can take at least 20 minutes for a response. They cannot afford a night nurse as recommended and because of the lockdown, moving to memory care is on hold.


Any thoughts/ideas on how to manage this?


Many thanks...this community has saved my sanity many times.

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Anything obvious behind the confusion? UTI? Chest infection? If so, get treatment for asap.

As very temporary measures.. some height & light adjustments?

A floor lowered bed up against the wall with 'crash-mats' along other side for Dad. (hospice may provide or hire). Won't stop a fall but he would roll out safer instead. *But only if he is unable to get out of bed by himself* otherwise it would make falls worse!

Sensor alarm mat on floor next to bed? Maybe would speed up staff? As instead of what now? They know he's up & they have that falls duty of care. Maybe. *Be aware that some people try to step OVER the mat thinking it's a hole & then fall*.

Motion sensor light in bathroom (if don't have already).

Hire a student CNA? They would sleep there but must wake to that sensor mat alarm, turn on a light & either bring a urinal bottle, or walk him to bathroom (if safe) or stall him until other staff get there.

An experienced hospice nurse should have knowledge of fall risk strategies.
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Find out through Hospice as to why it isn't covered. Also, he may need a higher level of care - SNF and Medicaid.
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Do you have long care insurance on them ?that will cover it. If he is a veteran are her that will cover them as well.
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Because of the covid issue being the hold up for moving to memory care, you should ask the facility or hospice nurse what they can do to accommodate his needs since this is through no fault of his own. Assuming they have been in quarantine all this time, they should not have exposure to the virus. Can you or another relative (who has also adhered to quaratine) go stay with them until lockdowns are over? -- I understand they may say no one can go in during lockdown, but if hospice is saying they need an overnight person...someone will be going in. Preferably it would be someone you know who has not be exposed to virus. Better you than someone you don't know.
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Since he is on hospice, check with their insurance company - who are handling the finances for hospice. He may qualify for an aide,
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KaleyBug. Student nurses have no licenses to care for anyone. Their clinicals do not really ramp up until later in their education. Elder care instruction is practically non existent until they are hired and get instruction in their specialty. So how do you expect students to be good fit? They are studying nursing that when they work, custodial care is a minor part of since PCAs bear the brunt of custodial work. Especially when someone with dementia sundowns or falls?
The question is about affordability. Our answeres in this forum are frequenty: hire an agency for licensed, bonded, and insured people who have references. Costs on average is $25/ hr.

TO IWishHeGotIt. I feel pity for you. Those frequent middle of the night calls that take a 20 min response, is it because the hired resident gets woken up and has to get dressed to give assistance? If my question is true, then you may need to get one step ahead. I suspect that if midnight calls are frequent then this is more than an IL can handle and you may soon get a family meeting that it is time to move on to AL. Start being proactive on this. There is starting to be an exponential call to you to spend down towards Medicaid and NH. You are describing that the living situation for both in IL is becoming unsafe. The key word from me is to be a step ahead, so start doing research. Keep searching for an AL. I suspect with COVID, that places will have plenty of openings. Dad may soon become hospitalized which means you may have to separate both if he has serious injury.
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DonnaF777 Apr 2020
You are right.... I was a nurse and also home health aide. I have found out... nurses do NOT know how to take care of people. Let me say.. MOST do not. Some do like myself usually for the reason they were aides BEFORE they became nurses. The BEST nurses are the ones who worked as aides (nurse aides / home health aides) I have seen the great majority of them have NEVER stood a patient up... walked them to the bathroom or anywhere, toileted them, given them peri-care, given a urinal. They have NEVER used a gait belt. Never used a walker or wheelchair. Many have never given a bath or shower. It is sad what nurses do. Most of what we do... was deal with the medications. And the paperwork. Yes.. someone has to do it but our educational system for nurses is really ... well... it royally stinks. I believe that ALL NURSING PROGRAMS should require their students become CNA's and HOME HEALTH AIDES BEFORE becoming nurses and work as aides/home health aides for at least a year before starting nursing school. This would hopefully weed out those who stink at being nurses. Believe me.. I have met them..and had to work with them. ( "I don't clean urinals and I DON'T give bedpans. I did NOT get into nursing to do THAT!) And they call the aide every time a patient needs to walk to the bathroom. Many patients can't wait that long! We need to go back to the "Florence Nightingale" way of teaching nursing. Just because they are a nurse, in NO WAY means they know what they are doing. I have seen some outstanding aides that know so much more than some of these nurses...
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Its amazing how the health care professionals so casually say "he needs a night nurse" or he needs more supervision as if it can easily be done. Yes, as others have said, it may be time for a SNF and Medicaid. Contact APS and/or local Area on Aging. Maybe there are options for in home care paid by Medicaid (but don't get too hopeful with that), but at least make APS aware that there is a vulnerable adult(s) with no resources for care.
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You may want to check any nursing programs that could be in the area. They may have some students willing to volunteer for this. They can add volunteer care to their resumes down the road. Volunteer work I did over the years helped me land several jobs.
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Grandma1954 Apr 2020
This is a great idea.
From the description in the original post I don't think a Nurse is necessary. Why pay a higher price for a Nurse hen a "sitter" or "companion" is all that is needed.
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It is likely that he needs a nursing home rather than memory care. Not even memory care will be monitoring him 24\7. Unless a private companion is hired, yes on dad's dime, then a nursing home may be the only solution.
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nursing home.
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Hmm with everything taking affect with cvid19 . I would ask if u can have a private care aide come in durning night .. there are resources to help with the costs . If I may ask what state are u living ? I do private home health care and would be more than willing to assist
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Ditto to 97yroldmom's comment about checking for UTI to discount that as a culprit and pinpointing exactly what good a night nurse would do. Is he getting up to use the bathroom? If so, and he is already wearing incontinence undies, can a potty chair be put in his room so he at least doesn't have to go far? Or, would a hospital-style bed that has side rails be practical? I wish you all the best as you work towards solutions!
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It does not sound like you need a "Nurse" if no medications are being given or dressing wounds then a "sitter" or "companion" might be a less expensive option. Someone to be there to help him to the bathroom, help "re-orient" him and keep him from wandering or harm.
Someone like this would not be paid as much as a nurse.
You can contact an agency and ask, or hire privately. The problem hiring privately is background checks and all the taxes and paperwork involved. And finding someone that is honest and trustworthy. You could ask a current employee of the facility and ask if they know anyone looking for hours. Might even be able to split the hours between someone leaving a later shift and someone working an early shift. (If they are allowed to work privately)
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Not sure what the solution is but I know this must be very stressful for all. Perhaps the hospice doctor can review your dad’s meds and see if there is anything he can offer to help dad rest at night. Make sure they have checked him for a UTI.
Poor mom. This must be very stressful for her as well. What exactly would the night nurse be expected to do? I ask because many times if it’s a sitter all they do is call for help and the same 20 min would be needed until help would come. Push back on hospice to get them to investigate dad’s situation a little closer. Let us know how it resolves.
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