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Would it be any different if I moved her to a different facility? How do I know if I'm expecting too much? I just have a feeling things aren't right. A few people I have spoken to says it might not be better elsewhere. I don't know what to do.

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Overwhelmed61, no facility of any type will be able to care for your mom the way you would. We need to trust that we’ve made the right decision. Have you posted before about moving Mom? I seem to remember a post like this but can’t remember if it was yours.

I sense a real indecision about placing Mom . I think that may be more a part of your inner turmoil than anything else. Ask yourself whether you are of the mindset and whether you have the physical and mental strength that you could have taken care of your mom until she passes, 24/7, 365. Could you have made your home handicap accessible? Could you have afforded all the durable medical equipment, incontinence supplies and everything else to take care of mom? I don’t recall if she's on Medicaid or Medicare, but Medicare does not pay for home modification or incontinence supplies and did not cover all of my husband’s DME. My home looks like a Medical Equipment showroom. My health has taken a nosedive since he’s become bedridden. I am looking at burnout in the rear view mirror. If there’s anything worse, I’ve got it.

Her facility has everything she needs, including round the clock staff. When my mom and Hubby were in Skilled Nursing, the dentist, podiatrist and ophthalmologist visited at regular intervals. Staff told me that I could take her to her own specialists if I wanted to. I did take her to her own dentist at one point. It was a trip from hell. After that trip, I was content to let the facilities providers treat her.

For myself, the only way I would move my mom would have been if she was not clean—herself, her clothes or her room. Bear in mind that rooms are not scrubbed from top to bottom every day and either are the residents. My mom ate alone in her room like your mom. They tried to get her to go to the dining room, but until she went into the dementia unit, they didn’t force her.

You need to make peace with this before you self-destruct. Do what you need to do; join a support group, see a therapist, start a journal, speak with your religious leader, something. If your mom sees you are upset and stressed out to the point you are having problems functioning, she will become upset as well.

You can always come back here for support, but we can only offer that cybernetically. We all send good thoughts that you find some peace and acceptance with this. It’s not easy and takes time, but trust yourself that you’ve made the right decision for her.
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overwhelmed61 Jul 29, 2018
I am in therapy and dealing with a bunch of stuff. Thanks for all the input.
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NO facility will be "perfect"
The staff is over worked, underpaid and in most cases they are short staffed.
(think about that when you pay the bill..I know not all goes to staffing but it is significant)
The staff can not "make" someone participate.
If they are negligent in care though that is different.
Ask for a meeting with the Director and explain your concerns and the fact that you have brought things to the attention to the staff and your concerns are being ignored. Now if the Podiatrist is at the facility one time a month and it is not yet time for their rounds is the problem you noticed something that can wait or is it an "emergency" that will require an immediate visit. No CNA or Nurse can trim toenails or deal with an ingrown toenail this is something that the Podiatrist has to do. (In the state where I live it is against the law for a CNA to trim toenails)
If your Mom is clean, or cleaned within a reasonable time when you bring the need for a change to the attention to the staff, if she is safe, well taken care of that is about what you would expect from any facility.
Your option would be to find a small licensed home that has a better ratio of staff to residents. I am sure the cost of that would reflect it as well.
There are websites you can check to get the ratings of a facility. You could talk to people on a tour and if you see someone leaving you could ask what their experience is. But I am sure you will get a lot of the same complaints, concerns at each place.
No place is "perfect"
Given certain times of day you will find...
Odors
people moaning
people in wheelchairs lined up around a TV or at the nurses station.
people just sitting in their rooms
people asleep in their chairs
You need to ask what the procedures are for moving people, trying to engage them, trying to get them active, ...
Depending on the physical and mental problems sometimes some of these things are impossible.
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You will need to "Copy and Paste" the URL to your Browser.  There are several article on this website about Assisted Living and what services they provide and how much it cost.  After reading several postings, I have noticed that some family members expect Assisted Living facilities to offer the same level of care as Nursing Homes--but they don't;  both facilities offer DIFFERENT LEVELS of CARE and have different amount of nursing staff and so forth.  Look at the webpages that I have listed below and also do a SEARCH of "Assisted Living Services" to just exactly what ALs provide.

I have found this website very informative about assisted living facilities:
www.assistedlivingfacilities.org/resources/choosing-an-assisted-living-facility/making-sense-of-assisted-living-ratings/
 
Here are some articles from this website:
https://www.agingcare.com/articles/assisted-living-questions-137146.htm

"Assisted Living Questions and Answers"
When it is time for a family member to move to assisted living, caregivers and family members have lots of question. We've compiled the most common questions that caregivers have about finding and transitioning into assisted living.

An assisted living facility is a type of senior housing provided for individuals who are no longer able to live independently because they need some assistance with activities of daily living.

Assisted living centers are appealing to seniors because within the range of senior housing environments they offer a relatively high level of independence. If your parent is in good health and doesn't require much assistance with everyday tasks, assisted living is a terrific option. In fact, residing in an assisted living center is similar to having a private apartment, complete with private bathroom and kitchen, but you can rest easy with the knowledge that trained staff is on hand to help your loved one when necessary. Assisted living communities might provide daily living care for bathing, dressing, toileting, grooming, and eating -- however be sure to read to the contract carefully. In some cases, "personal care" is an additional cost, or an outside home health care agency is required to perform these tasks.

"Difference Between Independent Living & Assisted Living":
https://www.agingcare.com/articles/difference-between-independent-living-and-assisted-living-168142.htm
Key Differences Between Independent Living and Assisted Living  By Anne-Marie Botek       3.9.2018

Senior care exists on a spectrum, and independent living (IL) is the least restrictive and assistive residential option. One step above IL is assisted living (AL). AL is also minimally restrictive, but as the name implies, this residential setting offers assistive services and supports. Let’s take a closer look at the differences and similarities between these two senior living options.

https://www.agingcare.com/articles/hidden-costs-assisted-living-154725.htm
"Hidden Costs of Assisted Living (Article)"
By Carol Bradley Bursack

In fact, residing in an assisted living center is similar to having a private apartment, complete with private bathroom and kitchen, but you can rest easy with the knowledge that trained staff is on hand to help your loved one when necessary.

But what about the basics of personal care: help with dressing, bathing, keeping track of prescription refills, setting up daily doses, injecting medications such as insulin, and a companion for trips to doctor appointments? Many assisted living facilities don't provide it in the "base" package. The services are add-on pricing.

https://www.caring.com/articles/how-assisted-living-facilities-determine-levels-of-care
"How Levels of Care Affect Assisted Living Cost"
By Caring.com Staff Writers
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overwhelmed61 Jul 26, 2018
Thanks for all the info.
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Usually with ALs you are still responsible for your medical care. My Moms Podiatrist visited her ever 10/12 weeks but Mom was still in the same town. I agree, the aide should have said something to the RN then the RN would check it out and call you. Dr. visits were my responsibility. If your AL has Doctors available to residents, then yes the RN had a responsibility to call in one, with ur permission.

Moms NH had doctors who would come in and I picked one. They had a dentist and an eye doctor too. But these residents were not easy to transport out of the facility.

So yes, you may be expecting too much if this facility doesn't provide this service. You will need to take Mom to a doctor.
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overwhelmed61 Jul 29, 2018
They do have a podiatrist that comes in monthly. All other doctors i have ti get her too. Its a challenge. She is completely wheelchair bound and says sitting up too long hurts.
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Assisted living is not the same as a nursing home. The residents in Assisted Living are expected to still have some independence and manage their own affairs such as letting staff know that they need to be taken to a physician, etc.

When the person gets to the point that they can no longer do those things for themselves, then they need to be moved to a nursing home.
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overwhelmed61 Jul 29, 2018
I think she would detoriate even faster in a nursing home.
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Good topic, I wouldn’t know, and good replies here. over, it sounds like that with the toe, have them spell out the process. Say that you noticed the toe, did they, ask for her to be seen then say, “So what part do you do and what part do I do?” Have them teach you how to work with them. You’re an advocate and they’ll understand that.
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overwhelmed, my mom is in assisted living.

if your mom has a problem with her toe, its probably best for her to see a dr.

then you can discuss if she needs an RX with the dr.

the assisted living where my mom is doesn't really tend to any illness.(they will help with dr. orders though, like bandaid changing/wound cleaning) 

I recently took her to dr for a skin rash on her ankle. and he prescribed some creams. so the AL will be putting that on her ankle.

does your mom have dementia? do you know why she doesn't like to participate in activities.?

my mom is super private, but she does get out for music, bingo, meals etc.
the aids will usually go to each room and do an "invite" plus its announced over the speaker system

is your mom able to walk or uses a wheelchair??. they should probably encourage her to get out, but I guess they can not force her.

when I visit my mom, if there is an activity going on - I don't stay in the room with her. I say lets GO!
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overwhelmed61 Jul 29, 2018
Pain is a big issue. Although uf she got out she might feel better.
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Just a thought. Look into a smaller board and care facility with more one on one care. I moved my mom from a nicer ALF (memory care) due to all the add ons and feeling she was not getting the attention we had been paying for (hence the add ons). As someone mentioned, they are overworked and underpaid. Staffing levels are below what we were told and turnover was getting too confusing for my mom. Her doctor recommended a smaller B&C facility. It has been the best mover ever. She has flourished and now she engages in conversations and has basically an immediate caregiver just for her. They do have less activities at these homes but the care surpasses that IMHO.
Maybe check around, check the state complaint and licensing board, and visit a few places. You will get a good idea of a nice fit and great care by these visits. Ask the residents there too. Any reputable home will not have issue with this. Also, some will even escort your loved one to appointments or the ER when you are out of town.
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overwhelmed61 Jul 29, 2018
I was afraid a smaller facility would be lesser care especially if they have turnover.

Mom also can get mean, not often, but she does. What if she manages to really piss people off?
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When my mom was in AL it was like a college dorm. Nursing office was on the first floor along with church service, dining room, activities, mail boxes. My mom went to the nursing office for morning meds and the nurse would go to the rooms for any night time meds. If my mom had any issues she would bring it to the nurses attention. There was a NP there if needed. Anything else I would have to take her.
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I moved my dad from an AL which was doing a terrible job to a SNF which did a wonderful job overall. I had issues with the SNF at times too, but overall so much better. I think the AL my dad had been in may have been OK for someone with lesser needs, but it wasn't for my dad. I had assumed when the AL said they could accept him they had done ethical due diligence and determined they really ad the right stuff. Or maybe another AL would have been OK. All these facilities are run by human beings, and some have better management than other.
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