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My mother is in an assisted living facility. She has dementia and hates the place. She tells me every time I visit her that the staff is mean and make her do things. Recently, I asked her to tell me what "they" make her do. Just then an aide opened her room door a little and gruffly said, "It's time to get to bed. Get your pajamas on!" The aide did not see me. When Mom did not answer, the aide opened the door more and saw me. She hurried to say, "What I meant was that I can help you get ready for bed now. If that is what you want?" We both told her that later would be better. After the aide closed the door and walked away. My mother whispered, "That is what I go through every night." It was 7:45 PM. Mom explained that they make her be in bed by 8:30 PM.


This bothered me. So, I went to talk to the aide. I asked her if residents could stay up to 10 PM? She said, "Oh, no! Everyone is in bed by 8:30." I asked her why? She said, "Well after the patients have their pills, they are tired." I told her that no one should be making my Mother do anything. She is able to understand and comply with rules if they are reasonable and explained to her. But, why is it reasonable to force everyone to go to bed at the same time? Not everyone needs the same amount of sleep.


My mother has always watched the 11PM news before going to bed. Now she does not dare to do that. Should I feel that my mother's rights are being violated? Is a set bedtime the norm at assisted living facilities? Should I be suspicious of the "pills" the patients get before bedtime? I never approved a sleeping pill for her. It is not on her medication list. What rights does my mother have as a resident in an assisted living facility?

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An Assisted Living is a residence. Your Mom is renting her apt/unit. Aides are there to assist. The one my Mom was in did get residents "ready" at a certain time. Getting them in their rooms and dressed for bed but not "in" bed. They can stay up and watch TV, read, go to the common area to sit in their PJs. The aides should have an idea when a resident is usually ready for bed. At that time they go back and help them get into bed. If Mom is paying to be helped to get dressed, that aide needs to do it. I think u have a lazy aide. RN, her boss, and is probably leaving by dinner. You know the saying "when the cat is away the mice will play"

Yes, I would question with the RN why Mom is getting a pill before bedtime. There has to be a prescription from a doctor for it. If you find it is a sleeping pill and she has never had one before, I would question it. I would also bring up the incident with the Administrator. Your Mom does have the right to get up when she wants, eat when she wants, and sleep when she wants. Yes there are meal times but she doesn't have to go. Just not sure if they have to feed her at any other time. She has the right to have her meals brought to her. My Mom had a kitchenette with a small fridge and microwave so she could cook if she wanted.

If you get no satisfaction, I would start looking for another AL.

By the way, a CNA cannot dispense medication unless they have training to be a Medtech. Otherwise an LPN or RN gives meds. If u find that a CNA is giving these pills, I would report it to the state.
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Reply to JoAnn29
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lealonnie1 Jan 22, 2020
Not all ALFs bring meals to the residents rooms for a variety of reasons. Memory Care units do not have cooking supplies or microwaves/fridges at all. Memory Care sectors of ALFs do not function the same way regular ALFs do. For instance, my mother is brought out to the activity room in the morning where she stays until dinner time unless she's not feeling well. She eats there too. They don't want the residents holed up in their rooms all day and isolating, etc. The rules are firmer in a Memory Care environment due to dementia being SO tough to deal with. The stronger the routine, the better the resident thrives
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My mother lives in Memory Care too. They get her ready for bed around 8:15 pm ...into her nightgown and washed up, etc, but she can stay up as late as she wants. You should know what meds your mom takes, as I do mine. The aide may have been speaking in generalities to you, saying that after the residents get their meds, they're tired....not necessarily that your mom gets meds etc.

With dementia, lots of residents tend to sundown and worsen at night.....they wander and roam the halls, knocking on other residents doors and things like that. The caregivers do try to get the residents into their rooms by a certain time to minimize the chaos. But your mom has rights, of course, and shouldn't be prevented from staying up as late as she'd like....even if the tv is loud. They're ALL loud!! Lol

Anyway, make sure you have regular care conferences with the staff and admin so you can express your concerns and get questions answered. You can call the nurse or the Exec Director any time, as I do, to chat or to ask for changes or whatever you'd like. Make your wishes known.......its always a good thing to do. Get a list of her meds, too, and be sure to ask for updates and calls from the doctor after a visit. That helps a lot.

The other thing to do is to fact check what mom tells you. With dementia, they tend to have LOTS of stories to share, many of which are fabricated. I've listened to my mother tell me about her friends boyfriend who comes to visit naked......I used to get my stomach in a knot before I realized the need to sort the bull from the crap. Obviously, there is truth being told also.....you just have to figure out when! 🤣

Best of luck
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Riverdale Jan 23, 2020
A perfect reply. I can understand the time frame for helping a resident get dressed for bed but it is very wrong to have a bed time insisted upon and that issue should certainly be brought up. My mother in her present AL facility completely keeps her own sleeping times and is allowed to do so. I have even heard that some residents have the TV on late which I feel is a bit wrong if the volume is up so high that it keeps others awake. I would also be concerned if all residents are given the same sleep medication. They are not in psych wards.
(2)
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Contact the Ombudsman and voice your concerns NOW. Patients have rights! How outrageous that your mother was spoken to in such a tone and then when the nurse/staffer saw you, she changed her voice!
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Reply to Llamalover47
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One of the fundamental rights that a patient has is the ability to keep their own wake/sleep schedule. It was in the list of "patient's rights" in mom's NH.

Work with the SW and DON on getting the staff retrained. If they don't please contact the ombudsman.
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Reply to BarbBrooklyn
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No, this is NOT okay. This is not person-centered at all, and even CMS uses this as the standard of care to be provided. The staff should be grateful that your mom still has an interest in the news. I wonder if the director of the facility and the director of nursing know that aides are getting everyone to bed early--no doubt to lighten their workload, which may be obscenely heavy. If this doesn't change immediately, call your county ombudsman.

If the aides are ignoring your mom's wishes to stay up for the news, they may indeed be doing other things your mother experiences as 'mean.'
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Reply to thepianist
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This practice was cause for great distress and annoyance for my mom when she was in ALF. She was a fall risk, so I understand they wanted to help her get ready before the staff thinned out for the evening, but she wanted to watch TV in her living room as her bedroom TV was at an awkward angle and she could not see it. It made for a very long night for one who slept but a couple of hours a night. The staff denied making her get into bed, but she would call me crying from bed. The staff and director denied her accusations and assured me that all she had to do was request to be brought down to the common room and she could watch TV in comfort and safety as late as she wanted. So I started requesting that action from the caregivers, it never happened, as they were always understaffed and experiencing employee turnover. I recommend you position yourself in the bathroom in your Moms apartment during caregiver visits, you may be as appalled as I was at the crappy way some of them talk to their clients. Sadly, the nice ones always moved on to better paying jobs.
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Reply to kwyattearp
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Those who need assistance getting dressed are going to have to be changed on a schedule because it takes staff time to get to everyone. Ask if it is possible that she be farther down the list, but recognize that it might be impractical if this is a large facility and that means staff would have to back track.

Unless she is in a shared room I can't see any reason that she can't watch the news or do whatever else she wants in her pj's, how exactly are they enforcing the 8:30 bedtime?

As medical proxy/POA you should have complete access to her medication charts and they can not give her anything not on the list, did she not take any medications prior to living in AL? Might these not just be her usual medications?
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thepianist Jan 26, 2020
The staff schedule should not dictate care quality. We cannot accept this, we must demand, yes demand, adequate staffing so that the needs and preferences of the residents come first. Most care communities today say this in their lofty mission statements. They just don't walk the talk.
(5)
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Yes - her rights ARE being violated.

The only reason I can think of for this early bedtime is to give the staff time-off of their duties to the residents.

AND, you heard her - she wasn't respectful of your mother. Speak to someone in authority and threaten legal actions if your mother isn't apologized to immediately!

Elder attorney time.
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Reply to RayLinStephens
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As a retired State surveyor, I can tell you this is not normal and should be investigated. Call your ombudsman or call the medicare complaint line. They will send in a surveyor to investigate the complaint. Residents have rights and bedtime choice is one of them for sure.
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Reply to mudslidemary
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It depends on the facility but this doesn't sound good at all to me. I think it is very reasonable that aids who are on duty say until 11, have the duty to do "bedtime care" but that can be anything from helping with care to doing nothing at all. Generally in Assisted living they are there to assist in your normal adl (activity daily living) if you need it. The person "coming on " shift at 11 may be staffed less well and the expectation may be that the 3-11 person has everyone ready for bed whatever that means.
I can certainly understand that no one be in communal areas (TV room, Dining-game room) after a certain hour and that is the case where my bro is. A loud TV for a hard of hearing person would disturb the person whose room is outside the TV-Living Room, and loud game playing and raised voices would be hard for those outside the dining-game room. But as to telling a resident in her own room what time she must be in bed, seems a major no no to me. It may be a need in memory care, but cannot imagine it in Assisted Living. Don't know what the choices are but may be a good time to discuss with the supervisoral staff, and look at other facilities if they exist in your area.
There is also a way to approach people, and her approach was NOT good. And she got caught. The approach should be "I go off shift in another hour, Mrs. Breck; would you like help getting ready for bed, or into your night clothes, or can you do that on your own when ready.
ANY good place should have a plan of care. For instance my bro resents people entering without knocking; that is on his care plan. He also wants to be in his room when it is cleaned. That is on his care plan. For your Mom the care plan should say "Enjoys watching the 11 p.m. news and is not ready to get ready for bed until it is over. "
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Reply to AlvaDeer
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