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?
Then as the nurses and aides were half way down the hall, some of the residents who were already in bed started to wander the walls. The nurses and aides once again put those residents back into their rooms.
Before the Staff had finished at the other end of the hall, it was like herding cats, trying to get those back to their rooms for the 5th or 10th time. I overhead one nurse say "Lord, give me strength".
So it is understandable why residents are turned in early. At my Dad's assisted living/memory care, he was in bed early but he could watch as much TV as he wanted, as long as the sound wasn't too loud.
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.
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
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?
Work with the SW and DON on getting the staff retrained. If they don't please contact the ombudsman.
If she does not want to go to bed at 8:30 she shouldn't have to.
The problem is is she falls asleep in a chair it is difficult to rouse someone and help them get ready.
Also there may be a shift change a bit after and reduced staff would have a more difficult time getting everyone ready and into bed.
Possibly helping her get ready for bed but not "making" her go to bed until she wishes might be an option.
Many medications are given in the evening and some do make people sleepy. If a sleeping pill is ordered then it will be given. If your mom's medications do not include a sleeping pill then she should not be given one. You can ask to see what medications are being given. Each medication should be identifiable and each pill given must be by a doctor order.
And yes if she wishes to watch the 11 pm news then she should be able to do so. (as long as the volume does not disrupt others)
This might be worth a discussion at the next meeting you have with the administration.
MC is different than standard AL..where people are more able bodied and don't need to be prompted. They can pretty much do what their heart desires, though there may be quiet hours. In MC, there is often a standard bed time, though it is within your mom's rights to have reasonable adjustments to the norm. This would be part of her care plan.
Also that aide was rude and should be reported. No one should be talked to that way. The comment about the pills was likely just an excuse. However I would review your mom's meds when you review her care plan. There's an outside chance the staff had a prescription put in to a physician without your knowledge. best wishes
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.
I’m not offering any advice here but, I would very much appreciate what the AL folks tell you if you meet w/them about these issues. So, if you don’t mind following up w/an update, that’d be great!
Thanks, in advance, for sharing.
Lynn
She has rights.
Talk to the horses mouth. Director!
Why waste your time here?
Research. Good Luck.
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.'
At my mother’s Nursing Home, they start getting residents settled for the night around 5:30 for those who want to go to bed early (and there are many!). Wake up time is super early in a NH. The rest, like my mother go to bed around 8:00 to 9:00. Yes, they can watch TV as late as they like or even not go to bed at all, though staying in their room is encouraged. I have been there until late at night many times, and I usually see one of the residents watching TV in the main lounge. She is 103 years old, and everyone dotes on her. One night I asked why she wasn’t in bed like everyone else. The nurse told me that she refuses to go to bed until midnight most evenings and tells them that if they try to put her to bed before then, she will get out of bed by herself. They let her do what she wants!
At one time staff told me that the residents, despite dementia, still have rights. They have the right to refuse meds and medical treatment. Obviously most of these are necessary, so they work on coaxing the resident to comply. With skill, this can be accomplished.
It sounds like this place is oriented to doing what is best for staff, not the residents. If working with "higher ups" doesn't resolve any issues and concerns you have, I would consider finding another place for her. Moving is hard on those with dementia, so this should be last resort, but given the statement by the aide and then the backpedaling, I would also have concerns!
I have also seen some residents eating breakfast at almost lunch time, others eating at random times. For some it is difficult to stick to a "routine." However this is how it should be. It makes everything more difficult for the staff on one level, but trying to force someone to comply to strict routines is going to be more difficult. The comment about being tired after their evening meds IS a bit disturbing. If nothing on your mother's approved list is any kind of sleep aid or anti-anxiety med, I would get all her info, both from the facility and her doc.
When mom first moved in, they asked the doc for anti-anxiety, to help with the transition. I was aware of this because the bill was given to me. It was not renewed. Sometime later, mom got a UTI and was off the rails. We had to get this med again, to calm her, but ONLY while she was treated. It did generally result in her retiring around 9pm, but they didn't make her go. At some point that doc refused to renew it, citing it as a fall risk. It was a running argument for a bit because having her in that state was more dangerous than a small fall risk! We (staff and I) wanted it only "as needed", because she has a tendency to get these UTIs during non-office hours, like a weekend! Who wants to deal with a raving person for days?
You should also be aware of each and every pill your mother is getting. Others in the facility do get sleeping aids or meds that make them sleepy, so they probably do drift off early in the evening. If you're mom is not on a med like that, she should be able to watch TV all night long if she wants to...unless...she is sharing a room with someone else. Then she needs some sort of privacy screen to block the TV light and headset to keep noise out of the room
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. "
You said your mom has dementia that does not mean she loses her rights! If your mom wants to stay up until 11 pm that is her right. If she has been declared incompetent then have her power of attorney tell the staff that she is to be kept up until 10 pm.
I would suggest you contact your local Long-term Care Ombudsman Office, they are the Federally mandated advocates for residents in long-term care communities which includes assisted living communities. There is no charge for the Ombudsman to help you resolve this issue.
If you are the power of attorney ask for a copy of her medication list. You have a right to see this as poa. You can also tell the staff that they are to notify you before any new medication is given to your mom. As power of attorney you ask for copies of her medical record anytime you need to.
Note: The home can charge you a "reasonable rate" for the records. This rate is regulated under the regulations, the Ombudsman can tell you what the current rate for medical records is, it changes from year to year.
You need to learn what your mom's rights are, the Ombudsman can give you a list. Another right your mom has under Federal Law is the Right to Refuse. She can refuse anything from medication, therapy, diet, activities, doctor's orders or any treatment. Families need to learn what their loved ones rights are so they can become effective advocates for them.
I’m really glad you brought this up though. If I ever have to move mom in the future, I will know to bring this issue up.
again, thank you for being present in your moms care.