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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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Pr0f3ss0r, one night I was visiting my Mom at her long-term-care facility and we were sitting in the common area. Around 8pm I saw the nurses and aides getting the residents at one end of the hall ready for bed.

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.
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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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lealonnie1 Jan 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 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.
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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 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.
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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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Are you sure they aren’t just getting her read for bed?
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Assisted living is just that they should be assisting her when she needs it.
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.
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You don't say if your mom is in MC or not...just that she is in AL with dementia.
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
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thepianist Jan 2020
Sorry but your are wrong about persons living in memory care having fewer or weaker rights than others. They may not be as adept at exercising their independence but this doesn't give aides or anyone the right to dictate. The standard of care is PERSON-CENTERED care. Standard bedtimes and rising times and mealtimes are not person-centered. And if someone added a medication without informing the PoA, this is probably a violation of law. I would love to know the name of the place your mom is living.
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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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It's hard to believe everything a person with dementia tells you. So before you get all upset, do what you can do to get more information. Also, unfortunately the majority of people living in homes "hate" it. They want to be in their own home and most don't understand that their love one's may not have the wherewithal to help them in their homes. Just do your best to make your Mom's life as nice as possible. Perhaps, if she is able, take her for walks. Go out for tea and a snack on and on. See if you can get her interested in something....
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JoAnn29 Jan 2020
OP was there when the aide came in and told her to get ready for bed. She didn't see the OP.
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Mover her, if possible, once you verify the bedtime for everyone comment. If true, that is unbelievable.
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No! A.L does not strip residents of their rights and free will. Overstepping staff for sure.
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Hi PrO!

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
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No,
She has rights.
Talk to the horses mouth. Director!
Why waste your time here?
Research. Good Luck.
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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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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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Check the lease you or mom signed if it doesn’t say they go to bed at 8:30 pm then no she doesn’t have to go to bed. Maybe they have to go to their rooms but not to sleep. I can’t see going to sleep at 8:30 and also does mom have. A TV in her room she could watch TV in her room . It sounds Ike the place you chose just wants to make it easier on themselves and is not complying with the comfort of the residence that pay good money to rent these places. I’d watch out for other things going on if they are making people go to bed at 8:30 .. if it were me I’d be moving my mom ..
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Judysai422 Jan 2020
I totally agree. Just the way the mom was spoken to would make me move her.
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It sure sounds like the facility/aides just want to be done with patient duty as soon and they can be. Assisted Living shouldn't mean "prison." It is not OK.
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Yes, further research into this is needed. I know that in an ALF, patients have more flexibility because they have more ADL’s than in a nursing home.

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!
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Given your mom's list of medical issues, assumption is AL = MC. Our mother is in MC and from what I have observed each resident has their own "routine." Some need help and to be put to bed earlier, some later. There doesn't seem to be a strict regimen at her facility.

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?
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The place is forgetting the “living” in assisted living. You’re the advocate for your mom. Please review her meds to ensure she’s not getting anything she doesn’t need and talk with admin about the bedtime requirements and whose convenience it’s for
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You need to be discussing this with a person at higher management level than an aide. An aide is looking at this from the perspective of get them to bed and asleep and the job is much easier.
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
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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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Absolutely NOT! Under Federal Law residents in assisted living communities have rights which are guaranteed under the law. One of those rights is the Right to Choose. Every resident has a right to choose when they get up, and when they go to bed, what they wear, what they do, when they choose to take a bath as well as what type of bath they want. They can choose what activities they participate in and what they eat.

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.
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kwyattearp Jan 2020
Yes, they do have rights, the right to choose when they want to get up, go to bed, etc. But if they need assistance with getting up, going to bed, there are no guarantees that a caregiver will be available for them at their chosen times. So they are stuck waiting. In my Mom's case, she would sometimes fall forward into her closet trying to get herself dressed because the caregivers were overwhelmed getting people dressed for breakfast and stretched too thin. Mom did not want to be late to meet her friends for breakfast. So much for rights. These places always have staffing issues, and if they meet the ratio, they are excused.
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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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You would be doing your Mom a big favor by contacting the Ombudsman for your area. The Ombudsman will meet with you and also with the Administrator and is the go-between to resolve issues. We pay the Ombudsman with our tax dollars so use them. It is their job to get to the bottom of a problem.
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elaineSC Jan 2020
Just wanted to add that if you haven’t spoken to the Administrator, try that first.
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Everyone go to be at same time, less work for staff, so they can wind down as well.
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jmacleve Jan 2020
Sorry, but the staff is there to help the residents, not the other way around. I don't see why someone can't stay up and read or watch TV -- it's not like they're running the halls training for a marathon.
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Holy cow! My mom wouldn’t last a day there, but I wouldn’t have picked a place like that either. My mom is up at 3:00 AM watching tv and working a puzzle, as if she were living in her own home, which she is to some degree.

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.
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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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Yes you should be suspicious. My mother spent many months last year in rehab. Regardless of the soothsaying we give ourselves. These places must be monitored. Kudos to you for being present with your mom to identify a problem. Seek out other families and try to identify if this is a problem employee or if it’s a cultural problem at the center. We’ve experienced both. You have a right to expect your mom be treated with kindness, reverence, and respect. She is not a child. Inquire with an ombudsman in your area. They may be aware if this is a cultural problem. These places don’t pay much at all, but the residents do pay much even if on Medicaid. They should be treated with respect regardless. I never felt so helpless as when my mother was in a rehab here in Memphis last year.

again, thank you for being present in your moms care.
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