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We questioned some of the care issues, or lack of. And the director suggested we could bring in someone. We have cameras in room so we can monitor if she is being cared for correctly. How are you to get them to do the job? Can they kick you out for this?

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Every case is different but my case was similar to yours. I was told to hire a private caregiver to look after my husband in the memory care. I was paying $15k/mon (Maryland) and now I had to pay additional $6-7k/mon on caregiver on top of that. I am not Michael Bloomberg with a super deep pocket. I decided then to bring my husband home and hired 2 caregivers for 2 shifts. Expensive still but much less than MC.

MCs and NHs are there to make money. It is a huge biz in America. Nothing they do is free. Be careful of the beautiful pictures with smiling staff and residents on the website.
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Beekee Mar 27, 2020
Good grief! $15,000 per month for memory care. Which facility? My mother is in Brooke Grove (Maryland) assisted living with memory care for $9,000 per month.
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I’m so sorry you’re going through this. It’s very stressful. I went through the same thing with my husband. I was there everyday at different times and was sick how a lot of aides treated the residents. They never yelled when I complained they weren’t getting him to eat though. I kept asking for hospice (I wanted more trained eyes on him) and they kept saying he wouldn’t qualify. Finally I just called hospice myself and they came in. That put more qualified caregivers with him and they also went with concerns to the nurses. He qualified with the Alzheimer’s. Their weight is one of the things monitored on a regular basis. Just see what their rules are and if you can live with that. Again sorry, it a horribly stressful situation.
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Judysai422 Mar 27, 2020
Good for you! A quality facility would welcome hospice. In reality, it makes their job easier. For example, Hospice gives 2 showers a week, freeing up facility staff.
My mother far prefers the hospice staff giving her showers as they allow 30 minutes as compared to ALF 10 mins. Mom no longer feels rushed, which she hates.
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Had to use a separately paid caregiver for my mom, on and off for two years. Mom's behaviors were off the charts and we were not paying for one on one care. The facility was not able to monitor mom 24\7. They have other residents they need to care for. In home caregivers would cost about 9K a month, minimum. Nursing homes start at a minimum of 10K.

Have you shopped for the next residential facility?

My mom was kicked out of memory care in spite of the privately paid caregiver that mainly kept her more engaged and out of trouble; and helped. Mom was on hospice at the time. Hospice recommended a smaller care home, caregiver/resident ratio was lower, monthly charge was less and the care was better because of the lower ratio. Mom still needed a separate outside caregiver sometimes.
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TrishM Mar 27, 2020
Iit's a shame that the state guidelines are not better, which allow them to have minimum training and staff for these units.
I was a caregiver for wheelchair and mental challenge children....if we cared for our clients the way they do we would have been fired by now .
But I guess the elderly are not protected, as one would think the law would say.
Why are you having to hirer addition staff to take care of a client that they are getting paid to do? And there advertisements says they are equipped to do, and licensed?
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My mother's memory care has periodic meetings with the health care POA and a written care plan is discussed in detail. A printed copy is given to us. If the duty or care that you expect is not on the care plan, they won't provide it. When we add additional care duties to the care plan, the monthly fee usually goes up. Presumably you have a copy of the care plan. If not, request that.
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TrishM Mar 27, 2020
We have requested the care plan.
We have request her med list.
Both of these were updated, after we had a meeting with Hospice reps and home director and nursing department.
Hospice evaluation are done once a month. If changes are needed then home is updated.
Anything you need done has to have a written order. We have a Hospice doctor assigned to our mom.
Order to have lotion put out on.
Order to have her food chop.
Order to get her toenails cut, diabetic. That service is available once a month to her.
I guess I could get an order for them to change her clothes daily...but again that would be basic care. You would think.
I cut her toenails and cleaned out black dry dead skin between her toes. I took photos of condition. Then I found out from nursing that their podiatrist come ever two months. She wasn't seen.
So my sister was last one to do anything with her feet was
Jan 5... I came from out of state feb 5 to see what my sister was coveying. Month of feb I got lack of communication from all parties above. My mom finally received a shower from me 3rd week of feb...when I was told by staff Hospice does that,,,,showing Hospice signing in at home...but again mom says no 2xs and they removed her from bathing list. My sister was last one to bath her in jan. The home of course did not know this because no one from Hospice related the info?
So who faulted is that one,,,and what I ask is how many other clients are getting the same minimum treatment.
Then we find out a few days later that the head nurse and some of their personal have been let go.
Start this all over with another facility and Hospice staff...call me crazy but got our foot in the door and expecting them to work together and communicate.
My standards are high yes, tell me if this was your parent you wouldn't expect better care.
And bringing her to one of the 5 siblings homes is not possible. Unfortunately in 2010 when I asked that of everyone they were more interested in her assets then her care.
She was put into a facility for care, safety lock ward and so she would get correct meds and they are licensed and equipped to handle these clients.
This is second facility was brought from a different state to be closer to my oldest sister. She is the one who makes sure she gets to doctor appointments and visits. AMD requires injection to eyes 4-6 weeks.
That was a major deal then and it has taken her awhile too adjust.
There are 13 clients on this floor currently. They are not full to how many units open.
Am I fighting a losing battle here?
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Oh dear.

Getting a person with dementia to agree to personal care is delicate, time-consuming work. Do the staff in this specialist memory care unit have the time and training they need for the job?

It sounds like they're falling back on the old 'respect for autonomy' get-out-of-jail-free card.

You must respect your resident's autonomy. If they don't want to wash or change their clothes, you cannot physically lay hold of them or dunk them in the tub. If they say they have washed, you cannot contradict; and it is wrong to browbeat them by, for example, showing them the dry flannel and the wrapped soap and "proving" that they haven't. We do not belittle our clients, we are not there to win arguments or even enforce norms.

But that does not mean that you may neglect the need to encourage, assist, support, motivate, and facilitate washing and changing. If one approach doesn't work, try another. If that doesn't work, try again. If they won't have a strip wash, how about washing their hands in a bowl if you bring it to them? How about a manicure? - or even, on a really good day, a mani-pedi? One good experience can lead to another - though you also need to quit while you're ahead, and not tire your client out. Clean trousers today. Clean blouse tomorrow. Next day, clean trousers AND socks? - Yay!

If staff in a memory care unit, with the luxury of seeing the same residents over a period of time and being able to build relationships on trust, are walking in, being refused, and walking out - the unit might be getting away with that in the documentation but this is not dementia care.

I should ask the director what training the staff are given. If you also go online and research expected standards and qualifications, you'll be able to judge whether the unit is fulfilling its responsibilities. Michigan Dementia Coalition publishes an excellent "Skills for Dementia Care" booklet in pdf format (I keep a copy on my computer desktop) - have a look at that and see whether you'd guess any of the staff at this unit are empowered to act in the right way.
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TrishM Mar 27, 2020
THanks
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Do they know you have cameras installed? What are you seeing? What do you want them to do that they are not doing? You could change facilities once this outbreak is over but most facilities provide similar services.
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Yes, explaining what your concerns are would help with answering your question. I thankfully had my RN daughter who told me what to complain about and what not to complain about. She also explained to me a CNAs duties. If a MC is like an AL the ratio of CNAs to residents is low.

I found I expected too much. Mom had a couple of appts. The first one was after breakfast. The AL would not allow bibs so Moms food was all down her. Change of clothes. Next time, they allowed her to lay down right before the appt. It was very hard to wake Mom up and have her "with it". Was it me or them? I was going to talk to the RN to see if making sure Mom was ready was my job when we had to transfer her to LTC. I think I would have been told that was my responsibility. CNAs have a routine. I told my daughter Mom had been without a bra a few days. (Mom was lg breasted and would get a yeast infection if skin on skin) Daughter asked me where they were, in the drawer with the socks. Thats the problem, aides go from the top down. So by the time they go for the socks, the top is already on and they have to get to the next resident. I had always matched Moms tops and slacks and put them on one hanger. So I added her bra. After that no problems.

I was a little OCD about Mom. I wanted her to match. I carried a brush and hairspray in my purse because the aides never combed her hair right. I figured she no longer had her mind, she might as well look nice.
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Were you given guidelines as to what the staff will and will not do, what they can and can not do?
If they are failing to meet their own minimum standards then that is on them.
If this person needs more care than can be provided by Memory Care staff the next step would be a LTC facility (Long Term Care or Nursing Home)
If you are asking the staff to do more than what is usual then they can ask you to provide a caregiver for your loved one. The only problem I see that would happen with this is that your caregiver would be providing all the care and that frees up facility staff to provide more care for others. And some facilities have restrictions on who you can bring in, they may want you to use a particular agency or hire from their pool of personnel.

It might be time for a Care Plan meeting so you can all come to terms on what is expected and what needs are being met and what ones are not.
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TrishM Mar 25, 2020
We are taking about her basic needs,
She can walk with a walker, needs assistance dressing. Showering, still feeds herself, and can use restroom.
Making sure she is brought down for meals( not left in bed to sleep)
She is now 95pds and 2 years ago 115. And I know he loves to eat because on visits she eats all if brought out to eat. And she eat alot when out to restaurants)
Getting her clothes changed daily( if she says no staff will not redirect and do job leave her in clothes for longest 4 days)
She has a hospice caregiver who comes two times a week to shower her and dress. They are not changing inbetween because she says my clothes are clean, no)
I can go on. Their contrat stats they are equipped and licenseing for alzehiser and demientia clients..the only thing is if a bed sort at a certain level they dicharge and tubes...
I could go on we have cameras in this room so our records are correct.
We dont want to relocate,,we want them to get their heads put of their-asses and do the job.
Director quit suggest we bring in another staff, when I mention to to that. If I didn't provided adequate care for my mom at home I would be charge with neglect and abuse of an elder person.
So does this make it different for your facility?

You know all we want to to be able to visit and enjoy what time we have left with her.
We have told the home this with meetings that have been between home and hospice.
Our mother may pass away sometime, but it's not going because someone is not doing their job.
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“Additional care” or additional behavior management?

If the level of CARE isn’t sufficient for her needs it would seem as though you should be considering a different setting with a higher level of staff/resident interaction.

If more behavior management is needed, has she been assessed for a trial of medication?

In light of the fact that you feel that you feel that monitoring her care as you do, it would seem that this setting isn’t a very good fit for her.
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TrishM Mar 27, 2020
She is on meds, Hospice is doing care plan. And with dementia clients
You know we have looked for different fit, as you would say it..
Im just going to say it
She is located at Water edge
In lake Wales, Florida you tell me if this not a good fit after you look at it...
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What were the care issues?

I ask, because when you ask 'what are we paying them to do?' - this is by no means a rhetorical question. What is in the agreement? - and where is the shortfall between agreement and delivery on the one hand, and between care needs and delivery on the other?

If the person needs more support than was anticipated in the agreed care plan, supplementary care is a reasonable suggestion. If the person is not getting the support which the unit undertook to provide, then the suggestion is almost insulting.
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