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It’s 5 Star. She does have dementia. She has episodes of anger against the employees there a lot. How do you know for sure that what there saying might be true or not? She complains there making her a bed patient. Not giving her therapy. She wants a phone and we know she can’t really use one. She’s wheelchair bound but thinks she can get on toilet by herself. She can’t. They have to use a lift to get her up and down and put her on bed pan for toiletries needs. She’s getting violent at times. Cussing and saying she wants her money from her now deceased husband. He died a year ago . She can’t see very well, and had hip surgery 20 years ago, and now has knee problems which they say she has bone in bone and is not a good surgery prospect . She has had all the shots in her knee she can have. She forgets everything you tell her. But she knows everyone. She's on Medicaid. She doesn’t like being put to bed at 6.30. Which we don’t know if she is all the time or not? She forgets. Her son, my husband always gets her angery when he visits cause she wants to go to a different nursing home. She thinks she will get better care. He says no you're staying here. She says why?? We say because this is a good place where you wanted to come. My husband is a disabled vet himself and we cannot take care of her. Sorry so long . I guess the main question is how do you know for sure your loved one is getting treated properly?

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Heather10--Thanks for your comment. However, my mother is completely incapable of using the call button, so I happened to use it. It might have been this way for a long time but without its being used it wouldn't be obvious. Most of the time I've simply gone to the nurses' station when she needed help, but this time I didn't want to "pester" them so I used the button. Some of the staff will respond very promptly if I ask for anything because my mother is pleasant and very easy to get along with, so they like her. I will bring this up when we have a care meeting (I don't think there has been one for at least 6 months, so it's about time for one). I don't believe legal action at this point is warranted unless they resist taking care of this. I'll suggest a program for checking the call buttons. By the way, I'm not sure how someone could disconnect it without actually going into the wall and cutting wires or whatever, although I suppose it's possible and could be passed off as "maintenance" to avoid suspicion. It's possible the bulb in the hallway simply burnt out, but I'm not sure why the light at the nurses' panel didn't work.
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Sounds like most of the problem is your MIL!!! If it's 5 star pretty much it. Maybe some of this needs to be addressed by her doctor---maybe her dementia medicine needs changed!!It's going to take time for her to get used to being in there!!Like I always tell everybody nursing homes are hard on the patients (especially if they're memory care), and it's hard on the families, and the nursing home staff!!! Nursing homes have pretty much the same rules--patients can't just do whatever they want they have to go by have to go by the rules (basically). Sounds like she hasn't been in there long! They have a lot of trouble with memory patients--they usually have a family meeting when ever to discuss issues with them and the patient. They can't just spend all of their time with just one patient. You just have to visit and get "a feel" for the situation--maybe ask others that know what's going on! Sounds like most of it is she just doesn't remember. Maybe you could get some advice from her doctor or the nursing home on how to deal with her. Good luck and may god be with your family.
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In some nursing homes, they get the person out of bed at 7:00 A. M. So if the person is going to bed at 6:30 P. M. that's an almost 12-hour day. I suspect that the patient may be sleeping part of the day when they're up; that's not uncommon. Most nursing homes have meetings with the patient and their family members. Are you attending?
Not every facility is reputable. My late mother's was not. She was told she was too well to stay there. WRONG ANSWER! Less than 48 hours later, she suffered a stroke there. She did not live.
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The best way to tell if she’s getting good care is to go there daily at different times. In our experience, the hands on staff is overworked and underpaid. Some were great. Others were horrible. My MIL didn’t get baths for 8 days at a time, twice, because the shower tech was too busy (or lazy). She actually said that they had run out of towels. I complained, told them I’d bring my own towels, and the front office said there were plenty of towels. Being put to bed early is an easy way to lighten the staff’s workload. I would hate being stuck in bed for 12 hours every day. There were people in my MIL NH who were forced to wet their diapers because the staff wouldn’t answer the call bell. She was encouraged to do that, which was humiliating for her. Bottom line: go daily, don’t believe everything you’re told without you your own verification, and listen to your loved one.
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Jacobsonbob:

It's best to address this issue of the call button, promptly. Going forward suggest to the facility director that all the workers check it frequently to ensure it is operating.

This button is a safety net.

I think there are a lot of workers in these homes who do care, and they engender respect from family members because they respect their jobs, respect themselves, take their job seriously and act respectfully to the patients. They new what the pay was when they took the job. But still carry out their duties responsibly.

There are unfortunately, a lot of terrible workers in these facilities.

The good ones likely see their job, no matter the pay, as a calling, similar to a pastor, who receives very little pay, but earns mega respect from his congregation.

With that said, It is not unheard of that a lackadaisical worker on duty disconnected it so they would not have to respond too often because this button is needed and should be checked periodically to ensure it functions.

You should talk to an attorney because that fact that this button does not function and has not been checked may be considered negligence on the part of the facility.

If you win this case, the facility will have to cough up your legal fees.
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I agree with what Isthisreallyreal said. My dad is generally ok unless I’m there. In fact the last 3 times I went I seemed to remind him that he was old, no more control and the source of his unhappiness because I "put" him there. He became so verbally abusive that I took a hiatus and haven’t been for two months. I felt my presence was making his ability to adjust worse. Of course he complained about everything and hated it etc. I stay in touch with the care coordinator and DON and his psychologist. We have a care conference if needed.
Your husband must use therapeutic fibs with his mom. If he can say "I’ll look into it" about her wanting to move that will settle her. Say it as often as needed. I liked when I heard Teepa Snow say they have "brain failure"....this really is a typical pattern with dementia. And if they were complainers before dementia you can bet they will be worse with dementia. Sorry to say this. It’s just hard and there’s not a lot you can do to change their minds.
Do look into medications if that hasn’t been done.
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One thing I discovered in my mother's NH is that when I pressed the call button to get her some help, I discovered that the light in the hallway didn't go on, and the light on the panel at the nurses' station also did not go on. They suggested trying the other call button in the room (currently there's no roommate), and that didn't work either (only the small light where the buttons' cords are attached to the wall goes on). I mention this because one may believe the staff to be unresponsive when the real problem is that the "message" isn't actually getting to them.
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Grandmas suggestion about a camera made me think of something. My mom is still living in her home so I'm not sure if the NH will allow this or not but when she was last in the hospital with heart issues we set up an Amazon Echo Show in her room. We have tried Face Time with her but since her stroke she just can't answer the FT call easily and reliably (doesn't help that they keep changing the process), the Show allows us (people given the permission) to "drop in" like popping in for a visit in person. It was great in the hospital because it enabled me to be present from 300 miles away and my brother who lives closer to leave without fearing missing a doctor visit or something important since she isn't able to communicate well under stress or remember everything she is told if she hears them. It also seemed to be a great comfort to my mom who really liked having one of us there with her even if it was by video for lack of a better word. For several nights while I was preparing to make the drive to CT I stayed with her on the Show, not necessarily talking but just company like it would have been if I were there physically but she wasn't as concerned about my comfort or "putting me out" by being there in person. Lol, I remember one night they decided to move her to a different room, my brother had left for the night and I was hanging out with Mom on the Show, I was talking them through how to move me (the Show) which they did carefully setting me back up in the new room and adjusting things so I had a good view of Mom in her bed and she could see me as well. The staff including the doctors that came around each day seemed to really like it as well because it gave them someone who could answer questions and take in info readily available. My brother and I were able to check in to see if she was awake yet each morning too before ordering her breakfast and heading up to the hospital, the nurse or PCA would let us know if the doctors were even on the floor yet and when they were expected so we didn't rush up for nothing but we also had the back up of being there by video too so we never missed rounds which is really the key time for getting any info when you have someone in the hospital, I mean other than the nurse when you have a good one of course. I'm wondering if maybe one of these Echo Shows might help your situation Deej62 not so much to check up on the staff and how they are treating her, though it certainly works for that as well but maybe having family "drop in" often would give her the sense that you are around more and she isn't alone with these strangers who aren't treating her well. It might give you the ability to converse knowledgeably about things that happened during the day as a gentle reminder before she gets set on how negative it was or make the suggestion she might be tired and want to get ready for bed (or the person visiting with her does) when it's time, the problem may be that anytime feels early to her when someone from the NH is saying it's time to get ready for bed, you know that reverse psychology thing.

Anyway once out of the hospital we set the Show up at home and have since gotten a second one for the kitchen because everyone was liking the ability to drop in and see each other so much. Mom really like it too and for us it gives us the ability to check in on her visually if we can't get in touch with her to check and see if everything is ok. I have popped in and seen that she is napping on several occasions or found her asleep and used my voice to wake her up because she was over due for meds or needed to get ready for an appointment or something and the phone ringing wasn't waking her up. Sometimes it takes several modes because she's deaf in one ear and she is sleeping on her good one (which only has about 50%). I'm way off on a tangent, sorry. Maybe check out the Show set up and see if that might help you out, it might just be too foreign for her to get comfortable with too but my guess is it would be more easily received and acceptable to a NH then a security camera but I may be wrong about that.
Good luck, I know nothing about this is easy.
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If the money, time and expertise that is currently devoted to overseeing and regulating the work of the care sector were diverted to the direct delivery of care, what would the impact be?

It's an idle question, of course. And I am in favour of advocating for residents, and in favour of continuously improving care standards, also of course.

But I personally feel that if there were one single cornerstone issue - it's a hugely complex area, multiple factors at large, but if there *were* - it is that we keep pretending that the quality of care we want for the number of people who will need it is attainable, let alone affordable, in the current model of Western society. It just isn't.

How much would a care home have to pay you to do the job of a CNA?
What training would you be willing to undertake?
What status and recognition would you deserve?
What minimum standards of accommodation would you impose?
What entitlements would you grant to people over, say, 80?
How many people over 80 will there be by 2025?
How much will this cost?
Who's paying?

Suppose you were the Wrath of God and you could magically appear in every nursing home in your state and go through the records of every staff member. You immediately fire all those who don't meet the minimum requirements, while your colleague, the Scourge of Satan say, lassoes those without the correct residency and work permits. And what happens at dinner time that evening? Who'll be assisting the residents? You?

Or, let's take a more strategic approach. We know we will need tens of thousands of trained, qualified, screened workers in five years' time. So we go into schools and colleges and say "want a physically demanding minimum wage job with almost negative social status that requires exceptional soft skills, a genuine vocation, and considerable practical competence? What do you mean, NO???"

It is not just a question of money, though it is going to cost us whether we solve the problems or not.

It is a question of value. How do we recognise the *value* of this work, which we do not want to do, which we do not respect, which we do not take seriously as a career? We need a great many people of high personal calibre to *choose* this vocation. Who are they, how do we reach them, how do we change what's on offer to them?
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My personal experience has been that whatever makes my dad unhappy or displeased him is how it is, all the time.

From I only ever get fed cold cereal and cold sandwiches that have 1 small piece of meat and a single slice of cheese, that's all they ever feed us, regardless that 5 minutes ago when I picked him up I could smell the bacon from breakfast, ask pointedly, did you have bacon and eggs for breakfast, yes, I did. Then the above. I think that he uses those things to try and make me believe that he is uncared for and miserable. It used to keep me up at night, now I understand that nothing is ever going to stick in his brain unless he can complain about it. He makes me think of the saying, misery loves company.

Some seniors will not face that their youth is long gone and this keeps them unhappy and complaining.

The advise to stop in at different times is a good one, I used it to find out for myself the realities and I found that he is quite happy, unless I'm present😯.

May you find the truth and I pray she is being taken care of.
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I second all of MInstrel's post.

It is very easy for the staff to suddenly become attentive and seemingly kind and caring when visitors are around.

A hidden camera is the only way to truly know what is going on, when you are not there. Hide it in a place and at an angle that does not invade another patients privacy.

Contact an elder care attorney before installing the camera.

The fact is that most people working at nursing homes earn very little in wages.

Also the homes are desperate for workers, so they often hire without looking too deeply into backgrounds.

In addition, there is minimal training required for the support staff (typically only a H.S diploma and certificate. The cert. is acquired with minimal training

Worse. there are six states that do not require background checks for such staff or nurses or CNAs.
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They are called ombudsmans. Not sure of the spelling. They come in periodically to check if patients are getting the proper care and will address any concerns the patient has and will evaluate her care. I always saw them come in to my NH (I worked there) but I was never sure what organization they came from but I just knew that in our State it was required. I would start asking the NH if they had such a person and if they didn't them I would start calling your local government offices to find out how your relatives claims can be examined.
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I believe that most problems in nursing homes stem from the fact that staffing is inadequate to attend to the needs of residents, especially when the person is living with dementia. Long term care homes do meet the federal and state requirements for the number of staff on duty, but these requirements are woefully inadequate. We who have family members in these homes need to advocate for good care, need to lobby our representatives to do something about the regulations. We start by documenting the deficiencies we see in care. Those of us who have family members living in nursing homes have been relieved (if that's the right word) of caring 24/7 for someone with great needs. We now need to give some of our time to advocating for those we love.
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FACT SHEET from The Consumer Voice website:
HOW TO SOLVE PROBLEMS IN A NURSING HOME
Despite efforts by facility staff and administration, you may sometimes have trouble getting the quality care you need in a nursing home. If so, there are steps you can take to solve such problems. Below are some tips and resources to help you in these situations.
Communication Tips
• Ask open-ended questions
These are questions that cannot be answered with “yes” or “no.” These questions build rapport and help you get more information.
• Listen
Restate in your own words what someone has said. It shows you are truly listening and trying to understand the other person.
• Say “we” whenever possible
By saying “we,” this sends a message that you want to work with the facility to ensure quality care.
• Write down any problems or incidents that occur
Be sure to include the date, time, person(s) involvement and what action(s) were taken following the incident.
Steps You Can Take to Solve a Problem
Within the facility
• Consider asking a family member, friend or staff person you respect for help in resolving your issue.
• Speak with the staff person you were told to contact with any questions or concerns. If you do not know who that person is, start by talking with the facility social worker, or ask who the person is to contact.
• Talk to the staff person involved in the
issue. If this does not resolve the problem, go to someone with more responsibility. Speak to:
 A supervisor
 The administrator of the facility  The person to whom the
administrator reports
• Use the facility’s grievance policy.
 Submit a written description of your problem or complaint to the facility. Include information about who is involved, what is happening, and when and where it is happening. Pull from what you wrote down about problems (see “Communication Tips”).
 Keep a copy for your records. • Ask for a care plan meeting.
• Include family, friends and/or others who will advocate on your behalf.
• Be sure that the person who can fix the problem is at that meeting.
• Take the concern to the resident or family council
• Resident or family councils help resolve complaints before the initial problem becomes more serious and tensions arise between residents, family and administration. If a council exists at your facility, ask a staff member to connect you with the council president.

Outside the facility
• Long-Term Care Ombudsman Program
Ombudsmen work to resolve complaints on behalf of long-term care residents; they can answer questions, give suggestions, offer assistance and
support, or address issues you may have.
• State Licensing and Certification Agency
In every state this agency
monitors or regulates licensed nursing homes. You can work to get your problem corrected by filing a complaint.
• Citizen Advocacy Group
Citizen Advocacy Groups are concerned citizens who advocate on behalf of quality long-term services and supports in their locality, state or region.
To locate the State Ombudsman, Program representative, State Licensing and Certification Agency, or Citizen Advocacy Group in your state, theconsumervoice.org/get_help
No matter what, be persistent and don’t give up!
Additional Resources
• For more information on how to get quality care in a nursing home, refer to Nursing Homes: Getting Good Care There at theconsumervoice.org/ product/nursing-homes-getting-good- care-there-hard-copy-book
• For more in-depth information on these and other related topics, see the Piecing Together Quality Long-Term Care Guide produced by the Consumer Voice theconsumervoice.org/product/ piecing-together-quality-long-term-care- a-consumers-guide-to-choices-and- advocacy.
For more information and resources on getting quality care go to, theconsumervoice.org
National Consumer Voice for Quality Long-Term Care (formerly NCCNHR) is a nonprofit organization founded in 1975 by Elma L. Holder to protect the rights, safety and dignity of American’s long-term care residents.
©2018 The Consumer Voice for Quality Long-Term Care
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Observe her situation when you visit. Is she clean? Is her room clean? Is she up and moving around? Do the nursing home personnel attend to her and interact with her? Answer those questions for yourself and trust your gut as to whether you feel she is being treated properly.

Complaining about terrible treatment is common with our elderly parents/in-laws. My mother raised holy hell about how she was being treated at her first assisted living facility. So, we moved her to a better one nearer our home, with all the amenities she wanted but didn't have at her first place. So what does she do now? Complain about how much better her first place was than her current assisted living facility.

Bluntly put, our elderly mothers complain to high heaven when they hit this stage of life; they make our lives miserable; and somehow we have to dig deep and love them through this final stage of life. Here's what I do. I talk to the living facility personnel. I get to know them. I check mother's room for cleanliness. If I am convinced that she is being fed, cared for, kept clean, clothes washed, and is being given proper attention, I have to accept that we are doing all we can and that she's never going to be happy until she goes to meet Jesus.
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I tell by her general weight (she is tiny), if she’s groomed, if she greets and smiles at others (staff & fellow residents) and if we’re out she’ll announce she’ll be late for dinner so she better head home. (Not her home she built in 1979 but the ‘home’.

As to things she says, she’s sometimes thirteen years old and it’s thanksgiving and her entire extended family is there. Other times she is angry and combative but not often. I ‘feel’ what condition her mind is in.

Look for suspicious neglect or inexplicable bruises. Unless she’s fallen or something that’s a mishap.

If you wonder hang around with her A LOT. You’ll see.
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Dealing with agitation and anxiety are a priority.  And many of the things you mentioned can be directly related to both.
As far as the early bed time that can easily be checked.
Several responses mention therapy but you don't in your question. Is she getting therapy? If so if there are any pain medications she is taking is it possible that they can medicate her about 30 minutes prior to a therapy session so it will minimize some of the pain she may have. Also at this point is physical therapy doing anything to benefit her?  If not why continue?
As to other aspects of what is going on. Check your state laws and the rules at the facility where she is. It may be possible to place a camera in her room so you can observe her. Some state laws allow this, some may not, some facilities may allow this others not. If she is in a shared room it may be more difficult.
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Just to add to the above cautionary tale...you know what DID help? Getting mom evaluated by a geriatric psychiatrist. She was already on one antidepressant, which had been started just after her stroke. I believe once she was diagnosed with dementia, they upped the dosage and eventually added a second antidepressant to the mix, along with a low dose of an antianxiety med.

Mom was not doped up. She became calm. Not agitated and not set off by any little thing. She still had delusions that there were floods and that there was a union taking over, but she was calm when reporting all the terrible things that were happening.
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Minstrel, there is much truth to what you say.......but--
There are some folks ( and of course this includes some people with dementia) who can always find fault with their living situation. They would be unhappy living with their child ( I'm bored, I'm lonely, I don't like your cooking) and they are unhappy in care centers ( I don't like the people here, I don't like the activities, no one pays me any attention).

As children of adults with dementia, it's important to find out what is actually happening and to separate fact from fiction.

I clearly recall sitting with my mom in her rehab center, where she said the aides were having sex in her bathroom, that she was required to pay for any help and that they were always transporting dead bodies around the facility. I was very concerned and spent the day. With a nurse sitting in the room, who had just given my mom her afternoon pills, my mom said testily " I have to manage my own meds here, as you can see". I sputtered a bit and pointed out that she'd just been administered her meds by a kind and caring nurse. Mom arched her eyebrows at me, gave me a "significant " look and pointed to her water pitcher.

I have NO idea what my mother was thinking. Clearly, in her mind, she wasn't being cared for. No amount of extra staff made a difference. No amount of reassurance did either. Dementia sucks.
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The five star rating that CMS gives to nursing homes means so little it makes me want to cry. I'll go out on a limb and say that no nursing hare is providing the care needed by persons with dementia, because they simply don't have the staff. They may mean well but look at how many aides are on duty to care for residents with all the needs of a frail elderly person with dementia and other medical problems. Nursing homes will tell you they meet the Medicare and State requirements for staffing--and they do, because these standards are so low, thanks to lobbying efforts of owners of LTC homes. I don't have a quick solution but I beg every family member to notice what is going on when you visit these homes and lobby your legislators to do whatever it takes to make these homes places where residents feel secure, cared for, happy.
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How do you know she is being treated properly?

Well, let's start with the kind of grievance she's raising.

Use of a phone.
Early bed time (?).
Therapies not taking place (really? Sure? Sure she isn't saying 'not now'?)
Husband not handing over the money.
Being stuck in her wheelchair.

She is angry and annoyed at all of these things; but you know very well that the reasons behind them are not anyone's doing. They are part of the rough deal that old age is handing her.

If the staff were unkind or abusive.... If your MIL were somehow fading, in unexplained pain, withdrawn, fearful, over-sedated... THEN you might worry. The fact that she is so vocal on such a variety of subjects, all of which you know the background to, kind of proves that she doesn't have anything more sinister to worry about. But no harm in checking. Pop in to help with her next PT session. Have lunch with her one day. It doesn't hurt anyone for there to be extra eyes on her.

Just in case your husband doesn't already know this: this better NH she's so keen on. You can be sure as you're born that if he were to move her there, by sunset she'd be demanding to go back to the nice NH he just "forced" her to leave.
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She has Dementia. Everything you wrote are signs of Dementia. To me it's sounds like she is bedridden. Agree, and it's hard I know, your husband has to stop arguing. With Dementia little white lies are good. You should be getting care meetings every so often. If you haven't, request one. Tell them you want more than 15 because you have questions. Good for ur husband he sticks by his guns. Until her Dementia gets in the last stages, she'll always want to get out. Keep in mind, they become like children. The brain is dying.
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A good way to see how your MIL's being treated is to visit at odd times of the day and evening. And scatter your visits so there's no pattern to them. This might give you an indication of how the NH's treating her.

For example, go in the morning one day. The next day go after lunch. Then go around dinner. Skip a day or two. Then go after dinner. Skip a day. Go in the late morning. Etc.
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My mom is in bed between 6:30-7:00, she’s tired. She attends most activities and is always strolling around in her wheelchair. When she was going to PT the Therapist always told me if I had any questions to call the Pt Dept. When I was working we (CNA’s) were called jailers...We were to have all Residents in bed by a certain time. We started with the Fall Risks. You could always ask if they could not put her to bed so early...
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Is she supposed to be getting therapies?

Do you or your husband attend her care meetings? What do the therapists tell you about her progess?

What time does it say in the notes they put her to bed? Your mother should be able to request a bedtime! That is clearly stated in the nursing home patient's bill of rights.

Please have your husband watch Teepa Snow in Youtube. He needs to learn how not to argue with his mom and say "we'll see what the doctor says", or " I'm working on it mom".
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