My sister is about to get Dad kicked out of AL! What do I do?

We had this issue with a family member at an LTC I used to work at. the family member was rude and downright mean to staff at times. This person would be there for 8 - 9 hours every day, and was so critical of staff that they didn't want to go into the patient's room, because she criticized every thing they did. She also did some things that weren't in the patient's best interest, even though the management staff asked her several times to stop. The patient was unable to talk, but would often cry during her visits.
We finally had our medical director write an order that she could only visit for 1 - 2 hours each day, and the visits had to occur in a central location, like the lounge, where she and the patient were visible to staff.

Hi SandwichGen,
I'd like to comment on others' suggestions. In most AL facilities, video'ing is prohibited. You might get staff fired if they agree to it.
I've got a brother and SIL who are compulsive liars. I've recorded most of what they say to me and what they do because history shows they're going to deny it or change it later. But, when I've played it back for them to prove they said/did something they claim not to have said/done, they get angry and change the subject. So, I keep the recordings now for when they lie to others either about our parents or about me, so I can play the recordings to whomever they've told the lies. I'm not convinced that showing videos to your sister will change her or be helpful.
Also, others have said you can limit visits, time, etc.. as POA. That's a slippery slope. I have POA too but have been warned against restricting visits because it can backfire and appear that you are trying to prevent your Dad from seeing those he loves and them from seeing him, which makes YOU appear to be the controlling one.
I put my Mom in a rehab facility for a few weeks to get her back on her feet, but thought it would also be great for my niece to see her. I had banned her from the house (when I found out she had gone to my parents church to accuse me of assaulting them), and two hospitals restricted her visits due to her constantly distracting (and even calling!) nurses and her inability to refrain from creating drama.
So, what did my niece do at those visits to Mom's rehab facility? She spent every day telling anyone on staff who would listen to her that I must be watched and am dangerous (she's trying to get rid of me so can resume her position of control over my parents in which she was able to get a free car, a free house, and constant gifts of cash, all of which my parents stopped when I arrived in town).
I was only given a few hints as to what was occurring. CNA's would come running into the room when I arrived, and made odd excuses to be there. Or they'd walk into Mom's room, and instead of asking, "are you Miss B's daughter?" they'd ask "are you the aunt?" The facility director was a friend and she finally told me that my niece had been trying to convince Mom that she was there forever and that I didn't want her to come home.
I asked the director what she recommended. She said they could not keep my niece from coming there, in part because there's no guard stationed at the door. People come in and out as they please. And I suppose she also meant that, for legal reasons, they couldn't restrict her visits. Or they didn't want the nurses to have to become police. So, restricting your sister might not be as easy as it sounds and might not have the desired effect.
And, btw, you said your sister doesn't have an SO or kids. That is utterly irrelevant. There are plenty of annoying and/or obsessive and/or controlling people who are married AND have kids. We all see them all the time.
Bottom line:
This is the facilities problem, not yours. I cannot imagine ANY facility kicking a patient out because s/he has an annoying relative. They're in the money business, and they deal with difficult patients/family all the time, so they'd never make money if they kicked out every patient who has difficult relatives. Unless she's putting staff or patients in danger, they're not likely to kick her out, and certainly not your dad.

My father is in an AL facility and I work in a nursing home, so I see both sides. You probably cannot restrict your sister from visiting unless you have a restraining order, and you probably don't want to cause even more friction in the family by doing that, and you might not even be able to get one even if you wanted because it does not sound like your sister is not hurting your dad, so what judge would issue one?

On the other hand, as a staff person, it is extremely hard to work and keep a good working outlook when a family member is constantly obsessing over the small things and yells at staff and mistreats the staff. And I can see why staff don't want to work when she is there. One way to handle it might be to have staff go to their administrator and say that they are working in a hostile work environment and they need to address it. That would make administration stand up tall and listen because if they do not address staff concerns of a hostile work environment,then they could face their own problems. We had that here where I work, and the administration put the family member on a behavioral contract and was told if they continued to abuse the staff then they could be prevented from visiting. This puts it on the facility to be the enforcer, not the family.

Not an easy situation, good luck to you!

AS P.O.A. YOU ARE IN CHARGE - you can have the staff tell her there is a limit on her time & number of visits - my cousin needed to do this when her aunt kept coming at all hours with 'treats' that pushed her mom into diabetic issues ... up to & including T.I.A.s - we believe that this lead to her death after 38 strokes & T.I.A.s -

Sis may be trying to undermine your status as primary care giver because she believes she could do a better job but that isn't what your dad wanted

When her presence is an issue with staff then she needs to be shown the door until she gets in step with the programme - document, document and then document some more in case she does a challenge - I'd go so far as to talk to the staff supervisor about it & tape the whole interview without them knowing it just in case sis tries something because then you will be able to show how she is seen by staff -

I hope you don't need this but maybe your level headed approach is why dad picked you not her & don't forget this because that is of primary importance

Sincere CONGRATULATIONS to each of you, for visiting your LO daily/almost daily - staying lengthy times, providing all your love, empathy, support, plus 'the hands on CARE' that you observe is missing; for finding the emotional strength - often severely depleted after you have given all to your LO --rectifying issues that impact very adversely on the resident's physical, emotional, spiritual well-being - and then, saddened beyond belief, you address those issues with staff.
Way too often, siblings who don't visit very often at all, then stay (at a stretch) 10 minutes (occasionally a whole 20 minutes!) - have no insight into the care or lack there-of, in aged care facilities. Sometimes they actually do see major issues, but do absolutely nothing!
They are sometimes the ones the staff are happy to 'have visit'.
Those who advocate in a civil, professional, but of necessity, persistent manner, for elder's rights, (these 'rights' are often a FREEDOM of ABUSE of ALL KINDS!) are sometimes not well appreciated. One of the saddest of indicements on society!!!
These poor vulnerable people are at their most vulnerable stage in life and they are living a most tortuos existence.
We must place ourselves in their shoes.
We must treat one another with the respect, we ourselves expect!
Royal Commissions into Aged Care are essential and long overdue. But the residents' families must have the voice for these poor souls!
The accreditation of facilities seldom reflects the true culture. They don't walk in on attendants, be it in their rooms or bathrooms, where dignity and respect is so sadly, and often, replaced by impatience and annoyance!
My LO for example, is terrified of the worst offenders amidst staff, and is intimidated by them to a shocking degree.
One attendant pretends she's the most loved of all attendants, 'coaxing' my LO to agree, every time she is on duty. This falseness is not wasted on my LO who rolls her eyes, knows to draw me closer to 'whisper' her disgust in that person, when sure the attendant has left room. I have reported that attendant, regardless my LO's fear of retaliation. I thought she'd be removed from my LO's location and observed by management.
I should add that my LO's Aged Care Home is amidst the very top bracket of same and where their very much displayed 'mission statement' of compassion, dignity etc, could have ordinary short-time, infrequent visitors blinded to the reality.
Yet staff ratios are vastly inadequate. It was through my attendance at a meeting for residents and representatives of the facility, that I was just one amidst the majority, who had been told at individual meetings, that staff ratios were in accordance with the guidelines. In fact, all aspects of neglect, apathy, cruelty, etc, that I had approached staff/management requiring addressing, were urgently voiced eloquently by others on behalf of either themselves, or their Loved Ones. What an 'eye-opener' to us all and a very healing experience to know we were not just a few people who 'cared enough to advocate'; indeed we were the majority!
Do visit and stay with your LO as often and for as long as possible!
Be vigilant - take steps to correct the wrongs!
Stay brave amidst the long, draining haul!
And then try to find time in your day to prepare a healthy meal for yourself.
My LO comes first just as I can see from some of these comments, yours does also!!!
I could have it no other way...
May God and Holy Spirit give you the courage to help in this quest and I pray that the industry attracts and retains only the truly caring of staff, one day, very soon.

I try to go see my brother every other day. When I don't it seems his wounds, showers, clean clothes, combed hair are a thing of the past. His dentures are disgusting. I have posted about his wounds... well, all the puss, blood and fluid were traveling into his shoes. When and if the nurse tended the wounds, they didn't take off his saturated socks. The tops of his feet had a crust! I threw a fit when I saw it. Part of his "program" is the aid are to wash his feet when he showers (my brother isn't capable of doing this.) That didn't happen until they sent him to the hospital and they saw the condition of his feet and wounds. I went to the director/owner of the facility with photos of his feet and asked if he thought this was acceptable care and if it was someone he loved how would he deal with this - no answer. His feet are now washed and moisturized. His wounds are being tended too and he gets his clothes changed daily. If he resists - they redirect him. The dressings don't stay on long, but every hour helps. Non of this was happening when I only visited him 2x a week. I had zero problem talking to the staff about this and having it documented. However, I did it tactfully. You don't want to piss off the staff, but when they start sliding their responsibilities you have to make them accountable.
When my father was in a nursing home I did go everyday at random times, but it was a private facility and we didn't have that problem. His only problem was they didn't want to help him to the bathroom and insisted he use a bed pan. This humiliated him beyond words. It is sad that we have bad suspicions of care in nursing homes because dementia/Al's is way to common and more people seem to be on waiting lists. I can't imagine what it was like before all the patient rights got into place. The death rate must have been incredible.

I would tell the stall that you are POA, and if your sister starts with them that they should tell her you are in charge of his care and they will talk to you. I would also get a lawyer

Greetings!
It is not correct for your sister to be argumentative and mean toward the staff however she has every right to stay on top of your dad's care. In 2013 I almost lost my mother who was in a nursing facility. My mother is my world and I am a beast in a good way when it comes to her care. You must be pleasant but very direct with the staff. If I had not been at her facility all times of day and night, I would not have caught the male staff attendant standing over her bed just watching her. She took the same pills everyday when I noticed one did not look correct. It turned out on that one day to be the wrong pill. One day I found my mother sitting in feces. After investigating I found out she had been in it for over an hour when I arrived. This facility was not a bottom facility. It was rated very good. I have also lost three family members (yes three) in nursing facilities to no fault of their own. I backed off so their immediate family members could handle things and three deaths were the end result. I often wish I had stayed on top of their care with the immediate family. So To YOUR SISTER, good job with staying on top of your dad's care. Be direct but leave out being mean and argumentative!

I had a similar situation a couple of times. In one, I met with Nursing Admin and filled out forms regarding a difficult family member. It was understood security may have to have him removed at any time.
Another time, a family member brought a bunch of loud, disruptive, rowdy grandchildren for many days in mom's final hospital stay prior to entering hospice. It was a very stressful time for all the family. I finally told family member the kids would have to leave. He didn't like it but complied. As POA's, we have a duty to protect our family member, as well as provide the very best care possible. In your situation, I would start with restricting sister to a set time each week to visit dad (ex. Sunday 2-4) but also warn her that, if her behavior continues, she will be banned completely. I don't think, at this point, that the situation with your sister will get better, only worse. I hope you have protective measures in place for mom, as well, as sis may try to be her POA to get back at you. Remember, dad is your focus and priority over others.

This may be a control issue and if it is you may be for a wild ride.

You might want to have a talk with your sister (maybe with the rest of the family there too) and explain that she will not be becoming your parents' caregiver and her access may be restricted if she cannot be more cooperative and respectful to the staff.

You probably need to start acting like the POA too. You shouldn't be worrying about your sister endangering your father's safety by taking him out of the facility at inappropriate times. She should be asking for permission to take your father out of the facility and have him back at a time of your choosing. Maybe the facility could help you out here by requiring 24 hour notice before any trips? If at all possible, please get your other siblings to help and present this as family decisions.

If this is a control issue, be prepared for your sister to ask your parents to sign new POA documents or bring a guardianship petition to take control. Prepare your defense now as much as possible. Document the problems she is causing so you will be in a position to demonstrate to a judge why your sister isn't a good choice as a guardian. Make sure your have documentation of your parents' competency so your can challenge any new POAs. Get ready but do not confront your sister with these possibilities - no need add a spark to a smoldering situation.

I sincerely hope you never face any legal challenges, but it is best to consider the possibilities before you find yourself in the fire. My mother's POAs were over a decade old from a time she had no problems at all. But when my oldest brother found he had been excluded from the POAs in favor of younger siblings he filed a petition for guardianship. Although there were some monetary issues, I believe the primary reason was he just wanted to be or felt he had a right to be in control. My attorney (who has an undergraduate degree in psychology) believes my brother shows signs of being an injustice collector. A couple of injustice collector characteristics are the normal rules of society don't apply to them and they see themselves as the ultimate judge over everyone else's actions; it's awful for you to raise your voice to them but perfectly acceptable for them to raise their voice to you. Some of your descriptions of your sister's actions remind me very much of my brother.

The AI should have lots of experience with family matters. The staff should be able to handle your sister if she is causing problems. I find the more you try to restrict someone like that the harder they push for more control. Sometimes that is what it is about, loss of control. Give your sister time, you Dad will likely be there a long time. She will adjust just like your Dad but if you make an issue out of it she will just push back and it will get worse not better.

Thank God you have a sibling who actually engages your Dad. You do not mention any other family members that visit your dad on a regular basis. I have seen many situations in AL and memory care where NO ONE gets a family member to visit. Unless you take an active role in caring for your Dad, you really have no idea what really goes on in the facility.

As far as denying your sister to visit her dad, you have no legal right to do so without a court order.

I suggest you arrange for you and your other siblings to visit your dad on a regular basis. This will benefit your dad and all the family members and alleviate the burden your sister has endured

As POA and primary overseer for mom's care, had to get involved with siblings efforts of taking over mom's care for feeding, bathing, and dressing. My wife and I sought the AL management and nursing care staff suggestions about what we should/could do "for mom". One family member was seasoning mom's food to their taste and then force feeding her. Another felt the need to caress and touch mom even though it was obvious it was not comforting. We forbade them from taking mom out of the AL facility to control mom's desire to leave the facility. We sought and received the staff's support, understanding, and assistance in restricting the sibling's involvement . Fortunately, the siblings live some distance from the AL and their "efforts to help" mom ceased after talking to them, the AL staff restricting their access and their departure to go home.

My mom was in AL to avoid "low
income"nursing home that siblings
had picked because they resented
taking care of her and resented my
POA (neither could continue to steal her money w/me in charge).
Mom was afraid in her new room&
didn't like her 2hr/day homemaker.
The facility had one aide to wake up,wash,dress, get 30 residents to
dining hall..in 2hrs (4min.each)so I
hired someone to come in help mom from 7am-9am.She also did
laundry,cleaned room,went to dining room for food.Mom didnt like her,resented not being home so I was driving an hour each way
twice daily to help her up and get
her dinner and help aide put her to
bed.It was too much so after 2wks
I began spending the night.Mom had OT/PT from 9am-10am after I left.I didn't see a change so decided to stay to talk to therapist.
First overnight,I was awakened by
doors slamming.Mom was in last
room and I laid there listening to door after door SLAMMING twice. When night aide entered mom's room,I told her to CLOSE the door
coming in&out for"night check".
She did the "check" 2x/per night.
No wonder the residents were all
zombies who only left their rooms
for meals..they were sleeping the rest of the time because no rest at
night! She told me she was just doing her job.I told her that is she
slammed mom's door,there would be a problem w/me.She stopped
slamming doors,told me she would
have to report me.So be it,I said.
OT/PT person arrived at 9:40am
(not 9am)was startled to see me.
She apologized..traffic.I asked if she was staying until 10:40 since
she was late,she couldnt.So I said
I wasn't expecting 1hr billing for 15min.She said that day was free.
Two nights later,I stayed overnight
..no door slamming.OT/PT arrived
at 9:25am,surprised to see me.It
was traffic.I contacted her boss&
requested someone who could give mom the full hour per our
contract. The AL facility served
the same meal every morn..sweet
water,bread,powdered eggs,bacon
Mom was diabetic,hated eggs.I asked for fruit.One resident said
she'd been there 3yrs&would kill for a banana.I asked for facility
meeting after new,on time OT/PT
commented on how aides were inappropriately working with residents with obvious dementia..
like my mom.He said they needed
training&welcomed his advice on
doing things differently.I asked him
AL mgr &dietary dept to meet.
During meeting he offered to do staff in service to teach how to best work w/ dementia patients.
AL manager declined help.When I asked about the dietary guidelines
they were following for seniors,I
was told"corporate"set them. I
asked bout fresh fruits/vegetables in meal planning..fresh,not in her
"guidelines"..just canned.I asked if
frozen cost a lot more.She said no.
Then why not have some frozen
and occasionally fresh fruit.Week
later..bananas,the place went wild!
Zombies were getting rest at night
&a piece of fruit.However,despite the ads that showed "fun",events,
etc..there weren't any. Mom was used to her senior daycare.They kept her moving,engaged&fed her
based on her diabetes.So I had bus pick her up after OT/PT take her to daycare&back.I noticed that
her dinner was being given to her
cold so she wasn't eating if I wasn't there to warm it.I asked an
aide,who mom liked,if she could warm it,leave mom in dining room
watching TV ..that way it wasn't extra work for her to warm it and just leave until bedtime.She did,it
worked well until she told me mom wouldn't feed herself.So I
had fruit in her room came@ night w/home cooked or Subway. She
loved the sandwich,ate every bit.
I knew she had good lunch at day
care.She cooperated more with helper once she started back to day care.She got dressed easier so
she could get on bus to go.It was
comical.OT/PT was difficult do I
often stayed to help them.Then I'd watch her board the bus,perfectly
manipulating her walker,no help..
doing exactly what she refused to
do in the PT session.She loved the long bus ride,arrived in time for
lunch and activities,then long ride
back..no other resident left except
occasionally.Mom lived

It is sometimes necessary to attend daily, for many and varied reasons. Initially, the reason may be to continue to assure our loved one, of our love for them. They desperately need this, and, if it's the one thing that makes their day, well, one has simply done what is humane.
Should neglect be evident, or, any other undesirable behaviour for that matter, it is essential to address such with management which will attempt to address the wrongs. Daily visiting and advocating can be imperative to the well-being of our LO.
Could it be your sister has her reasons - you say she has a big heart.
Staff often don't like being addressed by management, and can react with 'getting colleagues on board' to try to redirect blame unfortunately, to the person who is astute, who cares so very deeply, who is often the 'lifeline' to the resident...
It's a good idea as has been mentioned, to hold a meeting and get to the real 'nitty gritty' of exactly what the apparent offending person is actually doing....!?
I pray the situation can be resolved without banning your sister's rights to visit, to care, to love. This would adversely affect your dad, also, surely?
God bless your family

Treats the rest of the family so poorly? E.g.?

What job does your sister do? Is she successful at it?

Looks like sis will be the caregiver and she can micromanage to her heart's content--but she will have to do all the dirty work herself. Maybe give your sister POA and just let her do it all. Tell her that..and see how far this "micromanaging" will last when she has to clean up feces, his privates and bath him. and pick up dead weight. and take about 2 hours to feed him.. per meal. and struggle getting his teeth brushed while he's fighting you all the way. Caregiving is pure h*ll and it seems she has no clue how it's really like.

I would find a way to have her forbidden to go there , call him , etc.
As a former worker , I know these people have ENOUGH to do just getting their daily work done for the residents . Get written proof from those who've experienced her and take action . No warnings to sis , just do it for the sanity of all ! I thank God there is someone who can see the truth . Emotional stress on daddy and staff is just wrong and I don't think you will have any trouble getting an injunction . ( Mgr may even be able to refer you to get this done asap ) Worry not about sis being mad at you , she has issues , give her to God and do what is right and good . God bless you !!

Who did you have the conversation with, when you were warned that your sister is impeding the staff etc.?

And what, exactly, is your sister doing that is so terribly unacceptable?

Reassuring stressed and jittery family members, who because they're stressed can often come over as plain... let's say "difficult," is part of the process of settling a new resident in. Good team leaders or managers or even just ordinary experienced aides should know how to cope with this.

The constantly taking your father out of the facility, though, is a terrible idea. He needs to become familiar with a new environment, just at a time of life when that is bound to take him a while. Uprooting him every day will make it much harder for him. And maybe, while you're explaining to her that she really does need to cut that out and it is vitally important, you can lead her gently on to understand the value to him of developing good relationships with individuals on the staff.

Try not to let her develop even more of a "her and Dad against the world" feeling. Remind her the idea is to help him adjust to his new home, not to struggle against it.

Would you consider asking the staff to record her "wrathful" behavior.  Maybe they can team up when she is going off on a staff member, another could record it on their phone.  You could play it back to her.  She may be appalled at seeing herself.  She may not realize how abrasive her own behavior is.  It may be a hard pill to swallow, but maybe the medicine she needs.  Does this idea sound too harsh? I hesitated posting it.  It may cause more issues...????

What helped me when Mom was in the AL was my daughter. I am a little OCD. Not overcontrolling because I did understand the jobs a responsibility of staff members and their limitations. I would ask my daughter if I should complain about this or that.

Do you know anyone who has worked in rehabs and NHs? If you do, ask if they will sit down and explain to your sister how these facilities work.

Here is an example. In Dads facility, lets say, each aid has 5 residents. Breakfast is at 8am. At 6am aides start getting residents up. If needed, they have to toilet them, if needed new Depends. They have to dress them for the day. Now this is for 5 residents. If the resident can do this for themselves, ok, if not divide 5 residents into 2 hrs. The aides then have to make sure they get down to breakfast. At Moms AL aides were expected to help serve and clean up. Being an AL Dad is not suppose to be needing constant care. Aides do not babysit. When they have time they will sit with the residents and talk. Keeping them busy with activities is the activity directors job.

I complained that the aides were not putting Moms bra on (she broke out with skin on skin). My daughter asked me where the bras were. I said the drawer with her socks. Daughter said that is why no bra. The aides first put on bra and top, pants then socks and shoes. By the time they see the bra, she's dressed and they have other patients. I always hung Moms tops and slacks that matched together. So I started putting the bras on the hanger with them.

You sister needs to understand that she and Dad have to adjust to what works for the facility. Being nice to the staff goes a long way. Not saying there won't be times to speak up, but pick her battles. And having Dad rely on her, he will never adjust.

I would tell the facility that they have your permission to ban her from the facility.

You basically need a family intervention with this matter. Each of you need to express how impossible she is turning a situation that is positive into a negative one. You don't need to tread lightly. I have dealt with employees in 2 different AL facilities. I only complain when some aspect of care is negligible.

I was also with mom everyday just because of her abuse she was scared . I often would leave room when changing was necessary. Layout her nightgown have an outfit hanging out for next day. As hard as they try aides only have so much time with each patient. We all worked together for our LO when hospice came in big difference since all they had to do was her. She was in great NH I love them all and thanks are still there for them

I would think about setting up a formal meeting between you, your sister, and the manager of the AL. Plus possibly a ‘neutral’ third party with experience but not part of the AL structure (perhaps suggested by them). I think your sister needs to hear the concerns direct from the facility, not as retold by you, and she needs to be outnumbered in the meeting. If the meeting doesn’t result in a change of approach by your sister, at that point you pull rank as POA. The meeting should help to provide you with a clear justification for a ban if necessary, and protect you to some extent from your sister’s personal antagonism. I know that it is your father’s business too, but I think that bringing him into the meeting would be very stressful for him and not a good idea in terms of family relationships. I would hope that the AL manager would respond positively to this (although of course preferring you to sort it all out by yourself!). If your sister refuses to participate in a meeting, then unfortunately her refusal is the justification for a ban. Best wishes in a difficult situation.

PS I wrote this before you posted last. I'll leave it to you to think about whether this fits in at all.

Tell her she is interfering in dad's care and causing problems for the staff. Also, let her know that this will not be tolerated and it is having a negative effect on dad and his care. If she doesn't knock it off you have no choice but to limit her visits or eliminate them completely. As dad's POA it is one of your responsibilities.

They can ban her from the facility.

Have you gone to visit when she is there and pointed out to her that her behaviour is detrimental and if she does not clean up her act, as POA you will request that she is banned?

Sister wants what is best for dad. Maybe she feels the facility is not doing enough for him.