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Tips from someone who's been there? My mother is 80, has Alzheimer's and has been in a nursing home for over a year. My mother is neglected. No shower for almost a year, etc. When I brought it up to staff in a very nice way and asked if we could find a solution together, they became defensive. I was yelled at, bullied, etc. They have started sending my mom to the hospital for typical dementia behaviors they are supposed to handle, and which they do handle when other residents do the same thing. Suddenly, she's a "danger to self and others." they send her to the ER where their doctor is on staff. They're trying to make a case against her to cover themselves. How sad.


Those old school nursing home ways are still very much alive. Be warned.


I am now looking for advice from anyone who has moved their loved one from a bad facility. Anything you can offer me as far as "insider tips" or "pitfalls to avoid" will be appreciated.

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My moms first NH morphed from a pretty decent place I saw when looking for places to a real nightmare within moms first 6 mos. I got her moved at around month 10 to a pretty great NH. For first place, the care wasn't bad but there was no administration....3 administratorsin a few months; social worker left with administrator #1 and was not replaced; staff were slackers. The DON I never ever saw on the floor (this is a bad bad sign) and the care plan meetings always ran late so a 1:00 scheduled meeting would happen till 3 and always departments missing. If mom had an issue -like a TIA - that required more care, the default was to call for transport to the ER. This happened frequently for residents. I do think a lot of this was about trying to get them admitted for a hospitalization so that they could then be discharged back to NH for rehab so their getting the much much higher medicare rehab rate. The medical director who had been with my moms old gerontology group was leaving. NH #1 wasn't a snake pit but more rudderless. Also some of the outside vendors were related to staff....I could see Stark Law issues coming up eventually.

The second NH required that I as DPOA sign off for them to evaluate mom at her current place to determine if they could provide her level of care needed. an RN and SW went to do this. They called me from moms bedside to tell me all ok. I went & completed a transfer request at new NH later that day. The new place had around 6 open beds as they just finished a renovation & they would hold moms bed for her. Now my mom was a pretty ideal resident as she had lewy body dementia with easy generic medication management, no diabetes or copd, still pretty cognitive, she was very social, did ADLs well and could walk with walker totally on her own. A low maintenance resident as demented but manageable.

You want to schedule the move do that it is right at the beginning of the month IMHO. They have to do their SOC to each NH to be compliant for medicaid. If mom gets paid on the 3rd, then move on the 5th - 7th. So you pay old NH to the penny the SOC for those days there & pay the new NH for the SOC for rest of the month.

If the old NH gets her check sent to them, you are going to have to deal with getting her funds back at whatever timeframe the old place wants to do this. You will out of your own funds have to pay moms SOC at new NH till you get control back on her monthly income. This can be a bit of a clusterF to deal with. Hopefully moms income goes into her bank account & you have been paying her soc from it each month.

If mom has a personal needs trust account at the old NH, you need to get these funds zeroed out & paid to you. I would suggest you do this as in advance as possible. If its just $50/$100 they will likely have the cash to pay it out. But if it's a larger amount, a check may need to be cut from corporate office. They can hold the PNA if there is any outstanding bill when mom moves.

You MUST make sure you get all her prescriptions & medications. Usually they are done in 30 - 90 day packs held in a big plastic bag at the nurses station or locked medication room. Medicare & Medicaid will not pay for a duplicate set of Rx's so you MUST get her meds. Otherwise you have to private pay for a second set. This could be quite expensive. Take zip locks & a sharpie marker just in case some meds are loose. Btw the nursing staff was totally ugly on doing this with my moms meds. The new NH told me about having to get their meds.

The new NH required mom to be there by 10:30 or so. I bet occupancy for medicaid reinbursement has a time which a count is based on. So ask about if there is a " need to be there by" time. Kinda like waiting till 9:15AM to get your kid out early from public school for holiday break cause district bills the state based on a 9:00 AM head count.

See if new place will let you set up moms room the night before. My moms second place did (tv, pictures on walls, curtains, bed linns all went in) and it made it really for a smoother transition.

Start holding back laundry too so you don't have clothes she needs in laundry on the day of the move if you need them. I jettisoned moms older & worn clothes during the move. Good luck in the move.
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So, just for comparison, my mom announced one day, in her NH "I can't take showers anymore". We attempted to figure out her reasoning, mom said it was because she had to stand in the shower. which wasn't true, but dementia reasoning.....it's not reasoning. so the "bath lady" went in the next time mom was scheduled and said. "c'mon, it's time to get cleaned up" and mom had a shower, or bath, or something.

Whoever is dealing with your mom doesn't understand dementia. And so, I think you should probably ask the SW, kindly, to help you find a place that does.
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Well the good news is that the hospital should be able to do a complete evaluation and find the proper meds to calm her down. Your first step should be to talk with the Social Worker and the Discharge Coordinator about the conditions she was living in. Ask them to find a bed in a different facility.
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I would get the ombudsman involved.

What is the reason for no showers? Is she resistant? Do they say "we can't make her?" That to me is the answer of a place that isn't very skilled at dementia patients; you may find someplace nearby that IS. Does she need memory care, as opposed to NH services?

Another question; are your concerns addressed in your care meetings? Who is being defensive? the "everyday" staff or the SW and DON? If the later, I would find a different facility; if they can't work with you, you need to find your mom a new placement.
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Christine, you "baker act" her. At the ER, you agree to a 72 hour psych eval, and they get her on the proper meds to modify behaviors. Once she is compliant, having been in the hospital 3 days, you move her to proper placement with the help of the discharge coordinator.
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Christine 73 --
About getting urine odor out of fabric; I was told to get a product made for pet urine, available at Wal-Mart and some super markets. My supermarket had a good selection.
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You should also call the area agency on aging and your local alzheimers association for advice and possibly some help in choosing a new facility.
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You are welcome google nursing facilities in your area that has a unit for such care there are more available now than when I worked feel so sorry for you and your mom also put protective undies on your mom fabric cleaner and odor ban will remove the smell from the furniture 😊
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Thank you Pamstegma and Brownbomber. Brownbomber, I don't think there are places in my area that truly specialize in Alz. All the places that have a dementia or Alz unit have told me they don't want anyone with "behaviors." I'll look for "odor ban" on amazon.

Pamstegma, thank you for telling me about the Baker Act. I will look into it more. I'll have to get her sent to an ER that has good geriatric psych, so I have some research to do.
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I don't have anything but a "gut feeling" that you wouldn't want mom in a place that isn't willing to do their own accessment in person. Seems to me a good NH would want to see for themselves if they could meet your mothers needs. JMO.
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