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My father had a stroke about a year ago, and it's left him with serious cognitive impairments. We've had to bounce him around to various facilities because of the outrageous insurance system we have in the US, and now he's in a facility that is doing the absolute bare minimum to take care of him. The staff are letting him eat 10+ desserts per day, they aren't showering him regularly or doing other basic maintenance. On top of that, they're giving him very strong pain medications when there's genuinely no need for it - he simply likes the way they make him feel. As a result, he's gained a large amount of weight in a short period of time, and in general he's falling apart. The fact that he's immobilized means that he's just sitting in bed all day, so these problems compound quickly. We've tried to address this with the home, but they keep saying that he's capable of making his own healthcare decisions. Anyone who interacts with him for more than a few minutes will know that's insane - he regularly has delusions, can't keep track of time, can't follow basic logic and engages in incredibly anti-social behavior (such as grabbing staff members inappropriately). This is due to the damage done by his stroke. Despite all of this, the regular MD that sees him has declared him fit to make his own decisions, and a psychiatrist has also said as much. I currently have DPOA and can make legal and financial decisions on his behalf, but that doesn't seem to extend to decisions about his health (based on how they're treating the situation). Until we can get him reclassified as incapable of making his own decisions, they're not going to do anything to stop him from eating himself to death, taking too many pain pills or turning into a raggedy, dirty mess. I'm at my wits end here. All I want to do is ensure my dad is taken care of, and yet this facility seems determined to wash its hands clean of any responsibility they owe him while he's under their care. As long as he's classified as capable of making his own decisions, they aren't obligated to do what's right for him. Does anyone have any experience with this type of situation?

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He has been moved repeatedly because his insurance company has continued to refuse to pay for his treatment. Even "difficult" patients deserve treatment and dignity.

His specific type of stroke usually kills whoever gets it, and the fact that he's even awake is a borderline miracle. Our healthcare system has zero incentive to take care of people who have brain injuries. Only here in the grand old USA do we think that people need to somehow earn the right to be treated with a basic level of care.

@rovana

We're likely going to get him declared incompetent legally because of this situation. Before we never needed to because even the worst facilities recognized that he wasn't capable of making his own decisions. This is the first facility to make that assessment and now we don't have many choices left.
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Has he been legally declared incompetent? Do you have doctor's letter stating he is incompetent? This is a big, big, problem for many because our legal system is very reluctant to abridge anyone's civil rights, BUT even if a person is not officially incompetent, they may very well be in practical terms. So the nursing home may be lazy, but remember that they have to follow laws about patient freedom to decide.
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The reason you’ve had to move him a lot is because he’s a very difficult patient. So this facility is keeping him but he’s not getting Cadillac service because staff doesn’t have time for that nonsense.

You really need to move him closer to where you live or he’s about to get kicked out again. So there’s no solution to your problem because you want everything your way, just like your relative!
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@cwillie

No. It's a very long, boring story, but this is the best place we can put him right now.
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I know you've had to move him a lot already, but is there any possibility to get him in a place nearer to family?
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@igloo572

I don't think you understand: he isn't competent or cognitive. It's totally bogus, and easily disproven. The facility is doing it so that they can avoid responsibility. Like I said, he's not even close to being in touch with reality and cannot be held accountable for his own actions. This isn't a light touch of dementia, this is serious, life-altering brain damage that comes with a total lack of mobility.

And yes, he's actually eating 10+ desserts a day. He demands 3 desserts per meal (if he doesn't get at least 3, he causes a scene, throws things, yells, etc.). Plus he is given desserts throughout the day by both staff and other patients who feel sorry for him. No one in my family lives close enough to the facility for us to watch his every meal, so that's not an option. Whenever anyone can make it, we do what we can to limit his intake.

We can't take his laundry for the same reason, and the facility is on the hook for that. They do change him occasionally, but not nearly enough and they don't give him showers on anything approaching a regular basis.

My family is on the staff regularly, and we've told them repeatedly to make sure he gets his basic needs taken care of. The facility isn't willing to budge as long as they can cling to the idea that he is responsible for his own well-being. Imagine telling a special needs child that they are responsible for taking care of themselves - that's effectively what the facility is saying.

I fail to see how his payment method is relevant, either. Even if he didn't pay anything (which is not the case), they need to be taking care of him - period. Stop making excuses for a terrible system!
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As long as dad is determined to be competent and cognitive, it’s on him to say yes or no to participating in things at the facility. If he chooses to stay in bed or in his room and not do activities, or go to dining room for meals, etc. that’s on him. But if you wanted to, you could find out what activities director has planned and get yourself to the snf the day of and get him over to wherever activities is scheduled at. Go and get him over to he dining room and stay for the meal. I cannot phantom that he actually eats 10+ desserts....

The MD medical director of the NH can write orders for a bathing schedule. If there’s doctors orders on file, it will have to be done by staff. Ditto for a podiatrist. Or for dental hygiene. There should be a care plan meeting held every 90 days and you should be working on a list of concerns and ?s for it and you can write them into the chart at the end of the meeting; or you can type it up and staple it onto the care plan meeting page (staff may faint lol). By doing this it creates a permanent record in his medical chart..... so 30 days later you can contact the DON as to the status of your concerns /questions. I assuming every 90 CPMs are standard. I know for all NHs involved for my mom or mil (both on Medicaid) they were and letters sent out in advance for CPM scheduling date & time.

You can take his worn, soiled clothing and wash them at home which forces him to put on fresh. You or perhaps a male family member can help him change into fresh stuff as well.

How is his stay being paid for?
Has he stayed - beyond a rehab benefit- for 3 months continuously in 1 facility? 
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