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I have a resident that has dementia, is deaf and blind. Her daughter is very protective and is always complaining about the care her mom is given. We do a great job of giving her all her needs but it doesn't even seem to be enough. We have 22 dementia residents with 3 caregivers on a shift. We can't give everyone one on one care all the time but we try very hard. The resident is very on adge all the time and she scratches which makes herself bleed. She also gets up and roams around, we always have to stop what we are doing to go sit her down and it's frustrating. We have to do a checklist now of just her care. What are ways can I handle her demanding daughter?

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Ur administrator needs to talk to the daughter. This is something I requested after my Mom was in rehab...the duties of the aides. How many times is a patient showered, what is neededin clothing and how often do they change them. Everyday, everyother. I also don't see how the daughter is allowed to fool with her meds. The assisted living facilities I have seen handle the meds.
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Would it be so bad for you if she took her Mother home? I am sure there is a waiting list for people who would really appreciate your help. Maybe her Mother needs a higher level of care, and her daughter should find a place that can accommodate that need.
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Trissfit, it sounds like you are a very caring and concerned caregiver. Although the daughter is going through a difficult time and has every reason to be concerned it's not okay that she yells and criticizes you and the other caregivers. She has a right to express her concerns and her preferences however she shouldn't be allowed to run over the caregivers at every turn. Perhaps you could speak to the director of your facility and he/she could intervene and help the daughter come up with a better way of communicating her needs? My mom is in assisted living and been diagnosed with dementia. There have been some instances that I wasn't happy with how they were caring for my mom but I would never go in and just rip into her caregivers. You have a very tough job and don't need that. I have hired a caregiver to come in once per week for a few hours on the one day that I can't get there just to make sure things are getting done. Maybe the daughter should try taking the mother home even for just a week and then she will see how difficult caring for her can be. If you haven't already, I would strongly suggest getting the director involved to work things out. Good luck to you!
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A couple comments....my Dad is in a dementia facility in AZ. I recently suggested music for residents after finding this great site: alzheimersmusicconnect I bought Dad an ipod for Christmas and loaded up music from this site. He loves music from his generation and it appears that music is well received by dementia patients, and helps calm them and give them something to focus on in between activities. Dad's facility is now purchasing ipods for more residents and making music more a part of their daily activities. We don't just give Dad the ipod, cause it would get lost. Also, I bought head phones to go with it....nothing overly expensive...but head phones seem easier to put on than ear buds. The activities director comes with the set up, and when they put the ipod on Dad, they clip it to the back of his shirt, so he cannot just find it easy and pull it off. The residents love it. Sometimes, they don't want the music to stop when it's time to pick up the ipod! With this resident being blind, this may be something to try! And this company does have ways to help bigger organizations download the music at less expensive rates. I just bought Dad's set up at Wal-Mart....about $30 total. NOT an actual IPOD...just an MP3 player. Not bottom of the line though. First one was a big mistake...at $12.00! Quit working right away. My second comment is to agree with Ferris about staffing. I am also a retired RN. Dad's facility consists of 5 cottages on the grounds....all inside a secured big patio area. Each cottage is full if 14 residents and state law requires 3 workers at all time if full....so basically a 1 staff to 5 resident ratio. Plus an LPN on all the time and a separate staff member that does meds and goes from cottage to cottage to give meds. In between meds, that staffer helps where ever it is busy. And they STILL work hard!! Redirecting, communicating, activities, showers, toileting and preparing for each meal (not cooking...but all the rest). I see really good caregivers and really bad ones too when I visit....just as everywhere. Some are there just for money, and will stand in the corner on their phone, or watch TV rather than interact with a resident...others are always with the residents and thinking of how to make them happy and OK. Training is everything....and it would be nice if ALL caregivers could put themselves forward and think about their work in terms of how they would like someone to be there for their own relative or themselves. It surely sounds like you are one of the great caregivers.... So keep in touch with your supervisors about ways to improve...and continue to be a great role model for the others you work with.
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Tris - first of all, thanks for coming onto this site, it's good to have the perspective of staff at a facility as to issues! It sounds like you work at a small board & care home rather than at a large AL or NH. Is that the case? My answer is based on that.

If so, part of the problems is likely the " level of expectation" of this residents family AND the owners of the facility. Board & care are very much less expensive than either AL or NH, which means less staffing and support services. I looked at a couple for my mom, but although she could "do" what was expected for ADL 's & be self-directed in medication at the Board & Care home, it was better for her to go into an IL which was part of a larger tiered facility that had AL & NH - so that if something happened there would be a higher level of trained professionals and services at the ready. Now mom never needed it, but was good to know could be.

Daughter is expecting Ritz Carlton for Quality Inn, she is never going to be happy. The whole list of what has to be done for mom is, her way of manipulating to get this. Not going to ever work as your place is just not set up for individualized care plans. Owners probably run on a tight profit margin, so want to keep all residents. Plus they are wary of daughter as it sound like she will threaten lawsuit or reporting to city, state, board of health. So a part of how they deal is to place the excessive caregiving on this 1 resident to the small staff of 3.

You need to let owners know how much time this 1 resident is taking up. Maybe you all - all the caregivers - do a log of time spent 24/7 for a week on the time demands of this 1 resident. Note ever item that daughter wants addressed too. Do all with exact time. With all this the owners can decide just what to do. With documentation, they can send the daughter a "30 day notice" that resident needs to move; that although they have loved having mom there, the level of care that the mom needs cannot be provided. Daughter will not be happy as the costs will go from maybe 2k to 8k, but she isnt going to be happy no matter what now is she.

Facility does not have to help find a new place for the lady either. That protection - I think - is only for SNF/NH on Medicare & Medicaid paying. They can however, attach a list of nearby ALF & NH.

Good luck in all this. You sound like a gem of a caregiver!
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I have gone through this caring for my Father. I cannot give you any suggestions, just support. Do the best you can. Sometimes the best is not enough for some people. If they get home care, I pity the caregiver. My sibling gave no help with Dad's care except to criticize everything. Even after Dad's passing, the criticisms continue....Just do your job the best you can and try not to internalize the family member's criticisms and complaints....Good luck....
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If I were this daughter, I would remove my mother from your facility. Three caregivers to 22 people is way too much! In AZ an adult care home can only have ten residents. Are you that kind of facility? Making a person sit down all the time is NOT good for them, and the fact you do not have enough staff to take residents for walks is disturbing. It sounds like you are just "housing" people until they die. Either reduce your total resident numbers, or add more staff to adequately take proper care of your residents. I worked both in hospitals and home care as a nurse and seven residents to care for is demanding and not giving each adequate care. It was exhausting.
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I think the daughter needs some meds. She is not dealing with the situation well. Any threats about taking her mother home could be met by something like, "When should we have her ready for you to pick up?" or "Will that be for the weekend or permanently?"

Being abusive to staff is not acceptable. The facility director should speak to her about it.

You sound very caring and that you are doing a great job.
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She can take her home at any time. She just threatening us all the time. Thank you for your input everyone, I guess I'm going to have to ride it out
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Ok, well you answered all my questions, except for the one about taking her mother home. Can't she "check her out" and take her home? I mean if she is POA or guardian? Maybe it's just an empty threat anyway.

With 22 residents and 3 aides, it would be difficult if not impossible to spend very much one-on-one time with anyone. I thought maybe she used a walker or cane or could hold onto the rails on the wall. Her blindness does present some extra difficulties for you to deal with. I just hate to think that someone who can walk 3 miles (I wish I still could) has to sit all the time waiting until someone can hold her hand.

Sometimes you just need to bide your time and hope that the daughter chills out after a while. You have 22 residents to care about, she has one mommy.

Nojoy3, you made some very good points.
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We walk with her as much as possible but it's the times we cant. We also have an activities person that helps with this too
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She always goes to the doctor and says it's not working right. My facility is an assisted living and memory care. The administrator does know and stands up for us, the nails are always clipped, and it's a small building with walkers, wheelchairs, and other obstacles in the way. She walks with someone holding on to her and she won't use a walker.
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trissfit, in any ALF or NH all orders should be written orders from an MD, not from family members. Withholding her meds is abuse and should be reported as such. Giving meds without an MD order would be a violation of health departments regulations.
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Good question Babalou. I missed that one. I thought medications were administered by the medication aide at most skilled nursing facilities. At the level of assistance required by the patient's daughter, I wouldn't think it would be an ALF.
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What do you mean, the daughter is messing with her meds? Aren't the meds prescribed by a physician?
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I just have a couple of practical questions. Why do you have to keep her mother sitting down, what is wrong with letting her walk around? If she can walk 3 miles in a day, she's probably pretty fit. Secondly, can you trim her fingernails so that she's not as likely to scratch her skin? Thirdly, can an administrator or social worker admonish the daughter about yelling at the staff? She is wound too tight and needs someone to talk to.

What kind of facility are you? The fact that she is always threatening to take her home makes me think that for some reason she thinks she can't?
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Trissfit: Sounds like you've done about all you can! Sometimes you just have to accept the fact that you aren't going to make someone happy and just move on. You are probably right this family member won't be happy until her Mom is at home with her, and then I doubt that she'll be happy. The next time she threatens to take her Mom home refer her to your facility administrator (I am assuming you have discussed the situation with him/her). It may be time that she do just that, take her Mom home. Family have the right to expect good care of their loved ones but they DO NOT have the right to verbally or physically abuse staff. Again, best of luck and thank you for loving your job, it truly makes a difference in the care pts receive.
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When she first moved in she had a personal caregiver but they ended up getting a job where I work! The residents daughter or the other family usually take her out walking around 3 miles a day and normally that helps with her being on edge but there are days they don't come. She is given a PRN and even wine to help her but her daughter changes her meds all the time or she will decrease it or increase it. She is part of her care, we have to Give her showers on the days she requested and the guidelines we have to sign off on. Now I don't mind doing all that and taking care of the resident is fine. We do do a great job with her mom and I wish she would see it but until she is back at home with her I don't see it getting better. She's always yelling at us, having her family in watch us, and always threatens to take her home. More stress to a very stressful job, which I love it and couldn't see myself doing anything else.
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It sounds like this is a difficult pt and that you're doing the best you can. Sometimes it's important to remember that you not only care for the pt but also for the family. Sometimes family members strike out at staff and their caregiving because they no longer have total control of the situation. Some are saddened at seeing their loved one failing and there is nothing at all they can do to stop it. Many times family members don't even realize the real reason they are lashing out at staff. The quality of the caregiving can be an easy target.
I would encourage you and your coworkers to really self evaluate your care of this pt. If you are doing the best you can for her begin to look at ways to help the pts daughter. You might want to bring the daughter more into care planning for the pt, it might help the situation. You mention that the pt is always on edge maybe a talk with the daughter and the pts doc might help.
Dementia pts are some of the most difficult pts to deal with. Its hard on caregivers and it's incredibly hard on family. As a family member with a Mother who has dementia I can tell you there is grieving everyday for the loss of your parent. Everyday it seems there is a little less of the person you used to know. It is a long, slow process down dementia road and it takes a tremendous toll on family. I wish you the best of luck in your care of this pt and her family.
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In a case like this, could the daughter hire a full-time one-on-one Caregiver to come into the facility? Would that be allowed?
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