My mother lives in a free standing locked dementia unit. Essentially like an ALF, but residents are able to continue living there even after they become more total care.
Over the past yr as my mom has progressed into the end stages of her disease, she has required more assistance as expected. However, we have had to complain more & more for basic care to be done. Ex: bringing her to the dining room with feces on her hands/fingers, feces on the toilet seat/commode handles/shower seat, not putting lotion on her following her bath, etc. (things I know the average LTC would be sure to take care of & anyone with common sense would do).
Things in general have improved regarding her hygiene needs. However, we discovered a few weeks ago that at night, they do not put pajama bottoms on her, just a diaper. My sister questioned the manager who indicated that she should not have been left that way, but kind of blew it off as a fluke occurrence.
Turns out, when my sister stopped by yesterday evening at 6:30, mom was ready for bed, again with no pants. She was told by the aide that it makes it easier for 3rd shift & that's how they do it with everyone. It should be noted that mom has lost 35 or so lbs the past yr & might be about 115 soaking wet. She's always cold & they left her with no pants or socks, just a light blanket over her legs (she sleeps in a recliner).
Are we over-reacting? I know when I did an evening CNA clinical, the immobile pts often were left open to air & then changed thru the night as needed; we do the same on the floor. But mom is still ambulatory (at this point); they are changing her brief/diaper while she is in the recliner. (It didn't help that 2 male residents wandered in & out while mom was only partially dressed.)
We hate to feel like we're complaining about something almost every month, but this costs mom over $1000 per week. She deserves to be clean & dressed.
My sister is thinking of going above the facility's manager, complaining to the regional director. Thoughts?
You have to remember memory care ALF are NOT medical facilities and often the caregivers aren't even CNAs (but trained by the company- and poorly at that).
I think nighties are the one and only solution to them not putting pants on her at night, most of these facilities have one aide to 20+ patients at night and removing and replacing pants on all of them would be a true PITA, imho. They should have asked for night gowns a long time ago.
When in hospice, I was in and out of many ALFs daily, and I agree they are NOT an appropriate setting for total care patients! Many have ONE nurse (usually LVN/LPN) on the entire payroll and she works in an admin roll, not 24 hour direct care. Those passing meds and the caregivers are unlicensed. Many wont even do a BP, temp check or even a suppository for constipation!
Many (not all) of these places exist to drain the elderly and frail out of every penny they have and in return give as little as possible by way of every day care. $1000 a week is absurd. I bet you still have to provide diapers, wipes, shampoo, soap, medication, and other sundries on top of that!?!
Sorry, I turned your thread into my own rant, but in short, no, I do not believe you're over-reacting.
Thanks everybody. I did mention to my sister (who is POA) a couple months ago that we may need to start considering traditional LTC but she's hoping to avoid it altogether & be able to keep mom where she is with involvement of hospice (as the facility has assured us is typical). Life expectancy after dx for her type of dementia is 4 yrs which is just about where we are now. I will broach the subject of LTC again with my sister soon if we don't see some changes.
How timely...just got a survey from the facility in the mail today.
Thanks everybody. I did mention to my sister (who is POA) a couple months ago that we may need to start considering traditional LTC but she's hoping to avoid it altogether & be able to keep mom where she is with involvement of hospice (as the facility has assured us is typical). Life expectancy after dx for her type of dementia is 4 yrs which is just about where we are now. I will broach the subject of LTC again with my sister soon if we don't see some changes.
How timely...just got a survey from the facility in the mail today.
People can live a good 10 years with this dx and without some measurable signs of decline to indicate she is within 6 months of death, she is not a candidate for hospice. These places LOVE hospice because it gives them FREE medical services, CNAs, incontinent and hygiene supplies, medications and 24 hour on call nurses, all the while they can continue to drain the patient/family of every penny. I don't know how many times I had to ration diapers, wipes, and soap because they would use them for ALL the patients, all the while still charging families for these supplies.
These places work in tandem with less-than-honest hospice companies to place ineligible residents on hospice to game the system...
Is your mom still mobile with assistance? Self-feeding? Toileting herself sometimes? I've seen bed-bound dementia patients live years.. hospice may not be available to you for quite some time.
Specializes in LTC,Hospice/palliative care,acute care.
You have to remember memory care ALF are NOT medical facilities and often the caregivers aren't even CNAs (but trained by the company- and poorly at that).
Many (not all) of these places exist to drain the elderly and frail out of every penny they have and in return give as little as possible by way of every day care. $1000 a week is absurd. I bet you still have to provide diapers, wipes, shampoo, soap, medication, and other sundries on top of that!?!
Does it include skilled services (medical procedures such as wound care, injections, breathing tx, etc) along with PT and other therapies. Do you have nurses staffed 24 hours a day that monitor health, lab results, medications, etc? Do you have doctor's that visit weekly?
While I think 300/day is pricey- at least medical services are provided in LTC.
Specializes in LTC,Hospice/palliative care,acute care.
We are an LTC,we are non-profit.That rate is all inclusive.Physicians are required (and reimbursed by insurance companies and Medicare ) to see each resident on a monthly basis in LTC but most of ours are in the building at least weekly.As an LTC we do care for residents with complex needs (skilled needs) We offer specialized wound care,palliative care,respite care and have a small rehab unit.We have a great therapy dept,(PT,OT and ST) Labs are drawn at the bedside,we also offer portable radiology services.We a number of specialists who round regularly in the building (podiatry,derm,psych,cardiology,opthamology,dental) and a staff who co-ordinate and transport residents out for appointments.Laundry,barber/beauty shop is available,fees are nominal.Basic supplies are included as well.In this state two RN's must be in house at all times.Each unit is staffed by a team of nurses (RN or LPN)and certified nursing aides.In this state in LTC a nurse must admin.all meds and treatment.Traches,PICCs and wound vacs are not un common.Our staff are skilled
Specializes in LTC,Hospice/palliative care,acute care.
I'll also agrees the use of hospice services in facilities like you are dealing with,everything the other poster said is true.A hospice agency will provide a nurse's for your mother for about an hour a day anywhere from 3to 5 days a week....That's it. Not sure what your sister believes LTC is but it's where people like your mother belong.In a safe environment cared for by people who are trained to anticipate her needs despite the fact that she can't voice them.And they will provide support for you as she declines.
We are an LTC,we are non-profit.That rate is all inclusive.Physicians are required (and reimbursed by insurance companies and Medicare ) to see each resident on a monthly basis in LTC but most of ours are in the building at least weekly.As an LTC we do care for residents with complex needs (skilled needs) We offer specialized wound care,palliative care,respite care and have a small rehab unit.We have a great therapy dept,(PT,OT and ST) Labs are drawn at the bedside,we also offer portable radiology services.We a number of specialists who round regularly in the building (podiatry,derm,psych,cardiology,opthamology,dental) and a staff who co-ordinate and transport residents out for appointments.Laundry,barber/beauty shop is available,fees are nominal.Basic supplies are included as well.In this state two RN's must be in house at all times.Each unit is staffed by a team of nurses (RN or LPN)and certified nursing aides.In this state in LTC a nurse must admin.all meds and treatment.Traches,PICCs and wound vacs are not un common.Our staff are skilled
The price tag for your facility is more reasonable than the $1k week for a facility that does not provide any medical services.
Thanks everybody. I did mention to my sister (who is POA) a couple months ago that we may need to start considering traditional LTC but she's hoping to avoid it altogether & be able to keep mom where she is with involvement of hospice (as the facility has assured us is typical). Life expectancy after dx for her type of dementia is 4 yrs which is just about where we are now. I will broach the subject of LTC again with my sister soon if we don't see some changes.
How timely...just got a survey from the facility in the mail today.
As a former hospice and LTC nurse (not at the sane time) I personally would recommend you move your mother to a skilled facility. She sounds like she is a max assist who is rapidly approaching total care and ALF just does not have the staff or the training to handle this.
Yes, she can be on hospice at the ALF IF she qualifies for hospice but that is for the last month's of life only. Dementia patients can require total care for years. And hospice does not provide staff each shift or even each day to help with the issues you mentioned, that come in a few times a week as a supplement. Also many of our hospice pts in Alf had problems because often their was no one to give prn meds after 9 or 11 at night and thus as they developed more problems as they declined they had to be moved ANYWAY. Frankly the ALF uses hospice to keep pts who are no longer appropriate for ALF level care, but really hospice can't provide all the services the pts need.
I really feel that when pts need this much assistance the best thing is to either hire private caregivers to be with her at the ALF if you really want her to stay there, or preferably move to a skilled facility. Most SNF do not change all la carte for services like ALF do and so it may actually be cheaper. But they are better staffed, pts are seen much more often by MD and specialty MD like psych and podiatry are routinely available. (As far as dressing at night I agree that removing pants etc frequently at night is not only time consuming for staff but disruptive to the resident. in ltc many of our residents wore hospital gowns at night to simplify care, and that was their choice.)
While I believe your mother absolutely deservesb dignity and hygiene I think your complaints may be unreasonable given her level of need vs the level of facility she is in- and the fact that facility management hasn't brought this up is a sign IMO that they want to keep your mom cause she brings in a lot of money.
I work as a RN care manager and recommend the appropriate level of care for my clients. Often times those with memory issues who are still ambulatory are BEST served in memory care assisted living. The RIGHT assisted living should be able to provide the care you describe.
Once a patient requires the use of a lift device or requires some kind of skilled intervention SNF becomes more appropriate. The cost of SNF will be twice the cost of AL, plus moving is hard on patients also. SNF does not always have the best interventions for memory care, and their staff is often not trained in this.
I agree with talking kindly but assertively up the chain with the AL so they can provide the care needed that you are paying for. You are not asking for too much.
OK; one more time for me...your mother is disrupted nightly. Who knows what goes on during the day. Those people aren't trained to assit/intervene/teach/assess/etc... Your sister sounds like she just wants to pay and ignore. The facility is keeping her for her income to them or else they would be helping you get your mom into a LTC that's appropriate. I think that perhaps your sister is anticipating that the inheritance may bleed more with LTC.
You let your sister read this please...your mother deserves better treatment than a wait and see, wresting with staff (that's just the part they tell you). I've seen my fair share of inappropriate people in ALFs.
Stool on her hands, and you people are just taking a wait and see attitude! I wonder what she would have to say about this if she was cognitive. Your the one who wrote into this forum for advice...you know she needs better care. She doesn't even have one leg in the grave and the ALF is talking about hospice! These people last for years. How sad, that in the end...it's only about money.
In both the nursing home and the group home I work at now the patients with briefs don't wear pants at night. The men wear a tee shirt or a night shirt and most of the women wear gowns. The home I work at the gowns are cut up the back to allow easier access to gtubes, colostomy bags, changing etc. A long tight nightgown can be hard to pull up for access sometimes so, if you do go with nightgowns you may want to buy them a little bigger than you think she needs.
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lifelearningrn, BSN, RN
2,622 Posts
You have to remember memory care ALF are NOT medical facilities and often the caregivers aren't even CNAs (but trained by the company- and poorly at that).
I think nighties are the one and only solution to them not putting pants on her at night, most of these facilities have one aide to 20+ patients at night and removing and replacing pants on all of them would be a true PITA, imho. They should have asked for night gowns a long time ago.
When in hospice, I was in and out of many ALFs daily, and I agree they are NOT an appropriate setting for total care patients! Many have ONE nurse (usually LVN/LPN) on the entire payroll and she works in an admin roll, not 24 hour direct care. Those passing meds and the caregivers are unlicensed. Many wont even do a BP, temp check or even a suppository for constipation!
Many (not all) of these places exist to drain the elderly and frail out of every penny they have and in return give as little as possible by way of every day care. $1000 a week is absurd. I bet you still have to provide diapers, wipes, shampoo, soap, medication, and other sundries on top of that!?!
Sorry, I turned your thread into my own rant, but in short, no, I do not believe you're over-reacting.