Need advice about nursing home placement for my grandfather

[swirlygirl]

My grandfather is 90 years old and has severe dementia. My mom took care of him at home for the past 10 years, but he's gotten to be too much to take care of at home, so they decided to permanently put him in a locked alzheimers unit in an assisted living facility about 2 weeks ago. He's become incontinent and started falling a lot in the past few years. He's been in different facilities for short respite stays during those few years just so my parents could have a break. They've also had home care nurses come to their home for a while, but that didn't work out.

Well, since this past Friday night, he's had 2 bad falls at this current facility - both falls have landed him in the ER. First on Friday night for a broken rib, and yesterday my mom went to visit him and found him in his bathtub with his head cracked open and bleeding. The staff actually had no idea he had fallen, they told my mom that he was in his room sleeping and that was how she found him. We have no idea how long he laid there. So he had another trip to the ER to have a head CT and to have his scalp stapled. So, now he's in the hospital for a day or two just to try to give my parents some time to find a new facility since he obviously can't go back to the one he's been in.

I really have no idea what to tell my parents to do with him, because he apparently doesn't qualify for a nursing home. The social workers keep telling them that he would do fine in an assisted living facility - but obviously he hasn't done well there! I was just wondering if any of you guys had some ideas about placement for this kind of patient that I could pass on some info to my parents? They're pretty much at their wits end and don't know which way is up at this point! Any help would be greatly appreciated!!

[StNeotser, ASN, RN]

Perhaps your Mum can talk to the social workers at the hospital v. those at the AL? They might be more sympathetic? It doesn't sound to me as if after two major falls he would be safe in AL either.

I'm sorry your family is going through this.

[Whispera, MSN, RN]

Absolutely have them talk to the social worker at the hospital for options!

[morte, LPN, LVN]

money........assisted living, isnt that for the most part private pay?......they want the money, and to keep the bed filled.....def. talk with the hospital SW.....perhaps a full neuro psych workup would give you a better idea for placement

[swirlygirl]

I think you're right, morte!! They don't care who is in the bed, they just want the bed filled so they can get paid! When my mom called to tell administration that she wouldn't be bringing my grandfather back, they tried to talk her into keeping him there telling her she was making a big mistake and that the CNA's on that floor do q15min checks.

One of the CNA's really put her neck out and pulled my mom aside and told her that she needs to get him out of there before he has a bad fall with a more serious injury. When my mom asked about the 15min checks, the aide told her that what administration thinks is going on is completely different from what actually goes on on the floor.

[Katnip, RN]

You might also want to check with your county's agency for aging. They will help determine what your grandfather qualifies for. Good luck. I wish you and your family the best.

[CoffeeRTC, BSN, RN]

Sounds like he might need skilled care aka nursing home placement. From what I understand (at least in my area) assisted living is just for folks that need minimal help and won't need watched 24/7 and for the most part are continent. It might be different for a alz locked assisted living, but it sounds like there weren't enough eyes and he can't call for assist on his own....

What do they do to prevent falls at the ALF?

I have to agree with an above poster...we get so many residents from assisted living who should have been in a skilled care facility a long time ago, but $$$$$$ kept them there.

So...what to do? Speak with the SW at the hospital, start looking at places in your area. Go in to see them, just don't rely on the online ratings and survey info posted on line. If you have the time, pop in un announced and ask for a tour. Places that want your business will give you a tour on the spot, you might not be able to speak with an admissions person directly, but someone should be able to give you info and take you around.

LTC places should have a system in place to keep the doors locked to wandering residents, ask about the staffing level (they should have it posted...it is law) Look at the staff, do they seem friendly? overworked? professional? What about the residents? any odors? Ask to see a copy of the menu and activities schedule.

[RedhairedNurse, BSN, RN]

I had a similar situation with my dad and it was a very difficult time in our lives. My dad was falling a lot and spending countless hours in the ER. I placed him in a very nice nursing home on a locked and secure alzheimers floor. Due to so many bad falls, I finally had to agree to restraints. It was a hard decision to make, but I couldn't stand to see him suffer from so many falls. He was basically confined to a wheelchair with one of those lap belt restraints. While in bed, we had to depend on bed alarms to keep him safe.

I feel for you and your family. My advice would be to look around for a nursing home. Look at several nursing homes before you make a decision. I never got much help from a social worker at the hospital. They can give you names of nursing homes, but you have to do all the work.....you know, to make sure it's a decent place and all. The social worker really isn't going to know what's the best fit, but they can help you some.

Luckily, my dad was poor so he was able to get on medicaid. I just lucked out and found a very nice facility that had a medicaid bed available. I pray for you and your family that you find a resolution.

[Saifudin]

Assisted living should not accept such a high risk patient and it is a huge business. You need a competent social services department for a proper referral.

You parents are admiral to have cared for your grandfather for so long.

[VivaLasViejas, ASN, RN]

How does your grandfather not qualify for a nursing home, I wonder? He may not be eligible for skilled services, but he certainly should be able to get an ICF (intermediate, or custodial care facility) bed. He is definitely too high-acuity for assisted living, and he would not be safe in any other setting, except perhaps a memory care facility, and those are few and far between.

Don't get me wrong, the nursing home isn't the perfect solution, and falls do occur because we don't tie people to their chairs or beds like back in the old days. But the staffing ratios are a little better, we have devices that let us know patients are trying to get up without help, and aides are better trained to deal with dementia and behavior issues.

You also might not be aware that there is such a thing as the geriatric care manager---usually a nurse or social worker---who specializes in finding the appropriate resources for elderly and disabled patients. Depending on where you live, you may be able to find one in the yellow pages of the phone book.

Good luck to all of you!

[swirlygirl]

Thanks everybody for all your advice and information!! Well, as of today, my grandfather does qualify for a skilled nursing facility. I guess because of all of the falls. Or maybe because he was finally assessed by a hospital social worker and not a nursing home social worker who is just looking to fill a bed. He's going to go back to the place where he was for 8 weeks for rehab after his first fall. He did really well there, since for some reason they are allowed to use lap belts and restraints. I'm pretty sure he will fall again no matter where he is or what the staffing ratio is because he's so confused and weak, but I feel better that he's going to this place where they know him pretty well.

Thanks again guys!!

[RedhairedNurse, BSN, RN]

Thanks everybody for all your advice and information!! Well, as of today, my grandfather does qualify for a skilled nursing facility. I guess because of all of the falls. Or maybe because he was finally assessed by a hospital social worker and not a nursing home social worker who is just looking to fill a bed. He's going to go back to the place where he was for 8 weeks for rehab after his first fall. He did really well there, since for some reason they are allowed to use lap belts and restraints. I'm pretty sure he will fall again no matter where he is or what the staffing ratio is because he's so confused and weak, but I feel better that he's going to this place where they know him pretty well.

Thanks again guys!!

I used the lap belt for my dad, it wasn't bad at all. This was recent, not back in the older day. IMO, it just kept a very confused man from getting up out of chair and taking a bad spill. Some people choose not to use them, but dear dad was having severe falls. To me, I had to weigh out the two......restraints with lap belt in wheelchair, or really bad falls. It was a no brainer.

The family must sign and agree to using such restraints. So many times, I would see older folks falling because family members not agreeing to use the lap belt. It was sad to see these people get hurt. It's a very hard time in these seniors lives, hard on the whole family. So hard to watch. Doesn't seem like a very fair part of the ageing process. I hate to see it.

I wish your family well. Take care and pop in at different times, all different times. If you go in the same time every day, the staff will know and expect you. Make surprise visits. Even the best homes have certain drawbacks, so keep a close and watchful eye on your dear loved one. He deserves the BEST of care and I know you will provide this for him.