Need advice re:LTC in London ON

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Good morning!

I've been lurking on the allnurses boards for a while after being pointed in this direction by a wonderful friend who is a member. I have learned so much here!

Yesterday, my mother was admitted to hospital in London ON. She is in (I would say) stage 6 of Alzheimer's disease but up until now was still being cared for at home by my father. However since the fall she has become increasingly incontinent (both bladder and bowels), and worse, aggressive especially towards my father. The situation escalated to the point where last night he took her to emerg as he just can't do it anymore. They kept her, worked her up in emerg and were going to send her to the floor at some point last night.

Unfortunately my father was very resistant to putting her on a list for an extended care facility so she has just gone on the list in the not so distant past; I'm not sure of the exact date but I would say end November or so...meanwhile she had a weeks respite care in Dec that only lasted a day because she hit a resident and my father did not want her "doped up", so he withdrew her after the 2nd hitting incident. that was the beginning of the aggressive phase and it has gone downhill since then. In addition my dad is having cardiac symptoms (chest pain, SOB, numb arm/pain in arm)

I am a pharmacist and I live out of town so I am trying to manage the meds and keep up via phone calls/emails from my sister who bears the front line support of being there for my parents. WIth this admission to hospital I will be heading to London in the upcoming few days to see for myself what is going on.

My question is this: what is the LTC situation in London? What are the "good" places for someone with ALzheimers, what are the places to try and avoid, any advice or tidbits I should keep in mind? I know that once she is ready for discharge, there will be no "choice" in where she goes in the short term but was wondering if anyone could share some words of wisdom about what I can expect as the only thing I know about London LTC is back in the 80's when I visited my folks, we'd drive down Southdale and see an elderly man standing at the corner in front of the Dearness home, waving at all the cars as they passed by, every day...

thanks for any help you can give me, from a stressed-out daughter who is too far away right now!!

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If LTC in Ontario is anything like LTC in Alberta, hmm.

If you can PAY and I do mean PAY you can go private and get what you want.

If you are looking for provincially funded, you basically have to accept the first bed offered and remain on the list for facility of choice and move when a bed becomes available. This basically depends on waiting for someone to die or to move on to a different level of care. So it can take a while.

A lot depends on the assessment done when she went on the list. Is she only aggressive toward you father, from the sounds of it no as she had to leave respite.

Dumping in Emergency is often seen as a way to move someone through the system faster. Health authorities try to place the patient quickly due to the cost of keeping them in an active treatment bed. But even then the wait can be 90 plus days. She will have her meds adjusted because the staff in acute care have sick patients to care for and are not geriatric specialists to care for her. She may well be discharged home depending on the bed situation.

Some Altzheimer facilities are really good BUT admission is often dealt with case by case. I know of one facility that is beautiful, clean, and has a great reputation. But here's the snag, no incontinent, no diabetic, or violent patients are admitted. Once these symptoms develop the patients are moved through the system to a more secure unit.

So basically, you are at the mercy of a system that is overburdened at the best of times. People magically expect a place to be available because they need it now.

One important thing to remember is now you are a daughter and not a pharmacist. Nothing is going to go against you faster than you doing a meds assessment of you mother. The staff are dealing with her at times you never see her.

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Specializes in Geriatrics, Med-Surg..

The above poster is correct in regards to the situation in Ontario. You will not have a choice in the short term. If I were in the situation you are in and I fully expect that I will be within the next ten years, I would begin by possibly speaking to the discharge planner or charge nurse at the hospital and find out what your choices are. Once you get a short list of facilities to consider, you could tour them personally. Ontario is ahemm, very frugal with information about the quality of LTC's but they do post recent inspections of the MOHLTC, web site and each facility is required to post their inspection in a public place. Of course these inspections have to be taken with a grain of salt as we all know that many facilities tend to put on a happy face for the inspection. There are some good facilities out there but you are best to inspect the facility yourself. If you have a bad feeling about a place, you are likely correct. Best of luck.

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One important thing to remember is now you are a daughter and not a pharmacist. Nothing is going to go against you faster than you doing a meds assessment of you mother. The staff are dealing with her at times you never see her.

I don't necessarily agree with this. I personally think it is impossible (for me) to separate my professional knowledge from the situation. I think there is a way to do things like this -- I worked as part of a multidiscipinary stroke team for many years so I think I have the interpersonal skills to voice concerns about my mother's medications should the need arise. I don't claim to be a specialist in the area of dementia but I certainly can ask questions in an appropriate way.

My mother is now in restraints at the hospital as she hit someone...

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Specializes in LTC and Retirement Home.
My mother is now in restraints at the hospital as she hit someone...

i'm sorry it escalated so quickly in hospital, my friend. :o

i suggested to kidsmom that she look at various threads here, as i have always seen that support is readily given. the poster implying that kidsmom shouldn't use her professional knowledge is off base... many hospitals around here still use haldol for aggressive geriatrics.

and that is the worst med to use. :angryfire

i think that kidsmom is well within her rights to say that to the staff. and to ask the doctor what other med choices he could make.

big hugs to you, HP, keep me up to date, and you are all in my prayers.

karen

ladylurker :redpinkhe

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Specializes in Geriatrics, Med-Surg..

I was just thinking that I would like to add that there are some really good places out there. I do not know the London area at all but I know of a couple exceptional places near me. I will look to see if they have any other facilities in London. Good luck and I hope that you are able to get her settled soon.

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Specializes in Geriatrics, Med-Surg..

I just did a search and the facilities that I was thinking of do not have locations in London, Ontario, however I am sure that eventually you will find a good place for your mother. Best wishes.

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Well, the situation was not nearly as bad as I had expected -- she is starting to settle down and although she is still quite labile behaviourally, she is becoming more cooperative with staff each day. So no restraints, no 24 hr supervision...but sadly I see my mom who has become unable to communicate clearly, unable to fully recognize her family; it's hard as a professional to help patients deal with these changes to their loved ones, but now I am the one in need of that moral support!

Now the wait for placement begins. My dad told the social worker he is willing in the short term to go out of town and as I told him, if my mother settled nicely somewhere where he as well as she are comfortable and happy, then nothing stops him from relocating out of the city. Options are being looked at properly for the first time, I'd say, and with a bit more realism. We (the children) have been singing the song for several years now but it's hard to argue with a husband who is willing to put in a few "for worse" years to go along with the 46 years of "for better" that they have had. He was bound and determined that she would stay at home.

If you asked me about LTC placements in my city I could list them from top to bottom in order of "that is a wonderful place" to "wouldn't even consider it" based on what I have learned over the 24 years I have worked here. I was hoping for some more specific recommendations re: facilities in the London area but I understand that this may not be the place to "name names". Thank you anyway for your words of support! (and if you want to name names off-board email me please!;))

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I finished my degree in London last year...I know there are a number of LTC facilities in the area and I'm sure some of them are good. All nursing students at western and fanshawe college go through a LTC rotation...I wonder if someone at the school or some of the preceptors would be up to talking to you about their experiences.

My experience was regetably very poor and I believe that students are no longer sent there. I don't think it is appropriate (or wise) to name names on this board...pm if more info is required.

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