Please help, questions about LTC placement

[gypsyatheart]

Hi there, I was hoping I could get a little input from LTC nurses....

LTC is not my specialty, although, I am familiar w/LTC and even worked, a long time ago, as an aide in one.

Sadly, just a week ago, I had to admit my mom into a facility. She has multiple medical problems, now most recently w/Parkinson's and a long-standing dementia diagnosis. She is ambulatory and pleasant. She typically denies any offer of help and, if left unattended will spend the whole day in bed. She will miss meals, not take meds, not bathe, etc. She is completely incontinent, and does not even realize that she is soiled, nor will she attempt to change herself. Since admitting her to the facility she has not been bathed, and has not been getting her Depends changed, nor her clothing. They are pretty much leaving her be. In fact, yesterday no one took her to the dining room for breakfast or lunch! I did speak w/the ADON on Fri to try and re-iterate her needs, and all she told me was..."well your mom looks OK, like she's independent, so the staff may not realize she needs help"! OK, why would she be there if she were independent, or not needing any help?? No one did an admission assessment, no one actually spoke to us and asked about her needs or what her level of care should be. I had already discussed this in length w/the Admissions people prior to admitting her, but, obviously, that was not communicated.

Also, they placed a blind, severely disoriented/dementia patient next to her, in the far bed a couple of days ago. The woman gets up, confused and tries to climb into my mom's bed, and has already broken a couple items of my mother's due to her behaviors.....I am continually speaking to the staff, but to no avail.

Is this the norm? I know there is an adjustment period for new residents, but this seems odd.....

Any input is appreciated. I have left messages for the DON, but she has not called me back and when I was speaking to the ADON last week, she could hardly wait to get me off the phone! I don't feel I'm being unreasonable when talking to staff, either, I make sure I am polite and respectful of their position.

Thanks for any replies.....

[paulla29]

Wow. You are right, your Mom would not be there if she didn't need help. Maybe some homes are like that, but not the one I work for. If the nursing assistants do not give their residents care, as their charge nurse on the floor, I WILL take corrective action with them. As they are "my" residents, I make sure care is given, meals are eaten, I even follow up to find out how much is eaten at each meal. I don't just take their word for it, I actually go around the dining room or into their rooms to check. I've also dated and timed briefs/depends and went back to check periodically to make sure they have been toileted and changed.

It blows my mind that the ADON acted like that, and that the DON hasn't reponded yet. My guess is that they know incompetent care is being given, and don't have any answers or methods of resolution for you. I would investigate other nursing homes in your area. If that's not a possibility, KEEP COMPLAINING. Keep calling the DON, keep on the nurses also, as it's their responsibility as well to make sure care is given. Talk to the administrator. Call their corporate office if you don't get anywhere, or the state ombudsman. Best of luck getting the issues resolved.

[gypsyatheart]

Thank you so much for your reply. I thought as much..... Well, still no call back from the DON, I guess I will have to keep bugging them, and I definitely am investigating other facilities in the area.

Thanks again!

[MisMatch, LPN]

This sounds way out of line for LTC! I am a nursing student working as an aid in an ALF (assisted living), which typically is for those that need less care than LTC.

If a resident doesn't show up for a meal, we go to their room and check on them - see if they are feeling well, have fallen, or need assistance.

All residents are gotten up and dressed in the morning. Those who are incontinent are checked q2H to assure they are clean and dry. All residents are scheduled a routine bath or shower.

Unless the resident is able to self-medicate (per Dr. order), staff is required to give medication and witness the resident taking it.

I'd definately recommend calling the ombudsman and/or checking other facilities!

[APBT mom, LPN, RN]

I'm not a LTC nurse but my grandmother was in a facility that sounds just like that. My grandmother wasn't able to walk due to severe osteoporosis that had caused several breaks in her left tib. Plus the staff liked to steal things out of patients rooms or meals that were brought in for the patients. We did the same thing as you with calling first speaking with her nurse, then the charge, then ADON, and finally the DON. All fell on deaf ears.

Here's what we did, first go and see the DON in person then they won't be able to brush you off and address your concerns then with the DON go to the charge nurse and let them know what your mother needs help with since admissions failed to do this.

When you visit come at different times and sometimes twice in the same day. It's annoying at first but when you do this the staff will start taking better care of her because visitors will notice when somethings not right annd they can get written up for it. The days you can't come call or see if you can get a private phone put in your mothers room so you can call her directly without the staff knowing.

Keep a pad and when you visit and see if anything is wrong write it down. Go to the nurses station and as who the nurse and aide were for that day and write that down to.

Ask what times meals and meds are and what days are your mothers bath days and write that down on a piece of paper and put it up in your mothers room as a reminder. We got a calendar and a digital clock for my grandmother and wrote everything down for her so she would know and could ask for herself when something wasn't done. If it's not done write it down.

After you do this you may start to see a pattern with certain staff/shifts. Then go ack and have another meeting with the DON and let him know if it's stil going on.

As for the other patient ask if you are able to install some kind of shelfing in your mothers room to put her things up on so the other patient can't break anything else. Also see if you can get your mother switched to another room.

When you research other facilities research the facility that oyur mother is at now. This may be an ongoing thing and they could already have an investigation against them.

Just know that all facilities are not like this. It took us years to get my grandmother in another facility and she loved it their until the day she passed.

[curiousauntie]

PLEASE PLEASE PLEASE keep bugging the DON. There is absolutely no reason that she has not returned your phone call. Standards of care are not being met...check and change every 2 hours prn, showers or tub baths at least 2 times a week, up and out of the room for meals and assistance eating if needed. And these are just the ones that pop into my head reading your post. If I was given a few minutes to really think I could come up with a lot more. The ADON is INSAINE! "The staff may not realize that she needs help"?????!!!! Please...if a competent nurse manager has assessed her, she should have started a nursing care plan and a nurses aide care plan that addresses all of the areas that your mom needs assistance in. Since the DON is not responding to you, you need to talk to 2 more people. The nurse manager of the unit. There should be an RN (although at some facilities it is an LPN) who is in charge of the entire unit. She is the one directly responsible to see that the resident's needs are met. You also need to talk to the Administrator. She is responsible for the facility...and the attitude of the ADON is one that will get the facility deficiencies during a complaint visit from the department of health! If you need to go there every day and every evening to make sure that the staff is checking your mom for incontinence and changing her brief and clothing and showering her, do it. The squeaky wheel gets the grease. I was a unit manager for more years than I want to admit and although I hated the squeaky wheel family members, I knew that if their mom or dad was not the way they wanted, I would hear it!!!! Be that family member. I was, when my grandmother and my grandmother-in-law were in a nursing home and both of them got good care. But your concern should be that if the DON is ducking phone calls and the ADON has an attitude like she does, then the staff is not going to be real receptive either. Find someplace else. Check out the web site for your state Department of Health. There should be links there to help you find a different facility. New Jersey has a search area where you can compare different nursing homes and there is also a report card based on their yearly survey (inspection) and any complaint visits. This is a first step. Next, visit any place you want to place your mom, and do not make an appointment. Ask for a short tour. If they won't give you a tour without an appointment, wonder why. Don't just rely on your vision...smell the units, listen for screaming or residents who are yelling incessantly, think how your mom would respond to the activities that are provided. These are just a few things that you can look for. Are the residents groomed, in matching clean cloths without rips or holes? Do the staff get down the face level with the residents when talking to them or are they standing over them? (that will tend to feel threatening to a demented resident, even if the staff member is not trying to be threatening). Do the staff put clothing protectors on the residents for meals? And NOT call them diapers (they are briefs) or bibs (they are clothing protectors). Are curtains pulled in rooms where there is care being rendered? Does the staff look happy? A happy staff is a happy facility. There is a lot to look for in finding a good facility, and it can seem daunting, but don't give up until you feel good about the facility you have chosen. And until you can get her transferred, show up daily, and at different times. Try to be nice, although if you find mom in a mess, you won't feel nice. Explain to the aide how Mom needs things done for her, and remember, you may have to do this often as the aides get days off, may rotate assignments and there are three shifts to consider! Your best friend will be the aide and the nurse who passes medications. They are the ones that provide the hands on care. And the ones who will not want you to be upset every time you come in to visit Mom. Good luck, I'll be thinking about you and your Mom.

Joy

[txspadequeenRN, BSN, RN]

my recommendation to you is pull her out and place her some where else. if you are trying to communicate with the adon and don and they are not responding to you....not good. they obviously are not

are not paying attention if she is incont and they feel like she can take care of herself. you will get nowhere with the nursing supervisors... move her now and know that not all places are like that. in my ltc...lol my boss would have been out the door and on the floor with hands around nurses and cna necks before you could express all your concerns. i am sorry your grandmother has to experience this...it is so sad that this is done to our elderly population.

[Valerie Salva, BSN, RN]

I agree with txspadequeen.

Sounds like a poor facility. I would move her to another facility.

Would it be possible for her to have a private caregiver in her own home?

[gypsyatheart]

Thank you all so much for your answers. It totally reassures me that my instincts were not wrong...now I'm just more determined! LOL! I am working on getting my mom out of there....problem was there were only 2 facilities that had beds available and the other one, believe it or not, has a horrible reputation, and is described locally as "the he**hole"! Yikes! This facility actually had good recommendations, however, recently, this group of facilities have been bought and sold a number of times over the last couple of years... I would love for my mom to be at home, but she really does need 24hr care, she has really bad "sundowning" behaviors, plus she wanders, gets lost, on and on. I need to work and have young kids, so I can't be at home w/her.... I wish I had the funds to provide a home and caregivers for her, but, unfortuately, I don't and this is just breaking my heart that she has to go through this.

But thanks to all of you, I feel justified and will be the "squeaky wheel"! I do have her on waiting lists at 2 other facilities, and hopefully, we can get her transferred before long.

Thanks again you guys; as usual, I knew I could turn to the nurses here for advice/support!

I will keep you all posted....:)

[txspadequeenRN, BSN, RN]

sounds like your mother needs more specialized care like the services of a alzheimer's facility. if this place is not providing her with adequate personal care ; i guarantee you they wont even know if she wonders out the door.

[curiousauntie]

sounds like your mother needs more specialized care like the services of a alzheimer's facility. if this place is not providing her with adequate personal care ; i guarantee you they wont even know if she wonders out the door.

moondancer, i can't believe that i didn't think of that...my mind has been a bit absent lately...

in my state there are assisted living facilities that have dedicated "memory support" or "dementia" units. they are usually fully secured (all doors to the outside locked and alarmed) and have more nursing staff and activity staff. but, the wait for a medicaid bed can be long (if that is your mom's payment source). the good ones will allow her to "age in place", meaning that as her dementia progresses and she needs more help, she will get it, hopefully without you having to place her in a long term care facility. as a hospice nurse, i see patients in 3 different assisted living facilities, and if i can throw out a name, the best one in my area is sunrise assisted living. their dementia unit is very well run, the staff are very caring and involved with the patients and their families. this is a nation-wide chain, and there are many sunrise facilities through out the country. there are also long term care facilities with dementia units, and they are usually also better staffed and the staff has additional training for the care of the dementia resident.

again, good luck in your search.

joy

[Daytonite, BSN, RN]

probably the most efficient way to handle this is just to show up at the nursing home as much as possible so you can get to know and interact with the charge nurses and cnas. when i worked in ltc we had a number of families that did this. this is how they made sure that mom or dad was getting the care they felt they needed. remember that the squeaky wheel gets the grease. if it still isn't getting done, move her to another facility or make a complaint to your state ombudsman who handles complaints like this. that will get the notice of the don. we had a daughter who complained to the ohio state department of health ombudsman all the time about the care her father was getting and the ombudsman (a really very nice lady) would come in and hold meetings with the don, charge nurses and cnas to, basically, discuss the care of the patient and how we were going about it. these ombudsmen must follow up on all complaints and reports. and, the facilities don't like it when a report is filed against them, but they do sit up and listen to what these ombudsmen have to say because they come from the state department of health who licenses their facilities to operate.