Please help, questions about LTC placement

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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.....

Specializes in Case Mgmt; Mat/Child, Critical Care.

Thanks for the continued support! I did speak to the DON, finally. She had a somewhat "chilly" tone, however promised she would speak to the staff and "look into" the situation.... I mainly wanted to make her aware that we were going to be on top of this and informed her that we would be there practically daily, as well as my understanding what the standard of care should be. She lightened up a little at the end of the conversation and offerred to follow up w/me after her "investigation".

The Assisted Living idea is a good one, bed placement, again, is an issue, plus the ones I found in her area that were reasonably priced, were not locked or secured facilities. They are very nice, ideal for the senior who needs mild-mod assistance, but I was worried my mom would wander off..... One of them even told me that if her doc wrote "dementia" on the admitting report she would not be a candidate. After more looking I did find some private residences, set up as ALF's for dementia/Alzheimer's patients, but no availability at this time. Also, staff there was "sketchy" to say the least....

I am hopeful to get her moved within the next 2 weeks, but I'm cringing at the idea of going through this all again, LOL! Hopefully, the new facility will have higher standards. Funny, cause this facility looks so nice, clean, no bad smells, etc., sigh.

Well, this has definitely been a learning experience for me and I am so thankful to have you guys to turn to. Thanks again! :)

Specializes in subacute/ltc.

Also besides LTC's check into Assisted Living Facilities. The one I work at per diem has a locked unit that is absolutely gorgeous and dedicated to Alzheimer's residents. I can vouch the residents on that unit receive fabulous care....not something I say lightly....

Tres

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.
the ombudsman are a great place to start if one has complaints or concerns about the care their loved ones are receiving in ltc. the ombusman are not the entity that regulates nursing homes, just keep this in mind. the entity that does the state surveys and regulating and supposedly enforcing , is your state department of health and family services.the agency (under the umbrella of the dept. of health and family services) that does the surveys is called the department of quality assurance in my state of wi. each state calls it something slightly different.

as great as the ombudsman program is , it does not have enforcement capabilities, and in some states if a nurse would report illegal/ unethical patient care practices to the ombudsman only, they would not garner themselves any protection from a retaliatory discharge. so for family and nurses alike, i would suggest reporting serious problems to the appropriate state entity,not merely to the ombudsman. here are some links from my state that addresses the role of the ombudsman.

http://longtermcare.state.wi.us/home/faq.htm

http://longtermcare.state.wi.us/home/ombudsman.htm

its worth a lookup to see what your own state regulating body is.the bon only deals with professionals and their licensure, some nurses are under the mistaken idea that this is also the entity that does the surveys.

Specializes in ICU, CCU,Wound Care,LTC, Hospice, MDS.

I have to agree with everyone else. This is a poor facility. I would move her ASAP. I have worked in several LTC's in two states and non were anything lkie you are describing.

Specializes in Case Mgmt; Mat/Child, Critical Care.
The Ombudsman are a great place to start if one has complaints or concerns about the care their loved ones are receiving in LTC. The Ombusman are not the entity that regulates nursing homes, just keep this in mind. The entity that does the state surveys and regulating and supposedly enforcing , is your state Department of Health and Family Services.The agency (under the umbrella of the Dept. of Health and Family Services) that does the surveys is called the Department of Quality Assurance in my state of WI. Each state calls it something slightly different.

As great as the Ombudsman program is , it does not have enforcement capabilities, and in some states if a nurse would report illegal/ unethical patient care practices to the Ombudsman only, they would not garner themselves any protection from a retaliatory discharge. So for family and nurses alike, I would suggest reporting serious problems to the appropriate state entity,not merely to the Ombudsman. Here are some links from my state that addresses the role of the Ombudsman.

http://longtermcare.state.wi.us/home/FAQ.htm

http://longtermcare.state.wi.us/home/ombudsman.htm

Its worth a lookup to see what your own state regulating body is.The BON only deals with professionals and their licensure, some nurses are under the mistaken idea that this is also the entity that does the surveys.

This is great info, thanks so much! I will definitely look into this. I hope to hear something tomorrow about getting her into a different facility(next week)....fingers crossed...:)

Specializes in Gerontology, Med surg, Home Health.

As a DNS, I am appalled that you didn't receive a call back immediately. One thing I've learned in my 25 years (yikes) of nursing is to listen to the family members. Of course they are not always right and some of them are lunatics, but you still have to listen to them.

That said-there are many long term care facilities that give excellent care and have specialized dementia units in them. Less expensive than assisted living and the good programs have activities most of the day....different activities geared toward people with different cognitive abilities (do I sound like a commercial?) All the staff who work on my dementia unit receive training in dealing with the dementia residents. Most of them are excellent and have enormous amounts of patience. We are trying to move to a less medical model....fewer meds, fewer fingerstick etc. No one who is 94 years old with end stage dementia needs to take 21 pills in the morning and have their blood pressure checked 3 times a day.

Keep looking. There are good facilities out there.

You need to call the state and the omsbudsman, while looking for another facilty. This behavior is totally unacceptable and if nursing administration does not respond, it will not get any better. So sad.

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