m.k.a.u.

Ugh. It's disgusting. I definitely would understand not visiting. I can't say I wouldn't have some sort of contact. Again, this is me because of my irrational feeling of guilt even though let's say I'd be the victim. Maybe I would write anonymous cards and gifts or something. Again, this may seem irrational to others, but I just don't want anyone to feel alone. But this situation is understandable why the family wouldn't visit. However, is this person living in a nursing home now? How does he afford it? When I think nursing home, I see a specific population that can afford it or has family paying or has medical aid. But even with aid you still have to pay premiums. I doubt after being imprisoned he earned enough money to pay for nursing care or has someone willing to pay for his care. There usually is a specific "type" that goes into nursing care. Usually it's not those with close cultural ties. Usually, not always. For example, Asian, Filipino, middle eastern, etc., take their loved ones into their homes to care for them. Looking at research studies on the demographics of nursing home populations, many are white women with well off families or well off themselves financially. Again, not always the case. These are inferential statistics. And from my observations, there is an imbalance in women to men and with the rates nursing homes and retirement communities charge, there better be money somewhere. Yes, people can be under Medicare and Medicaid, but again there is the need to pay the premiums. What I am trying to say is that nursing homes have a certain type of populationand characteristics. You may be referring to a whole other population where this guy would fit into. Unless he is in a nursing home now and I would be curious to know how he is able to afford it. Please do not mistake this post with any attitude whatsoever. There is none at all.

I am not contradicting myself. Read carefully. I said I can respect that. But if put in that position, I would want to be able to be near by. Therefore, I would have to consider that if my parent were in such a condition that she is unable to orient herself to anything, then why not take the chance to bring her closer despite her wishes. I want to be able to be involved in her care, but to do that actively we would have to be close together. And why am I riddled with judgement just because I want to understand families' reasons? I respect their decisions to place family in the nursing home. That wasn't my question. My question was why don't they ever visit? If they are close by and are not estranged due to family conflicts what reasons are there? I'm not saying there isn't any reasons. I want to know the reasons so I can put them into perspective. I want to understand for mere curiosity. I can argue and give reasons for both sides because of the information brought up here. It's research, it's curiosity, it's trying to understand. I get furious when I see my residents alone on holidays. Of course we are there to betheir family, but I want to know why family can't be there. Or even send a card or some sort of contact. I am trying to understand others because for me, regardless of what a family member could have done to me, it wouldfeel coldhearted to just leave them there alone. If I couldn't face them, then I would send a letter or gift or whatever during holidays. Because I wouldn't want them to feel alone. But that is me. So me asking these questions helps me understand others views. It's not about judging it is understanding others. I am not debating to win. I probe with more questions to get explanations and comprehend them. So don't attack.

Actually it's to understand thank you very much. And you should probably learn to communicate as this is an open forum and not a place to attack. But if I want to judge I can. If I want an explanation, I can ask for it. And again, you are assuming that I wi use the exanation to judge. I am not. I want to understand what is goingthrough people's minds during situations. I have an interest in psychology and so I am always wondering. Plus, asking questions and getting answers gives you a better perspective on things. Got it? Good!

No we don't throw out their wishes. Which is why I said I can respect that. I don't know what my decision would be if one of my parents decided they wanted to be in one place while I was in another far off area. I think that if they were demented enough, I would find a way to move them closer to me and the family. I would want to be with them on holidays and be actively involved with their care. So I would probably find a way to move them. I would see how well they could adjust to the new environment. But if they are so distraught and depressed then I have no other choice but to bring them back to where they belong. Can't say I didn't try. I just hope I never have to make a decision like that. But if i do, I would HOPE that I am always able to visit, near or far.

your assuming i'm judging. your assumption is no better. i am merely asking for an explanation. so my question to you then, if your mother has alzheimer's or dementia, will she know the difference where she is? some of our residents are not even oriented to person, place, or time. but of course, you could just be granting her wishes and ivan respect that. what about families who never even bother to call? some residents are still "with it" enough to answer appropriately.

Really sorry for you having to go through that experience. I had a demented resident who was just so out of her mind that we had to remove her from our whole facility. She would curse at all the staff and yell at the residents. She kept saying that there was a fire. She was moved from our locked dementia unit because she needed much more care, but we couldn't give her the care she needed. She needed an institution. So i understand when someone is too much to handle for a family. This resident was too much that a facility couldn't handle her!

yes this is true, but all bad parents aside, what about those who were good to their children and don't get any visits. if distance is an issue, why not bring her to a closer nursing home. some of our residents have been moved for that reason.

I know all about family abuse and molestation PERSONALLY! Don't get me started on that. And I do know some backgrounds on my residents. Some of them have no children and rely on distant families or nieces. But even those people make it seem like a burden to come visit (some of them). But anyway, upon admission, we do get some extensive history on the resident from their families and friends. More than we require sometimes because thetransition is such an emotional period that they share their stories with us. It is amazing what we can learn about our residents' past lives. So yes, I do know a good amount. I am sure I don't know the whole story, but we do get a good glimpse into the past. And I can say that the residents who were "awful" to their children, those are the families that actually stop by occasionally. Funny isn't it. Maybe this is thefamilies' way ofgetting that love they didn't get before? Who knows. Anyway, maybe I don't think all the background stories, fine. But I guarantee you that there are a few residents who were not bad parents, but their children do not come. How do you explain that?

It is absolutely a ridiculous mindset. I used to think exactly like that. I would think "how can you put your family in a nursing home and leave them there?". But then I started working a CCRC continuing care retirement home in the skilled nursing unit. What people have to realize is that caregiving is more than a full time job. It is an around the clock life consuming job. It is a lot to ask of the family to quit their lives and take care of someone. It is not an easy job to care for your loved one who may be suffering from dementia, chronic illnesses, parkinson's, incontinence, etc. It is even harder when you have your own family to take care of. How can you be a full time worker, full time parent, full time spouse, and then have a life as well if you are also take g care of your loved one who can't lift themselves up to get out of bed or even have the cognitive abilities to know where the toilet is. Family caregivers are more prone to stress and depression and you are putting yourself at risk. Sometimes our loved ones just need more care than we can give. Sometimes professionals need to step in as a resort. However, what I am angry about is when families put their loved ones in a care home, leave them there, and never visit. What is that? Even during the holidays they don't even show up. I love my residents so much and I never thought that I would ever willingly give my holidays with my own family so I can be with them for a while. It really hurts when families don't ever show up. Just imagine sending your old mother to a care home, the person who raised you and cared for you. But you can't even show up to visit. This is just sad. I always appreciate the families who visit regularly. But then I see the residents who don't get visits looking at others' families. It is heartbreaking.

Hi, I am getting a lot replies about how it may not be possible to add another form of documentation to a CNA's job duty, but let's say that it will be implemented regardless. Whether or not they will have time is not the matter in question. Also, I have seen the CNAs in action in that unit and I know try have the time to do so. My real question is how should I write up the documentation. It will be a checklist form for simplicity and efficiency. I just don't know what exactly to put on the form. Thanks all.

Hi Kitsey, Unfortunately that's true. I did consider the possibility of an extra charting task to be excessive. But in order to teach the CNAs responsibility and ensure they provide quality care, they will need to document. With such a small unit, the CNAs should have enough time to do so an I am making a checklist quick and simple enough so that it doesn't take too much time. Plus, I spoke to the higher ups ad they agree with it. And the LVN supervisor said as long as it is simple and doesn't require a lot of time, then it is possible.

Hi AJ, I will be putting together a separate activity chart binder for each resident much like what you are describing. Except I will be the one to manage it and I want to keep the CNAs from doing extensive charting like what you have to do. I want to make a checklist form so that there isn't a lot of writing going on and they will not be doing daily activity charting either. I will take care of that since I will be the one facilitating the majority of activities. What I would like the CNAs to do is understand that the activities of daily living they help the residents with is also considered an activity but they can take it one step further and bring value to that interaction. In that I mean help them learn the steps that is required in brushingtheir teeth, etting dressed, etc. It is like training them to become more independent. That's what will make that interaction more meaningful. And since the administration wants the CNAs to be more involved in activities, the CNAs should have more one on one time with them either reading books or helping them with puzzles, etc. Either way, they should at least have the goal of doing one meaningful activity with each if their residents. This is not about whether they have time for this or not. This will happen because the administration is making it a requirement. I am just figuring out a way to put it in paper form as a record. But one thing is for sure, I do not want them doing all that documenting the way you are. It just isn't possible for them to be able to do all that. It's time consuming and taking them away from resident care.

Hi canigraduate, They chat in the office and sort of lazily walk around. Their attitude sucks and their work ethics are nonexistent. This is one of my reasons for wanting to implement some sort of documentation. There are teo CNAs with a float making it three fr a 15 bed unit. And this is a dementia unit so there arecertain qualifications that the residents must meet in order to stay there. These residents do not need a very high level of care like the residents I worked with in SNF. therefore, I know these CNAs do not have to work as much as that unit. But because of their laziness, I need to implement a documentation form so that they have some sort of accountability.

Hi, I have been working in our skilled nursing facility/LTC for a few years as well and I know that our CNAs are seriously overworked. But in our dementia care unit, I see them stand around and have chats since it is only a 15-bed locked unit. And I did speak to the LVN supervisor to ask whether the documentation is possible. That is where I got the suggestion of using a checklist form so that they are not spending time writing down a summary. Which I thought was a good idea since illegible handwriting would pose as a problem. I also ran this by the executive director, but have not yet run it by the health services director. I would be using this documentation as an accountability form to evaluate whether the CNAs are working towards our new unit goals/philosophy and it will serve as an update for me as well on each resident during our resident reviews.

Hi, I just got transferred to our dementia care unit and we are trying to change the way the system works in that area. I am the new dementia care coordinator and I will be supervising the CNAs. The administrator and health services director would like to change the culture and get the CNAs more involved in the facilitation of activities and getting them to understand that every interaction they have can be considered an activity with the dementia residents. Not only is every interaction an activity, but we want the staff to make each encounter meaningful. For example, when they are helping the residents with their ADLs like dressing, do not simply put their clothes on for them. Include them in the activity and ask them what outfit they would like to wear, what matches what, etc. Or when brushing their teeth, some residents have trouble carrying out multiple steps. Therefore, to help the resident, the CNA should break down the process into single steps like get your tootpaste, open the cap, get your toothbrush, squeeze the toothpaste on the toothbrush, and so on. This way you are helping them go through the steps, fostering independence, and giving them a sense of achievement. So, my situation is... I would like to put together some kind of documentation form for the CNAs that they would fill out at the end of their shift on each of their assigned residents. It has to be a checklist form of documentation so that it does not take up too much time. It would have something like a general list of interactions/activities and how it was meaningful to the resident. I can't decide whether it should have a list that states the category of activities (ADLs, fine/gross motor, social, sensory, reality orientation, etc.) or if I should list specific activities (dressing, grooming, arts & crafts, exercise, musical entertainment, etc.). Then for the section where they would explain the activitiy was meaningful, I am not sure what choices to put (fosters independence, step breakdown, emotional support, self esteem, etc.). What choices are most appropriate? Does anyone have a form already put together that can send me in the right direction? Here are some sections I would like in the document: type of activity, value/meaningfulness (or another section name), resident response (conversed, refused, eye to eye, etc.), and resident participation (active, observer, passive). Thanks in advanced, m.k.a.u