Care facility expectations

[Scuba]

We moved DH’s mother into a Memory Care facility in March. We’ve been fairly pleased overall, but while visiting this week, we noticed that her sheets and pajama bottoms were stained and staff hadn’t noticed it, nor had she. We brought it to their attention and still had to follow up twice to make sure her mattress pad and fresh sheets were back on her bed by evening.

I understand that staff can’t give every resident individual attention and stimulation, but checking the condition of a resident’s bed and clothing would seem to be a basic requirement. I’m planning to discuss this with the Memory Care Director after Christmas.

I’ve noticed that some residents have private supplemental caregivers. We had previously checked into this option so she would have people giving her more stimulation and motivating her to move around more, but all the ones we’ve found want a minimum of 20 hours a week, which would amount to $40-$50K/year on top of what she is already paying to live in Memory Care. She cannot afford that.

Would appreciate any thoughts/advice about what we should reasonably expect from the Memory Care staff as well as any ideas about how to find someone who could come in 2-3 times a week for a couple of hours to visit her and give her more stimulation.

 

[youbet]

I'm assuming your DH's mother is private pay at the memory care facility.

You can discuss your observations and concerns with management at the facility and ask very specifically for their corrective action plan. And there should be periodic meetings where family or guardians (and the client if appropriate) discuss the client's situation, concerns and goals. Minutes are taken and progress (or lack of progress) is discussed at subsequent meetings.

In our area, private pay clients are often a sought after commodity. Don't be afraid about bringing your concerns to other competing facilities where you might find more desirable situations and a willingness to address your concerns.

We had DW's mom in a NH for almost 5 years and it was a challenge. Little was automatic. Eventually DW visited 5 - 6 times per week and we frequently brought in treats for staff and discretely tipped whenever there was the slightest excuse to.

 

[Scuba]

Yes, she’s private pay. Unfortunately there is only one facility in her town and all of her doctors, her other son, and friends are in this town. Moving her would be difficult.

I definitely will meet with the management. Just wanted to check others’ experiences. Sounds like being a very visible presence is a great solution, but hard for us to do as often as may be needed.

 

[MichaelB]

Can’t add anything to youbet’s excellent response. There’s really no good option aside from regular visitation. In this case the saying “expect what you inspect” prevails.

Being close to friends and doctors may be comforting to family members, but the resident might benefit from living in a facility close to a family member who can visit regularly and improve the standard of care. Better care and attention might be more important than close to friends, especially for someone in memory care.

 

[Aerides]

Perhaps ask the other private-care supplemental nurses if they can add your MIL to their schedule just a few hours a week? Might be easier than starting fresh with someone new. If they are already visiting that location, then perhaps 10 hours a week is negotiable?

If her other son is local, is he stepping up and visiting frequently enough to check on this? (since the location is good for him).

 

[pacergal]

Frequent visitation and involvement is key, whether in the hospital or a care center.
Unfortunately, with over worked/underpaid staff, things can get missed. I have witnessed that many times over my nursing career, both as a worker and as a patient.
As Aerides mentioned, if the other son can visit daily, it might help.

When my Dad was in the hospital and care centers the past two years of his life, he had family visiting every single day. Myself and siblings made sure someone was there am and pm so we could see how he was and how the care was. And I checked in daily with the charge nurse, for comments/compliments/concerns.

Do make sure you have the care coordination and follow up meetings, at least once a month. Usually the center director or charge nurse and a therapist attends.

 

[joesxm3]

I went to visit stepdad at the NH today. I had not tipped before but I slipped a $20 to two of the aides. One did not want to take it, but we were in the hallway and I may have not been discrete enough. That aide had been very good caring for my mother and I felt bad that I had not given them anything after we rushed out due to covid. I did give 60 N95 masks to the nurses and two dozen small bottles of hand sanitizer the week before.

I will try to slip some more to the ones I see doing a good job. But I will be more careful.

 

[Northforker]

Private supplemental sitters cost $13/hr with a 20 hr minimum in our town. That's about 14K/YR.

These are not nurses or even CNA's. mostly retired ladies making a little extra income.

We used this service for my mother when she was in assisted living. She had Alzheimer's and we wanted to keep her and Dad together instead of moving her to the memory care wing and splitting them up.

 

[Scuba]

Thank you for the responses. I really wish we could rely more on local family, but DH’s brother has two businesses and his attention to his mom has always been sporadic at best. Other family members live 2 hours away and see her only occasionally. She does have a good friend who visits regularly and often, but I think supplemental care would be helpful.

We sent a large box of treats to the staff and also contributed $500 to the employee appreciation fund as staff members are not allowed to accept tips from residents or families. Having worked in this industry before, I think that’s a good policy.

I’ll have to ask around more and see who may be willing to negotiate on minimum hours. I really don’t think she wants or needs 20 hours a week.

We will be able to inspect much more often now that we live in FL, but we aren’t willing to move to GA so that we can visit daily. We will just have to find another solution. She doesn’t want to move from the small town she’s in, and I think moving her would really upset her plus be much more expensive. She pays less than $5K/month for Memory Care in her small rural town. She can afford that but not much more.

 

[SecondCor521]

My Dad has mid-stage dementia and lives in AL at the moment. MC may be in his future; we'll see.

I just wanted to add that no matter how good the care facility is and how much the family does, dementia just brings a certain amount of instability and uncertainty. This has practical and emotional impacts. Practically it's hard to make plans because the situation changes. Emotionally it's hard because you want stability and health for your loved one, and you're slowly losing them no matter what you do.

It may help to try to accept the fact that there will always be something that you're chasing down, or trying to figure out, or adapting to, or whatever. Obviously make sure your concerns with clothing and bedding are addressed, particularly if there are patterns. But in two weeks or a month it will be something else - a medication change, a change in the person's abilities, a lost wheelchair or walker, a billing mistake, trouble getting the mail forwarded, family dynamics as a result of their illness, etc.

And all that wears on caregivers and families. I find the caregiver forums over at alz.org beneficial sometimes:

https://alzconnected.org/categories/supporting-someone-living-with-dementia

There also may be local organizations that can support you as you support your family member. My nearby local library connected me with a bunch of local resources when they had a "memory care fair" and it was very helpful.

 

[Teacher Terry]

I was the guardian for my friend with dementia and despite marking all her clothes, etc it didn’t take long until she was never in her own clothes and after awhile I just gave up. Originally as she lost weight I bought her new clothes but quit because of the above reason. She was well cared for and I decided that wasn’t the hill I was going to die on.

 

[pacergal]

Do they have some company such as "Visiting Angels", "homestead", or care.com there? Mostly for in home around here, but maybe they would do a facility. care.com does list companionship, so maybe that might include a facility visit.

 

[Scuba]

Thanks for the additional ideas and input. Fortunately I found a caregiver who is willing to be flexible on hours and doesn’t have a fixed minimum, so we can try her service in a small number of hours now, which will be a better match with what MIL needs at this point,

I can relate to what Teacher Terry says about the clothes and just in general accepting to a certain extent that there are problems with living in a facility. Still, MIL is much better off than she was when living alone and struggling with taking her meds correctly and other issues. Aging is hard!

 

[Badger]

Private supplemental sitters cost $13/hr with a 20 hr minimum in our town. That's about 14K/YR.

These are not nurses or even CNA's. mostly retired ladies making a little extra income.

We used this service for my mother when she was in assisted living. She had Alzheimer's and we wanted to keep her and Dad together instead of moving her to the memory care wing and splitting them up.

It sounds like you were happy with the service to continue using them. Those retired ladies may be just as competent as a CNA. This sounds like a great supplement.

 

[Koolau]

My mom and dad were both in memory care (same unit - a few years apart.) For the most part, I was satisfied with their level of care. But I found that, to some extent, you have to lower your expectations. Things that cause actual harm MUST be dealt with quickly and with follow up by the advocate(s). Other things may have to slip a bit.

I often found the staff being very caring toward the patients. BUT, there was virtually always "that" smell. Neither parent had that problem but in a ward of 25 or so, it's a constant battle to keep up with the patient accidents. I wouldn't say it was the 3rd circle of hell, but maybe the 1st circle (if such exists.) Some things just can't be perfect and memory care seems to be one of them - no matter how good or caring the staff.

God help the folks in memory care in a place like a prison or all-Medicade unit. God. Help them! God, let me die of something else! YMMV