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would they transfer her to a rehab place to see if that would help her with her hip?
I do know in MA they have some great homes who do take medicaid but that won't help you.
They gave her PT after she broke her hip for two weeks or so, and then Medicare stops paying for PT and it ends. Medicaid doesn't pay for rehab unless it is extensive.
One thing I know is that if she winds up in the hospital for more than a few days, she loses her bed and they have to place her elsewhere. With the number of falls, it wouldn't surprise me if she breaks something again (she has osteoporosis).
I think it is important to remember that someone can break a bone and fall or fall and break a bone. Sometime all it takes is pressure from standing or a twisting motion getting out of bed to break a bone.
Not all fractures in nursing homes are in any way the fault of the home or staff. Also as you have said, they cannot strap her down.
I think it is important to remember that someone can break a bone and fall or fall and break a bone. Sometime all it takes is pressure from standing or a twisting motion getting out of bed to break a bone.
Not all fractures in nursing homes are in any way the fault of the home or staff. Also as you have said, they cannot strap her down.
No, they cannot restrain her nor would I want them to. But laying on the floor all night after falling is not acceptable, IMHO. You would think they would at least check the rooms during the night.
I know adult homes are much better for one on one care in a much more intimate setting. I would recommend it to you for your mother. They're usually 5 or 6 people in one house together and have their own rooms. It's a home setting with a skilled CNA or nurse with them during the day and night shift. They provide great care for any ailments or illnesses. I remember when I was doing clinicals, they had me at a family home and the climate was very relaxed, (unlike many NH facilities) and personalized.
The residents had amazing care that was available to them and they get to live their loves without the routines of the nursing home. The situation with the man who is abusing your mother sounds awful. I hope they move him to another hall or floor. She shouldn't have to deal with being in a dangerous situation like that and the facility has to take the right precautions to improve her safety. I wish you and your mother well!
That is my mom exactly. She still does it. The nurses say she is too independent, and she tells me that she can make it to the bathroom alone and doesn't want to bother anyone. Sigh. But who wants to strap her down...that is worse. They used to do that, I was told. The problem is she just doesn't remember instructions (or pretends not to!)
I'm 62, worked in nursing homes back in the early/mid 70's, and re-entered the field in 2002. So I have a unique perspective, in comparing the facilities back then and today. One of the bigger surprises when I re-entered the field was that nursing homes had gone restraint-free! Can't restrain a patient without a Dr.'s order and permission from a family member. And the beds! Way back, they had beds with high, full-length railings you could pull up to keep the patient from getting out of bed. Now? Those beds are history, as that's considered restraining a patient!
The problem with tab alerts is they can be easily detached, the more alert patients can't stand the emission of noise, and if I'm at the nurse's desk, and I hear one going off, sometimes I can't decipher if it's going off on my hall or someone else's hall, and with 5 or 6 on your hall with tab alerts, you have to guess which room in which the noise is emanating, and by that time, it may be too late! And then, you may get there, and all the patient did was turn over in bed, not even attempting to get out of bed, and the alarm goes off! And if you don't replace the batteries when needed, they're useless!
Ah yes, those super-independent, too-proud-to-ask-for-help residents! Yup! I'll be one of those nightmares for the staff one day, as I'd rather take a severe beating than ask someone for help!
I know adult homes are much better for one on one care in a much more intimate setting. I would recommend it to you for your mother. They're usually 5 or 6 people in one house together and have their own rooms. It's a home setting with a skilled CNA or nurse with them during the day and night shift. They provide great care for any ailments or illnesses. I remember when I was doing clinicals, they had me at a family home and the climate was very relaxed, (unlike many NH facilities) and personalized.
The residents had amazing care that was available to them and they get to live their loves without the routines of the nursing home. The situation with the man who is abusing your mother sounds awful. I hope they move him to another hall or floor. She shouldn't have to deal with being in a dangerous situation like that and the facility has to take the right precautions to improve her safety. I wish you and your mother well!
I have yet to find an adult home here that will accept an Alzheimer's patient or who has an opening. If anyone has any suggestions for a home in NH near Lebanon or Hanover, I would appreciate it. The list I received from Servicelink wasn't helpful at all. Even further away is OK, but I do want to visit frequently.
Sorry to hear about this situation. The cops were used as a form of documentation to possibly "remove" him from the facility for" endangering himself or somone else", which was your mother.
Alz and Dementia are two hard diseases to deal with. It is actually like brain damage that is getting progressively worse if you really think about it. They have to be locked down or they would wander off and emotionally unpredictable like that man that hit your mom. And being dressed like everyone else, they could easily slip out a door and end up lost out in the streets somewhere. Most facility would have to have 1;1 or 2:1 supervision if they did it the way WE would want it and THAT would cost $$$ plus the personal caregiver would burn out very quckly and quit anyway. I hate to say it but Alz and Dementia patients do best in nursing home that specialize in these diseases...like what they call Memory Care facilities. The regular nursing home are not equipped to care for them and other who are in the same facility unless they have them in a locked ward or wing for their safety. Hope this helps.
Gosh, there are so many things discussed in this one thread alone. I will contribute what I know, which may be different from others. I have worked in Alzheimer's/Dementia care hands-on, in locked facilities.
Some of the decisions, policies, and rules of each facility are worked out in response to incidents. So as another poster who came back to the field mentions, policies change according to state QA, etc. It is extremely annoying that rules change on a "putting out fires" basis, knowing that behaviors and incidents among dementia residents are not exactly unknown.
Case in point -- the "no restraint" policy. So many residents who should not walk, have fallen multiple times, and are in wheelchairs cannot be restrained. But "Barbara" wants to get up and go! Of course! So what happens is that "Barbara" needs CONSTANT supervision. If you have 2 aides in a unit of 24 beds, and one must be deployed to supervise Barbara, do the math! You have one aide to bathe, dress, feed, clean up after, entertain, and move from room to room, 23 other high-need residents! Now take 3 or 4 Barbaras who shouldn't walk, can't be restrained and try to get up and walk constantly and you begin to see the extent of the problem.
Every every every facility I have worked in, private-pay or not, is understaffed. These private-pay outfits can be extremely unethical in these terms. The aides, typically, are dedicated, selfless women (for the most part), who are, let's not mince words, mostly uneducated, from disadvantaged backgrounds, and poorly-trained by the company. Within a few months, they realize they are wage-slaves, and they are really in a no-win work situation. There is little advancement, and the pay remains low. You see they develop an attitude. They are tired. They are cynical. Their work ethic decreases. Put yourself in their shoes! And NO, bringing them doughnuts does not influence how they treat your mom!!!! Shame on you!
My area is Activities / Programs, which means I create and run everything that is not ADL or nursing. I am with my residents 8 hours a day, 5 days a week or more. I have more "face time" with everyone than even the aides, because they do care on a one-to-one. I care so much about my residents' well-being, and i work hard to provide activities that will keep their brains and bodies active.
When looking for a residential facility for your loved one, your key point is Activities, I can tell you as a practitioner. The Activities Director makes all the difference in a locked facility, they should be able to tell you, the family member, exactly what they do, what they have observed about your loved one, strategies for preventing problems, etc. If the facilities you are looking at do not have a full-time Activities Programs, that you can directly observe and participate in, drop that facility from your list. Why, because if residents are not involved in activities, they are lonely, panicking, sleeping all day, or getting themselves or others into troubles. The Activity Director should be very very VERY hands-on. Drop in on Activities and observe. Is the AD loving, kind, funny? Does he or she try to include everyone in some way?
Now, in terms of Mom's unwanted "visitor", the gentleman who entered her apartment, hit her and was taken to the hospital, all of this is very typical dementia behavior.
Here's why: they are lost and disoriented. Imagine yourself in an "unfamiliar" place, and you can't find your home. And the person whose apt. was entered, she's gonna defend against the intruder, isn't she? All the rules are out the window -- gentlemen hit ladies, little sweet ladies smack others with a cane or anything and swear like sailors. Some facilities have locked the apts. for this reason. Some residents who can manage it are given keys, but the keys get lost, or they forget how to use them.
A funny that actually happened recently: One of my residents has a husband with no dementia, he does not live there, but spends days there with his wife.
He came up to me and said: "There's a woman in "Martha's" apartment and she just won't leave. We have tried everything, but she refuses to go." Now I knew exactly who it was, because this woman was not in my activities that morning, and she does this -- she tries all the apt. doors, and when she finds one open she goes in and sits down and refuses to leave. Sometimes she will bash the resident with her cane, and it quickly devolves into a physical fight. This woman, let's call her Betsy, is the sweetest, sweetest little cuddly old lady on the planet, not aggressive in her life, but her disease has changed her. So I go in 'Martha's' apt. and say to Betsy --
"Oh THERE you are, Betsy! I have been looking all over for you, I really need your help folding the baby clothes!" And Betsy happily takes my arm, and we dance down the hall singing "Tea For Two". And then Betsy very contentedly folds baby clothes and sorts socks for an hour, because that's what Betsy enjoys doing -- she loves to be busy and useful. We have a bin of clean baby clothes and socks for this purpose.
So you see what a difference an active and responsive Activities department can make? I defuse potentially dangerous situations all day. They do an hour of active exercise with me every single day (and it keeps me in shape too ), and we do quizzes, games, read the newspaper and discuss issues in the world. I never assume they "can't", and they inspire me in amazing ways. They remember me, and when I come in in the morning I shout "GOOD MORNING BEAUTIFUL PEOPLE" and the same guy always says sarcastically "Oh there she is, Miss Sweetness and Light". HIlarious, right? Also, they might not remember who I am, but they remember how I make them feel.
Sorry to run at the mouth (or er, fingers), I am just so very fond of my seniors with dementia, and I want them to be happy and properly cared for.
Oh, I forgot to tell you the funniest part about the Betsy and Martha story -- as I was walking Betsy out of Martha's apartment, Betsy muttered to me
"I thought if I just sat there and kept my mouth shut, she would shut up and leave". Betsy was the intruder, and absolutely unaware of that.
Another funny -- one of my residents, let's call her Sylvia, is a woman all of 4 ft. 6 of sheer indomitable will. She badgers and harangues! She will have her way, dammit! I just love her.
One day Sylvia was standing in the dining room in full indignant fury. Here's Sylvia:
"Everyone is insisting that I eat dinner every night IN THIS ROOM! I have never been here before in my life!
(Sylvia has lived in our facility for over a year, and always sits in the same seat in the dining room.)
Me: Oh gosh, well, you will enjoy it. Here's the menu for tonight. We eat at 5 o'clock.
Sylvia: WHAT? WHO eats at 5 o'clock? I have never ever eaten dinner at 5 o'clock.
(Sylvia eats dinner in the same spot at 5 o'clock every night)
Me: Well, it will be a fun adventure then. Your friends will sit with you.
Sylvia: Look, I don't know who you are, but you are crazy. Nobody I know eats dinner at 5.
(Along comes a gentleman, "Paul" with semi-advanced dementia, but who is perfectly able-bodied and well-turned-out and has lived there as long as Sylvia)
Sylvia: Excuse me. Excuse me. Everybody here is insisting that I eat dinner here every night. Tell me, have YOU EVER seen me here before?
Paul stares at Sylvia for a while.
Paul: No, I've never seen you here before in my life.
Sylvia: FINALLY, SOMEBODY SENSIBLE AROUND THIS PLACE!!
Just love them!
Last edited by birdinmigration; 07-04-2012 at 09:39 AM..
Reason: correction
Location: Went around the corner & now I'm lost!!!!
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And NO, bringing them doughnuts does not influence how they treat your mom!!!! Shame on you!
I am a Therapist; not a tech and have worked in many NH over 20 years in my field. And I can say the showing appreciation to the aides DOES make a difference in treatment. Even 'tjover' on this thread who is familiar with NH agrees. Even in my field helping an aide with ADLs (i.e. diaper changes, tioleting) and such brings favor. Not that I am working toward that but it my job to do so.. but I'm "old school" compare to those now.
Gosh, there are so many things discussed in this one thread alone. I will contribute what I know, which may be different from others. I have worked in Alzheimer's/Dementia care hands-on, in locked facilities.
Some of the decisions, policies, and rules of each facility are worked out in response to incidents. So as another poster who came back to the field mentions, policies change according to state QA, etc. It is extremely annoying that rules change on a "putting out fires" basis, knowing that behaviors and incidents among dementia residents are not exactly unknown.
Case in point -- the "no restraint" policy. So many residents who should not walk, have fallen multiple times, and are in wheelchairs cannot be restrained. But "Barbara" wants to get up and go! Of course! So what happens is that "Barbara" needs CONSTANT supervision. If you have 2 aides in a unit of 24 beds, and one must be deployed to supervise Barbara, do the math! You have one aide to bathe, dress, feed, clean up after, entertain, and move from room to room, 23 other high-need residents! Now take 3 or 4 Barbaras who shouldn't walk, can't be restrained and try to get up and walk constantly and you begin to see the extent of the problem.
Every every every facility I have worked in, private-pay or not, is understaffed. These private-pay outfits can be extremely unethical in these terms. The aides, typically, are dedicated, selfless women (for the most part), who are, let's not mince words, mostly uneducated, from disadvantaged backgrounds, and poorly-trained by the company. Within a few months, they realize they are wage-slaves, and they are really in a no-win work situation. There is little advancement, and the pay remains low. You see they develop an attitude. They are tired. They are cynical. Their work ethic decreases. Put yourself in their shoes! And NO, bringing them doughnuts does not influence how they treat your mom!!!! Shame on you!
My area is Activities / Programs, which means I create and run everything that is not ADL or nursing. I am with my residents 8 hours a day, 5 days a week or more. I have more "face time" with everyone than even the aides, because they do care on a one-to-one. I care so much about my residents' well-being, and i work hard to provide activities that will keep their brains and bodies active.
When looking for a residential facility for your loved one, your key point is Activities, I can tell you as a practitioner. The Activities Director makes all the difference in a locked facility, they should be able to tell you, the family member, exactly what they do, what they have observed about your loved one, strategies for preventing problems, etc. If the facilities you are looking at do not have a full-time Activities Programs, that you can directly observe and participate in, drop that facility from your list. Why, because if residents are not involved in activities, they are lonely, panicking, sleeping all day, or getting themselves or others into troubles. The Activity Director should be very very VERY hands-on. Drop in on Activities and observe. Is the AD loving, kind, funny? Does he or she try to include everyone in some way?
Now, in terms of Mom's unwanted "visitor", the gentleman who entered her apartment, hit her and was taken to the hospital, all of this is very typical dementia behavior.
Here's why: they are lost and disoriented. Imagine yourself in an "unfamiliar" place, and you can't find your home. And the person whose apt. was entered, she's gonna defend against the intruder, isn't she? All the rules are out the window -- gentlemen hit ladies, little sweet ladies smack others with a cane or anything and swear like sailors. Some facilities have locked the apts. for this reason. Some residents who can manage it are given keys, but the keys get lost, or they forget how to use them.
A funny that actually happened recently: One of my residents has a husband with no dementia, he does not live there, but spends days there with his wife.
He came up to me and said: "There's a woman in "Martha's" apartment and she just won't leave. We have tried everything, but she refuses to go." Now I knew exactly who it was, because this woman was not in my activities that morning, and she does this -- she tries all the apt. doors, and when she finds one open she goes in and sits down and refuses to leave. Sometimes she will bash the resident with her cane, and it quickly devolves into a physical fight. This woman, let's call her Betsy, is the sweetest, sweetest little cuddly old lady on the planet, not aggressive in her life, but her disease has changed her. So I go in 'Martha's' apt. and say to Betsy --
"Oh THERE you are, Betsy! I have been looking all over for you, I really need your help folding the baby clothes!" And Betsy happily takes my arm, and we dance down the hall singing "Tea For Two". And then Betsy very contentedly folds baby clothes and sorts socks for an hour, because that's what Betsy enjoys doing -- she loves to be busy and useful. We have a bin of clean baby clothes and socks for this purpose.
So you see what a difference an active and responsive Activities department can make? I defuse potentially dangerous situations all day. They do an hour of active exercise with me every single day (and it keeps me in shape too ), and we do quizzes, games, read the newspaper and discuss issues in the world. I never assume they "can't", and they inspire me in amazing ways. They remember me, and when I come in in the morning I shout "GOOD MORNING BEAUTIFUL PEOPLE" and the same guy always says sarcastically "Oh there she is, Miss Sweetness and Light". HIlarious, right? Also, they might not remember who I am, but they remember how I make them feel.
Sorry to run at the mouth (or er, fingers), I am just so very fond of my seniors with dementia, and I want them to be happy and properly cared for.
Thank you for the very informational post. I wish you worked where my mom is living! The staff are very caring, and I can't say anything bad about them...as you say, they are understaffed. I have never seen any one if them act in any other way but professional and caring.
But activities are few and are often canceled, the therapy dog never visits anymore, and it's almost impossible to get anyone to call me back when I have a questions or a concern. Mom took a fall again yesterday and today seems like she isn't feeling well at all. They don't have any way of locking their room doors, for good reason. The man that hit my mom wandered into a woman's room recently and urinated on her chair. It's just so humiliating to see my mom there, is all. And sad.
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), and we do quizzes, games, read the newspaper and discuss issues in the world. I never assume they "can't", and they inspire me in amazing ways. They remember me, and when I come in in the morning I shout "GOOD MORNING BEAUTIFUL PEOPLE" and the same guy always says sarcastically "Oh there she is, Miss Sweetness and Light". HIlarious, right? Also, they might not remember who I am, but they remember how I make them feel.
