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My 91 year old mom just moved into a long term nursing facility. She enter short term rehab after a horrible reaction to Abilify. She has dementia and I worry about her care being left to others. What can I do to keep her safe and healthy?

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While you are visiting with your Mom, keep your ears and eyes opened... if you see something that doesn't look right go to whomever is your Mom's regular nurse or Aide.

I found when my Mom was in long-term-care I kept any complaints to a very low minimum.... that way when I did need to talk to the head nurse, she knew it was something important.   Don't make it sound like a complaint, make it sound like you need advice.
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It's like sending your firstborn off to preschool, you have to step back and let her find her own way, trusting that those in charge have done it all before and can handle anything that might come up.
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Get to know the Head nurse on her floor. Make sure she knows you and knows you care. Forget meeting the Director, most of them are clueless. Know mom's aides by name, thank them when they do something right. A little appreciation goes a long long way.
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All the above answers are great. Plus i dropped by daily, at different times . So no one really knew when i would come. No place is perfect, but kindness and respect goes along way to those that are caring for your mom.
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All above responses are spot on. Speaking kindly to staff, making yourself known, being appreciative, but -- keeping eyes open as well. I have found that staff will listen if family has a good approach. However, do not hesitate to bring concerns forward, either. If she gets cold, provide sweaters or a favorite blanket (have laundry put her name on them) and let her aides know "mom likes to be bundled!" It must be difficult to surrender her care to someone else. But if you are able to be a regular visitor and a good communicator, sometimes that's the best advocacy you can provide.
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My mom is now at a Capital facility in memory care she wheelchair bound with advanced dementia and was asking to leave assisted living at a Brookdale facility. I visit 3-4 times per week and since it is a cottage setting I think being around each other and not alone in their room is a big help and since there are only 14 at the most they get much better supervision a 1to7 ratio instead of a 1 to 25 ratio at her former residence
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I will tell you a story about an incident with my Mom at the home where she was staying. The memory is very painful and I could not believe she was being treated like that. I walked in, and I head someone screaming in the back where the rooms are. There was an MA ( or whatever) Standing there on the phone talking and laughing. I tried to get her attention, she acted like she didn't hear anything then I realized it was my mother. I told her to please help me but she never got off the phone or did anything. I ran back there and my mother was lying on the floor, scared and screaming for help. I yelled for help, and one of the other girls came and lifted her into her wheelchair, what a nightmare. If I ever had a problem, all I had to do was go to the head nurse. I suppose a place is only as good as the staff.
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Wonderful nursing homes exist. Sadly, so much depends on where we live. However, if you have a gut feeling that the nursing home staff is good, keep your eyes open but show your trust and work with them. They are your frontline caregivers. Watch how they interact with each other and with the other residents. That means so much. The staff is far more important than the beauty of the home.

I'd love to seem more cottage type homes appear. This is the future (I hope). But meanwhile, we work with what we have in our communities.

I hope that everything goes well.
Carol
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I'd like to add that open communication with staff can ward off a lot of issues. If you don't like something or want something done differently, ask nicely if that is possible and listen to their side (one on one care is only possible for those with the money to hire a private nurse, so be realistic).

Again, I hope that all goes well. This is such a hard transition for the family to make and it's hard to let go of being the sole caregiver even when it's best.
Blessings,
Carol
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Soon my wife will be admitted to a long term memory facility and I want to thank all of you for your insight. My fear of her leaving my sight after 55 yrs of care as my faithful wife is terrifying me.
I treasure all of the advice you gave, thank you. JLW
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Excellent advice,pass it on to siblings and other family
that may visit.THEY cause problems by demanding,
asking too many questions
and finding "fault"w/every thing..then leaving.Make sure everyone voices any "concerns" to YOU,not the staff so you can tactfully address the valid concerns.
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My only experience is with memory care in an assisted living facility I chose for my two married friends when dementia and memory loss became too much for them to live on their own. It was the only place with memory care apartments large enough for two people and they had to go as a couple. I didn't know all what to look for, but I paid attention. Every contact with them by staff is written down, so if I go to the wellness director or nursing assistant in charge, they can just pull the file and fill me in. Like other contributors, I am always respectful and so very thankful for the level of care being provided, and I don't hesitate to give a good review of this facility. They are more experienced in this care than I will ever be and willingly give me advice when I ask for it. I get monthly billing notices of the medications being used and occasionally ask about my friend's blood pressure since it had been high a couple of times. They clued me in as the wife continued to deteriorate and advised when to start hospice care near the end and that level of care was awesome. I am so grateful these places exist and that I found one that worked perfectly for my friends. My friend, Jim, noticed that one of the senior staff seemed pretty prejudiced against him ( a black man) and I witnessed one long harangue my friend had with him. It was not long before that staff member was no longer there. Many of the help are immigrants from African countries and I let them know I appreciate their being here and helping. I literally welcomed one to Minnesota and told her I hadn't grown up here either but really liked it here. She told me no one had ever welcomed her to the U.S. before and thanked me. I think this caring should be a two-way street and make sure I do my share back to them.
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In addition to the advice here, I would try and make her room as "homelike" as possible. Pictures and maybe a chair from her home. Not only will it make her more comfortable but the staff will know that someone cares about her.
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JLW - I understand your concerns. In many ways we have been the best providers for our loved ones. But in other ways, caregivers can be as well. Keep and open mind and advocate for your wife by visiting and communicating with the staff. There will be good days and not so good days for both you and your wife. Try to give yourself some extra "self care" if possible by regularly talking with friends, family, or a spiritual leader about anything on your mind.
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Visit as often as u can. Set up her clothes in hangers for the week. Bring familiar items from home.
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Get to know the staff and be watchful.
I had 2 bad experiences with my Mom and one good one with rehab, but the good nursing home was not a Medicaid accepting one..families paid full price so I think that was the difference. That should not be ALL people should be treated with respect.
So what area of the country are these good nursing homes in???? I guess this is one of those secretive, cryptic things.
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Be diligent about knowing exactly who is taking care of your mother. Get their full names. Visit as often as you can so they know your mother is being monitored by family members. It can be scary placing your mother in someone else's care. My Mom was physically harmed by an aid in an assisted living facility for refusing to take a shower. Mom kept silent all day. Thankfully, another aid noticed Mom's bruises that evening and reported it. We made sure all authorities were contacted & that she was given an exam by her Doctor. The facility went through an amazing transformation. We noticed Mom received more assistance, there was new and more compassionate training for incoming aids, better equipment at the facility for residents and staff, better food, their transport van was finally fixed so they could assist in taking residents to hospital or dr. appts. The Facility Manager was replaced and the woman who harmed my Mom was fired immediately and was not able to get a future job in the health field. Stay in touch with everyone who treats or touches your mother and be sure they know you and your name and why you are there with your Mom. I had an inner, gut feeling that the aid that took the most care of Mom at the time was odd and a bit strange in her demeanor. I had no hard facts, just a feeling she was a little off. I was right. She got impatient with Mom and harmed her. We are very pleased how they upgraded Mom's care and the care of every resident in the facility, with speed and diligence. So, please take care and trust your instincts regarding people who are caring for your Mom.
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One important thing to look for is the ratio of CNAs to patients. From a practical standpoint the more patients each CNA is responsible for, the longer patients have to wait to be put to bed or to be fed if they need help. This isn't anything that family members have control over but it will give you an idea about how well the place operates. In truth, I think every nursing home is understaffed. My mother, siblings and I developed good relationships with the CNAs who we could see were the most able to physically handle my dad. He was physically combative on some nights and it was important that the strongest CNAs handled him because he had the ability to hurt people if he didn't like how he was being handled. We were able to specifically request which CNA would put him to bed. Other things: My mom visited my dad every day from 5 pm until he was put to bed which ranged from 7:30 pm to 9:30 pm. Also, the facility will make a big deal about the "activities" that they host for the patients. In our experience there were almost no activities. Generally after dinner, staff people each took their dinner breaks during which time the patients were parked in their wheelchairs in the common area with the TV on. There were some patients who could still walk and many other them walked the halls or sat at tables in regular chairs. A few patients were agitators and seemed to pick on others. Sometimes nurses or CNAs would intervene but other times they wouldn't. As the CNAs came back from their dinner breaks they would begin the long process of putting each patient to bed.
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I had an experience with facilities when a non-family member was in two facilities, one which was not a good one, and another that I'd say was a huge improvement over the first. Looking back I'm trying to recall the differences and similarities.

The good part about the second one was that my friend had much in common with the other patients. Many nursing facilities have a mostly female patient population, but during the brief time my friend was there, the male-female ratio was tipped in the male direction.

Also, he found himself in the role of "helper" much of the time. So when he saw they needed assistance with things he could help out with, the staff allowed him to do so. He felt a sense of purpose instead of feeling he had been discarded. Also, they kept him updated on his future discharge, informed him honestly of his progress, so he always was reassured his stay was temporary.

When I recall the first facility, I recall when I visited and asked him anything about how things were going, his responses were vague. He avoided answering me, refusing to tell me any specifics. I tried to ask open-ended questions that might clue me in on why he was avoiding telling me anything. I really hoped it wasn't as bad as I feared. Unfortunately the one detail I did find out was that there was no water pressure in the shower, and even if there had been, there was no hot water in the men's bathing area, and hadn't been since his arrival. Yikes.
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Good luck. I agree with posters above. Get to know the staff and realize there's only so much anyone can do to deal with a dementia patient. Reality comes and goes. It's a good lesson for us though about the trivialities we sometimes get hung up on. My mom forgot mostly everything recent and remembers her youth and how she sang and danced and was "an actress ". It's interesting. However she does have downtimes and says shes bored- but how does one engage or entertain a person who can't really engage or focus ? We try to keep her moving- take walks if possible- roll about the place and sit people watch. It's tough. But you're doing what has to be done at this time. Looking out for her safety and health.
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Hi there! I am actually an occupational therapy working in a long term care setting (nursing home). First, I want to say--the feelings you have are completely normal and this transition is very difficult for both you and your loved one.
There will be a transitioning period if your loved one has advanced dementia because change is difficult, someone with dementia thrives in routine and familiarity. Have no fear, a new 'norm' will be established. I also want to prepare you that, depending on the facility--staff will constantly be different for a while. Typically in this setting, aides are rotated between floors--but in time, mom will get to know everyone and they will get to know her. You can request consistency, however!
I agree with many ideas above, you will need to trust the process and the frontline (nursing aides and nurses) at some point but keep your eyes open! Unfortunately, there are just as many problems in these settings as there are benefits---monitor your loved ones' behavior when you visit. Look for warning signs of neglect! A GREAT RESOURCE from the National Center on Elder Abuse- https://ncea.acl.gov/resources/docs/STOP-Poor-Care-Brochure-Web.pdf

Encourage your mom and visit often. Introduce yourself to the activities department. Nursing homes are highly regulated and must ensure resident with dementia are mentally active and enticed throughout the day to encourage wellness. Find out about the program and who will be working with your mom. All of these things will give you peace of mind! Anymore information, please feel free to contact me!
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Violet521 makes a very critical point. Many facilities are understaffed (in my opinion) and the CNA's are running from person to person. I have witnessed this even in the poshest places. They get just enough staff to get by regulations and the CNA's are run ragged! I am a professional caregiver that works for an agency, so I have had the chance to witness these things first hand and talk to the CNA's. They are also greatly underpaid for the hard work they do. Unless you are an LVN, RN, you don't get paid well for all the "grunt work." My pay is also very low but I got into this field for different reasons. I wanted to be able to learn how to properly care for my Mom as a professional so I could keep her with me as long as possible. She had worked as an RN in those facilities her whole life and I cannot imagine turning around and putting her back in one! Unless she gets to the point where she has to be watched 24/7, I will keep her with me. I have also witnessed gross negligence in those facilities that made my blood boil! You have to spend enough time in there as an unknown observer to really get the true feel for a facility. Me being a hired caregiver is perfect as an undercover observer for facilities. If they know family is there, they will put on their best performance. I get sent to those facilities for the very fact that the families know their parent is not getting much "one on one" attention so now they are paying even more just to give extra individual care on top of the monthly expense of the facility! So very sad. I think facilities should hire a few people who just go around throughout the day spending time giving those people personal attention, not just what has to be done. It would make such a difference!
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Having worked in the field,stop in at various times and especially the weekends to observe the staffing .Yes the above answers are great.Get to know the nurses and the CNA's.Ask questions but not in a negative manner(such as how often will your mom be ambulated if she is ambulatory) How often will she be re-positioned? How many patients on one CNA's list? I remember having 13 patients on my list and having one hour and 15 minutes to get them all up for breakfast..with hoyers,ez-stands ,etc and having to wait for help because with equipment you need 2 people.Does you mom require 2 people to assist in cares? After breakfast what will the routine be with your mom? You do not want her sitting in her easy chair/wheelchair/ until lunch.Is she incontinent? She needs the bathroom after meals etc.Will she feed herself or does she need help? How much time is allowed for meals? How often will she get a bath/shower etc? Will she need special ointment to prevent bedsores?How often do the patients have activities? Just some of many questions.Take care and good luck
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Get friendly with the aides. Show up often and at different times so you can assess how she is cared for. Be there for a meal or two so you can see what is being served. A good nursing home will ask what the resident likes and does not like. (at least my mother's did) Assess if the food is cut up enough so your mom can chew it. Make a list of likes and dislikes to give to the head nurse to put on her care chart. Remove all valuables and jewelry. (They can't monitor who goes in and out of the rooms) If they don't sew name tags on every piece of clothing (including socks) you should do that so you don't have to keep buying pj's. Ask, don't tell, them how she is cared for, what she needs from you.
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First of all, does the nursing home have a dedicated dementia unit? If so, are the staff trained on caring for dementia residents? Show up at all different days and times. Check her diaper for wetting and defecating. Ask to see her chart. If she starts losing weight, ask to speak to the Dietary Director. Since she's in for short term rehab and she has dementia, she may not be able to participate in therapy.
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Approach the staff members as partners. Unless you know otherwise, assume they want to provide awesome care all the time. Approach incidents or mistakes as oversights or miscommunications (unless it's dangerous or overtly disrespectful or abusive, of course). It is wise not to assume that staff communicate everything with each other. A million things happen in one shift and it's easy to forget some of them. Expect to have to communicate the same thing with different staff members.

Put up a whiteboard in the room and keep a working pen and good eraser (and cleaner wipes). It's really helpful for communicating with all shifts. If you have nothing to communicate, put a fun quote, message, or Bible verse on it for Mom.

My dad has been in long term care for almost 4 years now and I've used these techniques successfully with his team. The staff at nursing homes have a very difficult job and I want to support them as much as possible.
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My friend worked at Brookdale Senior Living (Assisted Living) and she said they operated on such a small skeleton staff, it was shocking how neglected the residents were. It was run run run from the crack of dawn, no time no time no time..... That was assisted living, not a nursing home. Just FYI.... My mom had advanced dementia when she went into a nursing home, and it was an awful place, but she was happy enough there (didn't even know where she was) and we were lucky we had an attentive director and good staff. I gave the people on the floor some nice edible goodies on every holiday 'from mom's family' and when they saw me told me mom was doing well and she was an ideal resident! I am hoping they were telling the truth, mom did well there for 3 years before passing away.
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Make sure this facility is "on the up and up," e.g. they may try to pull a fast one on you. They did with my late mother, claiming she was "too well to stay there," but they were DEAD wrong as less than 48 hours after that statement she suffered a stroke there and deceased at the hospital several days later.
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Winter sun hit it on the head. A place is as good as its staff. If ur looking ask some questions. Is an RN on duty or on call most of the time. Is there an LPN when RN not there. Do they use agency CNAs. If they do, not good. May mean they can't keep staff. My Mom had been in her AL since August. October there had been a change with RN and staff. I felt like I was complaining all the time. I was Mom's clothes but I was told no soiled clothing was allowed to be put in hampers it had to be washed in their laundry. I found soiled pants, wash clothes and towels in Mom's bin. Found where they hadn't cleaned up. Her room all of a sudden wasn't being dusted. Sounds petty? I pay for the cleaning. I came in Mom's room and again, a dirty washcloth left in the sink and shower needed cleaning up, if u know what I mean. I washed up the cloth and brought it home. I was ready to clean up the shower (I keep clorox wipes in br and have left a note to that effect) and then I thought...Let the CNA on second shift complain to the CNA on first shift or their supervisor. Things will not be perfect. Have to learn to let some things go. And please, except that there are things they R not allowed to do because of State laws. Yes, having a hand rail on the bed helps so they don't fall out but State laws say no. There is a lot of catch 22s.
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Most facilities will allow you to stay with your wife for a while the first day. If she has dementia, it is best if you can sneak out discreetly instead of saying goodbye and making it more traumatic for her. Put some familiar photo's and a blankie or quilt she loves, near her bed. The first few weeks are stressful, but it usually gets better as soon as they get to know the surroundings and the staff.
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