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We finally got my LO in a memory care in assisted living facility. I put a camera in after month. I notice several of the caregivers getting aggravated with my LO. Incontinence is getting worse so more changes. Hasn't been aggressive with them during changes. Has done number 1 in another place other than bathroom. He does want to go outside and tries to leave...which he can't. Other caregivers seem very good.



I overheard one caregiver say he should be in nursing home along with half of memory care.



Am I missing something? I thought in memory care they are use to certain behaviors, how to deal with them, incontinence, and then aging in place. I want to avoid the nursing home. He is physically in good condition. I've been told he has started getting involved in some activities but they have very little for him to do.



At what time would a person have to move from memory care to nursing home? I thought getting hospice involved later would also avoid nursing home. Hoping some can help me understand why this would be mentioned.

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Having an annoyed caregiver say your LO and half the other residents belong in Skilled Nursing does not mean they DO belong there.....just that the caregiver isn't wanting to clean up urine on the carpet or deal with meltdowns or whatever.

It is very common for men (especially) with dementia to urinate in places other than toilets. Former mail carriers and truck drivers and other jobs that didn't have easy access to toilets found these men peeing outdoors. With dementia they regress in time, going back to when it was common TO pee in places other than toilets. There was a gentleman at my parents first AL who would customarily urinate against the dining room wall every night, while the residents were eating! He was eventually moved into a memory care AL where he could be redirected.

When I worked at a memory care AL, it was common to find residents squatting in the hallways or even taking a BM on an upholstered chair. The caregivers never threw a fit....they'd bring the resident back to their room for a clean up and then go see to the mess in the hallway.

I suggest you ask for a care conference with the head nurse and Executive Director of the facilty asap. Bring up your concerns, ask questions, ask why there aren't enough activities, and why some caregivers are acting disgruntled suggesting a SNF for your LO. That's out of line. My mother's MC kept her till death and she was a huge hand full! She'd fallen 50x over the almost 3 yr period she was there, was wheelchair bound, incontinent, up all night, etc etc. That's the purpose of MC.....unless they have a disease that requires IV treatment by an RN or something, the MC should be able to handle them, especially when hospice is on board. Straighten this out with a care meeting.

Good luck to you.
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Thank you all for responding and confirming what I thought. Posting late but we talked to the ED. Very good conversation and our concerns have been addressed.

I know how hard it is on the caregivers. I cared for him and is why we had to do memory care. He is being treated and taken care of very well. I feel he is doing much better.
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I do work in MC. The list of different " behaviors" can be an arms length long. NOT just with one resident. Accidents happen. We can't be attentive to one's needs 24/7 , the main reason... staffing!!! The training we have is 4 day's on the floor ( shadowing) then computer work. The whole NOC shift is run by 19 year olds. No experience necessary. Just filling up the schedule. And, no repercussion on calling in or how the residents are treated. MC is a revolving door.
Just to say, not to make it right, I'm sorry that this happened. I see it. Unless the family is involved in the residents care... having to go thru the appropriate channels, end of life should be with dignity!!!
Great cameras are set up. But, I thought due to residents privacy, they could not? That would be great. Instead of saying it's only a particular shift, make it a particular person. And yes, follow thru with any concerns with the " higher ups" or even call the state with any concerns. I did, as an employee.
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ArtistDaughter Oct 2023
This is exactly right. To show up if at all possible as often as possible to make sure the care is being given. I could tell my mom was happy and loved by the caregivers in memory care, even through the window at first. Once I got in I could see that her room was kept clean and she was also clean. She had more direct care than she did in assisted living. I did have to dispose of her chair though when she left. It smelled of urine. Not sure why they didn't notice that.
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Not all caregivers are cut out for the job, so I'd ignore the person who says he and others should be in a nursing home.

A good memory care should be able to care for a person all the way to the end of life. The only reason why someone should be in a "nursing home," (and I assume you mean skilled nursing) is if they need full-time medical care like feeding tubes, IVs, or are completely bedridden with associated issues. Your loved one is nowhere near needing that level of care.

My mother was in a memory care facility with congestive heart failure, survived Covid while there, and had wound care multiple times a week while on hospice care. She never needed to go to a skilled nursing facility. Ironically, she started out in a skilled nursing facility because I didn't know the difference between the types of nursing homes yet, and she was darned near killed from neglect there because she didn't require much care. They left her alone entirely too much, and it was not a good situation at all. I got her out of there and into a MC, and she did much better and was more engaged and stimulated mentally.

Feel free to share what you're hearing with the administrators at the MC and ask that the grumbly caregivers not be assigned to your LO. I guarantee those caregivers won't be working there for long
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Lovemydoggies Oct 2023
The month my husband spent in skilled nursing "care" nearly killed him. It was truly the month from hell. Returning to Memory Care was truly "heaven"!
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Memory care put up with my mom's strange bathroom (or sometimes not in the actual bathroom) behaviors. In fact that's one of the main reasons she had to leave assisted living. They don't typically like Hospice, but will usually take it. Hospice won't be there all the time, really not much at all, just come for bathing a couple or a few times a week, nurse check, and supply depends, medication, bed, etc. They also are good at letting you know what's happening at end of life. My mom's hospice sent 3 volunteers to sing to her when she was in her last days. Isn't there a courtyard or some sort of locked outdoor area for him to enjoy? It's very difficult to take a memory care resident on outings, so there should be a way to be outside a bit. It seems to me that nursing home is when there has to be a 2 person assist from bed to chair or completely bed bound, but I may be wrong. I hope he can avoid nursing home.
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Skilled nursing is for people who have trouble transferring (wheelchair), bathing, eating, dressing, and performing other daily activities. Incontinence is something that is sort of borderline and I would say if the person truly had issues toileting then maybe they do belong in skilled nursing. Memory care should be able to deal with incontinence issues if they aren’t too bad.

I am shocked that lealonnie describes people toileting on the furniture in memory care. That to me seems way beyond what a memory care should be dealing with.
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That caregiver should be reported!
I'm sure "good money" is being spent on the care for him. If the caregiver has that kind of attitude, they need to be addressed. It's a burden on everyone that they care for! Although the care is good, the attitude is poor! Obviously, this person has the ability but not the compassion.
We left our loved ones in their care and we depend on them to care about them like we do.
It really takes a kind heart to tend to these issues. I can't imagine what it would be like to constantly deal with it.
No, I don't think a nursing home is in order. MC is better, nursing home just puts everyone in the same category. With MC everyone is treated individually, they receive better care. Don't listen to the gossip,ask the administrator!
They want to keep the tenants to support the facility. You understand that they need the financial support and can find better caregivers. I'm seeing an obituary posted in my mom's facility nearly once a month. They need your father as much as your father needs them. They should be able to get to the bottom of your complaint, immediately!
Complain and they will take action, as they need your funds.
Sorry to say, the turnover is expected and they hold on to anyone they can. Don't fret it, talk to administration. They need you!
If they actually call you out,then they don't care and find a different MC! You don't want to pay for a facility that puts money first!
God bless you!
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It sounds like you need to find a different MC. I put my husband in one that turned out to be like the one you are experiencing. I did some research and moved him to one that was further away, but they were wonderful. It was the difference between night and day. They took great care of him until he passed away. I'm so glad that I moved him!
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It is important that you discuss your feelings and gain clarification from the administrator of the memory care unit in assisted living facility.

Nursing homes and hospices offer different although somewhat complimentary services/skills. The plus (from personal experience) is that nursing home staff are often over-loaded and may not give as much attention to a person/resident as you would like; getting hospice 'too' gives another layer of professional / medical care. Although, you must consider what Hospice offers - it is solely comfort care. There will not be any more hospital visits to fix or (try to) improve 'health needs / issues.' If he currently is in 'good physical condition' I do not understand why hospice would be considered - now ?

Personally, I do not understand moving a person from a memory care unit / facility to a nursing home. If he needs more care, you might need to hire additional caregiver a few hours a day, or find a facility where you feel he is getting better care than what he's getting now.

From experience (my client in memory care unit) of a facility with multiple levels of care (NOT a nursing home), they offer:
* puzzles
* entertainment / entertainers (perhaps weekly)
* TV Monitor - music, tv documentaries (animals), comedy, etc.
* perhaps other games.
* Attention, as they can - and this depends too on the personality of the aide / CNA.
* You might want / need to hire someone to take him outside (in the locked area - or not, depending on his abilities) to see different scenery.

* Ask the administrator / department manager what activities they offer or could offer.

Gena / Touch Matters
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I might add that there are certain complex medicine applications that require skilled nursing. This is dependent on the state definition of scope of practice through the licensing board recommendations. An example is complex anticoagulants, sliding insulin scale, or whether a person can self inject. Many of these medications do have a work around if the doctor can order another option.
What the OP mentions falls into the category of custodial care which is part of AL or MC scope of practice with just a limitation of a certain number of hours each week. Any additional hours of care or excessive laundry would or could be itemized for additional cost
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