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My Dad has dementia and is in a nursing home. The nursing home does not have the training or staff to adequately care for my Dad. For example, my Mom has asked the staff to "walk" my Dad. He is primarily confined to a wheel chair, but he has the ability to walk. Unfortunately, it is difficult to get him to stand up, not because of physical limitations, but b/c the dementia prevents him from understanding how to stand up & also he becomes combative when you try to force him to stand or sit. So it can easily take 10 minutes just to get him to stand up. I can understand how it is difficult for the nursing home staff to accommodate this care request, and that's why I am wondering if anyone on this forum has heard of "in-home care" working with someone who is a resident of a nursing home. That way there would be someone who has the time to help my Dad get up and walk and sit, and in general, just deal with him as a patient with dementia and not just shove him in a wheelchair and out the way.


Also - my Dad is a Veteran; I had heard he may qualify for benefits that help pay for "in-home care".

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When my mom was in a NH and her walking skills were deteriorating, we asked the PTs to evaluate her and they found that she was eligible for short term PT to prevent regression. It was so ordered by her doctor.

After the therapy was over, they arranged a "walking" protocol by which the aides would walk my mom some distance (I think it was 100 feet each day).

It may take some investigation on everyone's part, but I think you need to find out if there is some "trigger" that can get dad to cooperate. If his dementia is very advanced, this may be impossible. However, if he can respond positively to "now it's time to walk to the dining room for ice cream/cookies/hot coffee", you may be able to entice him into cooperation. Make sure the aides are not asking "would you like to.....?" For most, the answer is "no!"
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kgerise Apr 2019
Thank you for your response. I have noticed that the aides always ask my Dad lots of "would you like to" questions. I'll pass that along. I DO wish more of the staff would learn how to handle his combative behavior, but I know they have their hands full.
And PT was ruled out a week after Dad arrived at the NH b/c he can't follow any directions.
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Seems that your Dad has a transferring issue, one of the ADLs.

Maybe you can post and tell us if your Dad can walk without a cane or a walker? That would help with responses.

The aide to "resident" ratio in accredited nursing homes does not have enough aides to walk your Dad. I know, because I have requested the same thing for my mother and done the research.

As far as I know, there is no free in-home care when in a nursing home. Your Dad is not in-home, literally. Having anyone come in from the outside is private care...and the expense is your expense. However you are able to pay for it. Neither Medicare nor Medicaid will pay for it.

Please make friends with the director of rehab: physical and occupational therapy. Have your Dad evaluated. Maybe they can get him qualified from his insurance for some PT or OT. If he qualifies, then the PT or OT will get him out of his chair and walking. But, that won't last long. Maybe 2-3 weeks, because insurance won't pay for anything that is not designed to cure a medically related situation.

As far as the VA: I can only speak from my experience, in Florida, but, even if you had already gotten your Dad eligible for pension or aid & attendance benefits while he was still at home, once he went into the nursing home the VA would reduce the benefit to $90 a month which he would be able to keep and spend. And, it's a cash benefit, and based on your Dad's income and medical expenses. Generally, it takes 4-9 months for the VA to process a claim. You can try. But, I don't think it will solve your problem.

Sorry.....really. But, unless you have the funds to pay for an outside trained aide, I cannot come up with any viable solutions. For my mother, we were only able to get a volunteer companion from a religious based foundation for 2 hours a week, and the companion does not, and cannot be asked to, do anything that an aide would do. She's just a "friend."
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worriedinCali Apr 2019
He CAN receive HOME care in a nursing home with Medicaid and Medicare paying. Because the nursing home is his home. Medicaid has programs that allow the patient to manage their care and even nursing home residents are eligible and they can arrange to have additional care. There’s a member here who is going to be using it for their parent. It’s called cash & counseling program :)
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That is rediculious to think nursing home cnas have that amount of time to coax someone to stand with the chance of being hit or punched by a combative resident. There is always the imminent danger of falls. Always. If there is 1 fall, there is 100% chance of another. That is not me making that up, that is fact in OT and PT peer reviewed journals.

Guess who will be blamed if the resident falls and breaks a hip???? It wont be the resident. It wont be the family that wants to warmly remember the resident walking. What if he forgets how to walk ten steps out from the bed? You said he forgets how to stand/walk. He cant without huge amount of support. 2 cnas trying to cajole, coax, beg, and maybe slapped or punched by a resident to try to get him to walk stops them from caring for their 13 residents. It is VERY unsafe. He doesnt have the muscle tone or the memory. The cnas will be blamed if anything happens.
Residents get up and try to walk on their own all the time. They fall. Guess who gets blamed for not catching them, or not seeing them fall?
The ratio is like 13 residents to 1 cna. Residents bone density is nill. Is it worth having them break a hip? Severe pain and virtually little healing. It is better to have the resident SAFE.
Even PTs have put a gait belt on a pt and had them fall breaking a hip. Very dangerous when they are unsteady.
Your caring is wonderful, but the walking is unrealistic. You are remembering him the way he was yrs before. Not in his present state.
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Goodintentions May 2019
I was surprised when I saw the original question as well . All senior care facilities are understaffed. I belief all care staff at these facilities are underpaid. Unfortunately litigation has become too prevalent over the years
My father is now unable to walk and the plan of care (made by me, the POA and members of staff) no longer includes PT. There is no point as his Alzheimers is advanced. I am more concerned about the safety of the staff at this point. When he could walk he told one of the CNA’s that he would fall on purpose to get attention. We moved his room next to the nurses station as he refused to use the call button. He is very combative as well. Cursing at and hitting the nurses. When he first started falling almost daily I could tell the staff was terrified I would blame them for inadequate supervision. I know there is no possible way for them to keep an eye on him every second. Tethering him to the bed (jokingly suggested by me) is not legal. The staff at his facility are all saints to me. They call me when they change a bandaid. Instead of thinking of him as being a pain, his antics are looked upon as amusing. They always tell me they’ve dealt with worse.
There are a lot of us who understand very well how understaffed, underpaid and highly regulated senior care is but it is extremely difficult to navigate on both sides.
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This is what has happened to my father. He had a medical issue which had him admitted to the Nursing home, however after surgery. The therapy provided was poor. So we would go in and toilet him and stand him, however we were brought in to meeting and scolded for we did not follow his care plan and we put him danger, so they said. No harm was ever done. So we have hired staff and we are having him discharged in 2 weeks. He went in with a walker and he was slow....so place him in a wheel chair, tip the chair back so he can't even move his legs. And now after the care at the Nursing home he is wheel chair bound now.
I would recommend to contact your social worker, and have your requests put in writing have therapy involved. So you do not get in trouble, as they want you to believe, they have total control. As with my father, his decline has been very disappointing. But the care is substandard. As it has been 20 minutes to get a glass of water, 1hrs 7 minutes to get staff to take him to the toilet. He is a veteran, however help is based on income. Contact Veterans administration, have had discharge papers and his income. They can help if the income is within the range. Nursing home were my father is $10528. Per month...substandard care..
Best of luck.
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I have not had to deal with a extended care facility yet. So please educate me. Why should you have to pay for a private worker to go to the nurseing home when you are paying thousands a month for him to be cared for already. Please don't take this wrong. Bless the nursing commuity. I'm sure they are not paid for what they are worth.
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anonymous903302 May 2019
I can only reply about nursing homes; long-term care (not assisted living).

Reason is that the aide (CNA) ratio to "residents" is not one-to-one.

Nursing homes and those ratios are highly regulated, and few places staff above the minimum requirements. In my mother's nursing home, each aide has responsibilty for 8 residents. And, her "unit" has 16 resisents. So, that's two aides total. If one resident requires suddenly extra help bathing one day, or is having unexpected bathroom issues, then the other residents that aide takes care of will not be responded to as quickly. However.....a good nursing home makes sure that all staff on shift.....even a unit secretary....respond to the call bells even if all they can do is reassure the resident that her aide or a nurse will come soon.

Unfortunately, a lot of residents expect a one-to-one....come on demand....relationship with an aide. Especially if they had been receiving one-to-one care before moving into a facility.

Also, in some places, all staff, including the floor nurse, has to help out in the dining room for 3 meals a day. And, that's why they try so hard to get all residents into the dining room for meals. They have to get everyone into the dining room, and serve the meals -- making sure to follow any dietary restrictions----and bring more beverages when requested, and sometimes feed people, and then take residents back to their rooms....and then, sometimes, there's an immediate bathroom need. That makes it difficult for them to respond immediately to call buttons.

And.....non-meal time ---- if there is a common area with a TV, where you see residents in their wheelchairs watching TV......in many places a CNA must always be in that room to monitor residents who are in that room, taking away from CNAs who can go to individual rooms to respond to call buttons.

And, it's hard for any of the aides to respond during a shiift change, because there's usually 15-30 minutes when the floor nurse and aides are being briefed by the shift that is leaving.

Please find out the phone numbers of all of the nursing "supervisors." There should be at least one supervisor on duty all day and night. Those supervisors can be extremely helpful to you if you are getting frantic calls from your LO saying that nobody is answering her call button.
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You can ask if its possible for him to have therapy. Where I live, NHs have therapy associated with it. But, Mom had a therapist come into her AL.
Medicare will pay for this and Medicaid if a Dr. orders it.
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worriedinCali Apr 2019
Actually Medicaid may not pay for it, it varies from state to state, not all state Medicaid programs will pay for PT in a nursing home and Medicaid also has to determine that it is medically necessary. Just pointing that out because people here like to make it sound like everything is covered as long as a doctor orders it and that’s not necessarily the case. Medicare also may not cover the entire cost of PT and it will require several determinations not just a doctor ordering it.
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If Medicaid is paying for him to be in a nursing home then he can’t get “home care” through the VA. He may be eligible for a $90 a month personal needs allowance which is used for toiletries, grooming, etc.
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He might be eligible for Hospice. If this is the case Hospice would come in a few days a week and get him showered and up, they may not have tome to do a lot of walking, and would not if they determine it is not safe. Hospice also has volunteers that would come in and spend time with him. If it is safe they might be able to walk with him.
Is he getting PT? they should be walking with him if he is compliant or if the Dr. determines it would be helpful.
If he is a Veteran he might be eligible for some services. And depending on where and when he served he may be eligible for quite a lot of additional services. The VA has "Homes" they are small houses that are set up like a home the ones near where I am are called "The Green House" they are community houses and the staff to "patient"/resident is great.

But another thing to note...the facility where your dad is might have restriction on who can come in and help him out. You might be required to hire from a specific agency.

Another comment here and this is my personal opinion but if the facility where he is is not "trained or have the staff to adequately care for your dad" you might want to think about moving him. I do not say this lightly as moving someone with dementia can be difficult but it is concerning that they are not trained nor have the staff to care for him.
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worriedinCali May 2019
Hospice wouldn’t get him up & shower him. They would bathe him in bed.
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Kgerise, I’m not clear about why you feel it’s in your dad’s advantage to walk. Could you describe the benefits you think he might derive from walking at the present stage of his care?
My mom was in a similar situation during her residential care.
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cetude May 2019
Since I care for my mom at home, I get her up as long as I humanely can because it makes her care easier. She does much better getting up. However, she is also on hospice. When she is no longer able--as in progression so bad she simply cannot--most probably I'll call in the hospice nurses, who will keep her in bed, will just keep her drugged unconscious until she dies. My mom has been at very advanced stages for over 4 years now, and she is nearly 90. Had symptomatic Alzheimer's for 10 years now. One Emergency Room doctor recently (a few weeks ago) did a non-contrast CT of the abdomen and found growth on her liver suspicious of tumor. It could be nothing, or cancer; a definitive diagnosis could not be made. She's too advanced in Alzheimer's to treat it. So I just take things a day at at time.
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Why is it important for your dad to walk if it causes him so much stress?
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