I had to place my mom in an approved medicaid/medicare facility 4 months ago. Since she has been there I have had to address the lack of cleanliness of the bathroom, aides addressing her toileting needs. The nurses overall don't seem involved in the day to day care of the residents other than administering medicine whenever I go in the nurses are hovering over the medicine carts writing or counting pills. They don't even acknowledge when I walk in with a "hello" and let me know how things are going with my mom. Last Saturday when I arrived around 4 p.m. my mom was in the bed with her gown on, I asked the nurse why mom was still in bed and no one had an answer other than we just came on duty. They had no notes from previous shift to let them know why mom was still in bed or if she had been up at all that day. Last week when her blood pressure dropped very low, I was called and they told me what happen and that the doctor had been called and blood pressure had come back up. When I called back in an hour the nurse said the doctor said she probably had "orthostatic hypotension." When I got to the nursing home later that day I asked the nurse if mom's blood pressure had been checked in the last couple of hours. The nurse responded she did not have orders to check her blood pressure but if I wanted her to she would check it after mom ate dinner. I have sent numerous letters to the charge nurse and LPN in charge of aides concerning issues and they tell me they will follow up. Is this the norm in most facilities that accept medicaid/medicare? I can't bring mom back home with me because I am having health problems at this time. Do I need to look for another facility? My mom suffers from dementia and is wheel chair bound. Also, the room she is in has 2 other ladies and during most of the day I found they just push the residents in the hallway no activities and there is not a common room to visit. Has anyone else encountered a situation such as this and what did you do? Money is limited for us can't afford those private facilities that start at $5,000.
The nurses do not get involved with day-to-day care. They do monitor health and ensure that doctor's orders are carried out. When we meet at care conferences we have discussed various medication changes and whether we'd like her to pursue some action with a doctor. We know she cannot make changes on her own.
The worst time of day for finding anything out is at shift changes! The focus is on getting the new shift up-to-date with what is doing on with the full range of patients. I found this to be true at all 3 shift changes. It is just not the right time for a family member to try to get information.
It is sometimes frustrating that a decision about care takes a while to reach all the people who need to know it. For example, when Mom had a catheter she kept pulling out, we decided that always wearing pajama bottoms would prevent that -- and it it! but only when the aides dressing her knew that. It was in her notes but aides don't always read notes when they are just dressing someone. We solved that by making and posting a big sign on her closet. The information really does get into the notes, but may not be available during shift change and may not be read by everyone on every shift every day.
Something like taking blood pressure several times a day has to be ordered by the physician. It cannot be ordered by a family member.
Part of a successful experience for a loved one in a nursing home is just getting familiar with who does what and what kind of orders they need to make changes.
Out of all you've said, my biggest concern would be that your mom is parked in the hall with no activities. Does the facility have activities? Would she be capable of participating? At my mom's nh there are scheduled activities every day. I have noticed that one blind lady enjoys the bingo sessions. Someone else has to watch the card for her, but she likes being in the room with others and gets excited when they tell her "you only need one more number" and loves it when she wins. A good facility will find ways to include as many people as possible in social activities. (On the other hand, Mom's last roommate refused to go to any of the activities.)
I suggest trying to pick out one or two things that seem inadequate to you. Try to work with the staff on that one item, not in an accusatory or complaining way, but by getting informed what their standards are, if they are having challenges in meeting their standards, if there is any way you can help, etc. Do let them know what you expect, but also listen to their explanations. A nurse must follow doctor's orders. You cannot blame her if the doctor hasn't ordered what you want but you can ask for her help in contacting the doctor. If after working with the staff you feel they are substandard on that item you can contact the ombudsman about it.
Personally, I wouldn't rush to find another place without working to try to make this one meet Mom's needs better. Moving is very difficult for persons with dementia.
It can be difficult to contact the doctor; we have found that the APRN (or Nurse Practioner, it's called) in some places is "go to" person for medical information.
If I want an update on my mom's condition on a given day, I call the nursing station on the unit she's in. I know when the shift change is and when they have their AM staff meeting; they've told me that 9:30 to 9"45 is the best time to call to talk to Mom's nurse. I generally email the social worker or the rehab director with other issues.
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