Bummed and needing advice

glitterqueenscare

We finally got the call from the nursing home last week that Mom was at the top of the waiting list.  It felt like God had answered our prayer. I am losing our main caregiver October 1 for at least the month and on top of that recently my boss has been giving me the side eye about all the interruptions necessitated by my Mom's care.  The timing felt like a blessing, doubly so because I was so conflicted about placing her into care in the beginning and had finally found a measure of peace about it. I also have a couple of health problems brewing that I have been putting off due to the demands of her care, placing her in a home will allow me to address those too.

When detailing her condition to the nursing home I asked that she be admitted as a one-on-one as her care at home and at the day center she attends twice a week is such that she is never alone, at all times having someone at her side.  The nursing home agreed they could accommodate her in that way.

Yesterday they called and due to the vaccine mandate they had several nurses quit and expect more staff to do so imminently.  Because of this they can no longer accommodate my Mom as a one-on-one admit.  

They want to do a home evaluation on her to see if she can make it without a one-on-one sitter with her all the time.  That evaluation takes place Monday.

I am very conflicted.  Although my Mom has no combative or behavior issues she does better with constant guidance (certainly emotionally) and I hate to think of her placed into a lock down unit without someone there for her at all times by her side to guide her and for lack of a better term kind of be her wing person and buddy.

Am I being too fussy with her care?  I know staff is present at all times, but they don't run any activities right now due to covid and I worry she will be left to her own devices and will be miserable and adrift.  She is still very mobile and doesn't nap, sit to watch tv, etc.  

That said, she is at stage 6c, starting to sometimes choke on her food, unable to formulate sentences well, swallow pills, is a wanderer etc.  

I spoke with my brother about it and he reminded me Mom placed our Dad into care with no such demand that he be placed as a one-on-one.  Ugggghhhh

If I choose to not admit her until she can be accommodated as a one-on-one admit they have agreed to leave her at the top of their list so at least she wouldn't be dropped to the bottom but it could be months, with the ongoing covid rodeo and staff shortages. 

I am just wondering what this group thinks, if any of you have experienced this type of situation.  Have you placed your LO without having them as a one-on-one and if so how did they do? Did they transition ok from constant one-on-one care into a group setting?  Am I being ridiculous to expect placement as a one-on-one in the time of covid?  Once she gets admitted if they see she needs that type of care will she get it regardless?

I have no problem with the nursing home mandating vaccines, they have had to continually close to visitors because of staff members testing positive. No patient has had it in 9 months thankfully so I trust their direction and hope it leads to less visitors closures.  These are crazy days.  

Thanks for any responses, we are really struggling with the next step.

jfkoc

I have never heard of any facility including hospitals (short term) providing one on one care.  I would check and re check and have in writing that your mother will have this care.

Marta

Yes.  You are being unrealistic in expecting one on one care, no matter the staffing ratio. 

The only model providing one on one care is either family care or private pay at home.  

dayn2nite2

Take what you can get, the staffing shortage will get worse.  Save yourself and your job.

Stuck in the middle

Ditto.  Save your job.  Being young and poor sucks, being old and poor sucks canal water.

Cynbar

I also have never heard of a place that promises ongoing one-on-one care. Most places are short staffed, especially in these COVID times. Frankly, it seems like an unreasonable expectation. I know you want the best for your mom, but I agree with the others here who say save yourself and your job. Sounds like time for placement, even without the desired one-on-one. Actually wouldn't every patient and their family prefer constant one-on-one supervision and attention? That's not sustainable.

Emily 123

Another vote for 'save the job'...

kmasen_act2

Can I offer my perspective as a nursing home Assistant Activities Director, Dementia Practitioner, and a former family member of a grandmother with ALZ?

For our family, placing my grandmother in a nursing home was one of the best decisions we could have made.  I was only 8 years old when she was diagnosed, and with both my parents working, there was no way anyone could take care of her.  With her in the nursing home, we never had to worry about her not getting the care we couldn't provide.  Plus, that allowed us to transition from being her caregivers to being her family again, which was a huge relief.  My grandmother didn't need the 1:1 visits, and adapted quite well.

Second, yes, many nursing homes are back on lockdown due to COVID restrictions, but the activities don't stop.  Many of them (not mine at the moment *knocks on wood*) are reduced to hallway or in-room activities.  Those in-room activities count as a 1:1 and are run by us (the Activities staff) most likely throughout the day.  Even when we bring a cart of snacks by the rooms, that's considered an activity.  So, activities are most likely still going on in your mother's perspective nursing home, just not in the traditional sense.

Third, even though many nursing homes are closed to visitors, many are still offering Compassionate Care visits (Hospice) or personal caregivers (such as Visiting Angels) to enter the nursing homes.  You would have to talk to the perspective nursing home about this, as they can give you some guidance on whether or not this would be allowed.  

What I do for residents who are transferring into the home is I set them up with a "buddy".  This is usually a fellow resident that can show them the ropes and is set up with them based on their personality.  That way, the newcomer doesn't feel so lonely and scared.  

As far as the 1:1 care if she needs it regardless, I know for Activities, every resident usually gets that.  I usually try to give as many of my residents 1:1 time everyday, even if they don't have it in the care plan as needing a 1:1 visit.  

If you have any questions, I'd be willing to offer my perspective.

MimiMinder

My advice: Take the spot if it is still offered to you. Once an entire staff is managing your LO, you might get a good night's sleep and even to attend to work matters with full focus. This is not being selfish - this is self preservation (and job preservation, too). 

Would I like my mother to have more care than she is getting? Yes, I would. But I have to realize the care she is receiving is 'good enough' and I cannot expect perfection. When she lived with me, I could manage everything but at what cost? 

My LO is safe and her basic needs are being met. With staffing shortages and COVID challenges, I take this as a win. You indicated that you have health issues brewing, so hopefully you will be able to get those addressed once you are not fully responsible for managing your LO's care. 

Please let us know how things progress for you!

Lindsay22

I'll add to the chorus.  Take the spot. As you said you've waited a long while already and your own health and job are at risk now.  It's time, there's a spot, you know what to do.

MN Chickadee

I have toured many facilities and never heard of any offering one to one care. A family could personally hire a sitter to sit with their LO but it would be outside of what the nursing home offers. I will say that my mother is almost never alone, but this is not one to one care. During waking hours they keep her in the common areas. If there aren't structured activities going on there are other residents to talk to, various staff coming and going, often the staff sit and talk with her. They can see her while they are in the kitchen prepping food. So she is under constant supervision, to keep her out of trouble, prevent falls, and keep her stimulated. 

Given the advanced stage of your mother's dementia and your own health concerns, I would take the bed when it comes up. 

jfkoc

So now I am confused. I thought that  1:1 24/7 care meant someone was with you 24/7.

Beachfan

I think you are correct, jfkoc, but a 1:1 could be hired for less than 24 hours.  I had a friend who had a 1:1 aide for his wife, but only for 8 hours a day.  The rest of the hours in the day, he relied on staff to assist his wife, but they were not with her 1:1.  (For example, once she was in bed for the night, she was safe with just the hourly bed checks. She could not get herself out of bed to wander and was not prone to falling out of bed.)

Jo C.

For so many logical reasons, I would take this admission - waiting for one on one care will in all probability not happen and you will lose the spot in a good setting that you have waited for, and your job may be in jeopardy if you delay.  I have never heard of a one-on-one NH care unless paid for privately by the family, so your idea of one-on-on may not be the standard practice or belief.  This is not a realistic standard.

Get your mother admitted, see if they have a "buddy" system with other residents, or if there is a several week period of increased oversight care while a person is adjusting . . . .BUT . . . . you can indeed hire a "companion," sort of person to drop in several times a week, or  hire an aide to be with your mother - all private pay . . . BUT . . . .this would need to be approved by the facility which may or may not happen due to the COVID risk - AND you want your mother protected as much as is possible from COVID, so strictness can be an asset. 

Also - nothing says you must leave your mother in NH care; you can choose to remove her any time you wish . . . .

NOTE:  Not only will your mother have a period of adaptation to the new setting; you too will have an adaptation period and you will have to cut yourself and others some slack during that adjustment period.  This is not day to day as usual; this is a very different dynamic due to the COVID situation and NHs are doing their best to protect their residents and staff and juggle staffing issues based on vaccination mandates. 

If this were me, I personally would jump at the admission chance, give it time as I adapted to the new way of being, and worry about other matters later knowing I  could aways reverse course if I wished. 

Best wishes being sent your way,

J.

Jo C.

Forgot to mention, be very careful with Monday's assessment visit.  Do NOT appear to be demanding or what could be interpreted as a "problem family" by the assessors.    Be the nice, reasonable, undemanding person you are and let yourself be seen as an asset rather than a liability.

Your mother is not a behavioral issue; she is not going to be a problem patient requiring much problem intervention.  Do NOT insist on uber-extra care for her - see first what the assessor shares with you about their care.  They, as are most NHs now, are doing the best they can under very difficult circumstances.  This will evolve.

I have seen families turned down for admission if they were judged to be probable problem families.  Just saying . . .

J.