what to expect from the MC caregivers?

M1

Well I'm on pins and needles.  I haven't heard anything from the MC unit since about 4:30 yesterday afternoon when they let me know the bed delivery was successful.  Should I call?  I haven't been told when I can visit, what to expect in terms of communication.  I hate that this all went down on a holiday weekend when things are likely off-kilter anyway.

I'm so tired and lonely I just don't know what to do.  I don't think I can hold it together for much longer.  I guess I'll wait til nine--that might be when shifts change or day staff comes in--but I'm just so over all of this.  

BethL

Call any time - no reason not to. Just because they suggested not visiting, calling is different. You and your partner are the customer; they should be available to take a call. 

Try to rest and do something fun for you (after the hopefully reassuring call). You now have time to take good care of yourself.

MN Chickadee

Sounds pretty typical to me. I had my mother in 2 different MC facilities over the years, and neither was sending me updates unless I asked even in the early hours and days. Mostly I think they are just busy and don't stop to think about it. It is so routine to them. To us caregivers it's the worst day in our life, to them it's the 4th new resident this month. Dozens before them, no big deal. But they did encourage me to call any time and would happily give an update when I asked. In the early days I called a couple times a day, to different shifts. I made sure to check with both the nurses and aides from time to time. Mornings are pretty busy for them, maybe wait until after 9. Shift change at least in my experience tends to be around 6 or 7 am, and then they are getting everyone up and ready for the day and nursing does their rounds and stuff. Usually by 10 the first activity has started and things may have calmed down. The 4 or 5 days after the move were so awful for me. Sitting on pins and needles is right. I'm sorry you have to go through it. I'm assuming there is always a nurse on duty? I would definitely call them this morning and have them verify what meds she has been given due the previous mishaps at the hospital. They've seen it all, hands on family and hands off family, nasty family and nice ones. They won't be phased by some extra phone calls in the first few days. If anything it sends a message that you care which is a good thing.

Gig Harbor

I agree with the others that the early morning hours are super busy getting everyone up, dressed and out to breakfast. I don’t know the layout of the facility but is there any way you could go and just stay in the main reception area so that you might get a glimpse of her without her seeing you. That might make you feel better. You might also ask if you can get text messages and maybe a picture of her taking part in an activity. That way the caregiver could text you when it is convenient and not have to leave the resident to answer a phone. I hope she is adjusting well. This is probably a good weekend to have moved her as there is probably increased activity to help distract her.

Beachfan

M1, This is such a horrible time for you; I remember it well, 5 months ago.  Because DH was so compromised by the time he was placed, there was no time limit  on how soon I could visit. I knew I needed to calm down, decompress, and catch my breath so I decided to wait a week to visit, but was encouraged to call “anytime”.  And so I did.  MNChickadee nailed it- - everyone with whom I spoke was friendly, helpful, and surprisingly, because the facility is so small, knowledgeable about DH’s whereabouts and activity at the moment.  After the first several calls and the first visit or two, I was much more relaxed and found that although I missed DH’s presence, I wasn’t thinking about him and worrying every minute of every day.  As time passes and I am able to resume a “normal” life, given the circumstances, I am more accustomed to the inner workings of the MCF.  I still address occasional “misfires” (wipes gone missing, odd clothing appearing in his wardrobe, a promised modification to his toilet) but I try to approach staff and/or the director respectfully and not appear demanding or aggressive.  So far, although I would much rather have DH at home, I am content that he is content.  I hope you are able to find peace and a sense of calm going forward, and above all, that your LO settles in and is happy.  Best wishes and Happy Easter, in spite of it all.

harshedbuzz

M1-

The adjustment period applies to you both. My mom really struggled with him not being around. There were rooms she avoided just because it made her feel even more empty when he wasn't there, and mealtimes were really hard, too.

It's OK to call and ask how things are going. I found checking in the night person around 5:30-6am to be a good time. After lunch is generally a good time to connect with day shift and after 9pm might be best for the evening shift. I used to call at different times so I wasn't always "annoying" the same person plus it gives a different perspective.

I found the MCF only ever called if dad had a fall. He wasn't steady on his feet and would sometimes sit down on the floor to avoid falling plus he liked to sit on the floor which meant they assumed he'd fallen when he probably didn't. 

Another thought is asking if there's a way for you to observe her without being seen. Sometimes that can ease your mind while not upsetting your LO. 

We chose not to avoid visits-- the facility left it up to us. I felt dad was enough on the ball to need to see my mom but I knew he would excoriate her, so I went with her initially so I could keep the visits in the public areas and extract her if things went very badly. It was awful the first few times and then improved more quickly than I had dared to hope. It helped to bring treats.

HB

jfkoc

No experiance but I would imagine that they are only going to call you as needed.

Give them a call and ask your questions. They know this is a huge adjustment for you too.

Ed1937

M1, I'm taking the liberty to copy and paste an excellent (in my opinion) post made by King Boo some time ago. I didn't go through and delete parts that might not be applicable to your situation, but the meat and potatoes are in there. I hope it helps.

 

  King BooPosted: Tuesday, September 30, 2014 2:07 PM

 

Joined: 1/9/2012
Posts: 3312

I am not one to glance backward and dwell too much on the "what ifs".  Things happened how they did, and with considerable work, research and much agony on my part, we have achieved good care for my parent, who is now on palliative care in Stage 6.

However, in the event this information is at all useful to anyone on the boards, here is what I learned:

 RESEARCH:

1.  Research ahead of need. Do not wait till Dad is "bad enough" or a hospitalization happens.   Choosing in a crisis significantly decreases your ability to have control over what facility you will use. Narrow down the facilities which seem to meet the needs of your loved one.  Go back and visit multiple times.  Evaluate how long the facility can meet your LO's needs.  Will you need to transfer, or is a higher level of care available?  Formulate Facility Plan B.

2.  Staff retention and facility treatment of staff is paramount.  There is a trickle down effect.  If staff are valued and treated well, this increases the chances that your LO will be too.

3. Are there at least some staff that really seem to enjoy their jobs?  Engage in spontaneous interactions with their residents?  Compassionate and patient?

PSYCHO EMOTIONAL

.  Staff at AL,SNF and MC fully expect family members to have an adjustment period in addition to their new resident.  It takes a while to form lines of communication, trust, and to let relative strangers take care of our family members.   Seek out what information and guidance you need.

However, do your best to keep family strife and discord out of the care facility.  It may be appropriate to say to the social worker "my brother is having issues accepting Dad's decline and the increased expenses", as a heads up to give her the information to support your brother.   However, leave family drama, outbursts and arguements at the door;this is  not going to be welcome on an ongoing basis.  Staff have enough to tend to with their residents.  .    If it continues chronically, it can be a strike against your loved one.  More on that later 

THE FINE ART OF COMPLAINING

 Things do not go perfectly, as we want them to go, in a care facility.  Unless it is an horrific breach, gradually work up the care chain.

For example, sporadic oral hygiene?  Speak with the CNA doing the work.  By doing this, I forged a relationship with the CNA, who throughout Dad's 3 years stay in MC would contact me whenever a care problem was encountered.   Going directly to the Director of Personal Care would not have achieved my desired goal, which, for the long term, was to facilitate Dad's overall care, not just toothbrushing.   I would have if it was not successful, but 1 conversation revealed what the problem was and together the CNA and I set up a solution that worked.  When we left MC for SNF, one of the CNA's came to me and said "You respect us and our work like very few people.  I hope your Dad can come back."

Was care perfect?  No.  Was it very good?  Yes.  Were matters of utmost importance and safety checks being conducted properly?  Yes.  Most importantly - Did I have the means to constructively enact change for Dad?  Yes-through the relationship forged with his direct care staff. 

We must choose our battles carefully, and plan careful execution of them for best outcome for our LO.   If I complain about things of relative inconsequence (why weren't the curtains put up in the morning) vs. very important items of concern (why wasn't I called about the fall that gave Dad a black eye). . . . .we can be labeled noisy problems to be gotten rid of.

I would call this becoming the identified family (aka the resident we would love to get rid of at first opportunity because the family is a huge problem, and nothing we can ever say or do will make them content).  You don't have to be paranoid, just aware of this.  A care facility can and will refuse to take a resident back after a hospitalization

Please note:   I am not ever saying not to work on problem or to report problems.  I am just saying a careful evaluation of your actions and how it will impact things is indicated before you say or do anything. 

For example:  During one of Dad's rehab. stays, there was a very, very, bossy, dominant male nurse, who would not let any other staff have their say or input about Dad during his care conference.

What I did- confrontation.  Not a good call.   Saying "Could you please let other staff give me their input, why are you answering for them" made me feel good, but it got us bounced out of that facility as he had final say on re- admissions, after Dad's next hospitalization

What I should have done:  "Miss Smith, could you please tell me what you think of Dad's ambulation?"

Turned out not to be an appropriate facility anyway, but. . . . .my next point

A BAD FACILITY IS A BAD FACILITY . . .or, slightly modified AN INAPPROPRIATE FACILITY IS AN INAPPROPRIATE FACILITY

 If you encounter one of these, if at all possible, do whatever is in your power to get your LO out of there.  Even if your complaints to the Ombudsman enact some change, if the underlying corporate or social structure is bad, you will not be able to re-write the entire functioning of the facility in time to do your LO any good.

Bad care and bad care facilities do need to be reported.   Report as you see fit.  Report right away for serious breaches.   But for more minor things, sometimes the knowledge that you are aware of the Obudsman can enact change for your LO temporarily while you find a new care facility. 

Just some thoughts from my 9 plus years of dealing with hospitals, rehabilitation, assisted living, memory care and skilled nursing facilities.

We must advocate for our LO's - this means dealing with difficult situations in the most productive manner possible for them.  It frequently means that we must maintain objectivity in the face of great emotional upset.  I have to constantly remind myself that my decision making must have Dad's care at the center of it. "

Jo C.

Care facilities do not routinely call us unless there is a problem to report; we call them at appropriate times. Nine o'clock is not a good time, but that boat may already have left port.

 This is that unfortunate period of adaptation for yourself and finding out how to deal with your own emotions and fears.  For me, that was the worst of it; but over time, one does  adapt.  I would probably wait until Monday to ask about visiting time, etc., and what the staff recommends especially based upon how your Partner has been doing.

As for times to call;  - do not call the facility at 5:30 or 6:00 am.; end of shift care tasks are being done; end of shift charting is being done; and preparing report for the next shift is being processed.  Then they go into shift report at start of the new shift. It is a lot for them to be doing.

Not good to call at 9:00 am; the staff is hugely busy getting the patients up, providing hygiene, grooming, dressing, breakfasting, dispensing medications, etc.  Best to call around 11:00 am when things have simmered down a bit and lunch has not yet started.  

I used to call once in the a.m. . . . . OR once in the afternoon about 2:00 pm.  The first few days, I was so concerned that I called once on the day shift and then once in the middle of the night at 2:00 or 3:00 am.  Embarrassed to say that the first day I called on each shift I was so worried that  my LO was falling apart; that did not happen. Imagination can cause worries that do not exist.  Just needed to know my LO was okay and even able to sleep.

Still; I had concerns about how my LO was functioning, I was really fortunate that the facility had an office area with a one way window/mirror on the door. One could see the outside activity room from inside the office outward, but anyone outside the room could not see inside.  One day; about a week or so into the admission, I was able to sit in the office and observe my LO at an activity - found my LO to be engaged and actually doing well.  What a relief from what I had been concerned about. 

The lonely part; doing without the one we love in our sphere and usual way of being, that is another thing altogether.  So lonely; but also a period of grief for that which is lost and never will be again.  Heartbreak.  Some folks here have found visiting a counselor to be of great help in working through that and it is always an option if it becomes necessary.

You have done an amazing job under the worst of circumstances and are to be commended for the persistent advocacy that has made such a difference.

J.

M1

I called about 10:15 am.  She's isolating in her room, was suspicious about taking her pills this morning (until shown her orders on the computer).  I let her have a television on a trial basis--but it's not working as yet.  Doing okay but not happy is the report.  About what I expected.  Wouldn't eat breakfast with the group, wanted to eat in her room.  I suspect that's likely to continue.  She's so used to doing what she wants, when she wants--not very likely to adapt to a group setting easily and when she wants to can be disruptive.  We'll see.

harshedbuzz

Jo C. wrote:

As for times to call;  - do not call the facility at 5:30 or 6:00 am.; end of shift care tasks are being done; end of shift charting is being done; and preparing report for the next shift is being processed.  Then they go into shift report at start of the new shift. It is a lot for them to be doing.

J.

Ouch. 

In my defense, that is the time requested by the overnight shift when I asked. Because I did ask.

Perhaps this is something that varies depending on the size of the facility and whether it's a SNF or a MCF. Dad's was a 44 bed MCF that was at around 75% occupancy. 

Marie58

The MedTechs at DH's MC have a cell phone (it's passed from one shift to the next) on their person at all times. I was told to call anytime, not just in the beginning but even now, to check on DH. It was suggested that I not visit the first week or so but I did call everyday. They are used to that and it's one reason they have the phone. It's a direct call. As far as them calling me, it's only been when he had a fall or if I needed to bring something in. I know at my DH's facility, they like family involvement and have told me that they wish all residents had a family member like me who was supportive, involved and visited their LO. Prayers for you both as you adjust. I know how hard it is, how quiet the house is, how lonely it can be. Get your rest and try to stay busy.

MN Chickadee

Marie58 wrote:

The MedTechs at DH's MC have a cell phone (it's passed from one shift to the next) on their person at all times.

Yes! The nurses at our second facility had a cell phone they passed to every shift, and it was incredibly helpful. I could text a question or text them to call me when they had a moment. If any of you are at facilities with family councils or a means of making suggestions you might consider bringing this up. It seems like a win-win for everyone.