Information For Those Beginning Movement Toward NH or MC Placement

Jo C.

The link is an excellent and lengthy overview of so much regarding many NH dynamics; kind of a "how to" model:

Chapter 1: Before Your Mother Enters The Nursing Home | Illinois Citizens for Better Care

Input from Members:

From "King Boo:"

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. 

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From Jo C.

Dear King Boo; that is such a wonderful Post that I think it is worth it to copy and place it on both the Caregiver's and Spousal Forums again.  It continues to be timely and addresses so much that is important.

I found both in my professional life as well as in my personal life that the non-admin. people were seriously, seriously important and I always made connections with all those in various settings of the care facilities whether acute med centers or non-acute care settings.  We got to know one another by name and when I was in the presence of staff, I got to know a bit about them and their families; they were not invisible.  They counted.

The housekeeping staff are the ones who do deep cleaning of areas as well as every day housekeeping; they are key in keeping the infection rates down and makes them part of the Infection Control process.  We would be lost without them; they are hard working..    The staff in the engineering department (sometimes called janitorial) keep things running and useful and often quickly respond to urgent situations; their job is never done.

The aides; what wonders.  They are the hands-on far longer than the licensed nurses because the licensed staff are so few.  The aides are our LOs main care providers working off the orders as written by the doctors and as assigned by nursing.  These are the bedside people we depend upon and not to be dismissed as "less."  If anything; they are "more.'

The dietary people work so hard in such difficult areas to work in; they fix so many different diets and sanitize the dishes and other implements; they are not seen and are mostly unsung back in the far halls of the  facilites.  Rarely do they get recognized; yet, they are key.

The front office tries to keep all paperwork up to snuff and current and assist us.  Social services run themselves silly . . . they do intakes, they meet and greet new people; they address a myriad of problem issues, they deal with and meet with families; they make transportation happen; they make arrangements for transfers, appointments, discharges with discharge orders for equipment, ,etc. for ALL patients with such needs. 

So many, many more making it possible for care to be provided and to keep our LOs safe.  Of course we also do our best to communicate and provide some oversight which is much more difficult in times of COVID not only for families, but also in some ways for multiple levels of staff.

There are no little people.  They are all big in the scope of things in care dynamics.

I always let the staff know how much I appreciate them in a variety of ways; and they are all very important.  We, if we try, become a positive part of the care team rather than a problem that cannot be eased.  If there is absolutely no trust, and severe issues that cannot be remedied, then one needs to find another care facility asap while there is time before all erodes to the point of beyond and we find ourselves in a major bind.

Ed1937

Thank you, Jo. I've seen these before, but it's always good to be reminded about them. It's well worth remembering the pointers.