Lack of managed care plan and communication

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My husband was admitted to a memory care facility in July. I joined this forum at that time hoping to get information  about what to expect in facility management and other’s experiences in dealing with facility staff, etc. After 3 months at this facility, Bill has “eloped” once and fallen twice. He is diabetic and his blood sugar is traveling up and down like an elevator. He has been put on Adivan and Depakote, plus his insulin. The psych PA refused to put Bill on an antidepressant despite the fact that that he wanted to kill himself and cried every night wanting to come home. We had to go above his head, contacting the psychiatrist the PA works for. She prescribed the antidepressant. His meds have been juggled around since he went there.  Now he is back on Adivan. The psych folks have not discussed a plan of action with either us or the on-site  nurse or his primary care PA. We have asked for and never received his daily blood sugar reports and a list of his meds, despite being promised they would send them  

We have had meeting after meeting with the facility staff hoping to get this mess straightened out, but nothing changes. He has been “exit seeking” for the past few days, thus the addition of the Adivan, again!  And the risk of falls. Now they want us to provide a full time “sitter” or they are going to discharge him. We have engaged the help of the Ombudsman to facilitate the next meeting. 

Bottom line:  is this a common problem in Alzheimer’s long term facilities?  I just want to strangle these people!  The thought of moving him to another facility is just another set back for Bill. Must I lower my expectations?  

toni2

No! You should not lower your expectations! You are the one who has his best interests in mind. Unless they can explain why they are doing what they are doing and how it will be in his best interest, keep on with what you are doing. 

At this point you are his voice. Saying all this, you still need to remember to take care of you. My husband was in a facility like that one and I had trouble with the staff, so I went to the doctor who had sent him there and he took care of it for me. We had him moved to a place where they took great care of him. Sometimes the move is better than staying where he doesn't get the right care. 

I'll be praying for both of you. 

Toni

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Thank you Toni!  You have given me new impetus!  My daughters and I have set up an appointment with all concerned in this matter, including managers, ombudsman, VP of operations, etc. 

And, Thank you for your prayers!

Marcy

dayn2nite2

There is so much wrong here I doubt it’s fixable.  I’d be looking for a different facility.  You probably can make them bend to your expectations, but they won’t be happy to do so.  How do you think this will reflect on the willingness of the staff to care for him?  I fully believe that covert retaliation occurs in facilities.  Just because it can’t be done overtly doesn’t mean it won’t be done subtly.

Marie58

I haven't had issues like this with my DH's MC, but when things did come up and weren't resolved quickly by going to the first person in the chain, I went straight to the director of the facility. Things always got resolved. 

None of this is acceptable, and no written plan in place?? That should have happened right away with a review shortly after. Lots is going on here and moving him to a different MC facility might be better for both of you. 

Hope things get better soon!

Jo C.

I am so sorry this is happening and can well understand how stressful and upsetting this must be. I so hope your meeting will bring about some much needed change.

If nothing changes, or if he is asked to leave, then one option would  be to find another placement setting for your LO, but that is not always easy.

Another approach option could be an admission to a GeroPsych Unit where he could be monitored on a 24 hour continuum and treatment adjusted as appropriate with oversight for effectiveness. However, if you do this now, the likelihood may possibly be that his present facility would refuse to take him back; that is as risk.

What is the diagnosis for type of dementia?  Sometimes, initially the diagosis for Alzheimer's Disease is the first diagnosis, but as time moves forward, occasionally this is adjusted as symptoms evolve.  There are multiple different types of dementia of which Alzhemer's Disease is only one.  Meds in one type of dementia can be contraindicated in another and that can cause issues.   Is it possible to have his specific diagnosis looked at and confirmed; and it would also be a good idea for all of the meds for all conditions be assessed by the Psychiatrist, not the PA, to determine if there may be issues with that. 

If all fails re quality of care, one can even make complaint to the department that oversees care facilities. In our area, it is the County Health Department that sends out RNs to inspect and review complaints.  In other states, it may be a different entity that does that review.  However; if that is done, it may be an issue for the care facility that may not be taken lightly, you will need to think about all the ramifications.

Though you may not be getting copies of your LOs daily blood sugar reports, and that is a lot for the staff to remember and to get to you depending on how they do their charting and with staff changes;  you are by law permitted to see his medical record when you request to do so.   BUT:  Please only one of you; the one who has DPOA or the spouse.  HIPAA laws are strict.

If you feel that you need to find a new setting for him, or if he is asked to leave because the facility cannot provide the level of care needed for him, it may (or may not), possibly be that admission to GeroPsych first to get meds assessed and straightened out may be a helpful step; you would have to ask the physician about that. If that is thought to be worthwhile, that way, he would enter into his new setting with a better opportunity for success and relief for him as well as for the family.

I so hope that all will work out, let us know how it is going, we will be thinking of you.

J.

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We have been searching out other facilities. The good ones are few and far between and only one opening. If this next meeting doesn’t get things on track, then a move will have to be made. I do worry about how all of this is effecting the staff and their attitude toward Bill. The caregivers seem to love working with Bill as he is very passive and introverted, so fairly compliant when asked to to something. But, the exit seeking behavior is the situation that upsets the management. They never explain how this behavior manifests itself, other than he is trying to get out. Nor does the exit seeking occur everyday. We were hoping to make this work, however, I’m not sure it is worth the effort.  There are too many things that need “fixing”.  

One last question: do you ever have scheduled meetings with those involved in the care of your lo?  The primary care physician, psychiatrist, etc.?  Or, do you have to request one? At no time did the folks at the facility sit down with us to discuss medications, past behaviors, or how we would proceed with his treatment. Any questions asked were on the intake form we filled out. The only way we know his meds are changed is when the director of the unit emails or calls to say his meds are being changed, either increased, decreased or completely changed. Or another on added. 

The information you all have given me will help us find the best facility possible. Thank you!

dayn2nite2

A care conference with nursing, dietary, and other staff but not physicians was held once per quarter.

Between those, I had a good relationship with the aides and they would answer my questions or get nursing to talk to me.  This was a nursing home, not memory care.