Care plan meeting tomorrow

Nowhere

M1- my husband also refuses assistance and has had similar lack of  hygiene issues. Again, I wig up and enter as a 1 on 1 aide. With different hair style , fake glasses,  Covid mask,  and fake accent, and a fake plastic name badge identifying me as house cleaner/ gardener he doesn’t recognize me. And he desperately wants to find me! He’s very in the moment walking and talking. Lately when I leave he’ll run over and say, “Wait! What’s the Code” for the locked facility exit. That being said, I know you feel this will not work for you, but it might be worth a try. It has kept my sanity as I love him dearly and all he asked early on in the disease is that if he required placing that I make sure he is treated kindly. 

Before, I thought of going in undercover, the aides would occasionally (grrr) change sheets and clean his room when he was in the dining room. He was paranoid about their stealing and wouldn’t allow entry if he was in the room, and I and the staff totally respected his right to refusal. His need for feeling safe was a big as his need to be clean in my eyes. His personal care went down the tube!!! His ADLs are still in place but he wouldn’t change his clothes or shower. He sleeps in his clothing - same socks, etc! 

When I enter I oversee his showering otherwise he’d just get naked and then out the same dirty clothes back on. He doesn’t know he has a closet, let alone clothing, even though everything is labeled. He can read, he can write, but he cannot quite use the information- advanced dementia and very little executive reasoning. He will still hold doors and help other residents in the now/present. 

I wish you peace, M1, and your wife good care. 

ghphotog

I've heard some good and bad things about MC.
I know the MC is probably short staffed, they are stressed working in that industry so I hope the staff are well paid to make working there worthwhile. For a 100g a year from all of the residents it would seem to me that the staff could be compensated for that kind of stressful work. . . but in the end it's all about profits and MC is no exception. I just hope they are not intentionally trying to cut corners, hiring inexperienced and untrained people to increase profits.

My stepdaughter works in mental health and that kind of career can take a toll on anyone in a short period of time. I would safely assume there is a huge turnover in that field.

I am looking at MC for my DW possibly in the next year or two. She needs to be in MC now but I will take care of her as long as possible, especially after hearing about the issues a lot of MC units seem to be having.
I thought MC as the last stop on the journey, would be professionally managed in everyway by people that are trained and understand the dynamics of working with ALZ people.
I'm finding out that is not the case.

Elshack

dayn2nite2 wrote:

Elshack wrote:

Even though the aides are very nice I have to be on the ball re: many issues. One day I brought home his clothing and lo and behold his slacks were filled with poop. I took a photo of it and sent it to the director of the memory care and also a lady who is in charge of admissions etc. Now I heard they reamed everybody out and said if it happened again they all would be written up! 

I have so many signs in my DH's room re: to put in his teeth, put in his hearing aid etc. They managed to lose his new $ 1800 hearing aid several weeks ago so he is operating with 1 hearing aid.

Unless you want everyone avoiding his room so they can avoid the write-up, the next time something like this happens, please wait until the next day and address it with the aides directly and not their superiors.  Just as there are many things you can pick your battles about, there are different methods of getting an effective outcome when failures like this occur.

I made sure I had an excellent relationship with the aides taking care of my LO daily and a more professional relationship with the DON/administrative staff.  Because I didn't have a terroristic method of addressing issues (top-down) and came to them face-to-face with a respectful, collaborative approach, they also felt comfortable enough to let me know when they were seeing new or exaggerated behaviors or other issues.  I'm not saying you need to shower these people with gifts and praise every day, but definitely giving them a chance to fix things before reporting to their bosses and treating them like the important members of the care team (as they are) goes far.

Regarding the hearing aids, if they lose the other one, don't replace it unless you are a very wealthy person who can buy multiple pairs of hearing aids.  It happens with things like hearing aids and eyeglasses.

M1 unfortunately was a trigger for behaviors and has had to send others to visit, which is why we're only finding out about the ongoing issues now.  In this case, it is certainly more appropriate to go to DON and administration, because the issues seem to be pervasive and "standard operating procedure" and that needs to change.

I hardly call my method terroristic and actually I have a good relationship with all the staff. Some said what happened was a bunch of crap which it was literally and figuratively. I think the person who did this was a night staff person.I often ask them if my notes taped on the wall are offensive and they all have assured me it helps them have a checklist of what to do.

I really wasn't asking for your commentary on what I did. I see these people everyday and everyday I thank them for taking such good care of my DH. Actually I find your comments rather offensive and judgmental. I know what the situation is and they have assured me that I am not a pain in the a** . ( I am talking about the 5 different aids I see during the day )

dayn2nite2

Elshack, you can feel any way you like, makes no difference to me.  Post on a public board and you’ll get responses from the public.

ladyzetta

M1

I hope all went well when you visited your DWs room in MC. I agree replacing from Goodwill would be the way I would go. 

I was very pleased with the care the staff was giving my DH. There were a few things I chose to overlook. At times he had someone else's shirt on, and I noticed his shirts on others, as long as he was clean it was something I overlooked. All of his shirts were marked with his name, again it was not an issue with me. And it made no difference to him.

This has to be very hard on you, please allow yourself some down time and overlook the small stuff. Take care of yourself.

Hugs Zetta 

ImMaggieMae

M1, thank you for the update. Some of the issues you describe, like your wife being so angry and blaming you for not taking her back home are big hurdles to overcome, but it sounds like you are finding ways to resolve them by joining her in group activities and maybe in the future visiting with friends until she becomes more settled. But issues like dirty linens, lack of toilet paper, leaving her belongings unpacked or stacked out in the hallway are things that the staff should have taken care of during the first few days or certainly the first week. You shouldn’t have to be chasing them down to do their job 7 months later. That’s what you’re paying for. Doing the cleaning or putting unused bedding in a locked area when she is out of the room isn’t rocket science.  They should be able to get it right after 7 months. If she is too difficult for their staff to handle, they shouldn’t have accepted her. Maybe it’s time to look for a better facility. All MC’s have social activities, don’t they? That sounds like the easy part.

The high fees these places charge should be to give you peace of mind, not cause you more anguish.

M1

One more update, and then I'll call it quits on this thread.

I was able to go this afternoon and inventory her things while she was on an outing (see below, her first), and there wasn't enough missing of anything to worry about.  Which was very reassuring.  She is beyond peeved that they've locked up her things--but we'll see if there is a middle ground that allows her access to some things but not all.  I did have a chance to talk to the aides in depth, and I was very glad for that, I agree completely that this needs not to be a top down thing.  In fact I put most of the responsibility for poor communications on the nursing staff, and i have told them that.  We'll see if it improves going forward.  

The really, really, really good news:  the outing went great.  This is truly her first time off the MC campus since April.  they went to the (new) Tennessee State Museum, and she absoltuely loved it.  Reportedly was a little reluctant to go back in the MC building when they got home, but her favorite aide was with her (who also happens to be over six feet tall) and was able to persuade her.  

I am exhausted--Ed, you are totally right about the stress-but thankful.  Very apropos the season.  

Jo C.

Oh M1, she looks so tiny in front of that exhibit.  It is wonderful that she enjoyed her outing, really a positive and hope there are more to come.

Am hoping (but concerned) re the dynamics with the sheet changing; if they did not do this when Sharon was at a meal or activity, it would as though there was another failure; it is simple common sense in a simple and considerate approach for a needful resident with dementia who has not got the ability to use logic and who gets easily upset.  Same with putting away supplies; so hope they did that while Sharon was otherwise occupied.  Considering the history, I agree that I would find a way to mark the sheets in a place not easily seen so you can monitor that it doesn't take months to have them changed again. Does Sharon sleep well?

As for the DON going ballistic with staff. She was probably embarrassed as well as highly miffed she needed to be involved in such a debacle that reflected back upon her and it was not the first debacle.   I wonder how often she rounds on the units and how often she reinforces policies for the basics and does adequate inservice and appropriate oversight.  Seems to be a bit disconnected to the here and now of managment, but I could be wrong.   Wonder how large is the facility - how many beds?  And how many on the MC Unit?  How is staffing I wonder and how many aides per resident and is there at least onc licensed nurse on each shift?   MC usually has less, but hope it is sufficient.   Most facilities will have only one licensed nurse for the entire facility on the night shift and that was not a big positive as the number of aides on nights is also very, very low.  Things get missed. 

The second facility my LO was transferred to did such a great job; (far different from the first one), and almost no staff turnover at all.  The DON was highly professional and really engaged and actually made it a point to visit each unit every day and usually managed to frequently visit all shifts.  She had high performance standards which staff easily were engaged with and staff was treated very well.  One day I heard her outside a patient's room.  She was talking about a patient's being dressed; "Please be sure that you dress her in her color coordinated clothes which she has.  Just because she is in a nursing home does not mean she has to look like it."  She really cared, had a lovely sense of humor and also engaged with the patients/residents whether on the MC Unit or SNF side.  How I wish all could be as professional and hands-on caring.

Have you had an opportunity to read Sharon's patient record?  That may be interesting and if requested, it must be made available to the responsible decision making party.  When I did that, I found it enlightening with lapses that made a difference with some things that had become a problem and it assisted in making a more realistic plan of care for the significant issues where things had fallen by the wayside.  I also occasionally checked the med record on the med cart to ascertain use of PRNs when things were a bit "off."  That too led me to realize why certain things were happening the way they did; once that cme to light, it was adjusted for a much better outcome.  Never made any comment on mild matters, just those that were important and were consistently missed over time.

You have had to wrestle so much and I can imagine it truly is exhausting.  Wish you could do something just for yourself to give a bit of respite to a tired spirit.

May your caring advocacyinteraction lead to more positive dynamics and much better care. 

J.

Ed1937

I'm glad she had a good time at the museum. She looks like she was enjoying herself. Hoping things like that will help in some small way with her accepting the place. It's sure been a long time coming.