Any tips for meeting with administration, director and DON?

katwjr

Wow, reading this post and comments was the inspiration I needed. This is so hard and I am trying to stay positive, encouraging and hopeful. Good days are great and bad days render me hopeless and defeated. Reading others' experiences really help me to understand that I'm not crazy or alone in this, but then again, it's not about me, it's about my mother. Daddy died suddenly just before Memorial Day. He was 97, so I was blessed. They were married 73 years and lived together in our home for the past 63. We moved my mom to AL in July. We chose a facility close to the majority of the family and were sold the ultimate AL experience, a lovely new facility, supervised, with man-to-man coverage for the first 30 days. The whole team was there to support her transition and acclimate my mom to her new home. Day one it fell apart. They "forgot" to bring her breakfast three days that week, claiming "she wasn't in the system yet". Then breakfast came as late as 10am, "due to unforeseen circumstances on the floor delivery prior to her floor, services may get delayed, for example if someone on the 5th floor fell and staff was needed to care for them"... No one came to help her shower, no one came to take her to the church service, the activity director stopped me in the hall one day to tell me how much my mom - "loved the music show - she just clapped and sang along" THAT is not my mom. There was no communication with me and what chatter I did receive was false. I could go on. I absorbed all the ups and downs and tried to figure out how the system worked/or didn't - I was there three times a day, despite working full time. I was getting burned out and that wasn't helping mom.

I prefaced this to set up my ask... I am meeting with the new administrator next week (third one since the property opened three years ago, (third dietician director since January). I met her at the meet and greet and asked her for a meeting, bluntly laying out my agenda. "How would you want your mom taken care of?" "What would your expectations be?" Based on what your sales staff is selling, what is reasonable for me to expect, and how can i do more? I told her I didn't want to come to her with a list of complaints, because I was sure she is already aware of the facilities' shortcomings. Since my mom has been there I have listened to constant complaints from staff, residents and family members - so I'm sure she has a bucket list of things to fix. Anyway, I have been warned by family members, not to be too demanding, not to overstep, not to "stir things up" because it will only but a negative spotlight on my mom and get the opposite response from the administrators. Has anyone had a meeting with the director(s) and how did it go? I plan to go in with notes and be matter of fact, not emotional - but what is the best way to effectively communicate with these people? My initial meeting with the fill-in director, fill-in DON and my "sales lady" left me discouraged. They nodded and head tilted, were "sorry for my loss" and encouraged me to get my mom to join all activities. I felt defeated, unheard and dismissed. Please offer any comments. I am learning here - I want to help my mom feel comfortable, safe and not alone in her displacement. She does have mild dementia, is depressed and misses my father terribly. I'll wrap up for now, although I could keep going - I'm sorry for the long rant. I'm trying to sort this out in my mind as I write. Thanks to all of you out there for sharing your posts, they have been a tremendous source of encouragement and guideline for me, Kathryn

Emily 123

Hi there,

Your mother should have had an intake assessment and care plan drawn up for her at intake. Typically these are used to assess the level of care needed, and the pricing is based on that. A usual schedule would be: an assessment at intake, reviewed at 30 days, then every 6 months, but it may vary. the parameters should be in your intake contracts.

The care plan should lay out what they're supposed to be doing (and what you're paying for). Does the section of the care plan that reviews participation note that your mom will need prompting before events? Does it specify what events she would like? Or list a goal of, say, 5 events a week? Does the section that reviews hygiene require that someone helps her with shower set up? I would go over your copy of the care plan ahead of time. (If you don't have it, ask for one.) At the meeting I'd note (with examples) where it isn't being met, and discuss what workable solution they'll offer.

It may be that the AL is more of a hospitality model, and/or there's a mismatch between what the facility can provide and what your mother needs. Even with mild dementia, the loss of your dad and the move to a new place will be very disorienting for your mom, and she may need more support than at home to get through her day. She may not need memory care yet, but perhaps a smaller facility with a dementia focus or a care home might be a better fit. Sometimes all the bells and whistles aren't what's needed as much as a clean place with friendly staff who can get your parent to meals and activities on time, and makes sure their meds are correct. If it's as chaotic as it sounds, with everyone dissatisfied, how long are you willing to wait to see if the new Admin can turn it around? If the (temp) DON isn't impressing you now, both you and the new admin may have an uphill battle.

Another option, if the AL can't meet her needs, is to have an aide come in to fill in the gaps so you're not hotfooting it over there three times a day (yikes!), making sure that the care plan/bill reflects that the AL isn't performing certain tasks.

Best of luck!

harshedbuzz

I am sorry for your loss.

Are you using "assisted living" as a euphemism for MCF or is it, in fact a hospitality-model assisted living facility? Most folks who are successful in AL require only minimal assistance-- meal prep, light housekeeping, transportation options and maybe medication oversight. Needing hands-on assistance with showering or a prompt/escort to attend meals would be more of a personal care/MC level of care.

Sales people will lie. They will tell you whatever you need to hear to extract a community fee and fill a bed. Perhaps they have a MC side to which they plan to turf her now that you're in their system or perhaps they expect you to hire additional help.

Is very likely that your late father provided a great deal of scaffolding to support your mom to function at a higher level than she would alone. Add in the tremendous loss of her spouse/caregiver and one would expect a lower level of function.

I personally wouldn't start the conversation which a passive aggressive hypothetical question about what they'd want. I would meet with the DON with a concise list of expectations for mom's care and ask if that level of care is going to be possible at the facility. If they say "yes" ask how they can provide care when another resident is having a crisis-- at dad's MCF, the other 3 halls could send one caregiver temporarily as needed, the sales person (a former caregiver at the facility), DON and/or activities person could be called on and the MCF on the same campus could send back-up as needed.

HB

towhee

Oh my- This post does take me on a trip down a "bad" memory lane. I think the question you should be asking is not what the new director can do, but whether they have the power to do anything. This all sounds like a staffing issue. Either the facility does not intend to hire the amount of staff they need to provide what they have promised or they just cannot with the money (or maybe staff pool) available. The director is unfortunately not the owner and has to work with what they are given. Sometimes all the money is spent on the fancy new building and staffing is a lower priority. Also, any time you get 2 or more administrative positions with new people at the same time there are going to be problems.

I would suggest that before the meeting you try to do the following:

List all the complaints you have heard, by who is complaining, staff, family, etc. If you lay it all out you may get a better picture.

Find out how many CNAs (or personal care attendants, however they are called) there are on the morning shift. How many residents there are. Get a feel for how many residents are in wheelchairs, or seem to need more help. Whether the staff are permanent or temp staff. How many different CNAs care for your mom during a 7 day period in the morning (4 is not totally unusual, more than that is really bad). Some idea of CNA turnover. Find out the same info for the people who do medications and activities. Do the kitchen staff serve meals and help in the dining room. Do the CNAs help remind and transport people for activities. I am saying do this for day shift because that is usually the one CNAs prefer, so it is likely to have the best staff.

Some of this you might have to find out from the administrator in the meeting.

In MC or in a nursing home, where more people are in wheelchairs and they need a lot more supervision the CNA to resident ratio is usually 1 to 6-8 (or maybe 9 these days). For ALs where some people need assistance with showering, etc, but others do not maybe 1-20. For med techs in a nursing home ratio 1-20, AL 1-30. These are just ballpark figures, based on my limited experience. Some states have minimum staffing levels, but most do not. For activities it varies by how many people they have to transport, or gather, and how far they have to go. For the 120 bed SNF my LO was in there were 2 full time people and one part time and it was not nearly enough. For the 45 bed AL there was one 3/4 and one part time. It was usually ok.

You gave two examples of problems- meal not getting served because not in system- This does happen, but not for 3 days, and a regular CNA will pick up that there is someone new, it might take a while, but a meal will get served.

Not getting picked up for activities- I had trouble with this at all 3 facilities my LO was in. It took several conversations over several weeks, I think activities gets in a routine with their regular attendees.

The new administrator can put new procedures in place for better communication, although it may take a while, but if they do not have the staffing for the level of care your mom needs, you need a plan B.

katwjr

All great things for me to think about and act on! i have been putting together a list of complaints as they were posed to me. I have the contract and intake assessment which I intend to go over when I have time to concentrate and make notes. The intake assessment was virtual, and totally inaccurate, mother was labeled a Level I, which is "no charge", although at 93 with MC issues we even had her "self-assessed" at a Level II-III, They may have done another assessment, I have asked to be called so that I can be there, but no one has contacted me. I need to get access to their records (her file). She also wears a NexGen watch for emergency contact, in researching this tool, I found it tracks her and that we are supposed to have online access to that info, but the facility says they don't have that capability. I so want a better experience for her, and I know she would prefer that I was there all the time, but I have to work, have responsibilities at home, and I'm tired - combine that with the guilt that I'm not doing more, well I'm sure you all get the picture. I have thought about moving her, and may pursue that avenue. I do believe I was expecting more and that this is a hospitality-style facility, two residents have level V care and still outside care - that is not encouraging. I will hold out until after I have met with the new admin, and implemented some new in-room activities - puzzles are OK, maybe an art easel, and we are going to make photo albums for all the grandkids' families. Thank you all for responding, just knowing that I'm not alone has helped me tremendously, I talk to my siblings (I am the youngest of six) but they are not here and therefore don't experience the everyday issues. I will keep trying... things will get better with time, I'm sure. Thank you again!!

M1

Kat reading this over, i suspect the bottom line, as you've already concluded, is going to be that she needs a memory care level in a different facility. Having made a move after a year in one facility, i can tell you to expect pressure-they want to keep a warm body in the bed. But i wouldn't believe anything they tell you and suspect your energies will be best directed to making sure the next placement is a better fit. Chalk it up to learning curve and let it go, you're not going to change them ultimately. I'm sorry you had this experience, but it's pretty common sadly. I'm sure it's been a rough year for both you and your mom.