Advice Needed, Please

LucyStone

Hello. Does anyone have advice on what to do when the staff and administration of a nursing home are unhelpful? My mother has Alzheimer's, and yesterday, I called to ask if the doctor could please call me after he saw my mom. ( The Dr.s office is independent of the nursing home, and because the nursing home would not answer my questions, I spoke directly with his office.) The nurse was so rude to me on the phone that I called the administrator to ask her to please make sure he calls me before he leaves the building. ( It is a very small town. Everyone knows everyone. I have known her forever.) She told me she would go and see what was happening. Three hours later, I called her back. She told me my mom was not on the list to be seen; the doctor had left, and they had looked at her chart, and it was all good. When I asked her why she didn't have him check in with me that the main office had arranged it and why she hadn't called me back, she told me that I was upsetting HER and she wanted to cry. I was frustrated. But I did not become belligerent or mean. I wanted answers to why I couldn't get someone to help my mom. I should not have to beg. Then, she hung up on me. The administrator of the nursing home. I promise I am not THAT person. I am kind and trusting. I swear. I should add I live out of state.

M1

This is a prime example of how hard it is to coordinate care from long distance. These homes contract with local physicians to provide oversight, but it's minimal and many times cursory. I don't know how you overcome it except to be there in person. Is you mom a candidate for hospice care? that might provide different oversight. Just a thought. the other possibility would be to move her closer to you, which also is not easy. If she has Medicaid, it's state-specific, and getting her qualified in your state would take time.

harshedbuzz

@LucyStone

Distance is never your friend in caregiving. But there may be other factors in play here specific to the dynamics of SNF/affiliated doctor arrangements.

Do either of your sisters live near her? Is one of them the POA? IME, the SNF and physician's office likely have one point person for your mom's care and information. If you are not that person, it will be expected that you communicate through the POA. The reality is that most places are quite short staffed post-COVID and there just isn't time to be communicating with multiple people from a single family. If you are the POA, it might make sense to move mom closer to you if at all possible. My aunt moved her sister 3 on becoming guardian; this involved a 3-hour drive to another state with medical transport.

The other piece is that often these facility-affiliated doctors have a schedule they need to keep. A nurse might pass the message to call, but there's no way she can force him to if he has another urgent patient to get to. They don't work for the facility per se, but the patients. Dad's MC-physicians (geriatric doc and geripsych) tended set their own schedules as they were managing care in several facilities and, in the case of the former, his own private practice. If mom/I needed to reach out, we called them directly and they returned calls when they could. The geripsych tended to see people late morning/afternoons and call back in the evenings. The geriatric doc saw his facility patients very early before going to his practice around 9:30am; his called backs might be on the drive to the office or around dinnertime.

HB

forbarbara

Dealing with MC staff is like dealing with a PWD - I’ve learned to do a lot of things that aren’t natural for me. I spend a ridiculous amount of effort telling the nurses how good they are, thanking them, empathizing about how hard they work and how difficult their patients can be, even complimenting their physical appearance. In other words I’m a total suck-up. But it has been worth it because the nurses now care for my LO the way she would want

If your mother has to stay at this facility, ignore the staff’s outrageous behavior and send a thank you card.

You might also ask if there’s a good time of day for you to call and find out if they’d rather communicate by texting.

LadyM

I hope I can be of some help. Can I ask what specific information you wanted about your mother? The reason I ask is I was recently a nurse and a memory care and assisted living facility and believe me everyone is so overwhelmed that unless something is really an emergency, they tend to prioritize based on that or if there is a significant change of the resident. We used to have a family member call every night and want to chat and ask how her family member was doing but honestly staff just does not have the time to do this and I always say no news is good news we don’t want to be that way either believe me we wish we did have the time to talk to everyone, but we don’t. We are so concentrated on trying to give quality care which most of the time I have to admit is very hard to do because people assisted living homes now need so much care
I hope and pray you find the information that you need, but I think the response by that other person about being a total suck up honestly that does help it makes us feel appreciated because the job is unbelievably hard and none of us do it for the money we do because we want to care for people and do the right thing and so many people staff become burned out and it becomes dangerous for everyone 😪

HollyBerry

One of the hardest things for me was figuring out "who does what." My brother called everyone "the Nurse" and I finally figured out that there was actually only one Nurse, several CNAs, and other really valuable people and they all pitched in together to get stuff done —- but they also had defined roles and if I needed to ask about a bedsore, there was no point in asking the girl who came to take her to the bathroom.

It's hard enough to figure out the communication system when you're there in person several times a week. It was really, really hard to come for a 4 or 5-day visit and get to know everyone again, earn their trust (it's a 2-way street, and that wasn't something I knew up front, either), show them how grateful we were for their care, and have actual conversations about her health and happiness. I only realized most of this after she moved across the country to be near me. I was pretty clueless for a long time.

MN Chickadee

Are you the POA for mom and the main contact of the family? If so, I think it's reasonable to expect an update after she is seen by the doctor. If not, I'd say stop and get the info from the family member who is POA. The staff are extremely busy and do not have time to talk on the phone much at all, let alone to multiple family members. We had 2 very good facilities but I rarely got much useful info over the phone. Shifts change, people are busy. They have so many proverbial plates spinning at one time. Our second facility had a head nurse who wasn't the most friendly esp on the phone but she ran a tight ship and ensured good care with high expectations of the staff. The most useful feedback I got was being onsite and catching a spare minute with the nurse or aides. If you are the sole family member and POA you may want to move mom to a facility near you so you can better oversee her care. Long distance will only get harder as her dementia progresses. If a family member is local to her send them to the facility to check on care and be there the day the doctor visits. Being there for those visits was always the best way for me to properly have a handle on mom's health. Also, if the doctor is a private practice can you go through their office instead of the facility? Call the practice ahead of time to request that she be seen if there is a specific need, and call their office after with questions or better yet use the online patient portal if they offer it. That makes it very easy to read their clinical notes and send a message that the staff can respond to whenever they have time. If there was not a specific need for her to be seen perhaps they knew Medicare wouldn't cover it and didn't see her for that reason. It just sounds like perhaps there is more to it than people being intentionally rude or dismissive. And as others have said, the kill them with kindness mentality can help. I was the family member who sang the praises of the staff, brought treats for them when I came, sent thank you cards at Christmas, sponsored pizza for staff on all shifts a few times a year and occasionally paid for musicians to perform for the whole place. They loved me and went the extra mile for my mom. Yes there are some bad apples, both staff and entire facilities, but most of these folks work incredibly hard and are under paid. Just try to keep than in mind when dealing with them.