I am new to this board but have been reading many of the posts and finding lots of good information. I thought I would ask my questions regarding my father and get others' opinions.

Two months ago we moved my father into an ALF. He is 88 years old and his physical condition is degrading but his mind is still sharp. He took a fall in his home last Oct. and fractured a vertebrae. Due to poor balance and unsteady gait, and in addition, essential tremor, he now needs assistance with showering, dressing etc. He walks with a walker short distances but we use a wheelchair for longer distances.

Shortly after he moved into the ALF he had a minor fall when getting up from his recliner and going to the bed. He had fallen asleep in the chair during the day and woke up and wanted to transfer to the bed. He did not injure himself at all. A maintenance person was entering his room at the time and helped him up. Later the nurse at the ALF told me that the staff member should not have helped him and that they have to call the paramedics for all falls. She said my father exercised poor judgment by getting up without assistance. She told my father to call for standby assistance every time he was transferring. He does not want this much assistance. He was very upset by the new "rules" and so was I. I told her that dad did not want these restrictions and was unlikely to abide by them. He told her that as well.

This seems excessive and overbearing to me. First, if he has fallen and tells someone he is not injured and asks for help up, that should not require a call to paramedics. Second, if he wants to transfer from the chair to the bed by himself, I believe he has that right. Since he does not have dementia, he is certainly aware of his own fall risk. I must point out that he often asks for help, especially in the middle of the night to go to the bathroom. So to me he is balancing his fall risk and need for assistance with his desire for independence.
Isn't that the point of assisted living?

The nurse at the ALF has also requested doctor's orders for over the counter medications that he might want to use (Tums, Nyquil, etc.) He has opted for the medication management program, not because he needs it necessarily, but because they included in the cost and it's easier on him. She also questioned whether his primary care provider who is a nurse practitioner, not a doctor, could write the orders under the Illinois regulations for ALF. This also seems excessive and overbearing.

In several conversations with the nurse she has invoked the potential liability of the facility. I told her that I expect them to provide the assistance that he needs and wants (and is paying for). How do I get them to respect his decisions and provide assistance as requested?

As my father's primary caregiver, I am the one interacting routinely with the staff at the ALF. In general they have been great but I think the nurse interprets the "rules" of ALF in a way that seeks to minimize any facility liability in the event something happens to my dad.

I have already been through the eldercare experience with my mother who did have dementia and was in a nursing home for several years and so I don't have a lot of tolerance left for staff who don't seem to be focused on the elderly person's quality of life.

Thanks for any advice

The rules & regulations are different for Nursing Homes than Alfs.Alfs are less strict than nursing homes unless the rules have changed.......

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I'm still here though, because even if I'm not hands on for my mother, I'm going to need this board's support again very soon.

Oh merriwid, I am sorry to hear this... Please keep us posted on how she is doing - and you, too. Many blessings to you, m'dear.

MW not for nothing but your my hero! (((HUGS)))

I'm sorry, I've been away from the board for a while, and I try to catch up with everybody by rapidly scanning through some of the messages.
Sometimes I miss something really important, and tend to say things that put my foot in my mouth, so to speak.
What did I miss on this post?
Laura's dad is in an ALF because even if he is mentally stable, he had a nasty fall a while back and now is using a walker and a wheelchair.
If he is not using either one and he falls, he does not want any assistance getting up from the floor.
Laura,I'm presuming that if he DID require assistance, he would ask for it, but HOW? He's on the floor; his call button might as well be on the other side of the window. Yes, he could scream and holler, but how dignified is that?
And what if he hit his head when he fell, and was unable to call for help? THIS is why all those "unreasonable rules" are in place. They prevent early morning phone calls to you: "I'm sorry to have to tell you that your dad fell earlier today. He was unconscious when we found him, and he had a severe cut to his forehead. We had him transported to the hospital, but he is still unresponsive."
And I can almost guarantee that one of your first thoughts is going to be, "My God, you people KNEW he was a fall risk! Why weren't you watching him?"
I really am sorry you feel attacked. I hope you've decided to monitor this board just a little longer, because there are wonderful people here, with valid opinions. I've stepped on my share of toes, and they still love me. I am a former caregiver. (My husband spent all but his last week here at home.) I'm still here though, because even if I'm not hands on for my mother, I'm going to need this board's support again very soon. Not even the folks at work are as good at giving grief support as these people are.
And guys - even if Laura isn't here, I mean it! I'm not saying this just for her benefit.

I'd say bear in mind that the AL home has to be concerned about law suits. It's a shame but a reality. So rules that may seem overbearing probably stem from someone else getting the dickens sued out of them because they were deemed negligent. (That has to be why they were so fussy about *who* helped him get up again.)

Take a deep breath, and I'd suggest a good long talk with the AL management so you understand their motivation and you can all come to workable plan of action.

Laura, again, it is your choice to participate here. You have asked for and received opinions about this issue.

There are different boards for a reason, and this one tries to focus on reality, and what CAN be done to serve and protect our loved ones and their dignity. There are others that have different emphasis.

I personally believe that if your dad is competent, then as a fall risk, he should be encouraged by you to demand the care he pays for. Otherwise, since he is competent, invite him to live with you or hire caregivers to go to his home and do what is necessary to help him. Many of us have chosen one of those options if we didn't like regulations and personally assumed the liability of being the primary CG.

Research other homes. Interview, with Dad in tow. YOU also have choices. Find an ALF that suits you if this one does not. Talk to the administrator about the possibility of waivers, but believe me, if you like this place in general, encourage your dad to cooperate. They are trying to reduce his risk of becoming a bed ridden , brain damaged, sack of bones in a Skilled Nursing Facility.

If you can't personally care for him now, its a pretty slim hope that you will do so if he is no longer ambulatory. His dignity is best kept intact by preventing falls, but if that makes no sense to him or you, have it your way.

This message has been edited. Last edited by: Bobcat,

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My real question and purpose in posting was for advice on "How do I get them to respect his decisions and provide assistance as requested?" not to get the facilities point of view or lectures about the seriousness of falls in the elderly.

Therein lies your problem as you have said your father has an issue with needing assistance because of his condition.
He uses both a walker and a wheelchair what part of that says he can ambulate on his own without assistance whether it be by hard medical equipment or by a staff member?
Im a little confused here Laura you got information not only by exemplary at home caregivers, professional caregivers as well as a viewpoint from a facility standard and you think its overbearing???
As a professional caregiver when I go into a facility I have to follow their rules its non negotiable.
This is a whole lot of experience from different people with different points of view about caregiving BUT we all come together with the same thought the health and SAFETY of our LO's.

Maybe the issue is you are not the hands on caregiver. I dont consider myself my MIL's primary caregiver any longer because shes in a facility, as someone put it I am the director of her care and Im not going to enforce my beliefs on these people that have enough to do with her day to day care its counter productive.
I also do not feel guilty about this decision it was in her best interests.
These people here take time everyday of their lives to help others wrestling with CG duties while doing this task, many before you have got the same advice and points of view and they dont react as you are so it begs the question why you would attribute these posts as an attack rather than exactly how it is meant...information and guidance

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He does not want this much assistance. He was very upset by the new "rules" and so was I. I told her that dad did not want these restrictions and was unlikely to abide by them.

I guess he has answered your question, Laura.

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"How do I get them to respect his decisions and provide assistance as requested?"

You can't. With what you have listed as your father's issues, they would be derilict NOT to have him on a "fall prevention" program.

Let me be clear about something - I HATE facilities, but I respect the work they do and understand its import. Facilities are a compromise solution when there is no one who can personally attend to a LO's needs.

No one has lectured you, Laura. We have stated positions from EXPERIENCE of both sides of the issue. If we do not agree, we are not going to say so to placate.

I'm sure you want to be fair to all concerned and act in your father's best interest, which is why I spent my time writing to you. Frankly, I think your dad's needs would be better served by spending time trying to help him comply with the reasonable requests of the facility rather than try to make the facility jump to his tune, which ain't gonna happen.

My real question and purpose in posting was for advice on "How do I get them to respect his decisions and provide assistance as requested?" not to get the facilities point of view or lectures about the seriousness of falls in the elderly.

My father has used a walker for about 2 years. In order to keep him safe we could take the walker away and put him in a wheel chair permanently, but he doesn't want that. We wants to move about his assisted living apartment generally on his own with assistance at his request, which is perfectly capable of deciding.

This will be my last post. I have not found this forum to be helpful

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Two months ago we moved my father into an ALF. He is 88 years old and his physical condition is degrading but his mind is still sharp. He took a fall in his home last Oct. and fractured a vertebrae. Due to poor balance and unsteady gait, and in addition, essential tremor, he now needs assistance with showering, dressing etc. He walks with a walker short distances but we use a wheelchair for longer distances.

Laura,
I'm confused. Not to be facetious BUT are we talking about the same person?



.

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Originally posted by Laura K:
I am overwhelmed with the response that I received to my concerns. As I read a person's rights in assisted living, they have the ability to direct their care and even to refuse services. If they do not have dementia, I see this as individual choice for an elderly person in balancing their independence and quality of life with the risks that come aging. I don't agree that falls should be prevented at all costs and more importantly, neither does my father. While the facility may see it that way because of concerns with liability, that doesn't preserve individual's rights. Now, it's a business and they could always tell my father to leave. I certainly understand that. But if he is paying for care and has the ability to make decisions, I believe he should be in the driver's seat.

I think in the future I will just monitor the boards rather than participate. Thank you.

Laura, sorry you took offense. As BC stated, many of us here have been so put off by rules and regs that we turned ourselves and our lives inside out to care for our LOs at home rather than have to step to the tune of a facility. Many of us also have seen what happens when our LOs make poor choices and WE have to suffer the consequences with them.

It isn't a perfect world and as our elders decline they do lose personal freedoms that we take for granted. The "right to fall" is a bogus issue. IMHO. Who in their right mind would want to allow someone to fall if preventable? I personally hate the sound of brittle bones breaking and people moaning and screaming...

People always have the right to refuse care and they (and their families) also take on the responsibility for the consequences of refusing care. It sounds good on paper, but I can't tell you how many families find dealing with the real life consequences a whole lot more than they had imagined. While we often discuss the philosophy behind such events, hands-on primary caregivers must also deal with the realities of them.

My mother chose to fall. She was completely bedridden for 6 years after that fall. Because she was otherwise healthy, it took a long time for her to die and her quality of life was pitiful at best. Sure, she exercised her "individual rights" but then she suffered the consequence of dying by inches for the next 6 years, helpless to have much enjoyment of life at all. Gratefully, dementia protected her from realizing how bad off she was, but that didn't change how being completely bedridden compounded the duties required for her care. I did the work of caring for her and I can assure you, it was a heckuva lot easier and less traumatizing to us both when she was ambulatory.

There is more than "individual rights" at stake and the realities behind many of the rules and regs are unforgiving. Disease and attrition rob all of us of our "individual rights" if we are not fortunate enough to die suddenly while still ablebodied. Wisdom dictates that we should try to hold on to what we've got and if that means putting up with some invasion of our personal rights, it comes with the turf.

This message has been edited. Last edited by: Moms_Buddy,

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But if he is paying for care and has the ability to make decisions, I believe he should be in the driver's seat.

Laura absolutely!
I and others are stating why this occurs in a facility it is not representative of how we think.
Working in this environment I will tell you if a patient doesnt accept help theres nothing we can do except allow them to do for themselves its their right so instead we do what is called "Standby Assist" we as the staff in a facility must make sure we have tried to assist the person because of the liability issues.
For liability reasons I have to write EVERYTHING down in my notes even a patients refusal of help.
If that patient falls and is on my watch guess who gets called in to the office?
Not the patient its gonna be me and my notes and anyone else that has been witness to the refusal of help.
You may be one of very few people out there in this big bad world that accepts people fall.
I know I do as well as others here.
We cant watch our LO's 24/7 thats impossible but there are people out there that believe because they pay for a facilities care, that means absolutely no accidents should happen.
If it does theres hell to pay.
I hate when people dont listen to me in regards to my MIL for whatever reason but I know at the end of the day its their rules that they need to apply to the situation at hand not mine.
Iv been in facilities that couldnt give a rats ass about my MIL, in this day and age theres far too many sub standard facilities.
I would count yourself lucky these people actually take their job seriously.

Unfortunately, sometimes state laws regulating licensing of facilities and patient desires collide.

The only one that seems unusual to me is the one about requiring an attendant for transfer. I know that skilled nursing facilities and hospitals can make these rules, but it seems unnecessarily restrictive for an assisted living apartment in particular when there has only been ONE falling incident. When it comes down to it, is it even enforceable?

When my MIL was in ALF, they wouldn't take patients who required supervision or significant assistance with transfer. Part of it relating to staffing levels.

It seems to me, at least relative to this issue, they would accept a release of liability. (I'm not the bubble wrap type either, especially when they are capable of making reasonable choices for themselves.)

Laura, I am sorry that you feel that way about the responses here. I hope you change your mind. Asking a provocative question is a good and welcome thing.

Oddly, several of us have done triple double overtime to keep our loved ones at home and not subject to institutional regulations. Even then there is personal liability. If we have assumed the responsibility of care giver, we face charges of neglect from APS if we are not dotting every I and crossing every T. If an elder becomes dehydrated, loses too much weight, falls and has bruises, pressure sores, meds get mixed up, all and sundry, we might have to defend ourselves in court.

This is even more true in a business. If these rules are a state requirement for the level of care he is assessed to need, then he must have that level of care. He is there because he is a fall risk and this cannot be handled at home. (If uncooperative, he might very well be asked to leave.)

There will be others that are not considered a fall risk and not be required to wait for assistance. That would be based on the assessment of their abilities.

I am sorry that he finds this to be excessive concern and that it offends his sense of independence. My mother who is still in her home was frustrated when I first insisted on the use of a gait belt. She soon came to understand that a fall didn't only risk HER health, it risked the health and sanity of those helping her.

It is a fact that there may be a difference between what he wants and what he needs in the way of care. I agree with you that it is strange. We expect a child to fall in order to learn. Competent adults sky dive, ride bulls, ski steep slopes, snorkel with barracudas. No one can stop them. They slop around in parasite infested swamps if they are so inclined, but once we need assistence and someone, anyone assumes that responsibility, they are suddenly liable.

Our elders are not likely to fall and die. They are likely to live. Live in pain and further disabled, possibly needing risky surgery for broken bones, risky for clots, strokes , dementia. Those who have answered you here ARE on your side and your father's side.

I have worked really hard to allow Mom to have it her way. Sometimes we have to compromise. Preventing falls and what meds she takes count in as those times. I don't want to go to jail because she is old. I don't want concientious care facilities to shut down.

I am sorry that your Dad is losing his independence, as is my Mom, as one day I probably will also. It hurts, but no one is trying to hurt you.

Hang in here, you really are welcome here.

This message has been edited. Last edited by: Bobcat,

I am overwhelmed with the response that I received to my concerns. As I read a person's rights in assisted living, they have the ability to direct their care and even to refuse services. If they do not have dementia, I see this as individual choice for an elderly person in balancing their independence and quality of life with the risks that come aging. I don't agree that falls should be prevented at all costs and more importantly, neither does my father. While the facility may see it that way because of concerns with liability, that doesn't preserve individual's rights. Now, it's a business and they could always tell my father to leave. I certainly understand that. But if he is paying for care and has the ability to make decisions, I believe he should be in the driver's seat.

I think in the future I will just monitor the boards rather than participate. Thank you.

Dear Laura,
Welcome. As you can see our members will always give you their honest opinion and advise.
It may be difficult to accept at times but the priority here at ECO is for our Loved One's best interest in every way.

As for my 2 cents on the issue: it's this simple, "Why take chances?" Your father's health and well being depend on it. That's more important than propping up his ego.

I agree:

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Falls are the #1 cause of rapid decline in elders and should NEVER be ignored.

Just to empathize- My Mom (84 yrs) has been in an ALF for a year now. She uses a walker, head injury, mod. dementia, and has assistance with showering, dressing, and medication. When she first moved in she had a couple of "falls". One time she was picking something off the floor and just gently went down on her rear, the other she rolled out of bed. In both cases she was able to call for assistance to get up, the charge nurse looked her over thoroughly, notified me and we kept an eye on her. (I did purchase a low profile bed after that). I can see in your case that the maint. person should have called a nurse for assistance and I can understand with your Dad's unsteadiness that they want your Dad to contact them. As a new resident- they are still getting to know him and are looking out for his safety. I also completely understand the balancing act of maintaining independence with safety. Mom often takes showers, dresses on her own. My current thought is- Good for her! Until such time as it becomes a hazard. Even with all the precautions in the world- falls can and will happen.

One of the hardest things for me to accept when Mom moved into the ALF was my own loss of control of how Mom was cared for medically. The medication thing threw me (even TUM's!) for a while- even though I can completely understand the reasons. When medical issues would crop up and they would fax a request to her Dr. then call me- aggravated me. Keeping track of communications between Dr. and ALF so that nothing was changed without my agreement or notification was also a challenge. Once I figured out all the rules and how they could affect decisions I was able to manage things better- and accept those things I could not change.

There is usually a Charge Nurse and a Director of Nursing. For day to day stuff get to know your Charge Nurses (friendly chit chat (brief), thanks for the work they are doing, ask for their help in addressing issues with your Dad. They can have good suggestions if they have been doing this a while. For more serious discussions speak to the Director of Nursing. They should all be willing to talk and listen- if not them maybe another place is in order.

Laura, there are (too) MANY caregivers who would give anything if the facility where their loved one resides was this judicious about falls!!

Falls are the #1 cause of rapid decline in elders and should NEVER be ignored.

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In several conversations with the nurse she has invoked the potential liability of the facility. I told her that I expect them to provide the assistance that he needs and wants (and is paying for). How do I get them to respect his decisions and provide assistance as requested?

A facility has rules and liability concerns. It is a fact of life. No facility can allow each individual patient to "make their own rules." Sure, it's annoying sometimes, but they are erring on the side of protecting the patient, thus reducing their exposure to liability. That's a win-win situation. While some of the rules may seem overzealous from a personal perspective, they usually have sound reasoning behind them. Sure, the nurse (if she has a brain) is concerned about liability, as well she should be!! Minimizing liability is NOT an ugly point of view.

The only way a person can get personal care is for them to receive personal care, instead of facility care. And even with personal care, caregivers will (and should) override unsound decisions made by patients.

I think discussing this with the nurse in an open manner that is understanding both of the patient's desire for independence AND the facility's liability position could produce some kind of compromise. Whether your father has dementia or not, MANY elders make poor decisions for themselves. If they live alone, they are free to do so; but once another person - ANY person - enters the picture to render assistance, the patient is going to lose some autonomy. It simply cannot be helped. Expecting the facility to not follow best practice procedure because your father and you don't agree is not gonna happen.

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She also questioned whether his primary care provider who is a nurse practitioner, not a doctor, could write the orders under the Illinois regulations for ALF.

I do not consider a nurse-practitioner to be a good choice for a PCP. She does not have the education and training that a physician possesses. Here, NPs can call in prescriptions on the DOCTOR'S orders, but cannot write scripts themselves. That's a sharp nurse at your father's ALF and I wish she was in charge of facilities in my neck of the woods!! An ALF is NOT a residential hotel - it is a care facility with rules and regulations governing its procedures. Can you imagine how it would feel to that nurse to be audited by the state (a fairly common practice) and the auditor finds that they are not in compliance with state laws because of the patients all wanting certain things done "their way"? The nurse is NOT your enemy!! She sounds like a dedicated professional who has patient care AND liability firmly in her sight at all times. Cudos to her!!

Many caregivers and their LOs have an aversion to facility-style care and opt to care for the LO in a home setting.

While I can sympathize with your long years of facility eldercare and its challenges, it sounds like your dad has a very good facility and nurse in charge of him.