I will be having my first Care Plan meeting with the team of social workers, nursing staff, etc. regarding my mom next week. Please let me know if there is anything else I should add to my discussion agenda, which I've listed below:

CARE PLAN MEETING ISSUES TO DISCUSS

MEDICATIONS

• Review all medication changes with me prior to administering the medication (doctor said she had discussed the medication change with my mom, everyone needs to understand that I am the one managing my mom’s care, not my mom – ask my mom, she will tell you that’s why I have POA and am her Health Care Proxy)
• What times of day does my mom receive her medications?
• What medications and doses is she currently on?


HYGIENE

• When is her bath/shower scheduled for – at what time, what day – so I can plan when to take her out?
• How many times has she had a bath since coming there? My mom can only recall one time and I know she did not get her bath last week.


HAIRDRESSER

• Hairdresser only comes in AM, when my mom is asleep (she gets up a noon at the earliest). Is there any possible way for the hairdresser to come in the PM twice a month?


RECREATION

• Activities such as Trivia specifically designed to get high functioning verbal patients together. My mom has yet to meet another high functioning patient. She is very lonely.


WHO OVERSEES MY MOM’S CARE?

• Is there anyone whose responsibility it is to look at all of the elements of her situation at the nursing home and ensure that she is being well cared for? I feel like I am acting as the general contractor. Shouldn’t someone at the NH do this?
• Why haven’t the doctors who care for my mom or the nurses met with me to discuss my mom? I’ve been caring for her for the past 20 years and I know a lot that could be helpful. For example, my mom has no short-term memory. The doctor did not know this and the nurses don’t seem to understand this. The doctor says, “Well, I discussed the medication change with your mom.” The nurses say “Why don’t you tell your mom to discuss her concerns with us.” I can tell my mom anything, but the fact is she won’t remember it five minutes from now. How can we get the staff to understand this?’
• Is anyone trained to observe changes in behavior? For example, knowing my mom’s habits could signal a problem when there is a change in habits. My mom always watches TV from 7 to 8 PM every night. If she stops doing that, then that means something is wrong – either she can’t remember how to use her TV or she is sick or overmedicated.


COMMUNICATIONS

• Both my mom and I have felt like our verbalized concerns have no impact whatsoever. Staff is very polite and seem concerned, but the communications don’t get to the doctor or to the next shift. The communications process is broken.
• Who should my mom speak to? I will have her keep a time log of when she expressed a concern.
• Who should I speak to on which issues? I will also keep a time log of who I spoke to.

BC, a quick google for ombudsman answered your question...
http://en.wikipedia.org/wiki/Ombudsman

I'm honestly not trying t be cheeky here, I swear, but I would like to know the origens or history of the term "ombudsperson". Nothing of the sort is in my ancient dictionary, neither is laptop, or website, or many other terms used everyday now.
Optimist! I've not had any interactions yet with one, (or if I had I didn't know it) and I would really like to know what I should expect from a person of that designation. This isn't meant to be sarcastic, just ignorant.
Respectfully your's Bobcat

Just a quick update on my mom's situation. The nursing home gave her a roommate who had an extensive family that just basically moved into the room. We're talking about 6-8 people and up to 3 small children for up to six hour stretches at a time. I had the doctor write into my mom's chart that my mom has a need for a low amount of stimulation. My mom basically moved into the hallway and couldn't go into her room because it was so crowded and noisy. After many phone calls and meetings, including with the regional head and the NH administrator, my mom now has a private room. What a relief!

Optimist, I didn't have too much luck with the ombudsperson at my mom's old NH in a different state. I'm sure the quality of ombudsperson varies, and I just didn't luck out. I haven't contacted the one here yet, but I feel the NH is working with me and we are ironing out the kinks.

One thing that has really been effective, is that fact that I walk in with my notes all organized, color-coded and typed. When they bring up an issue, I can usually tell the group the facts on it before they can look it up in the chart. I also have conversations timed and dated. I am always polite and I compliment them on what they are doing right, but I'm truly relentless in following up with phone calls.

Anyways, things are now going well at the NH for my mom. Thank you all for your help.

Welcome in Optimist. Glad to have you here. How about giving us all some pointers from your experience in this job Im sure you have some great wisdom to share Were all ears.
Would you do anything differently? ect

It's good to see such a great online resource for caregivers. As one of those "ombudspersons" I want to encourage all caregivers to call to ASK your ombudsman program when you have a question, and not wait until you have exhausted all efforts directly with the facility. You do not have to report a problem to use the ombudsman program, and you may get some helpful tips that you can use at a care planning meeting.

Gail Susan, so glad to her things are going better for you.Makes each day a lot brighter to see results

The Care Plan meeting worked out well. I just happened to mention how I hired an attorney and called the AMA on the medical director of the NH my mom had been at, but I kept saying I want to work in partnership with you. I told them that I hadn't called the NH Ombudsperson and they said I certainly could. I said I know I could, but I wanted to work with them directly without any outsiders if we could.

Since then things couldn't be better in terms of care of my mom. Unfortunately, I saw how they treated my mom's roommate whose daughter was new at this game. I took the daughter aside and tried to coach her and even gave her my home phone number, but my mom said the next night her roommate was clearly in distress. My mom immediately went to the nurses's station and got a nurse to come. The nurse came and assessed the situation, called the doctor, and then a while later the ambulance came and took her away. However, no one stayed with the poor woman except my mom. My mom gave her comfort. Pretty scary to think that no nurse or aide could spend the time to comfort that poor woman. I can't wait to get my mom out of there, but it will not likely be until the Spring before she moves her way up the waiting list on the better places.

In the meantime, things are going well here. I cut back my dad's aide's hours to save money. I'm bringing my mom over the house 3x a week to get her out of the NH. We have our own senior recreation period here with my dad's aide, my dad and my mom playing dominoes while I try to run my business.

My mom is now getting PT 3x a week and playing
Bingo and Pokeno at the NH. They are also going to add more recreational activities for high functioning folks like my mom. My mom was put on the Resident Council and likes it. They are also going to extend the hairdressing hours for my mom. The squeaky wheel...(polite, but unrelenting, that's me).

Sorry I've been so out of touch. My husband hasn't been able to bring in work for the past year so I've been trying to bring in enough money to cover what he usually brings in as well as my contribution. We used to be 50/50, now I'm doing almost 100%, so I haven't much time.

You are all in my thoughts. Wish I could be here more often.

quote:

Originally posted by Hannah:
What, specifically, is your SIL observing that makes her believe that your mother needs a higher level of care?

Mom has recently been not doing so well at keeping herself clean, so we asked the staff to step in more there, and she recently started 'ruining things' (see my post in daily challenges of the same title). So my SIL think she is not being observed enough. But my Mom highly values some degree of privacy and currently has a private room. A move to the nursing home means a shared room. I don't want to move her unless we have to since she really likes her place now.
~Hannah

Our experience was very similar. She was really on the cusp for a number of months. When her needs exceeded what they were able to provide, they told us that we needed to make other arrangements for her.

The place had the option of having a camera installed in her room to check on her. I forget the cost as she didn't need that kind of monitoring. Someone at the front desk to keep her from getting out the front door was sufficient. You might ask if they have this service. A private aide several times a week for extra grooming help would cost around $15 an hour here.

Considering the cost difference between AL and the NH, a few hundred dollars a month to keep her in the place she's already familiar and comfortable is actually saving her money.

quote:

How do you know when you need to move from AL to NH?

This is a tricky one, Hannah, and I think it has a lot to do with how much monitoring your mom requires and how much your particular ALS charges for services. Some are GREAT; others slap on extra charges every time a resident needs help tieing shoes or opening their drapes...

If the money is acceptable and you are satisfied with the assistance and monitoring your mom is receiving, then hang in there. If not, you might look into how/whether her care would be improved at nursing homes in your area.

Good luck!

What, specifically, is your SIL observing that makes her believe that your mother needs a higher level of care?

Mom has recently been not doing so well at keeping herself clean, so we asked the staff to step in more there, and she recently started 'ruining things' (see my post in daily challenges of the same title). So my SIL think she is not being observed enough. But my Mom highly values some degree of privacy and currently has a private room. A move to the nursing home means a shared room. I don't want to move her unless we have to since she really likes her place now.
~Hannah

quote:

Originally posted by Hannah:
GailSusan,
Great list of questions! You covered alot! I copied yours and also the link from Bunnys_girl. Here is a related question... How do you know when you need to move from AL to NH??? I know it varies greatly with the individual, but are there any general guidelines at all? I have asked my Mom's AL staff and they seem to think she will be fin there for "a long time". I am not so sure as I see her abilities decline all the time. I don't want to move her unless I have to because she is happy there. My sister in law thinks she is not getting enough care and needs to be in NH.
~Hannah

Our experience was that the AL facility let us know when they could no longer support her needs.

What, specifically, is your SIL observing that makes her believe that your mother needs a higher level of care?

GailSusan,
Great list of questions! You covered alot! I copied yours and also the link from Bunnys_girl. Here is a related question... How do you know when you need to move from AL to NH??? I know it varies greatly with the individual, but are there any general guidelines at all? I have asked my Mom's AL staff and they seem to think she will be fin there for "a long time". I am not so sure as I see her abilities decline all the time. I don't want to move her unless I have to because she is happy there. My sister in law thinks she is not getting enough care and needs to be in NH.
~Hannah

Amen Gail theres an old saying... "you get more with honey than you do vinegar" and I am not saying you allow people to walk all over you, quite the contrary. CG is such an emotional roller coaster for all concerned even a nursing staff everyones first instinct is to get defensive with one another then try to cool it down when its too late..thats not always the best route to take. Be nice until you see nice aint working.... Then go for the big guns.
I hope you and your Dad have a great time tomorrow evening! Merry christmas Baby!

Hard to believe, but my mom's only been there 6 weeks. It is a rough start, but things straightened out at her last place and she was very happy there for four years, so I have hope that things will work out at this place. I don't feel the need to tape record as they have openly admitted when they've been wrong in all instances, so they seem to realize they are messing up and are eager to set things right. It if gets to the point where I need to tape record I'll bring in the NH ombudsperson, I've done that before, but don't like to do it unless all other options have been exhausted as it shows a lack of faith.

My mom finally had her bath tonight. They were waiting for her when I brought her back today after an afternoon at my house playing dominoes with my dad. Both my parents had a good day.

Tonight we had my husbands' step-grandchildren over with their boyfriends. They are such young adults now and brought us presents. It's so hard to believe that they once lived with us and were such bratty teenagers. It was such a delight to have them over for the evening.

Tomorrow evening I told my dad he's coming along with us to a friend's party that starts at 8 PM (the time he normally goes to bed). I told him to take a nap in the afternoon. We're going! I'm just not going to miss out on everything because of this caregiving. I think he'll find the party interesting. Of course, my mom will be jealous that we took him and not her, but Lord, we can't take my parents everywhere with us all the time! We won't have any friends left!

Best of luck, GailSusan. You have a good start on things... I pray that your meeting is productive. I think it would be entirely appropriate for you to not only document, document, document, but also to tape record conversations on the sly (such as the meeting, etc.). I can't remember exactly how long your mom has been a resident there, but it seems like it hasn't been very long - I am surprised that they did not have some kind of meeting or orientation for you to inform you of how and when they do stuff, etc. I must still be living in the world of civility or Disneyworld, etc. I get a scary picture of "fast food" style nursing home admissions...

Take heart! Many folks here have had rough spells with the NHs, but once they complained, things straightened out, so I am hoping that is exactly what happens with your mom's situation. BUT if they DON'T get on the ball, then we'll consider sending the dobermann gang to pay them a visit... Will keep my fingers, toes and eyes crossed for ya!

Gail here is a checklist for you I hope you find it helpful
http://www.aging-parents-and-elder-care.com/Pages/Check..._Home_Checklist.html

GailSUSAN. ALL THE QUESTIONS YOU HAVE STATED ARE THE ONES YOU NEED TO BE CONCERNED.My experience was no one ever checked the files of the person placed in their care.The right foot never knew what the left was doing.That is where all the errors begin.I understood all patients have to awakened and dressed before noon.The one important piece of information is for them to understand all changes and decisions come through you.They have to understand her mental abilities or so many things can go wrong.Ask them if they have snack and drink time in between meals.Ask if the person is sleeping if they still get awakened to get this.Check to see the wheel chairs are kept clean and has no parts that are broken .Ask to see the kitchen where the food is being prepared.You are allowed to bring her foods that she likes as treats like puddings , fruit .Make sure her nhame is on all her clothes .Even with this they get lost or given to another.Ask if they have a generator for when the power goes off.If they have fire exits and fire drills.Do they have a back up staff for times when others are unable to get to work.How often do they check her vital signs.Only allow the important items be in her room.Things get missing.Most of all requst a timely meeting with all that are responsible for moms care.Always ask to see her records on her daily care.Another, you will find a few who will do their job with pride.Beome friends with them and you will get good information.Watch the interaction with mom by staff, especially when they have them situated in an area all together.I took bacterial wipes with me to make sure the wheel chir arms were always cleaned as well as the bars on the bed.Check her fingernails to be sure they have been cleaned.Bacteria source.Tell them no finger polish as they do this to hide the fact they do not clean their nails.When you visit, try to be very aware of what you see and hear.You will learn alot of whats manager going on with the staff and the nurses.Listen to how they interact with those with serious dementia.Last, ask to see the menu for each week.Ask who assures she eats her meals and how long they allow for eating.If possible go there un announced at different times of day.Silence of presence will learn you much