Nursing Homes

It has come to what I dreaded, but I have to place my Mother in a nursing home. She has been falling a lot, and the last time she split the back of her head open and was taken to the hospital. For over a year she has been in assisted living, and this came on so suddenly I wasn't prepared to even think about it.

On top of it she got shingles and now can't walk because it spread to her feet! She was sent to a nursing home for rehabilitation therapy, but it's not helping very much right now.

Has anyone had to place a parent or family member in a nursing home? What should I be doing to make sure I have a good place and that she gets good care, not just when I'm visiting, but all the time?

[Mouse7088]

Oh Sandy. I am so sorry to hear this. I know there are a few folks here that could be very helpful in seeking the info you want/need.

[cujo0123]

I used to work at a nursing home. If you can get someone to stay at home with her that would be better but its expensive. If you have to put her in a nursing home, make frequent surprise visits at all hours, check their rating with the state and see what their problems are. There are tricks to make checking up on her easier and making sure she is getting good treatment. I have seen some really awesome people work in nursing homes and I've seen some really awful people work there from top management to housekeeping. If you have any other questions I'd be glad to help.

It's just my Mom and me, and I have a one-bedroom apartment. She lived with my husband and me for 33 years until he passed away and I decided to move. Her doctor suggested assisted living then.
The nursing home isn't far from me, and I have made frequent visits. She tells me of some people she doesn't like, but I see a lot of very nice, helpful and friendly nurses and staff.
She's on medication for pain so I attribute some of her thoughts to that, and when she is her normal self I know she will make friends and they will like her.

[GR8GIRLS]

Sandy,
First....check with the Dept. of Aging in your state to see if there have been any registered complaints against homes in your area. If there are any...immediately cross them off your list.

Second....ask what kinds of alternative therapies they offer....PT...Occupational therapy....Recreational Therapy... Hydro Therapy...Beauty Shop

Third....If you visit a place...and visit them all...check to see if the nursing assistants are "hanging out" or are they busy. Is there a strong odor? It might be indicative of a long length of time left in a soiled "diaper" The smell of urine is usually there, but if you visit more than once and the smell is there each time...cross them off the list.

Fourth...Don't be alarmed if you hear calls for "help" Patients with dementia do that...they either just want attention or may have forgotten they were already assisted.

Fifth...make sure that your mom will get assistance with feeding if needed. How long before they will "get to her?"

Sixth....Ask what the patient to staff member is....also, how many of those staff members are "desk nurses" and how many are hands on staff members. The higher the ratio, the less time they will devote to your mom.

Seventh (boy am I long winded!)...Are the nursing assistants certified, and does everyone have their Act 33/34 clearances?

Ask family members you see visiting, and ask what they would improve if they could. It's a big help.

I hope this gives you some direction...I was the Director of Activities in a nursing home, and my in laws were both in homes. I kinda have the edge from both sides. I'll pray for your mom too...good luck!

[cujo0123]

Its good that she can tell you who she likes and dislikes. Take that seriously. Even the patients I had that had a mental illness or alzheimers could tell you who they liked disliked in one way or another and usually they were right. The person they disliked usually ended up being trouble.
Staff can always seem friendly up front. They were good at that where I worked at. Even the worst ones knew they had to "act" in front of the family members. I saw it all the time. I'd go home crying at the things I saw and I stayed as long as I could so I knew at least my patients would be getting good care for my shifts but it got to be too much for me. I even had nightmares of things that happened. I had to leave because it was harming my health. Even more scary...they had very good ratings with the state. They got reported all the time to the state according to co-workers and the families that were very active there. I'm not saying everyone was bad though. I worked with some amazing people there that truely cared and did a wonderful job. But its the ones that were so awful that ruined things. As long as you watch every detail and stand your ground you will know exactly how she is being treated.
Some tricks/hints: Do her laundry. You can check it for body fluids that should not be there. If she is incontinent they should change her enough that she doesn't ruin her clothing. If you smell urine/stool they are not doing their job well. If there is blood, how did it get there? Check how many changes of clothing are in there by the days since the last load. You will know if she is going through too much or little. Is the clothing getting torn? If so, they are being too rough with her clothes.
Check her body for marks of any kind. There are very few reasons to see sores or bruises.
Sit with her for a day. Make sure her meds are given on time and correctly. Stop by when a med is due and make sure it is given at the right time. Ask to see her chart (if you are allowed to) and read the notes.
Place items she uses every day in odd places (but not too hard to find at all) and come back the next day to see if they were used. If she needs help brushing teeth/dentures, are they using the toothbrush or denture cleaner? If it is in the exact same spot they probably aren't. Same goes for her hair brush, deodorant, etc.
Mark the sheets with a washable marker to see if they are getting changed regularly. If the mark is still there...well duh. But when they wash the sheets the washable marker will come out so you won't have trouble.

I know its kinda sad to have to do this type of thing but its worth it. I know families who did these things and told me and I watched the good managers check things this way. Sorry this is long but there is so much I can tell you. I hope this helps and I wish you luck. She will be in my prayers. If you need any help at all just ask.

[cujo0123]

Originally Posted by GR8GIRLS

Sandy,
Third....If you visit a place...and visit them all...check to see if the nursing assistants are "hanging out" or are they busy. Is there a strong odor? It might be indicative of a long length of time left in a soiled "diaper" The smell of urine is usually there, but if you visit more than once and the smell is there each time...cross them off the list.

There should be NO urine smell. Urine only smells if if has been sitting for a while or if the patient has something wrong like a UTI. The longer it sits the more ammonia like it will smell. If they do not dispose of the diaper properly you will smell urine also. Sometimes other bad smells will be present but they are "normal" in a sense. If a patient moves their bowels you may smell it in the halls, but it should not be all the time.

[mayfly]

I don't have any advise, but I wanted to give you a (((((((big hug)))))))). You are a good daughter, Daiquiri.

[eldo]

(((Sandy)))

I have read all the great advice you've already received, so I don't have much to add. I have been in your shoes (with a grandparent) and I know what you're going through.

[telos2000]

Mom is in an Alzheimers Home. I found it on a web search. It is part of the Sears-Methodist system and is on the cutting edge of Alzheimers care. Her doctor has a Physicians Assistant (RN with more training) that visits her. I asked the PA about the home first and then the doctor. The PA contracts out to doctors to do their check ups on patients in nursing homes. She was a great source of information in selecting a place and is now my medical eyes and ears at the Home.

I would make sure that her regular doctor has some kind of system like this set up too. Regular visits keep them on there toes. Medicare pays for this service.

Thank you everyone. There is a lot to absorb, and I have done some of what you suggest. Last night a nurse called me because she had fallen again and she gave me all the details of how she was doing. This impressed me because today Mom wasn't sure about what happened. She came through it just fine and was hungry as a bear this afternoon. I finally have her calling me to talk and tonight she's going to watch American Idol. LOL

[GR8GIRLS]

Originally Posted by cujo0123

There should be NO urine smell. Urine only smells if if has been sitting for a while or if the patient has something wrong like a UTI. The longer it sits the more ammonia like it will smell. If they do not dispose of the diaper properly you will smell urine also. Sometimes other bad smells will be present but they are "normal" in a sense. If a patient moves their bowels you may smell it in the halls, but it should not be all the time.

I was only referring to the occasion where the diapers were not disposed of properly...and if they were on the patient...scratch that one off the list