Meeting with ALF Administrator shows some quick results.

Five days ago I met with the ALF administrator and outlined my concerns in detail; already I see an improvement in Mom's care plans. I began my discussion by telling the Administrator that the request of Mom's physician to move Mom was forcing me to talk with her. The Administrator responded very positively to me. Over all, she claimed that more training was required for all the aides. I agreed but also said that the shear number of residents required MORE aides. At some point it becomes a matter of safety.

I tried to be tactful, to site specific examples, names and dates. This approach was well received. She took the complaints about the food in stride and said most residents complain about it because it's one of the few things that people feel they can control. Food likes and dislikes are also quite different across people so each person is bound to have some complaints at some point.

The personnel matters I described were another matter completely. As a project manager, the behavior I saw on the part of the LPNs and RN indicate that there is an antagonistic relationship building and that the LPNs have no desire to work as part of a team. It's a hard thing to tell someone - that their direct reports are manipulative shirkers - and that I believe it stems primarily from having TOO MUCH WORK TO DO. Two LPNs to coordinate meds and doctors orders and one RN to over see treatment is just TOO few staff to safetly monitor 170 to 180 people. Some time, someone, some where will fall through the cracks. I just hope that the victim does not suffer needlessly. Until we can move our Mom, we need a strategy to ensure Mom receives quality care.

I, my brother, his wife and daughter realize that we must ensure that Mom doesn't fall through the cracks. We hope to plan our schedules so that at least one of us visits daily for the next couple of months. By then we hope a single room opens at the smaller assisted living residence. I hope this new approach will suit her physician and give him some confidence that Mom is getting good care.

Mom doesn't like ALF alternative - now what to do?

I took Mom to visit a small assisted living facility and she didn't like it. I believe she could be persuaded to move to the small facility IF she could have her own room. This ALF is the second of two recommended by her doctor; I ruled out the first after meeting the owner/manager's dog.

At the smaller ALF the only room available now is a shared room with an odd bathroom setup and Mom feared that she might fall. It's a valid concern and I don't want to push it. We are on a waiting list for an individual room so we'll just wait. I don't want to tell Mom's doctor, I fear he will be angry and expect me to force Mom to move into a shared room. He forgets that Mom is still cognizant enough that she should have input into her living situation.

Before I go into details I must admit to feeling very foolish at this point. I researched ALFs in Mom's town. I visited, unannounced, on more than one occasion. I snooped around; I talked with residents. I talked with others who've parents were in the same ALF. I did not decide on this ALF without great thought and investigation. Now I am regretting my decision and fear for Mom's long term safety and condition at this ALF.

Mom says that she's finally feeling at home in the ALF; she's become acquainted with people and enjoys her table mates. Honestly, I am surprised she said no to the move. Mom complains about something everyday - the quality of the food, the room, the lack of a view, the slow response of the aides; the laundry, the long corridors, the lack of good "company"..... on and on.. So- I will meet with the administrator and discuss my concerns along with the doctors recommendation that she move to a smaller facility. I hope I will get some positive results.

Mom's complaints are valid but my concerns are broader. On Monday afternoon I visited and the fire alarm went off. I was in the hall outside Mom's room and asked two aides - the ONLY aides for her floor of 70+ residents - what I should do. They said "we don't know, we have not been trained on that yet..." I was dumb founded. That event is the last straw, I MUST discuss my concerns with the Administrator. Other things I will brings up include:

• Relationship between the RN as medical coordinator with the LPNs who handle records and coordinate prescriptions. The RN is new to the job and the LPNs seem to want to make her look bad.
• Failure to empty her commode before lunch time. This has happened on four occassions and I'm disgusted by it. It can smell and I don't want Mom's room to reak.
  
• Failure to help other residents. More than one lady is incontinent and during long visits I see them ( and smell them) wandering around. They are pleasant enough but as they walk past I can see that they have wet spots; their depends are full and should be changed. The aides just stroll by; no one takes them to their room to clean them up. They let them wander around reaking - it's disgusting and makes me wonder how they might neglect my mom!
  
• The attitude of the LPNs toward residents who are sick; they are very abrupt with residents and make everyone feel like they are a pain in the neck.
  
• I believe that one of the day LPNs lied to me. Normally I get a call when Mom falls. She fell last week and they told me that they can't get through to my cell phone. However, the night aides manage to call me when Mom falls. The night aides have called me four times; the day time LPNs won't return my calls.
  
• There is no way to leave messages for a nurse or LPN; they have no voice mail and no one takes messages. When I've called I've been told to call back and when I do, no one is available. This is the same problem Mom's doctor described.
  
• The food REALLY concerns me. For supper one evening Mom got half a sandwich, three pieces of lettuce smeared with oil and about 1/4 cup of fruit cocktail. I feed my cats better than THAT! Supper is supposed to be "light" with their lunch or dinner being the biggest meal of the day. I'll be watching for those dinners to see how big they are.
  
• Overall lack of common sense among the aids. Here's an example: I go to Mom's room and find her trying to spread a shirt across her torso; her room is freezing and the AC is going full blast. She is like an iceburg. The aid said she was cold and asked for an extra shirt. Obviously it didn't occur to him to turn down the AC (ah duh??!!) or get Mom a small afghan that is on a shelf immediately above the shirt he pulled from the closet. I had to take her outside in the warm evening air and put her bare feet on the warm concrete to warm her up.

So - these are the things I'll discuss with the administrator. She is a sweet lady but I just don't know if she can be hard nosed enough to get these people in line. Many are kind and I think their intent is good but at some point it becomes just a job and they put in as little effort as possible. She likes to believe they have one big happy family but my family is fearful that theirs will not be good for our Momma!

Doctor limits new ALF choices causing problems for me

After a week Mom's doctor finally called me to discuss her situation. He feels that her needs mean she is on the high end for assisted living but not ready for a nursing home. He recommended two small in-home assisted living facilities. I visited both and believe Mom will hate them both.

The first was brand new, open, beautiful, the ladies warm and friendly but the owner/manager/main care giver has a small dog that jumped on me, growled on me and she didn't seem to care! The owner/manager/care giver is also a very small woman and she's there alone most of the day. I fear that she cannot physically provide the help Mom needs. I worry that mom's too far gone to live in this ALF. I can only imagine how mom would feel about the dog. She has never liked animals in the house and given her vision problems a small animal walking near her feet would make her fearful of falling over it. The growling is a completely different matter. The owner said the dog "likes to talk to people"... It growled at me, in doggie speak that is a hostile action and it should not be tolerated around elderly residents. The other disadvantage of this ALF is that they do not accept medicaide.

The second home was smaller, felt warm but the room available is shared with a failing 92 year old. Mom would hate that and it has a nursing home feel. They are more flexible especially with meal times which Mom would appreciate. She could sleep and eat on her prefered schedule not the ALF schedule. This place is also willing to accept medicaide so Mom can stay put if we can't sell her place.

SO - today, I'm doing another dreaded and stressful task - taking Mom for another visit. My brother and I spoke to Mom about moving during a Saturday evening family supper. She said she does not want to move; that she finally feels like she's getting acquainted and visiting with others. She's met a few people who are long-time acquaintances but several of those meetings were possible ONLY because I visited and took her to the large living room and outside where others gather. Normally she will not ask someone to take her there or attempt to go on her own. I will take her to the facility without the dog. If she does not like it, I'll take her to the one WITH the dog and see what happens.

I must say that I feel stymied at each turn; I feel it's a no win situation. Our options for facilities seem so limited; that's due to several factors - Mom's condition, her stubborness, her doctors preferences and opinions, the rules and conditions of each ALF and her possible need for medicaide. Ugh.

Doctor unhappy with ALF and I agree

My niece and sister-in-law visited the Doctor's office with my mother last week. His news was a shock: he feels that mom is not getting the individual assistance she needs at her ALF and he wants us to move her someplace smaller. I think I agree but hate the idea of going through it all again. I am concerned about Mom's state since she is getting regular healthy meals and her meds on time each day - which didn't happen at home. Why - after 3 months - has her condition deteriorated so much? She's lost more strength in the past 3 months than she had the prior year!

Before I go into much detail I must say that her doctor is great. He's been her physicial for 30+ years and is very thorough. I trust him and his judgement; he's kept Mom well and knows what he is doing. He has numerous small examples that amount to a very large issue for me - the ALF is not communicating, not with him and not with the family. Apparently he's made numerous times at various times trying to reach a nurse. He's been told that no nurse is available to discuss Mom's meds or condition. He's faxed her meds to them and received no confirmation. He's left messages but has not heard back from them after trying to reach them for three weeks.

I am also concerned and plan to raise hell. I've had a hard time getting mom on the phone - I call, she doesn't answer. I believe she can't hear it ringing. I hoped that she was out doing something but, it's not that good I fear. I came to town last night after being away for 6 weeks and found Mom asleep in her chair. During my visit, I learned from an aid that Mom had 6 falls in the week before my visit. SIX!!! I got a voice mail about one fall two days ago but not the other 5!

When I arrived I found Mom asleep in her chair at 130pm in the afternoon. We woke her up and she seemed groggy and very weak- much weaker than she was when I left 6 weeks ago. There is only one thing that it drastically different than her conditions at home - she is getting her medications on a regular basis. I fear that one of them is causing problems - plaquenil. Before moving into the ALF, Mom had used only one full, 30-day, plaquenil prescription during the prior 12 months. I was concerned that her arthritis was getting worse because she failed to take the plaquenil now I am worried that it's causing her decline! Possible side effects are:

• hearing loss - Mom's has worsened in the past 3 months
  
• muscle weakness - she is definitely weaker in spite of physical therapy
  
• ringing in the ears - Mom's complained of this for 3 months

I hope that it's as simple as this because I want what ever time Mom has left to be good and her state is not good right now. She's totally dependent on others and I know she'd hate that. It makes me feel all the more guilty for moving her.