I’m worried about placing my loved one who needs assistance with everything. Getting to the restroom to be changed, finding teeth, washing hands, where to go to eat, etc. After 5 yrs of constant assistance at home, I’m not sure how this transition will be. It’s like you're the person's shadow when it requires this level of care. Has anyone had success if there are facilities that can do this?
My parents have 24 hour home care due to my dad's issues. The aides do not really do 12 hours of activities or patient care. One caregiver does some extra. the other ladies only the bare bare minimum-some falling asleep in the chair-which happened a few times when i went to parents house to collect the bills- or spending nearly all day messing on their phone while they should be doing laundry, clean the bathroom, change the sheets. The regular ladies do not really even try to "act" like they are working when I turn up. Complaints do occur to the agency but does not seem to change things in a lasting kind of way. I refuse to manage the caregivers or the company. We tried another agency but they were even worse. Maybe and only maybe if you hired an extra attendant just to provide companionship, washing hands, clean outfit, pair of shoes that belong to the resident etc-basically what I did when I went to visit my sister-trying to pick up the slack/neglect however you choose to view the multitude of things not done most of the time-this was pre-covid too. Community care or agency care are unlikely to meet your expectations-just my opinion based on my own experiences in both types of caregiving.
Is there a medical need for SNF?
Granted in Memory Care or SNF the person is not going to get the level of care they would at home with 1 or 2 caregivers. It is just not possible.
At home you may shower or give your LO a bath daily, or every other day. In a facility that is not possible and not necessary. (check your state code as to how often it is mandated, in Illinois 2 times a week is the requirement)
At home a change of soiled briefs can be done almost immediately, in a facility that may not happen.
If a male, he may not get shaved daily.
Some states now prohibit CNA's from cutting fingernails so that will not happen often, maybe when a podiatrist comes and cuts toenails they might do fingers, or it might be done in the "salon" (again check state codes)
The transition will probably be more difficult for you than your loved one.
think to the WHY's are you deciding on placing your LO in SNF or MC.
Is it because you don't love them any more? Of course not. It is because you love them.
You want them safe.
You can no longer do the job safely, your LO needs more care than you can safely do at home.
Let the staff do their job.
Your job changes. you are no longer going to be a "hands on caregiver" you are going to Manage Care. You still need to be vigilant, you still need to be their voice.
If I wanted to provide the same level of support I would need to move, invest in a significant amount of medical equipment, quit my job which would significantly impact my financial future, not provide my own kids with the support they need, give up vacations and destroy my relationship with my husband. If I wanted to provide a level of support where her needs were met 100% of the time in a timely manner, I would need to add the loss of my sanity to that list.
Even if providing care at home, many people don't get all of their needs met as it is so difficult to deliver that level of care! In reality, this expectation is unrealistic and results in extreme stress, guilt, and anger.
I am grateful that my mother is in a facility as it allows me to live my life while ensuring she is safe and cared for. Every person I have met is very kind and my mother seems happy. It is outrageously expensive and I know that it isn't the same level of care she had when my Dad was providing 24-hour care, but I also know it is the only option if I want a life.
I've been hired onto care assignments where an elder's family was keeping them at home when they would have been far better off in a nursing home.
I distinctly remember one case I has for a woman who was 93 years old. She lived alone in the first-floor apartment of her house and her son lived has the second-floor apartment.
I was hired for two hours in the mornings and one hour in the evenings five days a week. Her son worked all day and was never there when I was. I'd get there, she would still be bed and everything would be soaked through with urine. I'd get her up, washed, dressed, and fed. Then it was to the chair in the living room to watch tv. There was a small cooler left next to her chair with drinks and food for her to have during the day.
I'd come back in the evening for my one hour and she would still be sitting exactly where I left her. Only now her diaper would be loaded. There would also be a covered plate on the kitchen table with supper that her DIL would leave every day. I'd clean her up and bring her the plate. What a life. She would have been better off in a nursing home.
You ask how we change the system of care. Here's how. Nursing homes and care facilities are allowed to charge whatever they want. The sky's the limit with these places.
If they are forced to treat their help better, they will. If they are forced to clean up their acts and business practices, they will.
If Medicaid refuses to pay unless they meet the standards they could set for them, they would meet those standards.
All nursing homes, MC, assisted living, hospitals, clinics, and homecare agencies should be non-profits. No shareholders they have to make and keep rich and no out-of-control salaries that have to be paid. Watch how fast patient and resident care improves.
She will get this from you. She will not get this in a nursing home.
After your grandmother is placed the facility will probably ask you not to visit for a couple of weeks. This is so grandmother can get acclimated to her new surroundings. Do what they say.
Also be prepared that things will be different. You will likely see her at times wearing another resident's clothes. This happens often in nursing homes and MC. It doesn't mean she isn't getting care. Teeth and eyeglasses go missing all the time too. Other residents take them. The patient themselves lose them too.
Nobody is going to style her hair, or put on make-up, or paint her nails. Don't be alarmed.
Here's what to look for when you visit. If she appears clean and her hair and clothes are then she's being decently cared for. Take her into the bathroom to use the toilet and have a look at her bottom and surrounding areas. If you don't see any rashes, redness, or skin blanching then she is being changed and toileted regularly and they're keeping up on her hygiene.
This is what to look for when a person with dementia gets placed.
She will not have her own private aide who works only for her. If you want that, keep her home and hire private-pay caregivers 24 hours a day. Look for what I told you after she's there and that's how to tell if she's getting good care in a facility.
Poodle
I care for my husband at home because of the reasons above. Cheaper with 1-on-1 care. 1-on-1 is not the same as 24-hr care because there are times when your loved ones don’t need help (sleeping, e.g.). I am tired but it is comforting to know he is well-cared for.
It was cheaper to keep sis home and just hire a private aides.
Though as you said it is unrealistic.
The system is the way it is because we do not have the means to meet the demand, and it is not like caregiving is a job people line up to do.
It's a tribute to the private caregivers that both succeed in persuading your mother to co-operate with showering and personal care, and I expect it's also because they have more (i.e. enough) time and know her individual routines - the right towel in the right place, the right water temperature, the signs that she is ready to begin so that she doesn't feel rushed into it. Your mother CAN refuse, whoever is paying for the services, and if she does and they can't coax her then they mustn't try to force her.
But the facility was very naughty not to tell you that your mother was declining care. How long did they let that go on before you found out about it?
My mother lived in Memory Care AL for nearly 3 years where she got an excellent level of care by truly devoted caregivers who loved her. Did they wait on her hand & foot 24/7? Of course not. Which is not to say that her needs weren't met, that she wasn't toileted when she needed to be, and that her social needs weren't seen to and exceeded, actually. They were. Her MC had no more than 23 residents at any given time, and the CG to resident ratio was 5:1, which meant the caregivers were able TO give the residents great attention. My mother was a gigantic handful, too, requiring a LOT of care which she did get. She was incontinent, wheelchair bound, fell 55x in under 3 years, needed help with ALL ADLs, etc., and she was helped with everything at all times. She fell b/c she forgot she couldn't walk, which nobody can prevent from happening; whether it's at home or in managed care.
So do your homework if you want your LO in managed care. Find a SNF or an Memory Care AL that has great reviews, a good caregiver to resident ratio, is clean and well organized, and then be your LOs advocate all the time. Be there to check up on them and to make sure the facility is giving them good care.
Best of luck!
My father is an ill tempered man who would not thrive in memory care, he is content to sit in front of the tv in his room and take his meals there, just as he has at home for the last several years, albeit with much better service.
My mom's place had great systems in place. There were two levels of care -- though all were there for memory care -- and those who could dress themselves or use the bathroom on their own were supervised as needed, but those who required more help like my mom (incontinent, wheelchair-bound, mostly blind, stone deaf, crabby) were handled by a couple of caregivers in the mornings and evenings. Everyone was up, dressed and in the dining room by 7:30, then those who needed bathroom help were taken to the bathroom or changed on two-hour schedules.
Everyone spent most of the day in the common room doing activities under supervision, and those who could take themselves to and from their rooms were free to do so to take a nap or watch TV, etc. They were checked on by their assigned caregivers if they were gone for more than a half-hour or so.
I'd advise you to ask the places you're considering what a typical day is like. They should have their activities on their website, so look it up and see what they do all day. Obviously take a tour, too. Avoid places that park residents in front of the TV for hours at a time, and if possible, find ones that have multiple levels of care. You don't want someone with mild dementia being forced to hang out with those who are barely cognitive. My mom's place had a huge common room, and one side was used by those who needed the most help (lots of music therapy there and caregivers talking to them) and one was for those who could play bingo and trivia games and move around better. The TV was turned on for 30 minutes after dinner, and then the bedtime routine started. Everyone was ready for bed by 8:45.
My mom did better in the memory care than she had at home, because there were things to see and hear and do. People always talked to her when they walked by, and she didn't take a nap during the day until the last six months of her life. Before going to the MC she slept around 18 hours a day because she was bored and my dad couldn't engage with her while doing everything else he did to keep the household running.