What is the best way to express complaints about care in a nursing rehab facility? Which person is the best person to direct concerns to?
My mother has Parkinson’s disease and recently she could not get up from the bedside commode.
She has been declining for some time now, being very slow and rigid movements. But never has it taken her an hour to get up off the commode.
So of course I was very concerned. After she was finally able to reach her bed and rest I called her neurologist and he said to get her to the emergency room.
I called an ambulance and followed in my car. They kept her for several days in the hospital doing all sorts of tests, a little bit of physical therapy towards the end of her stay. No UTI, no stroke, no heart issues, etc. They tested her cognitive function. That was fine as well.
They recommended treatment in a skilled nursing facility to gain strength to which I totally agreed with. She has been there for a few weeks.
It’s an older nursing home but the skilled nursing rehab section is very good. Some people on staff leave a lot to be desired. I was hoping for the best but the nursing homes in our area are not the best facilities.
I completely realize that they are understaffed, have a very demanding job, underpaid, etc, but I do expect them to do a reasonable job in caring for the residents. I do appreciate everything they do well. The social worker is wonderful to work with. I recently had an update from the social worker about her progress. She is willingly doing all of her physical therapy. She has been tested for cognitive skills also. The social worker says her cognitive skills are great for someone her age. (93)
The social worker says she is making progress with physical therapy in all areas except for balance which is common for Parkinson’s patients to have issues with which is why she uses a walker. She is now needing more help with dressing, toileting, getting in and out of bed and so forth.
My concerns are my mom only takes very few meds. She has always been and still is extremely accurate and aware of the dosages of her medication.
She has a system where she places the correct pills out at the appropriate times of the day and in the home they were giving meds precisely according to her doctor’s prescribed amount.
The major complaint I have is mom told me last night they gave her two of her Sinemet, Parkinson’s meds at one time and she immediately pointed out that she takes one and the next dose is four hours later.
She said they told her to take both pills to which she questioned why, the response the woman gave was so she wouldn’t have to come back again later.
So mom asked if it would hurt her to take two pills at a time and she said no. Mom took it as she was told but it bothered her.
Needless to say, I am not happy about that answer at all. That is her job to give meds as they are prescribed. She wasn’t on duty when I was there so I didn’t address it at that time. I asked mom if she saw her name tag and she said no. I wish I had her name.
When I got home I called my local pharmacy and spoke to the pharmacist and she said if it happened one time that mom should be fine but she should have given it as prescribed and that she wouldn’t want it to happen again and also asked me to report it to the facility.
My friend who is a nurse told me awhile back that the staff takes liberties with meds that they shouldn’t and it always concerned her when her dad was in a home.
I was hoping we wouldn’t run into these issues. I felt terrible for mom because I told her when she entered the home that they would take good care of her. I visit regularly to check on her.
The other complaints I suppose are common. They don’t arrive to her room promptly to take her to the bathroom and they leave soiled diapers on for longer than they should. They use diapers overnight.
They also wouldn't give her a fresh cup to rinse her mouth after brushing teeth and she shares a bathroom with her roommate, plus the room next door to her. She didn’t know if anyone had used it. That isn’t sanitary.
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Ask to see the centers formal complaint workflow if it is not there.
Usually the person filing the complaint must follow a “chain of command” that begins with the Director of Nursing. If not resolved after that step has been completed then it progresses to someone higher up.
Write down everything you told us. Names, dates and times help. Document what you were told and by whom. Most care meetings are 15 minutes, but don’t let them give you the bum’s rush. Stay calm. No opinions or accusations, only facts. Bring someone with you. I brought my daughter. She kept me centered and also took notes on what was said.
Ask for what they think should be done. Don’t let them tell you she needs a private aide. This suggestion makes me crazy. This is not a solution. When they tell you what their solutions are, document them. Schedule a follow-up for two weeks. If their suggestions are not being followed, then you contact your ombudsman after registering a formal complaint with the LTC Administration.
She takes the same meds and supplements as she does at home. She only has three prescriptions which are Atorvastatin, for stroke prevention along with baby aspirin, Dilantin, for seizures, and Sinemet for Parkinson’s disease. The rest are supplements and vitamins. She takes a senior multi vitamin, Calcium, Cod liver oil, biotin, vitamin B-12.
She hasn’t had a seizure since 1996.
This answer helps. It’s baffling to me how these things happen. Overworked? Underpaid perhaps? Still not a valid excuse. What if it were their mother? It’s upsetting. I know mom says the physical therapists are terrific. Never leave them alone while exercising or anything like that.
She said in her room the CNA left her one time in the bathroom alone. Just once but that’s all it takes for a fall. The falls terrify me. She has fallen at home and it’s horrifying for her and me.
Have you had a care meeting since mom got there? Be prepared for them to tell you that you mom doesn't know what she's talking about (but they've told you that her cognition is fine--point that out to them). The meds need to be given as prescribed. If the DOCTOR says it's okay to double them up, s/he needs to rewrite the prescription.
They know mom is agreeable because they all tell me she cooperates so well but she did speak up. Why ignore her like that?
I don’t know how to feel because my brothers and I have been polite and friendly with the entire staff and residents. Even her roommate who plays the television so loud!
They have been very friendly to us so I wasn’t expecting this to happen.
Like I said, the meds are the big issue. Not crazy about them not giving her a fresh cup to rinse her mouth with either. I wouldn’t want to rinse my mouth after brushing my teeth with a used cup if someone else may have used it.
Small issues with laundry. Leaving her unattended once in bathroom isn’t good either. Diapers on too long is bad for her because her skin is breaking down. We’ve had to do the duoderm patch before with barrier cream. Nothing is perfect. Doesn’t have to be with most things but meds, that’s serious.
I can’t speak about the drinking cup process (Mom and roomie both had dentures so there was no rinsing going on) but that sounds just disgusting. Good grief I don’t even used my DHs cup. Do they actually use glass cups? Or styrofoam? Can you put her name on it? Or bring in a package of small Dixie cups for the bathroom for both of them to use? That also needs to go up the ladder to the RN.
And there should be a documented “toileting” schedule. (They call it toileting, even if it just means a change of pull-ups.) Mom was on a 2 hour check, although I think it really happened more like every 3-4 hours honestly. In other words she had to put on the toilet, and/or her pull-ups checked. Of course if she said she had to go in between those checks, they would take her. Again see what is documented on her care plan with the RN.
I was with my Mom 4 hours a day for 2.5 years...I saw a lot, learned a lot, and got comfortable with her care, which was good, but not 100% perfect. They’re definitely was a learning curve for everyone at the beginning. They got comfortable with me and knew what I expected, and I spoke up when something wasn’t right. So these are all just little signals that you have to be vigilant. My motto was Pleasant, Positive, Persistent.
One more thing...jumping from complaints with a CNA or LPN right to the DON won’t make you any points with the RN who you’ll have to deal with very often. Go up the ladder appropriately and you’ll be better off in the long run. If she doesn’t address the issues appropriately then for sure, up the ladder you go.
Shocking to me because I know how hard they are working her and she is 93! Although she worked hard with home health when they came after her falls.
The trouble is she doesn’t practice her exercises after they leave like they tell her too. You know how parents are with us, their kids. They tell us they are too tired to do it and feel they don’t have to listen to us as much or impress us.
I’m extremely proud of the effort that she is putting into her physical therapy.
I’m very sorry you are going through this nightmare. Just read your posts. Caring for a parent is an extremely difficult challenge. Your story is truly heartbreaking.
I do mom’s laundry. They have large signs saying that the family will do laundry and they still took some of her clothes to wash and lost them. I went to lost and found and was able to retrieve items for her. I feel sorry for residents who don’t have family to speak up for them.
Errors with meds is very serious. You should report this not only to the DoN in the facility but to your state Dept. of Health and county Ombudsman. They may try to say your mom "at her age" is probably unable to remember correctly, which you can rebut. Homes can lose licenses for medication errors, to say nothing of what might happen to the resident being over- or under-medicated. The facility has to keep a log of when meds are administered, and falsifying this is a huge no-no. Hard to prove but you should demand to see your mom's records, which you have a right to do.
And sharing a cup?? Also report the soiled diapers. Report all concerns to official bodies, not just to the facility, because these must end. While you're with your mom have the DoN come in to check your mom's skin for signs of beginning bedsores.
Thank heavens your mom has you. Good luck.
Keep up the good fight!
Do not make excuses for the facilities’s operations - they mostly stem from organizational choices.
The first thing you should do is address the medication errors with the DON (director of nursing). If that doesn't fix the problem, then go to the director of the facility itself. The owner. It's very much within your mom's right to file a formal complaint, and if you/she has already followed proper protocol and used the proper steps up the ladder, the last place within the facility to get results in house is the facility director. Ask for an appointment to be schedule immediately to address your concerns, have your mom with you so that they and you aren't talking ABOUT her. SHE has a right to speak for herself first....so don't over-shadow your mom's voice. Be patient, yet firm, and support your mom's voice.
There may be a need for an ombudsmen to step in and help arbitrate, but give the facility time to rectify their own mistakes first. When/if the ombudsperson comes, they will work for/with your mom....not for/with you. Their job is to care for the resident. They will likely want you involved, but even if you are POA, that doesn't mean they'll let you speak FOR your mom. They need to hear it first hand what the concerns are, so it's best if your mom can voice them for herself. And since it sounds like your mom is perfectly capable of speaking for herself, you should let her do so as much as possible. If not, then you'll work with the ombudsperson in your mom's stead. If you haven't already done so, petition the courts to become her guardian at some point when you deem it necessary.
CNAs are hard to come by, so are skilled nursing staff, and they may just be so over-worked they have lost patience. But that's no excuse to cut corners, and the issues you mention need to be addressed, and fixed before something serious happens. They need to know you are aware of everything happening in their facility and will take the steps necessary to report what you have to report if they don't fix those things themselves.
One thing that can't be stressed enough; when you see any staff doing things right, tell them how much you and your mom appreciate them. At my facility we have a thing called Kindness Karma. We celebrate staff members who really pull their weight. A pat on the back is often all it takes to give a tired, over-worked staff member one more breath to get through their shift....and want to come back for the next, and the next.
On the diaper subject - include that in your written letter. You expect them to work on the bathroom training while she is there so she does not regress in that department. Because that is exactly what will happen. Next time she needs to go to bathroom, tell her to call you - then push the button and start the time clock. It is very common for them to leave patients 30 min to an hour knowing full well they cannot hold it that long. Once you start peeing in your pants regularly, it's hard to reverse it.
Don’t worry that mom can’t remember their name. When a med tech dispenses medication, they have to sign their name to the MAR showing they completed the task. There is always a paper trail to hold people accountable depending on what you state and local laws are regarding elderly care.
In reference to call response times, this can vary according to case load in rehab facilities as well as what the care staff are having to deal with with each resident. I would recommend you ask the Director of Nursing to take a look at the call response log from the computer to see what their times are for your mom. Remember, your mom’s care should always be readily available to you if you are the Durable Power of Attorney.
I hope this helps.
Believe me when I say that I was upset. Very upsetting to have her double dosed.
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If my mother didn't have dementia (among other issues) I would have been more likely to take her in (we moved her to MC.) Clearly your mom is still in the here and now (not so with my mother - she sometimes questions or groans at pill time, but would have no clue what they were giving her!)
Having already had a medication issue (along with lesser but still concerning issues), if it we me I would take her home and have the doc order home PT. That way you don't lose clothing, have fresh drinking vessel, have timely bathroom breaks/changes AND proper medications. In addition, you would probably be more likely to get some "after-PT" compliance, so she practices with your encouragement (make it exercise class for both of you!)
After a couple of minor non-injury falls, our mother is refusing to even stand, much less walk with her walker. The doctor ordered OT/PT and she REFUSES to do ANY work with them, even told them THEY should do what she is being asked to do! As a result, she's being discharged from OT/PT. When I say you should walk, she lies and says she does, yet refuses to get up and is sitting in her transport chair. Be proud of your mom for working hard to get better and let her know how great she is doing!!!
As for lost items, laundry is included in mom's "rent", but I mentioned it before and again recently after being told mom needs bras - whaaat? She moved in with multiples and I picked up some more last year... I found AT LEAST 8 of them in the second drawer of her dresser. Apparently no one knows how to open a drawer. The problem I have is clothing I have never seen, which are not likely hers, show up in her drawer. They insist that each person's laundry is done separately... I think not. I have no idea who owns these items or I would give them back. Biggest laundry issue = washing her hearing aid!!! I didn't task them with managing it when she moved in, just mentioned that battery needs to be changed every two weeks. I would come to visit, it might be in her ear, and if not it might be on the end table, in the bed, on the floor. I would find it and check - sometimes battery ok, sometimes not. Those times she was wearing it, often it would be dead. Clearly they were not changing the battery. Even worse is not checking sheets before laundering - MANY things could end up in the bed - in her case, tissues, which can make a mess in the washer/dryer. So, her hearing aid went through the laundry. :-( Finally found a new, local provider (the other never responded), bought a new pair ($2700+) AND since it is rechargeable, I tasked them with this. Take it at night and charge it, return it to her in the morning. I knew if I left the charger with mom, it would disappear. Not even TWO weeks goes by, I get email saying the thing is MIA. Seriously??? She only wears one, so we had to scramble to prep the second one and get it to her. I am STILL waiting for word on how they will handle this. I understand things can get lost, damaged, etc, but TWO WEEKS??? We cannot afford to buy another set, especially every two weeks....
Anyway, NeedHelpWithMom, would you consider bringing her home and get the OT/PT at home? Also, did you ever hire some help so that you get a break now and then?
we cannot escape the nightmare of having a loved one in a nursing home. Sooooo many things done poorly and fear that the staff will take it out on your loved one.
i wrote a great letter to the Dept of Health in charge of nursing homes. I had legitimate complaints... I wrote everything down and spared them nothing. I told nobody I was doing this and really didn’t care they would find out it was me. What happened was a very unexpected visit from a person who inspects nursing homes but this time there was no notice to staff. As far as retribution... I met with the CEO of this nursing home and believe me, if I heard one complaint from my mom that she wasn’t cleaned up when needed and not waiting an hour. The nursing home was going to limit the # of diapers a day and when I heard this... I said over my dead body. My mom was to have as many as she need and I wanted a case in her bedroom so they would be available.
Tell none of your complaints but write a letter to dept of health and human service and let them know everything and a lawyer if needed would continue with all complaints.
my mom was treated much better and I was there a lot to be sure...it is their job and responsibility to care for patients... a lot of time is wasted with lazy underpaid people... that’s the big problem so complain over their heads... it is a necessity....
Make sure they're being seen by staff. That will get their attention
and straighten things out shortly.
Nov '12 I had Chron's and ruptured my colon, nearly died. In a coma 21 days.
Hosp another 2 weeks, then 9 weeks in a N/H. First month I didn't care if I lived or died and would have been a whole lot easier to die. They'd left my belly open to rinse me out 3-4 times a day. That had to heal from the inside out. Finally I realized it wasn't going to get better until I wanted it to. I couldn't even stand up without help. The PT worked with me til I could walk well enough again to come home with home care an hour a day.
The last place you want to go is a lousy N/H! My two main complaints were the air mattress's would never stay up and leaked off. I'd roll from it down between the bed and side rail where i couldn't reach the pull cord.
They didn't care if or when pill time came. I'd pull the cord and wait, maybe they'd come in maybe not at all. No way to repeat the call. They'd come sneaking in real quietly with soft rubber soles and if my eye's were closed, they'd turn the light off and leave without checking with me. I had to be constantly watching to catch them coming in, if not no service regardless of what I needed.
Complaints had no effect on anyone.
I got thru it and home, had around 25 more surgeries since. Still doing ok and living alone at 75.
Those recorders and a camera WILL get their attention fast. Whether you use them or not. I'd take a picture of all staff and get their names so your Mom can ID them when something isn't right.
Good luck