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Mom has moderate severe dementia, so has been living in memory care. Her memory care has 1:6 to 1:12 ratio caregivers and has about 50 residents. She has been safe and gets her basic needs met. Her caregivers are really sweet, and she has her own room. The facility has places to roam indoors in a circular pattern and outdoors.
The facility smells like really strong, musty urine and feces the majority of the time. The smell is so strong it hits you like a truck, and you have to breathe through your mouth. Mom is not wearing her prescription glasses. I have addressed the glasses many times, but she continues to not have them on. She has soaked briefs usually when I visit, but has not had rashes. Nails look like long claws due to no visits. Visits are only at window and will be that way for many months.
Other place is a large house and has 1:4 to 1:5 ratio caregivers. It has less than 20 residents. It has a shared room and the roommate is friendly. The facility has a place outdoors to roam, but inside the roaming would be around the inside of the house (no circular area to walk inside the house).
The facility has no bad smells and is clean. There is a computerized system for staff to read each day that lists each resident's needs, like glasses and when to change. Residents still get hair and nails done by caregivers, can be visited by doctors/dentists. Family and friends can visit outside with family member, with distance.

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Is your mom in a nursing home with MC rooms or is she in a MC facility? If a nursing home, those smells are not unusual. If a MC facility, those smells are inexcusable, along with the negligence of her nails. The smell in a facility is one of the first criteria I suggest to people looking at MC facilities. I'm usually opposed to moving an AD patient unless abuse is involved, but a smelly MC facility is another.

The other location seems more of a large group home. Many AD patients do much better in a small facility. The ratio of 1:5 is excellent and implies a better caring environment. If you can get into the cleaner facility, I would recommend it.
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Roseformom Sep 2020
Thank you!
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You're faced with a difficult challenge.  

Questions as to the first place:

1.  The 1:6 ratio: for what level of care does that apply?   Both nurses and aides?  As to the 1:12 ratio, it's been quite awhile but if I remember correctly, that's not out of line.   But it's been more than a few years since I've dealt with this issue.

2.   Have you raised the unacceptable odor issue with any of the staff?    It surprises me that this exists, given what seems like an otherwise good facility.  Her nails should have been trimmed as well.  

3.  How long has your mother been there?  Was the odor and lack of nail care always present?  Has the facility lost employees during the pandemic?  

I would first raise the odor issue and give the admins a chance to explain and correct the situation.  If the odor situation alone isn't corrected, like ASAP, I would DEFINITELY consider another placement.   This to me is just intolerable.

Second facility:

1.  It does sound superior, in all ways.    Is it a private facility though?    Is it subject to oversight of any state or federal agency?    How long has it been in operation?

2.      Are there shower heads (for emergency fires) in each room?   I noticed that in my father's last placement, the shower heads were prominently visible and placed, something I hadn't noticed in previous facilities.


Another issue is whether you've signed any contract with the first facility and if there would be penalties for terminating the contract (other than for death).  

However, I think the odor issue is not only intolerable, it's unsanitary, unhealthy  and dangerous.    If this facility accepts Medicare patients at any level, I'm surprised it hasn't been shut down.   Something's definitely amiss to allow that kind of stench in a facility with a vulnerable population.    It can't be tolerable for the staff either.   This really doesn't make sense.

If you can't get a commitment to rectify this situation ASAP, I'd move Mom to the second facility, also ASAP.
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Another question:   Not putting you on the spot, but how long has your mother been in this facility, and has the odor problem arisen since the pandemic, or did it always exist?
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Roseformom Sep 2020
It was clean smelling when mom moved in, or else I wouldn't have moved her there. However, a couple of months afterwards, it started smelling really bad and has progressively gotten worse. It was smelling horribly way before the pandemic.
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My mom was in a NH that also had a MC unit (mom was in regular NH part) for 4 1/2 years. This place was not particularly highly rated by CMS but had caring staff.

We visited several other, more highly rated NHs in the area before we made our choice.

The other, more highly places smelled horrible on several visits. They always said "oh, someone just had an accident" but after 3 visits, you know that they haven't developed a good system.

The NH we placed mom in NEVER smelled. Never in 4 1/2 years. We were happy that we made that choice.

If you have a system in place for immediately bagging and disposing of diapers/pullups, you never have any smell. If you have a staff member whose job it is to mop the floors more or less continuously, you never have a problem.
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RoseforMom, have you checked any state ownership records to see if the place has changed hands?    Or is it a franchise?   Have you noticed a staff turnover?

My guess is ownership or management change, and possibly staff turnover as well, contributing to a decline in maintenance.

Forget about my earlier suggestions.    Review the admissions papers to make sure you do everything that's necessary for compliance (such as 30 day notice), but arrange for transfer to the other place ASAP and don't give the current management any opportunity to further complicate the situation by retaliating against your mother.
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If I walk into a facility and it has a bad smell, I automatically know it is not a good facility. It should not be.

Hint ... You stated she has soaked briefs when you visit most if the time.
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Roseformom Sep 2020
Thank you! You're right about the smell and the briefs. I'm so glad I moved mom.
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