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 Hired Caregiver's Guilt Trip 
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Joined: Tue Feb 23, 2010 10:32 am
Posts: 215
Location: Kalispell, MT
Post Re: Hired Caregiver's Guilt Trip
Some things that made big differences in my husband's facility (probably mentioned them elsewhere also)(.

Geri chairs--comfy cushioned recliners on wheels. Easy for me to push around, including to dining table.

Observe staff/resident interactions. Do they take their time with them? Act like they really care? Staff/resident ratio really important.

Are their schedules for the benefit of the staff or the residents?

Only about half of the residents take part in activities--there are sofas and recliners around the room, usually with a few residents asleep. They can sleep where and when they want, in their room or anywhere there is a sofa or recliner.

Very important IMHO: Separation of staff and residents? In my husband's facility, there is virtually none. There is an office with records, electronic stuff, meds, etc., but paperwork is always done on a table in the corner of the dining room totally accessible at all times. Also, there are no barriers such as desks, nurses stations, etc.

Staff takes their meals with the residents--yeah, sometimes they don't get to eat without interruption, but this makes them part of the family. Remember, the residents don't as a rule engage each other, so it is important that the staff be their friends and family as well as caretakers.


Tue Aug 23, 2011 12:47 pm
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Joined: Fri May 28, 2010 4:46 pm
Posts: 119
Location: Salem, Oregon
Post Re: Hired Caregiver's Guilt Trip
I visited during mealtime, and I saw probably about 4 or 5 caregivers with the residents (about 15), so the ratio was really good. They were sitting next to them, and some were feeding them. They seemed to be actively engaged. I don't recall if the caregivers had food in front of them. Later I saw one of the caregivers stroking the hair of one of the women residents in the common area. It seemed very sweet and loving to me. I also was impressed because the two women that gave us a tour (one was an R.N., and one was in charge of admissions, I believe) greeted the residents by first name. I just sensed a warm, loving environment, and I hope it wasn't just show.


Tue Aug 23, 2011 2:21 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Hired Caregiver's Guilt Trip
SandwichMom wrote:
I visited during mealtime, and I saw probably about 4 or 5 caregivers with the residents (about 15), so the ratio was really good. They were sitting next to them, and some were feeding them. They seemed to be actively engaged. I don't recall if the caregivers had food in front of them. Later I saw one of the caregivers stroking the hair of one of the women residents in the common area. It seemed very sweet and loving to me. I also was impressed because the two women that gave us a tour (one was an R.N., and one was in charge of admissions, I believe) greeted the residents by first name. I just sensed a warm, loving environment, and I hope it wasn't just show.
I see this in Derek's facility, too. Everyone, and I mean everyone except the top managers, take part in assisting residents with meals. There is at least a 1:2 staff to resident ratio at mealtime in the dining rooms. Others are one-on-one with residents who have to be fed in their beds. When I am there, I assist Derek with his meal in his room but when I am not, he eats in the dining room with staff assistance. Meals are something they do extremely well there.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Tue Aug 23, 2011 2:46 pm
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
Post Re: Hired Caregiver's Guilt Trip
I am at my Mom's facility for at least 4 evening meals each week. There is no 2:1 ratio. It's more like a 6:1 aide to resident ratio (not counting nurses), depending upon the night. But this ratio is augmented by people brought in specifically for the activity, such as meals. There are meal companions who are there only to help residents for their meals. None of the staff dine with the residents. With the amount of work there is to feed them, I'd be surprised if they would be able to. 100% of their time is dedicated to making sure all residents eat, or try to eat. Many of the residents are pretty far gone, but not meeting hospice criteria yet. Every bite has to be given to them. I sometimes try to eat half a sandwich with Mom, but I can't really get to it, either. Not necessarily because Mom needs my help, but because another resident is asking for my attention (I have to ask Mom if it's OK to help or Mom gets upset.) More than half of the residents need to have help with their meals. There are 2 residents who have to be followed around with their plates and given bites "on the run."
Aside from the legally required 15 minute breaks that staff members get, I think they also need their lunch breaks as private or at least relaxing times. Where we all have the experience of caring for one or two loved ones, the staff is caring for so many more. Imagine the stress. I would think that their lunch breaks would be sacred. Certainly breaks that are needed. And I would rather that the staff were concentrating on getting the residents fed than eating themselves. I suppose a lot depends on the condition of the residents.
Yesterday, I saw one resident grab the hair of an aide and refuse to let go while she also hit the aide. I would think that aide is entitled to eat her lunch privately, at the very least. I am not saying that just for the aide's benefit. I'd like to have the staff experience no more stress than they can handle and be calm around my mother.
This is not a small facility. I would say there are 40 or 50 residents in the dementia unit alone. Staff members move between the dementia unit and the hospice unit (same floor) as they are needed. Yet, so far, they have given my mother very personal care. And I know that Mom can stay there for each stage of her journey. I know of people who have been asked to leave their ALF or private facility when they needed to start Medicaid - just because of limits those facilities place on how many Medicaid residents they will accommodate.
You really need to first assess what your needs are. Then assess what you can afford and for how many years you can afford it - and what will happen when you can no longer afford to meet all needs. Then start the selection process. It was easy for me to go straight to the "what can we afford and for how long" stage. I knew Mom's resources wouldn't last beyond the first month. And I knew how long her mother lasted in a nursing home (almost 5 years). So I knew to do the best I could keeping in mind both Medicaid and longevity.
Then, I guess, look to see if the doors to the rooms are lockable or not and what really are the duties of the staff. And then pray you made a good choice.

Kate

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Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Wed Aug 24, 2011 3:02 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Hired Caregiver's Guilt Trip
Kate, it sounds like you did some solid research and found a good place for your Mom. I agree we need to look ahead with a realistic eye on the finances because moving them is not a good idea. I feel really blessed to have found Derek a place so close to home. It's not small, 128 beds, but is divided into four separate units, each with its own name, staff and even personality. While they don't have a dementia unit, per se, most of the residents in Derek's unit clearly have dementia.

The caregivers are amazingly patient with the residents, as I'm sure you see in your mother's facility, as well. Considering the aides' very poor pay and working conditions I feel an overwhelming gratitude toward them for all they do, not just for Derek but for all of the residents there.

That said, NO FACILITY IS PERFECT and I don't want to give the impression that there haven't been issues there, as I have posted about in the past. But, as the staff became more familiar with Derek and his disease, problems and individual needs things have improved immensely. It takes a little time.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Wed Aug 24, 2011 3:37 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Hired Caregiver's Guilt Trip
Sandwich Mom,

I'm glad the issue of falls was discussed and that the facility pointed out that the falls will continue. Sounds like a good place.

I do think it is possible for facilities to be odor-free or mostly odor-free; I have been in some that always seem stinky and some that don't.

Robin


Wed Aug 24, 2011 3:40 pm
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
Post Re: Hired Caregiver's Guilt Trip
You're right, Pat. No facility is perfect and no facility is going to meet everyone's definition of perfect or awful. And within Mom's facility, my sister and have come to recognize the A, B and C teams. (Though they're getting smart and mixing the teams up.) A lot seems to depend upon how engaged the nurse is.

My only real complaint is the protocol the nurse has to follow before bringing the doctor in when a patient is displaying problems. Sometimes the protocol can take a couple of days to get through. But I found my way around it. I call the doctor's office directly, in addition to anything that's done through the SNF. They have a great NP working on my mom's case and she doesn't stand on ceremony. If she hears from me, she acts on it.

Well, protocol and the soft mechanical diet. Sometimes the food is unrecognizable after being ground up. And who grinds up a grilled cheese sandwich? (bread crumbs with a slice of cheese melted over them) Or meatloaf? (seems to me it is already "mechanical soft.") But even with this, additional food is sent to the unit with each mealtime just in case someone doesn't like what he or she gets. And I have, on a couple of occasions, gone up to the kitchen asking them to correct an error or just give Mom something different - and they comply.

The moral here is to not be shy about asking for things, I suppose.

Kate

_________________
Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Wed Aug 24, 2011 3:57 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Hired Caregiver's Guilt Trip
Quote:
I call the doctor's office directly, in addition to anything that's done through the SNF.
Yep. I fax the doctor directly.

Quote:
The moral here is to not be shy about asking for things, I suppose.
Amen to that! I go out of my way to be considerate of the staff and to express my appreciation. But I'm not reluctant to point out lapses [ones that NEED correcting, not just picky stuff] without singling out specific staff members. No question in my mind that being on top of things gets our LOs better care. It may not be fair but that's the way it is.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Wed Aug 24, 2011 4:22 pm
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