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 Locking my dad's door after mealtime to keep him up 
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Joined: Wed May 26, 2010 12:53 pm
Posts: 12
Post Locking my dad's door after mealtime to keep him up
Hi all,
The NH staff has been locking him out of his room after every meal. I had already guessed their motivation: to make him sit up for a while, with the thought that sleeping too much may open the door to bed sores, pneumonia, etc. Dad usually just walks into a random room to lay down when they lock his door. Is it cruel to interfere with his natural inclination to sleep? My guess is that the door locking is one part therapeutic, three parts concern for image. When I question them about his habits, they seem overly concerned with minimizing the amount of time he actually sleeps (and how much he actually eats without gurgling/coughing). I'm already more aware than they think...I guess I don't understand why they are so touchy over this.


Sun Aug 21, 2011 10:27 pm
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Joined: Wed May 26, 2010 12:53 pm
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Post Re: Locking my dad's door after mealtime to keep him up
To clarify: my dad has worsened over the past few months. He doesn't have as much interest in food, sleeps nearly constantly, and has tremendous trouble forming words. There haven't been any med changes or infections, I checked on that. So, in short, why should they interfere with his rest? I'd say he needs it.


Sun Aug 21, 2011 10:45 pm
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Joined: Tue Feb 23, 2010 10:32 am
Posts: 215
Location: Kalispell, MT
Post Re: Locking my dad's door after mealtime to keep him up
Totally unconscionable. You might check with your state's NH ombudsman about what is and isn't acceptable.

There should be NO coercion on anything not unsafe they want or feel the need to do or not do. Skip supper and ask for a sandwich later? OK. Sleep whenever and as long as they want? This need to sleep is not just about rest as with normal people, it's about the body dealing with this dreadful disease.

I spent a lot of time at my husband's facility, and cannot think of one thing they do to convenience themselves at the expense of the resident. Occasionally he would resist showering; they'd work around it somehow.

At one point, my husband barricaded himself in his room. The aides went outside and clumped through several feet of snow and looked in his window. He was standing there naked, so they just left him alone till he wanted to come out. No big deal.


Sun Aug 21, 2011 11:26 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Locking my dad's door after mealtime to keep him up
It sounds cruel, to me, to keep him up when he wants to sleep. Late in the disease, it's typical that they sleep a great deal. Don't they understand that?

_________________
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.


Mon Aug 22, 2011 12:04 am
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Locking my dad's door after mealtime to keep him up
I learned from the speech-language-pathologist that folks with problems swallowing (who tend to get stuff caught in their throat) may be a little safer sitting up and not lying down immediately after eating. Who knows? That may be part of their concern.

It sounds like it is time for a heart-to-heart care meeting. They need to know that you are not blaming them for his decline. You need to know what their reasons are for this coersive behavior. Together you need to work out what the best practice is in this situation.

Start with the assumption that they, too, want the best for your dad and will be willing to work with you. Time enough to change your attitude if the evidence warrants it.

Does your dad have a recliner in his room? Would encouraging him to sit in it for a while after eating satisfy whatever their concerns are? Would he be willing/able to remember to do that?

I would try to work it out on the assumption the facility means well, but I would definitely not want to have my loved one locked out of his room. And it certainly isn't accomplishing whatever objectives they have, if he merely uses someone else's bed.

Good luck!

_________________
Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Mon Aug 22, 2011 1:32 am
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Joined: Sun Oct 21, 2007 4:18 pm
Posts: 835
Location: Acton, MA
Post Re: Locking my dad's door after mealtime to keep him up
If it's possible choking they are concerned about, what about after breakfast or lunch? I still have Frank at home but our schedule revolves around him. I'd say he's in late stages, for the last few months he'd sleep 14-18 hours a day, then the fluctuation, he's up all day and walking around the yard. I never interfere with sleep, as long as he's sleeping thru the night I let him sleep or doze as he wishes.

I'd talk to them, I think locking your dad out of his room just causes more confusion and stress for him. They have lots of patients to take care of, but you only have 1 Dad and you want the best for HIM. Good Luck

Gerry

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Mon Aug 22, 2011 5:05 am
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
Post Re: Locking my dad's door after mealtime to keep him up
Before getting to much more worked up, do have either a formal care conference or just a conversation with the nursing director. There are many reasons that dementia unit staff try to keep people in the day room. If he has food in his room, they may be concerned about choking. But there are also other things. Like falling and not being discovered right away. My Mom is so hard-headed that she'll try to get to the bathroom alone, if she doesn't get help right away. Find out what it is that your Dad tries to do that makes them worry.
The SNF my Mom is at has couches and recliners in their day room so that, yes, it is easier for them (with limited staff unless one can afford to hire a personal aide) to watch the residents for possible dangerous activity. And that could be anything. The simplest things for you and me are momentous for our LOs.
The simple fact is that, unless you are extremely well off and can afford 24x7 personal care, you have to accept that the staff needs to do the things they do so that they can be the most effective. And that includes wanting the residents in the day room during the day.
These folks are doing the best they can with the budget they have. Though I do call the nursing director for the dementia ward fairly often to let her know about something that shouldn't have happened (like the majority of the aides taking their lunch at the same time, which was dinner time and one poor aide was left to take care of the whole room).
I think the key is ongoing conversation, with the staff, the nursing director, the clinical coordinator and anyone else who is involved in your Dad's care. Yesterday, I stopped a maintenance guy to talk. I got some things taken care of in Mom's room within the hour.
So, give the staff the benefit of the doubt. And ask why they keep him from his room and discuss what you can do to make things better. They probably have a good reason, even if it is just from their point of view, for doing it.
One point: I generally get my Mom settled in her rocker and watching TV after supper and before I leave. I know they go in a half-hour later and either get Mom in bed or in her wheelchair to keep her in the day room so that they can watch her. And that's OK. I get to be the loving daughter, settling Mom comfortably and they get to do what they need to do to take the best care they can of everybody in the unit.

One more thought. Anything you do to make things more functional for the staff goes a long way. Something like arranging your Dad's room so that he is as visible as possible from the hallway may even be enough for the staff to be more confident about his being in his room alone.

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]


Mon Aug 22, 2011 1:20 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Locking my dad's door after mealtime to keep him up
Yes, by all means have a care conference. I have never heard of this sort of "policy" before. I can think of no reason to have your dad unable to sleep when he wants (except for the issue of GERD if you lie down within 30 minutes of eating...but I don't think you should be concerned about this...my two cents). If you need "back-up," I suggest consulting with your dad's neurologist first.


Mon Aug 22, 2011 3:23 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: Locking my dad's door after mealtime to keep him up
Kate, the staff at Derek's SNF also likes to keep the residents in one of the common areas as much as possible to more easily watch them but they do not enforce it as policy. While many of the residents like being among other residents and within view of the staff most of the time, some do not and their preferences are honored, too. When Derek is falling asleep in his w/c or asking to go to bed they will take him regardless of the time of day. But, as I have posted before, it is an Eden Alternative facility where flexibility and resident preferences are high priorities. It is by no means a perfect setting but I am impressed with it, overall, in the eight months he has been there and I visit twice a day.

_________________
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.


Mon Aug 22, 2011 3:43 pm
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
Post Re: Locking my dad's door after mealtime to keep him up
I didn't mean that forcing someone to be out of their room was OK. Just that there may be a very good reason for it.
At Mom's SNF, I'd say that more than half of the residents are on MA. I don't know what the budget looks like, but I suspect that there are limited funds and that staffing levels reflect that. I still say it is one of the best places in the state, but it is also one in which they need to be concerned about how best to effectively use their staff. And the staff members are terrific. (We have unofficially rated an A, B, abd C team and we are there more often when the C team is usually scheduled.)
The place that is actually in our neighborhood is probably much more like an Eden Alternative. I have noted that they do have a better aide/resident ratio. But they are not particularly open to MA participants. You need substantial funds to be there for any particular amount of time. Though the state does regulate the rate that nursing homes can charge, this place always seems to cost more - probably through additional fees.
I still say that sometimes there are things that the staff needs to do in order to care for all of their residents. While I question locking a resident out of his room, I can understand wanting him within eyesight, without having to dedicate a substantial part of a staff member's time to watching just one resident. (This is the first time I've heard of locks on residents' rooms. There are no locks like this at my Mom's SNF.)
I often remind myself that Mom isn't the only resident in her unit and that some of them need a lot more care and watching than she needs. I just thank God that she is easier to take care of than many others. And I know that, when she does need more care, the staff will do as much as they can to provide it. Today, with my back shrieking its pain from too much Mom care this weekend, I'm very grateful to the people who take primary responsibility for her day to day needs.

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]


Mon Aug 22, 2011 4:11 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: Locking my dad's door after mealtime to keep him up
katelu wrote:

I often remind myself that Mom isn't the only resident in her unit and that some of them need a lot more care and watching than she needs.

So true and often so hard for us. It's one reason I am there twice a day to do some of what the staff would have to do. Derek's SNF does take Medicaid, which he will be eligible for in a month or two. After paying what we have this past eight months they had BETTER keep him in there! Actually, there are quite a few MA residents. They won't let him keep his private room when he goes to MA and that might prove interesting.

You are right about their having to make ends meet with pretty poor reimbursement from the state. They get $5K/month for MA residents and nearly $8K/month for private pay.

_________________
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.


Mon Aug 22, 2011 4:35 pm
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
Post Re: Locking my dad's door after mealtime to keep him up
Pat, I'm sorry Derek will have to lose his room. I've seen two very strong women in Mom's unit have to go from a private room to having a roommate and it was pretty hard on them for a few weeks. Eventually, though, it worked out. Maybe because now they each had a roommate (captive audience) to listen to them. :roll:

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]


Tue Aug 23, 2011 12:14 am
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Joined: Wed May 26, 2010 12:53 pm
Posts: 12
Post Re: Locking my dad's door after mealtime to keep him up
Thanks for all the helpful replies. I have a lot to think about, but the need to address my concerns directly with nursing home staff is validated. I can think of several reasons why they might be doing this (most of which have been mentioned in posts above). I do not think that their intentions are malevolent, but rather a matter of well intentioned blundering with a dab of image consciousness thrown in.

I don't have any legal power over my dad's healthcare, which is pretty frustrating. I still think I can raise the issue with some success.

All the obfuscation is frustrating; I wish I could simply announce to my aunt (dad's healthcare guardian) and the nursing home staff that I don't blame them for his condition, I understand that it's a degenerative disease, I understand that he isn't going to maintain, etc, etc, etc.

Added: I just wanted to say that according to a CNA, the sole reason they are doing this is to keep him from laying down so much. Once he's in his room, he doesn't wander around or anything, so he isn't likely to put himself in danger there.


Tue Aug 30, 2011 11:38 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: Locking my dad's door after mealtime to keep him up
Can you enlist your aunt's help in this conversation?


Tue Aug 30, 2011 12:53 pm
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Joined: Sat Oct 06, 2007 4:28 pm
Posts: 741
Location: LA
Post Re: Locking my dad's door after mealtime to keep him up
Laying down so much???? That's what someone with LBD must do!!!!!!

Don't they know the basics of his condition??? Poor, poor man.

Dorthea


Tue Aug 30, 2011 1:07 pm
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