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 From ALF to dementia unit - HELP! 
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3430
Location: Vermont
Post From ALF to dementia unit - HELP!
This afternoon the head nurse at my dad's ALF told me they will probably want to move my dad into the dementia unit there. When I toured the dementia unit, everyone looked WAY worse off than my dad. I can't imagine him in there yet because he does have some pretty lucid times, but he can't speak most of the time. I asked what the criteria were for moving someone from Level 2 care or Level 3 care to the dementia unit. I didn't get a clear answer but she started to tell me that he has recently gotten mad in the dining room and shouted about how his rights are being violated and the administration is not doing what they should be doing. He apparently got everyone else all upset and had to be taken back to his room to finish his meal so the others weren't all upset.
This is a man who, most of the time, can barely get a word out that is understandable. When he can talk he is barely audible most of the time. How do I know what's really going on? I can't imagine him having enough strength to yell so that others could even hear him. He is angry most of the time, so that part I can believe. But screaming and getting the others all upset???
The asst. director in whom I put a lot of faith just resigned to take care of her Alz. mother at home. The truly wonderful and very bright director just resigned to take a promotion in the same company. She'll be there another 2 weeks. This head nurse will probably be in charge until they hire 2 new administrators.
If anyone can give me any advice, I sure could use it. Thanks, Lynn


Sat Feb 13, 2010 5:36 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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Lynn,

Can you ask non-demented residents about what they saw/heard?

I know change is hard. Every time we moved my dad from one place to the next or one level of care to the next, I was terrified that this meant he was closer to dying. I fought each change but eventually learned that this did no one any good and that the move was for my father's best.

Would being in the dementia unit be so bad? Perhaps the workers would be better-able to care for your father since, presumably, they have more exposure (and training) on dementia and dementia-related behavior.

Robin


Sat Feb 13, 2010 6:07 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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There is one man whose full name I know and he is not as bad off as my father. There's another lady too, whom I only know the first name. I can try to call them. I wish I'd known this earlier today so I could have done something more while I was there.
Re: people in the dementia unit - most of them looked totally out of it, staring into space, some with heads hung down, barely looking alive. He can watch tv at least and follow what's going on. In the dementia unit they are all brought out to the living room area every day so someone can keep an eye on them at all times. I don't think he needs that at this point. It was a lot more depressing than him being in his room watching his own tv, for sure.
I'll try to call some of the other residents and see what they think about the supposed outbursts in the dining room.
I went to 2 nursing home/rehab centers in the town where he lived for 60 yrs. One of them looked so old, shabby, institutional and depressing I just about ran out of the place. They mix the dementia patients in with all the other folks. Don't know if that is good or bad.
If I have to pay thousands more a month and move him, I'd rather move him close to home so his friends can see him more and we don't have to drive 80 mi. a day roundtrip. That's 2 more hours we could spend with him instead of riding the roads. Wasn't able to get a tour of the other one's dementia facility but it is newer, cleaner, the staff seemed better educated and friendlier. I wish I didn't have to think about this now!


Sat Feb 13, 2010 6:33 pm
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Joined: Sun Feb 07, 2010 10:41 am
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I will say what I wouldnt do , and that is bother with any patients to ask what they heard or saw.
Try not to worry about it ahead of time, stand your ground and be firm on the why,and your not wanting moving him
and ask if his next outburst could be videoed tape?? or if a dining room worker can verify the next one, by the Head Nurse asking her to??.
Remember she is just a head nurse, not the administrator ,
in all walks of life there is usualy someone above another person including a head nurse.
Enjoy your valentine weekend and try not to let it worry you. You believe this isnt true or possilbe of him, so it probably isnt true


Sat Feb 13, 2010 7:02 pm
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I am sorry Lynn! Make a few observations in the unit. Maybe they can do something with meds to calm him down. My mom to had behavior problems in the unit. As I said to Robin, my Moms memory unit was not any better. The staff to patient ratio was one person higher justifying the extra cost. I had a friend whos mother died in the memory unit and she filed a complaint about her mothers bruising. I am soooo sorry. I know exactly what you are going through. Check it out carefully.
I am thinking of you and I guess I am back if they dont kick me out.


Sat Feb 13, 2010 7:06 pm

Joined: Sat Oct 06, 2007 4:28 pm
Posts: 758
Location: LA
Post Too bad
Lynn, I feel sad for the situation you find your dad and yourself in. It takes me back to Easter 2008 when the week end crew took over for the regular staff with whom I was allowed to say how things needed to be done. This group decided they would not let me do the things necessary for a good day... finally when I was exhaused and had embarrased myself in front of all the Easter visitors, I threw up my hands in a "give up" sign because the administrator in charge had been called to the floor and she agreed with the staff on the floor. I reached toward her and read her name tag saying quietly, "Nurse so and so, Dr Walker will know about this." Guess what, I was given what I requested and offered more. I stayed well after visiting hours were over and could not have had more help. She was my new best friend and the next ten days before I brought my LO home, I could not have asked for a better environment. It had not been an idle threat. I meant it, however, I did not report anything. I have no problem accepting an apology when one is offered.

Hang in there, Lynn, he needs you.

DrP


Sat Feb 13, 2010 8:11 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
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Lynn, have you spoken with any of the CNA's [or whatever they call them in that unit]? They are usually closer to the issues and probably know what's going on. I do know that, when my husband was in the dementia unit, everyone else did seem a lot worse than he. But I also know he was a different person in the evening [just like he is now] that he was during the day. I would ask to see the documentation of his behavior.


Sat Feb 13, 2010 8:24 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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Thanks for all your suggestions and support, everyone. This is a small ALF with 38 people in the "regular" part and 19 in the dementia unit. The caregivers rotate through the 2 units and through the different hallways in each unit so every day they are moving around. I think this prevents burnout for the caregivers so they don't get the difficult people every day. My sister is going to be here next week, I won't be, so I am going to ask her to talk to this one lady who is totally together and often comes over to me and tells me little things she's observed about my dad. So, it wouldn't be unusual to talk with her. She is very nice and helpful.
I do want to know exactly what their criteria are for moving someone. I think that's only fair. This head nurse was the administrator when the other 2 were out on medical leave, so she probably will be until the new hiring is done. Thanks again, Lynn


Sat Feb 13, 2010 8:27 pm
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Joined: Sat Jan 03, 2009 2:59 pm
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Lynn,
I would think that a memory care unit would be better to deal with these outbursts, for you I imagine you see this as yet another decline in your Dad's illness and it is hard. I am sure the ALF is thinking of all residents while making these comments! But by all means ask around to others and get their reactions I would also explain your objects to the person who told you this and let her further explain the reasons behind it. Perhaps there have been small signs of outbursts prior to this one that they just haven't mentioned!

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Irene Selak


Sun Feb 14, 2010 10:54 am
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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I just don't know how there could be loud outbursts when his voice is so quiet you almost can't hear him, and most of the time he can't say one word a person can understand. That's what has me so baffled, so I will be checking this out with a few others.
This nurse has told me several times that my dad "cleans his plate" at meals. I told her that every time I or a family member or friend eats with him, his table mates and his caregivers observe he eats about 3 bites per meal. She got mad and said "those caregivers are not documenting this then and they should not be communicating this stuff to the family. I see his plate coming back empty after lunch and dinner." So, I don't dare get the caregivers in trouble for telling me their observations again. I will find a way to ask them without her knowing.
I'll keep you all posted, and as usual, thanks for your concern and advice. Lynn


Sun Feb 14, 2010 11:14 am
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Lynn,

Before I sign off I must tell you something in regards to this.

It was sooo bizarr.... My mom never had great motor movememts/walking as she had chronic back pain. With LB you can have parkinsons issues right. Well she shuffled etc. Had to use cane, walker, wheelchair. When she was hallucinating she regained all of her motor skills and acted like she was 55 again. ( No wonder the staff at AL didnt believe she had chronic pain and was a drug adict.) I couldnt believe it until I experienced it. Maybe something like this is happening to your dad.
Best wishes,
Sharon


Sun Feb 14, 2010 11:28 am

Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
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Quote:
they should not be communicating this stuff to the family


Actually, they should be documenting this information and you do have a right to see the documentation, assuming you are his health care POA, unless the law is very different in VT than in WA or AZ.


Sun Feb 14, 2010 11:59 am
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3430
Location: Vermont
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Thanks for your comments. You're right about the documentation - I am sure that in MD, where my dad is, I can see his documentation. My sister and I both are his POAs, and one of his best friends is the "backup" POA. I will have my sister look at the documentation this week. Lynn


Mon Feb 15, 2010 4:06 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
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Lynn, sometimes the only difference between and ALF and a 'Dementia Unit' is that the latter facility is locked. Try to find out if the staff is specially trained for dementia residents and what kinds of activities they have for them. I'm assuming they charge quite a bit more, so you have a right to know what kind of 'extras' you're paying for.


Mon Feb 15, 2010 4:11 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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The extras we would be paying for is twice as many caregivers to patients, and it is the same caregivers as he already has, they rotate through both places regularly. So, it isn't like there are better trained people. You get what you get. I think they are afraid of him falling again, so we pay more to have them less likely to be libel for an injury. I hate to sound synical, but I truly think that is what it is all about. And they get sick of him being "the boy who cried wolf". Now that he can't make phone calls that shouldn't be as much of a problem....


Sun Feb 21, 2010 8:12 pm
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