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Where to get more supervision than MC?
DogofDogs
Posted: Sunday, February 4, 2018 7:03 PM
Joined: 5/22/2017
Posts: 12


My mother has been in MC x 8 months, on a locked unit with 12-14 residents.  She has her own small room with a small "powder room" with a  toilet and sink attached.  It has taken months and several med changes to reach a state where her anxiety and agitation have reached a reasonable plateau.

She usually manages her own urinary voiding but stooling has become a problem where she either is incontinent or tries to clean it herself; usually once a week there is a major accident, often happening after breakfast, or after her early afternoon nap.  

I visit her most mornings from 10-12, participating in whatever activity is going on, sitting with her at lunch in the main room, taking her back after lunch to use the bathroom, brush teeth, and take a nap.  (I bring my dog also, which soothes her and pleases the other residents) My father comes most afternoons from 2-6, reading to her, watching TV, helping her with dinner and by 6 she is ready for bed.

I have been told when we are not there, she zips in and out of the main dining/living area.  She is up early and usually brings her breakfast plate back to her room to eat it. (then returns later and scavenges off other trays of residents who are still in bed)  I often find table decorations or other items she has brought back to her room.  She sometimes participates in the exercises and "walking club" when I am not there, but is easily overwhelmed by a lot of commotion.  

Today my father was reluctant to drive due to icy weather, so I went from 4-6.  I found her in her room struggling with a small Scrabble-type letter tile in her mouth, along with a zip-lock bag full of the same, obviously taken by her from the activity area.  I think she thought it was a bag of crackers, for it has a natural wood finish.  

This incident has shaken me, for although this facility tries very hard to be safe, I wonder if her cognitive deterioration means she needs almost constant supervision?  She has no skilled 

nursing needs whatsoever beside her medications.  Should I look for a Memory Care unit that can provide this? Or do we need to pay the hourly rate for a 1:1 aide during her waking hours?  

Any suggestions or insights would be welcome!


Twin Mom
Posted: Sunday, February 4, 2018 8:56 PM
Joined: 12/9/2015
Posts: 295


I guess I would have thought that MC would have covered this type of supervision.  When we take our kids to daycare when they are toddlers we certainly expect there to be supervision when using things that might pose a choking risk, or not using those things.  I would have thought MC would have included this type of supervision.  I would sure be asking questions, and would love to see other commenters who respond with knowledge on this subject.  This is more than scary.  I was just thinking today one reason that might land my husband in MC is because there is absolutely no way to totally baby proof our household...and at some point that will be necessary.  I say there is no way...there is...but the disruption to the functioning and safety of the rest of the household may make it totally out of the question.
jfkoc
Posted: Sunday, February 4, 2018 9:22 PM
Joined: 12/4/2011
Posts: 15110


MC should have no"chokeables" anywhere. And do they think scrabble is a good activity??? I would personally go through the activity area myself.

Please check on staff training!


Iris L.
Posted: Sunday, February 4, 2018 9:31 PM
Joined: 12/15/2011
Posts: 15411


Mouthing is a common behavior in later stage PWDs.  There should not be chokeables in her area.  Also, she should be monitored after meals and after napping for toileting so accidents can be avoided as much as possible. The staff does not appear to be attentive.


Iris L.


Rockym
Posted: Sunday, February 4, 2018 9:37 PM
Joined: 1/17/2016
Posts: 746


DogofDogs, this may not be the right MC.  My mom's MC has about 22 residents on each side of the building.  Residents are usually out in the common area and kept very busy.  The few that are at much further stages are usually in a different area since they simply cannot participate.  I visit twice a week and even when there was a new resident who was confused, the caregivers really kept their eyes on her until she acclimated to the community.

My mom is a tough cookie and I was surprised that she settled in after a month.  She has been there 3 months now and I'm pleased.  I think if your mom has been there 8 months and they still can't redirect her, keep an eye on her, etc. it may be time to find a better facility.  Not all MCs are created equal.  I found that to be the case when I moved my mom from her AL (and they had an MC in their building too). Bottom line is they should know what she is up to.

 


citydock2000
Posted: Monday, February 5, 2018 12:18 PM
Joined: 9/7/2017
Posts: 407


Have you had a conversation with the care manager about how this happened?  It can be hard to tread that line - not sounding accusatory, being collaborative.  "I'm concerned I found my mom with these small pieces, alone. How can we make sure she is safe?" 

MC does not provide 1:1 care obviously.  Memory care is responsible for the safety of their residents.  These two things can come in conflict - there was a poster her recently whose mom was hurt by another resident.  This can happen and there is only so much a caregiver can do when a resident grabs something or reaches out to hit someone in the next chair. 

HOWEVER. 

It is reasonable to ask what the facility/caregivers do to keep residents safe.  For example, I noticed that when an craft activity was completed at a shared table, all pieces of the game or activity were carefully packed away in a tote.  

How often does a caregiver make the rounds to check on a resident in their room?  How many rooms/residents does a caregiver have responsibility for?  Is there a standard in place - e.g., caregiver A is responsible for the West Wing - how often does s/he have to lay eyes on residents? 

How successful are the caregivers at keeping residents out of their rooms and in a common area?  If your mom avoids the common area and is alone alot - she will be less safe.  It's a give and take -  caregivers should be making an effort and be skilled at it, but some PWD REALLY want to be in their rooms.  Caregivers were constantly checking on my FIL to come out to common areas - it made them nervous that he was in his room so much, where he wasn't under their supervision.  They made a game of it and were very proud when they could tell us "he has been out of his room all day today!  Right, Jim?  We missed you. It so much more fun when he is out with us." They would play his favorite movies or music, do his favorite activities, and try to "charm" him out of his room.  

Also, now that this happened - and you know she is likely to grab small things, what are they willing to do to prevent this from happening again?  I was very conscious in the language I used - "I'm concerned about this, as I'm sure you are.  What can WE do to prevent this from happening again?" 

MC can't prevent everything bad that can ever happen - but you can expect them to work collaboratively with you to keep her safe, and to adjust for her individual needs as much as they can. 

** one more thing I thought of, if they are are used to you guys being there frequently, this might mean they are used to providing her with less supervision, maybe?  Caregivers are human - if they know Mrs. A's family is usually with her, then they may be used to providing Mrs A with less supervision.  Something to keep in mind. 


caregiving daughter
Posted: Monday, February 5, 2018 3:03 PM
Joined: 11/27/2012
Posts: 1874


Did I miss what stage? If your mom can use the toilet herself--I'm thinking she would also be able to feed herself or attempt to use a fork and cup and therefore, would still understand what food is. So putting something like scrabble tiles in her mouth could show delirium. Is she well hydrated? Has she been checked for a util?
caregiving daughter
Posted: Monday, February 5, 2018 3:06 PM
Joined: 11/27/2012
Posts: 1874


Another broader thought though is your comment on taking food back to her room. There should be rules that snacks or other in a resident's room be in sealed containers (pest control). At an earlier stage, people would give my mom cookies and she would keep them in tupperware. If though residents are regularly able to bring their meals back to their rooms, this is concerning. First, meal times is a main social time. Second, there can't be half-eaten food sitting or spilling in resident rooms.
JJAz
Posted: Monday, February 5, 2018 5:30 PM
Joined: 10/21/2016
Posts: 1797


As a friend mentioned to me, "Some MC facilities are only set up to handle the little old lady that can't find her car keys."  It made me laugh, but it's true that they aren't created equal.  Perhaps another facility?
Sather56
Posted: Monday, February 5, 2018 6:13 PM
Joined: 5/30/2016
Posts: 542


The memory care facility that my FIL stays at has supervision, but I have found that as this disease progresses, some LO start to exhibit unusual behavior. They will wander from room to room taking things, hide them or try to eat toothpaste or drink perfume. (seriously)  That behavior is dangerous and could be fatal.  The PWD that are at this stage go where the more severe dementia can be watched more closely. I would recommend that you alert the caregiver of what you have discovered and have them watch her more closely.  At my FIL's facility, they have "Transitions", where the residents are mild to moderate stage. When this type of behavior occurs, they place them in "Generations", where the latter stages get that one on one care. Especially when they can no longer handle their toileting duties. It can become a health issue. Also they allow the wandering and do not allow them to be exposed to games with small objects or puzzles.  I know you want to do what is right for her. I would be concerned about some of the behavior she is exhibiting. She doesn't need skilled nursing yet, but more one on one attention.

Sather56
Posted: Monday, February 5, 2018 6:26 PM
Joined: 5/30/2016
Posts: 542


They wander because they are in an area that is more secured and watched attentively.

DogofDogs
Posted: Thursday, February 8, 2018 7:41 PM
Joined: 5/22/2017
Posts: 12


Thanks everyone for your thoughtful replies.  I have spoken to the unit's care manager and activity director about the particular items, and they have been removed.  I snooped through the other accessible activity items, and none appear dangerous.  

Yesterday was another icy day where neither I nor my father could get in, and I called to alert the staff that we would be absent, and "Mom seems to get in trouble when we are not around".  They promised to keep an eye on her and things went well.   

There is another smaller locked unit upstairs, where I think the residents are more impaired and get closer watch.  A resident from my mother's unit moved there recently, after she repeatedly tried to get into the fire alarms and other residents' rooms.  I think we may need to make that move in the not-so-distant future.  


 
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