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FIL is 80, almost 81. Incapacitated (at rehab, not our choice told needed for safety) w/vascular dementia and Alzheimer's. This was after a failed home care plan because he couldn't or wouldn't follow it on his own and multiple serious hospital stays this last one was for pneumonia due to aphasia, and we were REALLY lectured hard on how dangerous that would be the rest of his life now that he advanced to that point. He was deemed a wander risk while in the hospital, and he required video surveillance. Once in rehab wandering issues continued several more weeks, hence the Memory care requirement, safe sealed space. He still to this day thinks he is 100% and is angry he's not home, because he is just fine. That is fed by a brother that refuses to follow Med advice for therapeutic lying, which is an ongoing issue too. When we were doing the advised therapeutic lying he had hope and was content in care, but the brother blew that and it did a lot of damage now he is just really angry mostly at us that he is not home. Home alone is an obsession now as a result :( They do take good care of him physically, we know it! His level of care is now obviously good for him, diet and regular meds have made a huge difference all around & we are very grateful for the physical care being quality because it has made a difference for sure. He is doing so well he's rebounded and is super feisty but his PT coming in has expired and warned she expects a physical slide because he doesn't practice on his own and he cannot recognize the need to or what has happened to him. We get no care info from the memory care center other than verbal "he is good" on rare occasion, so the only updates we have gotten was from the incoming insurance contracted PT :( We have probably two dozen requests to be included in the care plan to ensure DR advice is even in the plan (including the therapeutic lies for his mental health) We have been told "this Sunday" a couple times but we never end up called/included. When we researched and chose this center we were promised we would be kept up to date and included, now on his 3rd month and nada. Yesterday hubby sent an email and cc'd corporate so fingers crossed that helps. We don't want to make such a stink we alienate anyone but he has been harmed already, and it's our job to be sure his best interest are met. Any advice how to proceed and make sure the DR/counselor advice is understood, included and hopefully followed? Can they change off of DR advice without the POA? Yes POA is durable all inclusive. How often is reasonable to ask for an update if his progress is shifting around? Honestly I think the problem is, while they do a good job care wise, they have staffing issues and therefore time management issues and well they maybe think they know better than the evaluators? Not sure about the last but kind of the vibe and we feel we need to listen to the pro's who advised for his needs too.

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A few questions ..
Who is POA? Is it your husband?
Maybe if you do not get a response to the email that was sent yesterday a "gently" worded letter from the attorney that drew up the initial paperwork establishing POA might help.

Who is the "brother" that is stirring the pot? Is it a sibling of your husband's or is it FIL's brother? I would see if visitation could be restricted to supervised only. If that does not work then not allowing visitation if it is stressing FIL to the point where he become unmanageable.
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MickiLyn May 2022
Yes, my hubby is his only surviving child and durable POA. A letter is a thought. I feel like we need a lawyer for both, and I am not a lawyer kind of girl so ugh. I don't want to go there but I suppose we may have to.

The brother stirring the Pot and upsetting dad is his disgruntled little brother who thinks all Dr's are quacks and he's the conspiracy theory type. He is used to getting his way with bully tactics and being a tattle tale when he doesn't so we probably should have seen this coming, but we were hoping for the best. Limiting visits and calls if he will not stay in medical advice compliance was one of the things we want to bring up in the care plan. What he's done is honestly very cruel, even his wife has been really upset with him about it all.
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Send a copy of the POA to the director and inform them that if they don't start including your hubby in the conversations while including baby brother in them that you will file a HIPAA complaint against them. Cite some dates of occurrences. You don't need a lawyer right now.
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MickiLyn May 2022
That is great advice thank you.
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You and your husband need to send a copy of the durable POA and a short explanation of the difficulties you have had arranging a meeting with the care team, and hope that he can arrange this meeting for you. Be sure to note how pleased you are with his care, etc. No complaints or. naming names. That will create hostility that will be hard to undo. Right now the lack of attention to detail/inconsistent responses is more likely due to the reality of the staff CG's day, and the fact that they are generally encouraged to direct questions to the person in charge. If you want FIL to continue to do PT, they won't remind him - not skilled for that. You can hire an exercise assistant and private pay for 2 visits a week to keep FIL moving and socialized.
His other son is a pain in the neck. Your FIL is lucky you and DH are so sensible.
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MickiLyn May 2022
The POA and INCAP letter has been in the center's possession for many weeks and we have done all this and made multiple requests already. We graduated to written requests a couple weeks ago. We are moving on to a state ombudsmen to help get the proper health and safety procedures included that were advised by PT, psych and Dr. We just want medical advice followed so he can have peace and be safe. They act like we have no told them stuff but we have which is why the state requires these meetings. It was suposed to be close to entry/admittance but 2.5 almost 3M in we are still getting brushed off. So this would be great advice but we have done it all already :( Thank you though!
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You've got a lot to deal with. I've never heard of a state ombudsman for geriatric care but that sounds like an excellent plan. Another possibility, albeit expensive, might be to hire a geriatric care manager who can can evaluate the care your FIL is getting and do the necessary follow through to make sure orders and plans are followed. I'm also curious about any contract or agreement with this facility. I would think the person with durable medical power of attorney would have had to sign it. If you have the contract, look at what it says. Although I'm not familiar with state ombudsmen, I would think a copy of what the facility agreed to would be useful.
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MickiLyn May 2022
Honestly, I think his physical care on center is really good for the most part! Organization and admin are lacking a bit TBT. WA state has ombudsmen for each county to help with any problems like this, I learned this just recently! I was given the number for his county and left a message I hope that they call back! WA state requires a plan be put together with the POA if the patient is not competent when they go into care, or within a reasonable timeframe anyway so that nothing is missed. I feel like reasonable time has lapsed. He did do a contract if we have a copy I am not sure. That probably sounds dumb but the whole thing was a lot to do far away we had to get time off travel and all, it was kind of a blur trying to do it all. We are certainly not perfect, but we try our best and are exhausted. I have probably been too patient with his center and my first 20 or so requests were verbal or phone messages, now I know better. Paper trail it is! We are just missing some safety precautions for his outings and mental health. I feel like none of this should be as hard as it is. To us it should all be common sense stuff but it hasn't quite worked out that way :/ We are very determined to stick with following medical advice, and expect they do too, and we need to stay included and up to date. I will research a geriatric care manager, I have never heard of that but I learn something new nearly every day. Thank you!
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Just an update we finally got a meeting, in fact we got two and an ombudsmen chimed in too. It seems like everything is on track now. Fingers crossed what was said will be, will actually be. It is all still all verbal only so we shall see. It feels like progress to us both and we slept this weekend! That is actually really big for us to sleep well anymore. Things in writing and calls up the chain did help get things going, so did some really inappropriate behaviors on the brother's part finally being caught. We are still trying really hard to compromise, within reason for safety, and keep brother included because reality is Dad is close to him and will forget us before him. We already see that happening. We just need it to be reasonable. Again, my biggest complaint in being part of care team is it shouldn't be so dang hard to just do the right thing keep him safe and happy as we can.
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It is time to visit the admin of the facility. The two of you need to discuss exactly what you can expect, because I think you have a lot of expectations that they (and perhaps any facility) cannot reliably fulfill. Do tell them EXACTLY what you expect. IE: How often do you expect to be contacted about your father. Under what circumstances do you expect to be called. That is "Call me if " A)He has not eaten for more than 24 hour period B) There is a change in mentation C) There is a fall of any kind D) He will not accept his medications. And etc. Make your list VERY VERY SPECIFIC. Ask them if they can attach this to Dad's care plan, and if they can reasonably fulfill this.
PS When you visit with the admin start with the compliments on care, Dad's condition, and your feeling the care is overall excellent. THEN discuss expectations versus reality.
I am afraid a lot of this is about communicating. Not that things will not fall through the cracks. You are correct that staffing issues are AWFUL right now and in my city that includes closed bank branches, closed cheese shops and closed hair salons because there is no staff to manage them.
At some point you will need to conclude that nothing will be perfect; that overall you DO/DO NOT trust the care level given, and etc.
Again. Things will go wrong. If I told you the plumbing/heating/leak issues we deal with every day as landlord, you would know--things do go wrong. At any age in life, under any circumstances in life.
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I spent all day at Moving & Handling training on Friday. We have to take a refresher course every 12 months, as well as continual online training. Sections include ergonomics, risk assessment and a spaghetti soup of acronyms like RIDDOR and PUWER and LOLER - all related to legislative requirements governing Health & Safety.

Now then. Your FIL's PT, very conscientiously, is keen that he continue his exercises even after she finishes with him and has alerted you that he will need staff support to motivate and encourage him with this.

We are a reablement service, and it is not unknown for us to organize a dressing routine so that the client is required to stand, sit, stand, sit half a dozen times while putting his pants on. Subtle, eh? We also apply a principle called "Positive Risk Taking" - not as alarming as it sounds, we would always have to be extremely sure that the risk is under control - to build confidence and gradually stretch a person's abilities.

But people joining us from a traditional care background experience considerable culture shock over this approach. It is a different discipline. Does your FIL's rehab really offer its staff the training for what he needs? Because without it I can imagine the managers having nightmares about PT follow-up.
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MickiLyn May 2022
His insurance provided extra OT, PT, and speech therapy for his aphasia because of aspiration risk. Once he timed out, my impression was because he was not progressing past a certain point, it discontinued. The PT communicated well, and she did say she suspected he is likely to backtrack some without the extra help. I got the impression he didn't care for the extra help and complained he shouldn't have to do it, because he is fine and should be allowed to just go home. We are almost 4 hours away and work a lot. We won't be able to do a great job helping him keep it up ourselves. How often we visit is limited. His brothers are retired and closer and he will remember them longer which is why we chose to keep him in his home town. Our is small, costal more touristy and we didn't have as good of options for care centers or medical care as he has in the city either. So we made the best choice we could. The care center does some PT with the residents but probably not as much as he needs. I am not sure what we do about that but right now I can only handle one problem at a time. That can be as soon these get fixed ;)
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