I'm going to go back and look through all the paperwork from my mother's admission to her assisted living facility, but I do not really feel that she was assessed and I did not receive any detailed care plan for her. Initially one of the administrators or health director (or whatever) made an appointment to go to my mother's home to "assess" her. That appointment was cancelled however, and the person said she would just assess my mother after she moved in. I've never seen this assessment or any kind of care plan. When I've asked if we can meet regarding her care I've generally been asked what I want to talk about or what I'm concerned about and no one is available to even discuss scheduling a specific time to meet. I really feel like staff have avoided this topic and do not get back to me. They really have not acknowledged that something like a care plan meeting even exists, or should happen. I feel like I've been negligent in not pressing the issue but I also feel like I deal with enough on a daily basis and sometimes just want a break from mom's issues. Caregiving was overwhelming prior to the move to assisted living.
Since the move to assisted living I've pretty much discovered that the facility is low on residents and as a result very low on staff. I don't think anyone gets assistance with much unless they are together enough to ask for help on a regular basis. Please let me know what others are experiencing.
I would call the Executive Director immediately and demand a meeting with him or her in person so you can address these concerns. And if there are few residents who live in this AL and fewer caregivers, that sounds like a big red flag to me! See what the ED has to say about that, and what the plan is to hire people and get the ball rolling here. Otherwise, you may have to move mom to a different ALF that's been established for a long time & has good reviews from satisfied residents.
You are not out of line for expecting a care plan for your mom; THEY are out of line for not having one in force for her by the time she moved in, and for not having assessed her prior to her move in date. A big part of why you moved her into AL to begin with was to relinquish your duties as her caregiver and move them over to a staff of others to deal with. If that's not going to happen, what is she paying for? 3 meals a day? Come on folks, that's ridiculous!
Good luck getting the answers you seek!
Its been a month since your last post and I can't believe there has been no interaction. Just read you are her guardian so no reason not to talk to you. Did you give them a copy of your paperwork? Not sure if your State Ombudsman covers ALs but I would call and ask. A call from the state will get some results.
I noticed your note about a new administrator… my mother was at her memory care eight or nine months, first administrator was let go , the assistant administrator was promoted to temporary, they hired someone for that position, and fired the person they promoted temporary, and about six weeks before my mother passed they promoted one of the caregivers to the administrator position. Good help is hard to fine…. They are also on the third nurse that they are hiring.
Assisted living is real estate...
Folks in my neck of the woods in Assisted Living there is no assistance. Basically, everything is a la carte. You get a room, which is a usually a studio and a fancy menu. After about the 3rd day (just like being on a cruise ship) the resident wants soup and a sandwich or oatmeal. The fine dining wears off.
In my experiences of touring these facilities, everything is an add-on. You have to have your mother's primary care doctor or specialist assess your mother and write orders for care for your mother at the Assisted Living facility (ex. physical therapy, occupational therapy, CNA to dress Mom, shower, walk to and from the dining room). In my opinion, I always thought that you pretty much had to be mobile, if you are not up to par (if you break a hip) basically you're out of luck.
Another thing is in my neck of the woods they don't allow bed rails on the bed, which concerned me. The people they have filling prescriptions only have to train for about six weeks, that's it.
The fancy brochures and lobbies are attractive but it doesn't sound like they are meeting your mother's needs. Read your contract and you may have to start looking around. Be sure you know beforehand what is going to transpire.
I understand that when someone is frail and elderly you need to place them because you need immediate care. But from what you wrote it sounds like they are not delivering. A lot of these places have new hires after the Pandemic. There is no one to train them properly and they are run by a Board. There are signs on every street corner in my neighborhood for CNA, RN, LPN, etc. p/t, f/t with sign on bonus.
You need to contact a Social Worker and your mother's Primary Care doc and tell them what services you think your mother needs. You know your mother best. Don't let the Assisted Living be your mother's mouthpiece because it sounds like too much grass is growing under their feet. It's really not their role.
Remember, it's real estate, there is no assistance. These are (2) separate issues. It's up to you to bring in the medical services. Contact your mother's insurance company and sign up for the PCP portal so you can know what's going on and sit in on the assessment.
I rather tell you the truth because I have learned all of this over many years. You are paying for room and board and perhaps a nurse for too many residents. The fees can add up. For example I was told if they fill (10) or more prescriptions and dispense prescriptions, that would be $495 per month.
You probably felt a relief when your mother was placed but there are some loose ends. I hope this helped. A lot of it is probably what you didn't want to hear but I was surprised too to learn how little assistance is offered for that kind of $$$.
Knowledge is power and the Primary Care Doctor and Nurse Manager can guide you. You are in my prayers...
https://adsd.nv.gov/Programs/Seniors/LTCOmbudsman/LTCOmbudsProg/
Ombudsman Services:
Assist resident with concerns related to day-to-day care, health, safety, and personal preferences.
Provide information to the community regarding long term care in Nevada;
Provide education to residents, families, facility staff and others on a variety of issues related to aging, long term care and resident rights; and
Provide in-service training for long term care professionals regarding trends and best practices to improve the quality of care for residents
Who Can Make a Report to the Ombudsman Program?
All residents of long term care facilities;
Friends and relatives of persons living in long term care facilities;
Health care professionals; and
Long term care facility staff members.
*****************************************
In my service we work to a support plan, and I can't quite imagine how we would work without one - okay, we'd still look after people but there would be no consistency, no agreed standard, and no actual plan for each call. It would be chaos.
Speaking just for myself I often find that a support plan and the daily notes that depend on it are not necessarily as professional or as detailed or as accurate as might be ideal. But they're always (almost always) *there* (there was one occasion when there wasn't any plan or any client information, all we had was the name and address; but that was an urgent and very unusual situation which took three days to sort out).
This facility sounds as if it might be struggling. That's not necessarily a reason to move, but it's a very good reason to push constructively for this basic routine to be carried out properly.
So first question to ask, is your mom's AL actually Medicare and Medicaid qualified? IF NOT, then the AL is state regulated. ONLY Medicare and Medicaid qualified facilities [which may have AL wing but also have SNF (skilled nursing facility aka nursing home), Rehab (qualified Medicare Rehab - post acute care treatment), qualified Medicaid-covered long term and/or memory care] have a federal law requiring "a care plan" that is reviewed no less than every 90 days.
Those Medicare and Medicaid qualified facilities, also have a myriad of other requirements such so many RNs per patient load. And, in such facilities there would be a physician on-point for her care (could be a contract MD, rather than on staff but a physician you can speak with). And there would be a social worker assigned to her, a lead floor RN too; all of whom you should be able to contact and speak with about her care (not that you call them every day or week, but certainly more often when just arriving).
If you mom's AL is not Medicare/Medicaid approved then any "care plan" or "care plan meetings" may be required by state law, but each state is totally different. You may want to contact your Area Agency on Aging for assistant too or start with the Ombudsman as others have suggested. But if the AL is only state regulated, some states are a "hot mess" in how they regulate these facilities.
Good luck, this is not a fun journey.
I really can't tell you how many agencies, social workers etc etc I spoke with in the course of trying to find a safe place for my mother to be appropriately cared for. The circle kept coming back to the agencies providing therapies and caregiving on an hourly basis. I do think Covid has changed EVERYTHING. I couldn't even find a local caregiver support group which I wanted desperately just to try to find out how other people/families had dealt with these issues.
FWIW prior to each meeting I was asked what I wanted to discuss (personally I thought they asked so that the appropriate team members were available at the meeting) and I did not receive a written assessment or care plan although I made notes during each meeting. I also received calls from the nurses any time there was a change be it meds, diet, mobility and later a tumble and fall.
Oddly, I suspect the fact that I lived 500 miles away aided me. The team certainly gave me more latitude during the Covid visits than other families were offered but I was careful to never abuse the situation and by all standards Dad was a happy go lucky soul right up to the end, always with a kind word to the staff, a please, a thank you (not always the case with other residents so I heard).
Some people may think it was sucking up but in my mind the staff was caring for two of the most important people in my life so it was important to me to think of all of us as a team...my brothers and sisters in arms as I referred to them. Not sure if this helps but I'm wishing you the best.
By & large ime an AL does not do or provide staff for a detailed care plan. That level of care is done in a NH (& sometimes MC) and are required to do a care plan and do an initial one and thereafter every 90 days. It’s required as NH as they provide skilled nursing services and get paid in some way by Medicare (Medicare not Medicaid) for those services and there’s also a MD that is medical director of the NH services who also bills to Medicare. MediCARE requires care plans and there’s reporting forms that must be submitted to Medicare.
If she is in the usual AL, she is fully expected to be able to do the majority of her ADLs on her own and perhaps some with staff support. Like to help her do a back zipper or help her get into the van that takes them shopping. She should be able to transition herself from bed or chair to the bathroom on her own. She should be able to set her own clothes out, get dressed & down to the dining room at the appropriate time, dine & be civil. It’s unfortunate that a needs assessment wasn’t done on her in her old living environment ahead of ever moving into AL.
If she cannot then an AL can offer a list of services that staff can do for a resident and the AL can charge for those. Probably the most common is “medication management” so AL has an CNA come around with residents RXs and mini water bottles and oversees them taking their pills OR it’s done electronically from a central area at the AL which staff monitors. $300-$600 a mo fee added to their mo rent.
So right now if you were to go to the AL and spend the entire day, can your mom do what 90% of the other residents physically can do? Can your mom do mentally what 70-80% of the other residents can do? Like this could be getting up and dressed appropriately then off to the dining room or activities at the scheduled time; can recognize what a fire bell is and understand where to go to outside for a fire drill.
I’m going to guess that she cannot and if so, this is why you are not yet getting your calls & emails answered. That the AL is working up her assessment and it will be a timeline on all the inabilities she has and why she needs a higher level of care beyond what this AL can ever provide. AL will do a “we love your mom but….30 Day needs to move Notice”. Really, If you can easily see that your mom cannot so what the others do, be proactive in speaking with admissions as to what facilities other residents have moved to for MC or NH. If your mom needs to have her medical history beefed up to show she’s “at need” for skilled nursing care and mom doesn’t have a gerontologist ask the AL what docs their residents see. Should mom not have the $ to private pay for care, that means she will need to file for LTC Medicaid and by&large for most states that requires “at need” medically for skilled nursing care in a NH facility (rarely do AL participate in LTC Medicaid) and “at need” financially for whatever income / asset limits your States LTC Medicaid program has set. Tends to be 2k for assets & $2200 for income. Good luck in all this.
This facility has "houses" with 12 studio apartments per house and supposedly offers family style meals within each house. It seemed like a nice setting with more social opportunities than a group home but less overwhelming than the really large facilities that seemed more like big hotels. I would at least like her to be invited to go to meals and some planned social activities. Most often staff take her meals to her room which leaves her isolated in her room most of the time. She is capable of getting to the dining room herself but mealtimes aren't very regular. Census is WAY down apparently and there seem to be only 4-5 people in her house.
To me, your description sounds more like what I would think of as independent living. I visited some facilities that started pricing at that level and then increased the price for every minute of assistance needed, like med management added $500/mo. I guess that is common. I had to do a lot of digging to find the information but I believe an individual care plan is required for assisted living facilities in Nevada. I will be inquiring further about this with the administrator. I certainly want to know if her needs exceed their program and capabilities so I can start looking for a better placement if that is necessary.
If the Administrator is balks at the meeting your are requesting, you can always mention you are thinking of call the Nevada state Ombudsman's office (I assume they have one.......... I got so lost in the website.... I couldn't tell but I think that might be a requirement). That frequently works wonders in getting folks attention.
If that doesn't work.... you may want to consider moving your Mom to a different facility that is more responsive and that has more residents and possibly more staff. Be aware that staffing is an issue at most healthcare facilities post covid and that more residents unfortunately doesn't necessarily mean more staff.