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Archive: What's Your
Question About Nursing Homes? Question: My mother is very particular. We've always had to do things just right to keep her happy. Now she's at the nursing home. How can I get them to do things the way she likes them done? Answer: Well, you can and you can't. Nursing homes are required to "make reasonable accommodations" for a resident's preferences. However, it is inevitable that when someone moves into a group setting, life changes. You and your mother should discuss her preferences with the staff when you attend her care plan meeting. They should work with her to honor her choices and preferences to the extent possible. But, if she is used to tea at exactly 2:30 each afternoon, it probably won't happen right then. If she likes to sleep until 11:00 and then have coffee and a piece of toast instead of breakfast and lunch, they should be able to make that happen. For your mother, it may be a matter of choosing which parts of her routine she really wants to keep, and which parts she will have to let go as a result of living with 99 other people. A few nursing homes are really trying to change their "culture". The kinds of things your mom wants are the kinds of things that make a nursing home more "home". Perhaps you and other families can work with your administrator to try some of the new "culture change" concepts which really forward thinking providers are doing.
Question: The staff at dad's nursing home keep forgetting to do things for him that he needs–things like putting his foot up on a footstool and keeping his warm sweater on him. I want to put notes up on the walls to remind them but the social worker always takes them down. What's going on? Answer: This is a dignity issue, from the perspective of the social worker. The regulations that govern nursing homes stress that each resident is to be treated with dignity and respect. Putting signs up is viewed as a violation of privacy. Try this. Go to the Director of Nursing and discuss your problem. Tell her that your dad's foot needs to be elevated but that the nursing assistants seem to forget to do this. Tell her that your dad is cold and that his warm sweater makes a big difference in his comfort. Give her a few days to get the problem under control. If things are still not going well, check back in with her. Usually this will solve a problem. If it doesn't, you can go to the administrator or the facility ombudsman. It may be that the problem with your dad's foot is forgetful staff or, it may be that your dad himself doesn't want his foot raised or the sweater on. Your ombudsman can help you explore the situation. But, bottom line: the notes will have to go. It's just too invasive of your dad's privacy.
Question: Well, I think you're wrong! The staff keeps changing and there isn't enough help on the weekends. If I don't put notes up I just know my father won't be taken care of. Don't you agree? Answer: Yes. Staff changes; weekends can be a real problem; agency staff doesn't know your dad and his preferences. This is one of those things where families and advocates just have to keep plugging away. The problem of inadequate, changing, and unskillful staff is a very serious one. It won't get fixed quickly. You need to continue to ask the facility to care for your father in the appropriate manner. Specifically, document when the care is not done or not done right. Keep track of days, times, staff involved. Show your notes to the administrator and talk with her about your concerns. Be specific. Be polite. Be firm. Be persistent. If you still don't get results, it may be time to take your concerns higher. Everyone has a supervisor and if you don't get satisfaction at one level, go to the next. You can also report your concerns to the Office of Inspector General at 502/564-7963 x3292.
Question: It's not my job to monitor the staff. It's theirs! Answer: I couldn't agree more but focus on your dad. Sometimes we just have to work on a problem from whatever direction that can get it fixed. And it's easier to fix a problem that is specifically spelled out and not generalized.
This Column is presented as a public service of the Nursing Home Ombudsman Agency of the Bluegrass. If you have a question, send it to Kathy Gannoe, NHOA, 1530 Nicholasville Rd., Lexington, KY, 40503.
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