WatchI don't get it. I've seen people who are normally rational just go nuts when it comes to their parent's rehab or long term care. Seriously, I've been yelled at, threatened, spit on, called a liar... People demand to speak with administration, swear at the floor staff, demand special treatment for their family members, and generally treat the staff like servants. People don't understand that the nurse that they're yelling at has no control over the system.
Last week I encountered a patient's daughter screaming at a nurse who was passing her medications - the daughter demanded that the doctor call her as soon as possible. Unfortunately, neither the nurse nor myself have any control over whether or not the doctor will return phone calls. I understand her frustration, but screaming at us didn't help at all. The only thing that it did was create drama - and that nurse told all the other nurses, who in turn will avoid this family like the plague.
The nursing home staff no control over the doctor's schedule. The doctor doesn't visit every day; in fact, he's required to visit monthly. The doctor doesn't usually return calls from the nursing home until later in the afternoon or evening, and it's usually only to the nursing home staff. They don't usually communicate with families, allowing instead for the nursing home staff to speak with family.
Every time the family goes nuts on the staff, each member demanding to be the contact - or fighting with each other in front of the patient - they create a barrier to effective communication with the patient & family. How about treating us with some respect?
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So, I stumbled upon the story of Zsa Zsa Gabor's daughter, who is fighting with her mother's husband. This is so common, it's a different day when there isn't a huge fight over a family member.
http://www.thedailybeast.com/blogs-and-stories/2011-05-17/zsa-zsa-gabor-frederic-von-anhalt-and-francesca-hilton-the-sad-battle/?cid=bsa:mostpopular1
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elliemae says
Treat them all as patients with multi-infarct dementia, and you'll be fine.
Hang in there, bb!
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I saw this at the nursing home (dementia unit) where my father spent his last months. I think it's because people are so conflicted about sending their relative to a nursing home instead of taking care of them at home. They want everything to be PERFECT so that they will feel better about it. But the staff is dealing with a situation that is far from perfect and a reality that is often not pretty.
Also, for many of these people, it is the first time in their lives they have ever "hired" someone to perform a service, and they are confused about what it means. They actually do think they have hired a set of personal servants who are there to do whatever they want.
It's no wonder there's a lot of staff turnover. Anyone working in that world is heroic.
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Susan, I've seen so many instances of families freaking out, yelling & screaming at staff. Threatening lawsuits, creating so many problems, etc. I know that it's not "nice" of me to think bad thoughts, but there are a few family members that I hope will rot in hell for the way they treated the patient, staff, and other family members.
One of the greatest tragedies is when there's a significant other - whether it be opposite or same sex - that the family shuts out of the patient's life completely. It's heartbreaking to see it happen.
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People don't ask themselves a simple question: Could I, as an amateur, do a better job of taking care for my parent than the professional caregiver? If the facility is any good at all, the answer is no.
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No, they don't ask this. They demand that their parent be changed immediately when their brief is dirtied. The problem with this is that sometimes the patient isn't done "going" (I'm trying to be gentle, here) and this means that the patient will be changed several times in an afternoon, rather than once.
My personal favorite is the family member who demands everyone be fired - I know one woman who is down to one staff member who is acceptable to the family. The patient will have to leave in order to find "acceptable" help.
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I can imagine working in a nursing home is a pretty tough job, especially for those that work with the more debilitated and demented patients.
I wish there was a way to get better communication from the doctors, though.
I know the computer system keeps track of all the medications dispensed. I wish they would just have a web system plus an email every time there was a change. That would be a good help, and would also lessen the need to burden the doctor,
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The families are unreasonable because they are grappling with guilt. These people typically didn't care for their parents for years, and now that their parents are near the end of their lives, they start to panic, feeling that they have lost the opportunity to redeem themselves. So they redeem themselves through nursing home, the more "demanding" they are of the nursing home workers, the more "caring" they feel they are towards their parents.
A bunch of losers.
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I simply don't understand one thing.
Why can't people just hire a sleep-in maid to take care of parents 24x7? Build a secondary residence in the backyard, and hire someone to be there the entire time. Isn't this better? That is what I plan to do.
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justme says
First, doctors aren't on staff at the nursing home. Nursing staff call the doc and request medication changes, fax labs to the doc, etc. It's up to the physician to make changes.
The pharmacy has a computerized system to fill medications - but it's not their responsibility to call families. All they do is fill scripts. The nursing home rarely has a computerized charting system - even though the trend is moving toward electronic charting, it's expensive and there's no one standard to meet. They don't interact from place to place.
There are so many entities that require charting information - referral sources such as home health, equipment companies, social service providers, labs, x-rays, dialysis clinics, consulting doctors, the VA, Medicaid, private medical clinics, hospitals, etc and the systems must be compatible. They're not.
Every patient has a different situation - some have family members, others don't. Some have multiple members and others have one designated person. Nursing homes try to contact family members, but it's not that easy. Especially when the nurse has 15 patients to care for.
Nursing homes don't have docs on staff. They're not in the facility - they are in their office and they call the nursing home. They are required to visit once a month, but normally the patient is transported to the doctor's office. Most people don't understand that.
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OO says
Many zoning ordinances won't allow for another unit in the backyard, CC&R's are restrictive too. Hiring a sleep-in maid to be there costs about $200/day. That's more expensive than a nursing home in many areas. That doesn't count the overhead such as social security, unemployment & workman's comp, taxes, etc. Most people can't afford this, which is why they send mom to a nursing home and apply for Medicaid. Even tho it's cheaper, Medicaid doesn't pay for in-home care.
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elliemae,
In the Bay Area lots of cities allow for secondary residence in the backyard, it is not a problem of all if the FAR is satisfied.
Well, going forward, Medicaid will be broke before Medicare, so I don't expect the nursing home on medicaid kind of gravy train to continue for much longer.
The live-in maid costs far less than $200/day. Among our circle of friends, a live-in maid (documented or undocumented) costs around $2200-3800 a month, everything inclusive. Those who don't drive and are undocumented can be had for about $1800-2200. Those who can drive cost a bit more, but definitely less than $4K. The nice thing about a live-in maid is, she can also cook and clean for the entire family.
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oo, the issue isn't a live-in maid. The issue is someone to watch a patient 24 hours a day, bathe them, feed them, change them and provide their medications. Take them to the doctor, help them get dressed, etc.
$2200 - $3800 a month isn't adequate to pay for this and the medications, etc. Also the medical treatments, including wound care and assessing for medical needs. We need healthcare reform, but a live-in maid isn't what's needed. When a patient can't speak and appears to be in pain, it's better that there's someone around who can treat them rather than to change their linens.
It's not a nursing home Medicaid gravy train - there are cheaper ways to provide some of the care, but medical care is still needed. I doubt Medicaid will go broke, but people eventually will be required to sell their houses if they're single. Families are already pissed off that they won't be inheriting mom's house (it's sold to pay medicaid back when they die), they'll be really pissed if it has to be sold up front.
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elliemae,
I am not saying that everyone should build a secondary residence and hire a live-in maid. But let me clarify, there are plenty of ex-nurses from developing countries that are willing to work at $3K a month as live-in maid. If I send my parents to nursing home, they will be sharing 1 nurse with other 9-14 patients, at my home, it is 1 nurse dedicating 24 hour care, period. Medicine is paid by Medicare regardless of whether they stay at home or with the nursing home.
Also, I can customize their residence completely to the standard, and frankly I have seen quite a few nursing homes that are rather filthy and sloppy. When a patient can't speak and is in pain, you believe a nurse who has to serve 14 other patients that can serve my parents' need better than me + 1 live-in maid with nursing training before? When my in-law is in rehab at a pretty upscale nursing home, I have seen what kind of "treatment" they can get, definitely not as good as what I can offer at home with 1:1 ratio.
It will be stupid for my parents to sell their assets and pay the inflated price at nursing home, because they won't qualify for the Medicaid. I would rather hire someone at $4K a month to be a full time nurse/chauffeur and cooks stuff exactly to their liking. It saves my parents' money, and serve their needs way better than a nursing home. But I realize this may not be for everyone.
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If you're there to oversee the care, that's great. Most people can't be there. If you can afford the cost, that's great. Most people can't afford the cost (many I've seen wouldn't want to even if they could); the situation that you're describing is ideal.
Medicine is paid via the Medicare Part D benefit, but co-pays and deductibles can be well over $1,000 per month. Especially for psychotropics, which often are necessary and aren't covered under Medicare.
You are correct in that nurses to patients in nursing homes are at a 1:10 ratio - personalized care is great. I wish that everyone could do this.
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OO, you may not have taken in the reality of what is meant by 24-hour care of a totally dependent elderly person. The fact that you think the person doing this could also cook and clean for the rest of the family tells me that you haven't actually tried to do this yourself. Try doing that for a couple of months and then re-think your plan.
24-hour care means 24-hour care. This is not "full time." This is three shifts a day, every day. Yes the person might be able to get a nap in now and then during this time, but it is not a schedule that can be held up by one person indefinitely.
After taking care of my elderly and invalid parents for a couple of years, I was in desperation and thought I would look into hiring enough staff to take over their care at home with my supervision. It was not feasible, though I did have one 8-hour shift of help per day. After my mother died, I re-evaluated the situation and decided it was time for my father to go to a nursing home dementia unit. That was more feasible than hiring 24-hour care at home.
And, as Jeff S said above, my father was actually better off in the unit with professional caregivers who were not at their wits end. I chose the nursing home very carefully after my two years of caregiving, and we were very fortunate in the choice.