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Once again I come to this forum for advice & validation (maybe). My 95-year-old dad is in the MC section of an AL due to vascular dementia.. There are no locks on the individual apartment doors, unless you ask for one. So up until recently the residents (mostly women) were allowed to roam around & would go into other apartments if the staff did not catch them first. My dad's apartment seemed to be particularly attractive &, when I visited, would have to redirect at least 1 "visitor". Also, I never saw anyone go into another's apartment except for his. Granted, I'm not there all the time. This activity causes him great distress. One time, a resident came in his apartment, had all his dresser drawers open & was rifling thru them. My husband was with my dad at the time, returning from getting him a haircut. Dad reported this to the staff with my husband present.


Now before anyone chastizes me, I truly understand these folks have a tendency to roam & do not know what they're doing. But I thought it was the staff's responsibility to watch for this & head it off at the pass. Again, risking getting scolded, I understand they can't catch them all the time


Last evening I got a call from the facility that dad had a fall & sustained a skin tear on his arm. What I was told was that one of the staff was heading towards dad's apartment &, apparently unknowingly, was followed by a resident who came in right behind the staff person, proceeded to push dad & he fell.


I was very upset & sent a complaint email to the director. I don't understand how a person can walk down a long hall & enter a room without knowing someone was following right behind. Dad is very frail, has fallen a few times, & has had minor skin tears. What bothered me the most was that he was pushed by someone who shouldn't have been there in the first place.


This is not the first problem I've had with this facility. There are other issues & the care is mediocre at best. I am tempted to move him to another facility but he would have to acclimate again & who knows if it would be any better?


Am I asking too much for the staff to do a better job of monitoring the residents? We did finally get a lock on his door & I think it's helped even though the staff have to lock & unlock. The incident happened after the lock was installed.

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My mother is in MC, as well.

I would be pretty angry if I were in your shoes.

I don’t know what the answer is, but I sure do understand where you’re coming from.
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The staff is probably overwhelmed; these facilities do have a pretty high turnover rate and it's hard to attract job seekers.

Was the person that pushed dad and were rifling through his drawers. women?
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nature73 Aug 2021
Dad is only one of 2 men in the unit.
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Move him. A good memory care knows how to handle this sort of thing, and clearly this place does not.

My mother's place only had locks on the closets, and I never, ever saw anyone wander into someone else's room. They were perfectly capable of monitoring residents who ambled off in the direction of the rooms and it was never an issue.

That people could repeatedly end up in your dad's room unchecked is disturbing, but if someone could walk in and assault him is a whole different level. Skin tears are terrible to deal with, and I'm sure you know the state of his thin skin will only worsen, so this isn't something you want to have to deal with beyond the day-to-day bumps he may get.

Your job is to protect his safety. It's the MC's job, too, but clearly they aren't up to it. I would move him.
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You’re not asking too much. If decent solutions don’t happen soon, I’d look into moving him
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This would never be tolerated in my LO’s MC.

Please don’t be concerned about being “chastised” when addressing such a reasonable concern.

In your situation, I’d be taking tours of other facilities and including “privacy rights” as a potential question to ask social services and administrative personnel before considering choosing to move him.

Hoping for the best for you both.
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I would be asking what the facility is planning on doing to 1) deal with the aggressive other resident and 2) how do they plan on protecting your dad from aggressive residents and careless employees.

Your dad has a right to be protected and they are failing miserably, you should file a complaint with Medicare. This will get changes.

I would be looking for a new facility that actually cares about their residents.
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I wouldn't jump the gun, here. How long has your dad been in this facility? Where exactly do you find a facility that actually cares about the residents, and how would you determine that they do care? Unless you as the caregiver spend a week living in a facility, you won't know what care your LO will get. You do the best you can in screening facilities, then you place your trust in the staff. I guess the best way to place a LO is by referrals from the families of current residents.

I do not recommend a lock on his door. If only the staff can lock and unlock his door, how would he react if he wants to leave his room but can't open the door? This could be frightening for him and cause him major anxiety. If the door is locked so others can't get in, neither can he. Who keeps the key to his room and where is it kept? Is it readily accessible in the case of a fire? Would moving him to a different room help?

I'm not saying don't move him, that's your decision, but you don't want to move him from the frying pan into the fire. And, yes, dementia patients do roam from room to room because they don't know their room from any other. Nor do they even know their own clothes from someone else's. I once opened the closet door of my wife's MC room to get some clothes for her, and found Jimmy, another resident, in the closet with the door closed! Scared the livin' dickens out of me.

So at this point I wouldn't move your dad. I would continue to speak to the director about recurring problems and see if the problems correct themselves. You may eventually decide that moving him is in HIS best interest... not yours.
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nature73 Aug 2021
He's been in the facility for almost 2 years. The lock is in the door handle & opens easily from the inside by turning the handle. When outside & the door is locked, a staff member has to open it. He is not the only one with a lock.

I agree that moving him may not solve the problem, but I'm upset that watching & protecting the residents doesn't seem to be as much of a concern. If you were scared then imagine this happening on a regular basis! Also, I was told that other apartments in the MC area are spoken for so moving to a different one is not possible.
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You are right to be concerned although I have to tell you-- the gentlemen in MC/AL and NH are kind of "hot commodities" . The ladies do like to be near them even if only to just look. Most facilities are for-profits and pay low wages and overwork their staff (I know one kitchen aide who worked 3 straight shifts because of call outs and she had to even cook breakfast because the cook called out!) -- put a pandemic in the mix and they are probably even more understaffed than usual. I would definitely write (you want documentation) to the Director and the DON and perhaps also to the state Ombudsman's office. BTW, was the resident who pushed Dad male or female. We had a female dementia resident who was a former dancer. That woman could sneak up on a snake! She became your shadow. We had to double secure her unit. Once we figured her out, it was good until.... we would have a new nurse or CNA in to cover!
And I would start researching other facilities also (I think it always good to keep up to date on facilities even when you are happy with the one you are using). Just keep in mind that in any facility as the demographics of the population change the behavior of the group may change for a while. You could move into a great place with no issues and then have a new resident come in and that might affect someone into have issues or behavior problems that would need to be sorted out and addressed.
One thing is for certain... this role for loving caregiver/advocate is not for the faint of heart. I wish you peace and good luck on your journey. Let us know how it develops for you.
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nature73 Aug 2021
Thank-you for your kind words. The person who pushed him WAS female, & I'm told, is fond of Dad usually. There are only 2 men at present in the unit so they are quite popular.
I have researched other facilities & continue to return to them for repeat assessments. And I know you "can put lipstick on a pig" & make the environment look good. Yes, staffing changes all the time. It's a crap shoot. Just FYI: this facility went thru 3 nursing directors within 8 months, primarily due to poor management decisions. Things seem to have settled down a bit in terms of that.
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Door locks are totally required in Memory Care ALFs, I don't care what anybody has to say on the subject that's contrary. Naturally the resident isn't 'locked into his room'.........other's are locked OUT of his room! And for obvious reasons; privacy is a must and nobody has 'the right' to enter another resident's room and go rifling through his belongings, PERIOD.

That said, controlling a resident's behavior who suffers from dementia is nearly impossible. Even if a resident was following a caregiver, how would she know that the resident was going to push your father down the way she did? Such forethought or knowledge that the resident was even following the CG is expecting a bit too much, IMO. In my mother's MC, there was a resident named Denny who loved to hang around my mother's door, knock on it, jiggle the handle, that kind of thing. My mother decided he was 'dangerous' and going to 'punch her' or 'harm her' in some way, in spite of the fact that he had never displayed violent behavior in the past. So she had a meltdown (a big one) every time he even approached her or her suite door. She'd be screaming & carrying on for 'help' from the staff, or calling me on the phone screaming & carrying on, if Denny as much as touched her LOCKED suite door. Was it his fault that my mother was upset? Did he have as much right to live in the AL as she did? There's two sides to every coin and there's only SO much the AL can do when there are many demented residents all carrying on about something at various times. That's not to say your father is 'wrong' and the other resident is 'right'; of course she shouldn't have pushed him. And of course the CG should have stopped the altercation from happening. But in reality, lots of incidents DO happen in a Memory Care environment.

When I worked in a MC ALF a while back, we had a resident grab a hearing aid out of another resident's hand and EAT it. True story. Chewed it up into oblivion, she did, and that was the end of the other woman's hearing aid. Such is the nature of dementia and the atmosphere that prevails in the MCs from time to time.

My mother complains that the ladies all 'fight' like crazy all day long. So I tell her to go into her suite and turn the tv on when there's fighting going on. Will she do it? Nope. She's right there in the thick of it all, then calling me to complain about it later on.

You can't fix any of this. It goes on all over in MCs. It's good you got a lock for dad's door; that will help with a lot of the chaos and others entering his room willy-nilly. When Denny was bothering my mother, I had a chat with the ED who pushed a big easy chair in front of her door to dissuade him from going near it. Denny was wheelchair bound and could only get SO close to her door; the chair prevented him from doing so. But he moved on to someone else's door so who knows what came of that? But he passed away a few months ago & my mother moved on to someone else she 'can't stand' to complain about.

Call the ED and express your concerns & the two of you may be able to come up with a plan of action to address them. Before you move him, know that issues abound at ALL these places; it's the nature of dementia in reality, more than anything else. I've seen the CGs at my mom's place kiss her on the forehead & treat her with true caring and affection. It's NOT that they don't care; they just don't have eyes in back of their heads or 6 sets of arms and legs to handle all the chaos that's thrown at them sometimes. The best thing YOU can do is make your presence and your wishes known to the staff as well as your appreciation for all their efforts on your behalf. A little gratitude goes a long way.

Best of luck
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nature73 Aug 2021
Thanks - I realize that they are short-staffed & I always express my appreciation. Until this incident happened, I thought they did pretty well. I guess I thought that since wandering is a common behavior, they would pay more attention to that.
Another concern is that there are no regularly scheduled care meetings with family & staff. I have to ask for them (which I have). In other facilities in the area, this is a routine part of their services.
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Glad to hear your dad has a lock on his room, especially since having others in his room is distressing to him.

Since your dad is frail and prone to fall, does he have a walker? Will he use a walker? So many folks with balance and mobility problems find a walker helps prevent falls.

As for the person who pushed your father, talk to the administration about what they are doing to safeguard your dad from repeat incidents. It may be that the other person may need an adjustment in his/her medications or a short trip to an inpatient psych unit for behavior modification. If they can outline the changes they are making and they seem reasonable, take a wait and see approach. If your father has more incidents - 2 would be my guess in a short period of time since I tend to be more forgiving of staff efforts - then it might be worth looking into another placement.
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To be perfectly blunt, if you think any memory care has enough employees to monitor the wandering of the residents you need to spend more time at the facility. Not only can they not control wandering but with the industry standard of 2 employees and 1 med tech per 20 residents, what kind of care and supervision do you think is happening. Everyone with loved ones in these facilities needs a wake up call as to what is actually provided at these facilities vs what the facilities promise they are providing. If your loved one is in memory care there is a 99% chance they never even get their teeth brushed even if the "care log" says they do. I have a camera 24/7 in a high end facility and I see exactly what goes on. I finally pulled her out and have her receiving home care but cannot sustain it financially. I am stuck because it is not an isolated issue, all of the memory care facilities are run the same way. If families to not demand better care and believe the unrealistic promises from the directors and staff, the system will never change.
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Daughterof1930 Aug 2021
Enjoy painting with a very broad brush? Please don’t categorize anything or anywhere all into one bucket. Memory care places like all others vary, they are not all the same
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Boy this is annoying! But I imagine there is really not an awful lot to be done about it all. This wandering and entering others rooms and going through their stuff is VERY common. When you have a bunch of people the qualify for MC, some odd things are bound to happen.

There will never be enough staff to ensure things like this don't happen.

Was a lock on the door an option from the beginning? I guess this is the best solution since who wants other patients entering whenever they feel like it? No thanks.

Ask around re the reputation of this place. If it's average or above, leave him. If it's known to be one of the crappier places, maybe move him. Yes, he'd have to adjust, but so be it.
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My mother was recently in the memory care unit of her nursing home. There was one man who walked all day long up and down the hallways trying doors and if one was open would let himself in. I think it was because he couldn’t find his room, all the hallways and doors looked identical. It was a locked unit so he could not escape outside but he was always trying to get out the main exit too. The staff just let him wander all day. Several times when I was there he came into my mothers room and went into the bathroom and shut the door. I had to call staff to get him out. He was belligerent and argumentative and if you get too close to him physically aggressive. There were locks on the individual doors so I kept my mothers room locked as did many of the local residents. But a lot of them were unlocked and he would just go right in. In my opinion he should have been monitored more closely by the nursing staff but they just did not do that. This was a very high end, expensive, and very nice nursing facility. Like all, understaffed. I was only allowed to be inside because my mother was in the active dying stage and being treated in hospice. Who knows what went on during all those months and months when we were unable to visit.

I disagree with one of the comments where someone said the ladies appreciate attention from men. Dementia patients are confused and afraid of everyone and everything and should not be subject to wandering patients of any gender.
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Frances73 Aug 2021
My uncle was like that. He had Lewy Body Syndrome and would pace the hallways all day and night. The only solution was medication.
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Dear Nature,
At the Veterans Care facility where my father is in a dementia ward, the staff hangs a cloth across the door entrance. The door frame is metal. The cloth has magnets in each corner, total dimension maybe 36” x 36”.
When the door is left open, this cloth can be hung up to deter residents from entering. Maybe this is just enough of a deterrent to keep wanderers from entering?

Dawn
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Mjlarkan Aug 2021
That sounds like a fall hazard.
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Please watch the fabulous documentary The Mole Agent. It’s a foreign film made in a hike I believe.
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My Mom is in MC and if I was in your boat I’d ask for a care meeting and go from there? Identify the pusher and maybe more eyes can be kept on that person in particular? I’m sure that MC doesn’t want one resident pushing over the others, Meanwhile look into other facilities for reference? Of course everything and everybody is moving parts and all it takes is one bad person to come in...Somewhere among the ideas there’s the least bad option for this situation...maybe start feeling them out...?

And this might not be feasible, but for my mom I hired a sitter. Had to. Not cheap but in mom’s case I’m spending down her own money for her own care. These caregiving ladies are SAINTS and the double advantage I just realized is they can ward off intruders...or keep my mom from being an intruder! If this is an option maybe there’s a possibility of a few hours a week of sitting, get some peace of mind? I’m just thinking ‘out loud’ here...

Side note yes an entire ARMY of personnel isn’t enough to take care of my mom, I had to hire a care manager and one on one sitters 7 days a week. Her energy is that overpowering. When people think I can just take her to my place and care for her on my own I could scream. I visited mom yesterday ( which also gave the sitter a break! ) and didn’t want to use the restroom for fear she’d get up and do who knows what. So much in flux...

I hope you find a workable solution, wishing you the best!
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nature73: Imho, "the incident happened after the lock was installed" is very telling. My goodness!
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I had an aunt in a MC facilty. The only difference I saw between it and assisted-living was a locked the front door! People wandered into her room daily and rifled through her things. One gentleman kept coming into her room and trying to get into the bed with her early in the mornings! She punched him at least once that I’m aware of. She had her pet poodle there at the facility and one woman was constantly trying to take him from her. The woman even pushed her down one time fighting over the dog. I finally took the dog home with me.

this was a Brookdale facility.
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You definitely need better care for your dad. This seems like total neglect. This is the main reason why we need a better system to keep people at home with help. There is no way you can supervise nursing home care from outside. At home is much better.
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I have heard a suggestion to put a black mat at the door. People perceive it as a hole and will be stopped.

No facility has the staff to watch every resident 24/7. As a benchmark Mom's facility encouraged all the residents to remain in the large common area rather than their rooms. That way they were more socialized and the staff could keep an eye on everyone more easily.

Also they had sensors on the room doors that rang into a monitoring system at the nurses station. If they didn’t see that the whoever had entered had left within a few minutes someone went to check. This was especially useful at night to monitor both the staff and residents.

I do think you should pursue moving him to a different facility. I have found that smaller, local companies are much better at retaining staff than larger national or regional companies with a remote corporate office. The first AL Mom was in didn’t even have a phone number for the corporate office listed on their website! I only found that out when I needed to talk to a higher up after both the director and nursing supervisor quit.
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I was in an Embassy nursing home for two months. The first two weeks I was in a room close to the Memory Care unit. People came into my room day and night. It was horrible. They took things - snacks, clothing, books, etc. I reported and there was little change. Some man came and got in my bed at 2 am. I called the police. He was grabbing at my nightgown. Police came and escorted him back to his room. His family threw a fit because I called the police. The NH moved me to a different wing which had no access for MC residents. It was a horrible experience with the MC patients.
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Bridger that is horrible!! Both my Dad's and MIL's MC were locked down units,, they could not get out to wander about and get into trouble. I am betting that having the police arrive may help clear this mess up! I hope the family didn't blame you,, but instead the NH that allowed this to happen.
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I don't know - they cannot be in every room every hour of every day. BUT they should know who the wanderers are and for their own safety they should be in locked rooms - if they can get into your father's room they can get all over the place where they may put themselves in danger.
It is beyond me that these places do not have a supervision desk where they have cameras on all public areas and one person on duty to watch what is going on - it must be easier to monitor this way than for staff to hope to catch when someone is out and about, or had a fall whilst walking etc.
If you are thinking of moving your father is he capable of having a conversation on this? Otherwise if the lock on his door solves the problem perhaps a move would be very unsettling. To me it seems wrong to have to lock the "innocent" parties in their rooms but maybe I am very naiive as to these facilities - I would expect the wanderers to be the ones restrained.
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