Can the nursing home have a planning meeting without the family?

To daughterlu - those stinkweeds at the nursing home are harrassing you because you made a stink about how your mother was being treated - I would have refused to pay them plus put the head nurse on disciplinary action or have her fired!

My Mom is in an "intermediate care nursing facility" and I've found there can be issues with communication (between their staff and with their staff and myself), and "care conferences" are sort of a rubber-stamped requirement unless you do attend. I have POA, and get memos of planned meetings, but as they're usually on a day/time I have a problem with, sometimes I can't attend ("We only set these up on Wednesdays") As far as Medicaid not paying for Assisted Living facilities? I know at least in my state (Oregon), when Mom was briefly in an Assisted Living apartment, at that time "private pay", they said they would actually help with the paperwork/processing for Medicaid when her finances ran out... Their requirement was, though, that she had to be there as "private pay" for several months before going on Medicaid. They don't accept Medicaid residents directly... I don't know how Medicaid treats the private room/double with roommate situation here. Mom has been in a "shared" room because while private pay it was a lot less expensive and I was trying to conserve her money (don't know why I bothered, though, because it only drew out the time before her savings were "spent down" to qualify her for Medicaid. I only delayed the inevitable, and she could have been happier in a single room...). Now that she is on Medicaid, and is in a double room, she has been moved several times into different rooms or with different roommates. I did have input into that, and wouldn't be shy about protesting an incompatible placement. Her roommate in the first room they gave her was supposed to have a double "cheaper" room, but had found that if she was nasty and really unpleasant, her new roommates were quickly moved out and she was back to private - WITCH! No one has to put up with being sworn and yelled at! After that, she had a roommate who refused to let her out of the room (her section was behind the roommate's - poorly set up rooms! - and the roommate resented/got tired of having to accommodate Mom disturbing her as she passed directly by her bed to go out.) Mom told me she was being nasty, and had called Mom a liar (not something you accuse of my Mom!) I thought she was exaggerating - Mom's gotten a little "vague" sometimes - but then a resident across the hall took me aside and told me Mom was being abused. I talked to management and told them they needed to correct the situation... A week later, the same resident told me Mom's roommate was still yelling at her, blocking her in the room, and had now added whacking her on the back with a wooden backscratcher. I told Management at that point that they had to remove that roommate or I would turn them in to the Elder Protective division of the County. She was moved the next day... Her roommate now is a quiet little woman who is pretty much bedridden, and for whom Mom feels sorry. Lately, our worst problems are laundry issues! And that's obviously another subject for somewhere else...

You and the patient should have been included in this meeting.

... Houseplant, then perhaps when you begin your comments that sound as if you are offering advice on "fact, then be careful enough to offer the State in which you reside as to not misrepresent all states by your comment.

The nursing home was definitely in the wrong on this one, they overstepped their bounds raise and you probably should get a lawyer. They should've included you as the guardian in that meeting

They are required to notify you of the meeting. They may have sent a letter or made a phone call. Often times families, powers of attorney or guardians do not show for these meetings. The facility just has to prove that they did attempt to contact you for the meeting. They cannot make any decisions on your loved ones behalf but they can't hold care conferences without you in attendance as long as they notified you of date and time. You don't physically have to attend. You can phone conference in. They do need consent to move rooms. It sounds like your loved on has plateaud on rehab and at their current level are requiring long term care. You don't have to keep them at that facility, however, if your loved one is comfortable and happy their it's easier on the resident to not have to completely change facilities.

God Bless you efforts. If I had all this information at the time Mothers Care was taken over by her rogue Independent Living Facility things might have worked out better for my Mother. Mother was Subject to a "Care Plan" against my Mother's wishes, against my objections and against her Doctors orders. I was there for her first "Care" meeting with the Administrator and 6 staff people. She was injured in the first implementation of their plan which started with an assessment of Mother's range of Motion by P.T. She was injured in her right shoulder and her right lower rib area. I was interrogated for a day and a half and my attempted negotiations were mocked/ignored. Mother showered herself the morning before St. Patrick's Day, 2016. She had a lot of pain. We were waiting to get the results of the xrays from the night before. She was exhausted and the staff and Nurses Ads agreed to a sponge bath in bed instead of a shower that afternoon - two Nurses Aids from the "Care Program" gave her another shower in the afternoon after defiantly giving her a shower when she was sick in bed and did not need a shower. Mother did not want them showering her. She has a right to refuse treatment. We were harassed for a full 1 1/2 days before her fall that left her unconscious on the floor on St. Patricks Day at 4:00 am. I found her when I got up that night. She was taken to the hospital followed by another injury in their Observation Room where I was not permitted to stay overnight based on a phoney call by a Nurse saying she was from the Facility when she was not ( there is a Nurse by that name on the internet from a Hospice), and that the Facility suspected abuse. ( a state agency found that Mother and I have a great Mother Daughter relationship). It gave the facility a hook into the family. Further I was not permitted to stay overnight with Mother in Observation the first night at the hospital because of this allegation. After Mother fell and broke her nose the I was permitted to stay overnight but was not permitted to take Mother to another facility for her Health Care follow-up upon dismissal. Back at the "Rogue" facility the Doctor assigned to Mother in Health Care did not see her during her entire stay and as her cough got worse and worse the Nurses refused to call him as she was not showing "the signs" per the Nurses. I started calling his office and was told not to call there anymore. Mother had developed pnemonia and she was going without even a Dr. visit, antibiotics, etc. A kindly Nurses Aid brought the thermometer when I told her Mothers forehead got very hot. I think she was terminated after that because when I went back to thank her, she was not there and no information was offered. After calling 911, Mother spent 5 days in the hospital being treated for pnemonia. I stayed with her 24 x 7. We went back to her Independent Living apartment. Sparing you more details after 3 months she could use her walker to the elevator and back (100 yards each way) and she could Independently shower and go and do the following: 1.) go to the Deli in the basement; 2.) go to the Library on the first floor; 3.) walk around the apartment, use the bathroom, put on her make-up and completely feed herself. Skipping some details of more negligence, she was forced to give up her Independent Living apartment where I could stay with her 24 x 7. She was forced moved to Personal Care (based upon threats and a lie). Mother and I went the hospital where the emergency room DR. stated in her notes that Mother was fine and that she did not need to go to Health Care, further that she could go back to her Independent Living Apartment. I was not permitted to stay overnights with Mother even though she needed 24 x 7 care. Further, Mother had been paying an extra $1,000 per month insurance to the facility for 15 years in the event she needed round the clock care. They refused. They also insisted the floor Nurse and the Floor Nusres Aids could manage her care without me. The Floor Nurses Aids would bring her back from breakfast and place her in front of the TV in her wheelchair. Staffing knew that she could not get out of the wheelchair herself, she could not push the button around her neck for help. She had no balance, couldn't get to bed or go to the toilet herself. She had 3 or more bad falls, it left her disoriented. I started off staying with her 16 hours a day and we paid for private Duty Nurses Aids at $25.00 per hour. x 8 hours. The insurance that should have covered her for 24 x 7 Care per year would be over $200,000.00 per year. We stopped the overnight N.A.'s. after a few months. Her hospital bed was put down to the floor so she could not get out of bed on her own. Still she was found on the floor, several times trying to get up and go to the bathroom. Mother's Glaucoma became severe, she was experiencing visual hallucinations due to improper administration of eyedrops by the floor Nursing staff, i.e., being out of prescriptions, failure to use as directed, daily missing 1 or 2 dosages per day for 3 months before being discovered. All the while I was personally harassed by the staff as I made complaints. She was also subject to improper advances by the maintenance man. I even cried and blurted out at their Caregivers Support Group messy details upon coaxing. I called about 3 or 4 agencies with "complaints." In retaliation they cut my hours down to 5 days a week x 4 hours a day. I was personally harassed and my reputation besmirked. The dining room was very bad. I was told they didn't want to serve me, that I was a trouble maker and an instigator. I was blamed for things that had a place or time correct but nothing else, lies, lies and more lies. The staff supported each others lies when confronted. My son filled in some hours with Mother and I prayed each day and night that she would be safe until we could get her out of there. She is in a much better facility. She is making improvement. Her eyes have stabilized but still her condition is severe. It has become evident that the rogue facility has a Medicaid resident type handbook for a Private Pay Facility. I did not sign their Admissions contract for Personal Care. Back in July of 2016, they put me thru 2 1/2 days of badgering me to sign it. It never touched my hands. I asked to take it to an attorney before I signed it. I am Mothers POA of Health Care. Looking back I should have sent them e-mails or certified letters so I had more proof that they had Notice of each and every issue. When in doubt send them a written letter of e-mail and have proof that you sent the same. It might get them on the ball. Look at other places. A move might be the answer.

Tired 104 - In our state the waiver program serves those capable of remaining in the community, instead of a snf. In our state the waiver remains in effect if the patient is admitted from a community setting to a hospital short term. The state's objective is to save money by keeping people out of snf for as long as possible. If someone has been a Waiver for a long period of time, that may also follow to the nursing home. Waivers do not pay for private or assisted care in our state. Your state may be different.
Either way, families need to be included on care plan meetings and facilities are required to notify patient/resident, family, guardians. If onlyacaregiver found out about the meeting after-the-fact it is unacceptable and needs to be brought to the nursing home's attention.
My spouse was admitted under the snf Medicaid, not the Waiver, standards.
We had the choice of a private pay or public pay room, contingent upon our abilty to pay the bill. If the patient is admitted as a "private pay" he/she is paying the bill through his/her own assets. During the private pay months the patient gets a private room.
Once Medicaid starts paying the bill, there is no choice about roommates, what room or wing. I was told if patient/family wants they can choose a different facility. That is the extent of control the patient & family have if snf Medicaid is paying the bill where we live.

So if the patient can receive a less intense, less restrictive level of care within a family or community based residence, it is available to some under a narrowly defined group of people. Very few are eligible for Waiver services/placement. In our state there is even a separate Waiver for children who sustain certain injuries that require lifelong care.

If I could manage 7/24 all his meds, immobility, renovate parts of our condo we may be able to get a "home instead" senior waiver program. It's a limited number of hours per week for at-home assistance.

Medicaid does not get involved in any Assisted Living as that is all private pay.They typically have physical and/or mental limitations. Mobility is a common need. Lots of canes and walkers. They may need help with managing finances since they may forget to write the check or start giving away money. They may not be taking meds as prescribed. Most can no longer drive safely. They require help sort of like families provided Grandma or Grandpa in the earlier days. Those in Assisted Living have assets and/or insurances to pay the bill. They either have no family available to help or they refuse to allow such help from family.
My spouse was transferred direct from acute care hospital to a rehab setting within the 100 day limit.
My spouse has never been a Medicaid Waiver patient. He is straight Medicaid and the state pays. In our state a waiver is not offered to those in my husband's situation. On day 101 when all private insurances stop covering these items, a private pay room is available ONLY if we can afford.

Nursing Home Medicaid now controls. The is no choice in the room, who he rooms with, or the wing he is assigned to. Family can choose from among available facilities that are Medicare/Medicaid certified and deemed appropriate for the level of care needed by our loved ones.
In fact the facility he's at has a short-term 7/24 rehab, a long-term residential,custodial, and an Alzheimer and behavioral wing.
Any level of care available to my spouse is either for private pay or public pay. Since the state is public pay, the state will only pay the cost of a 2 person per room plan. The facility decides what room/wing to place the patient in.
Families can request room changes. If granted, it is to a room/roommate the facility deems suitable. Now, if we could afford Private pay he would not have to put up with a roommate who sometimes yells out. (His roommate can't talk after having a stroke).
If the facility does not notify families or guardians of changes and meetings something is very wrong, regardless of payment source or who controls.

Interesting comment - thanks! How we handle such actions is so much our dilemma today!

I've been so grateful for the one-floor facility's care over many years, I try to speak up, speak out, and not ask for consequences, for what you get with change can be worse than what you had!

I did speak with the long time lead manager of the facility once about that head RN - and found it interesting that she valued the RN, for being so clear and organized and focused in her supervision of paperwork, and for her ability to stand up to even the MDs to make sure information was exchanged on time, and I saw in that woman's mind, this was a special gift that made their lives easier.

I live in a different state, and I was not ready to find a replacement person or to do the job myself - and I've watched over time, much kindness, and noted how some kind helpers, were less aware of administrative clarity.

So I felt satisfied when I told that RN that I thought her plan was reckless and would damage plans that worked well now, for all the parties - she was fine hearing that, and backed down.

She's still the head, and she doesn't always understand what she's supposed to learn from me, but we communicated well over some paperwork and she has learned that even if it talk a lot more than she likes, that I do care and do pay attention to all the needs. She does let her underlings communicate with me, and honors what we decide, so overall, there's a stability, that can be shaken more than intended, when laws and consequences are brought in too quickly -

The system is not set up to take advice from a family member, there are no processes in place.

I tried to get their kitchen to monitor his food and give him smaller portions, non sugar desserts and snacks, but all the laws were written to protect the vulnerable from the one lawsuit that WAS filed in the past: protect them from being deprived of food.

So later, when my brother needed help in the opposite protection, help came, then nobody was set up to carry the plan through over time. I've seen a few others like him in nursing homes, one 40 yr old died, bed ridden, at over 300 lbs - my brother has now put on 40 lbs and "obesity" is in his MD's chart.

But he is used to their staff, some great volunteers, and the facility has noted and helped him through several medical issues, has made special plans to transport him places and prepare him for regular transport to his Brain Injury program.

I know the work of many of the staff - (many quit because of said Head RN) but the program goes on, Head RN kept the facility clean, running well - though i think, much too often with an attitude of rushing.)!

I would have seen to it that the head RN either be put on disciplinary action or fired; you were very happy with your brother's current arrangement

I've had similar situations at times because I'm my brother's Healthcare POA, not guardian - but because I helped him over his adult life, and chose that nursing home for him, because of its physical layout and location on flat ground - they all know that I expect to be involved. I get notices for all the planning meetings - and if I was not informed of something, I call up and ask to speak to the head honcho, and tell them they need to involve me, not separate me and my brother - that does not help him, and my input is helpful and respectful to them, but it is informed and my brother counts on it.

I've done it so many times, they know. And once the head RN planned to change his room, and also that of 3 other patients in order to do it, she said the new room was better for his mobility issues - I said that is crazy, his current setup was fine, small bathroom, and changing the rooms would upset him and everyone, for it takes time for anyone with cognitive or mobility issues to re-learn paths to the bathroom, etc. I got all the information, and said "no" to the plan and was vocal about it, and it never happened. Later when I visited the facility and looked at the different bathroom, I saw it had all kinds of mobility risks that she had not seen. Professionals often make decisions based on one fragment that they are focused on, ignoring others.

I do otherwise show my cooperation, and feel it is fine for me to object or criticize them, if I do it directly and openly, then we can resolve issues.

You're her legal guardian. They should have included you. As a matter of fact, any decisions by them, should be run by you first. If you also hold a medical power of attorney, they have to get your permission to do anything, like feeding tubes  or other life saving measures. I agree that you must see the Administrator and Director of Admissions asap. Good luck and best wishes for you and your Mom and family

onlyacaregiver, not only does every state have its own regulations, but so does every facility. Some facilities do have medicaid single rooms, the majority do not. The facility should notify you of any changes but a care conference or care plan meeting doesn't necessarily need to occur. Some facilities I have worked seemed to change resident's rooms as often as the resident's briefs but it wasn't at a care conference. I would talk to the administrator as well to explain the change. Was the short term a respite unit or rehab?

… House plant number 102, I must correct your information, it is not actually accurate… Facilities operate differently. If someone is a Medicaid Medicare waiver program recipient rather than private pay, that does not mean they are only eligible for a shared space. There are many facilities across United States and in every state that offer Medicaid Medicare waiver program within nursing home rooms and assisted living as single occupancy units. 

There are Federal regulations governing the requirement for the guardian to be notified of anything that affects the resident. I agree with those above, call the State Ombudsman for the facility, talk to the Director of the facility not just the Director of Nursing (the facility Social Worker assigned to your mother should have been the person to notify you of the meeting and make it clear that you are aware of your rights as the guardian for your mother (you can read the Federal regulations online). You can even review the Medicare ratings for care for this particular nursing home online. It is all public information.

They didn't mail you a notification of time/place of meeting? Unless she's private pay, she will be moved in with a stranger. It's two persons/two beds per room. If she started as a private pay, she should have had her own room the entire days in which she was paying the full per day rate. If she starts as, or later becomes Medicaid funded, she is only eligible for a two person per room plan. You should have had the option of either signing/approving the two per room arrangement or rejecting and signing her out of the snf. That would still leave you having to place her elsewhere under a 2 person/room arrangement.

They should not!!You have rights !Contact the Nursing Home Ombudsman. The information should be prominently posted.

... By law they are to inform you of any actual changes or placement changes if indeed you do have documentation of legal guardianship. They can have as many meetings as they want, they simply cannot act upon them without your approval. Take those very documents to the curator of the facility and demand an answer as to why you were not included. Be very direct with them in reminding them their position that they are not your mothers legal guardian, rather you are, and by them planning and then making decisions of moving and placement without you present, without your approval, is against the law. It is very clear that 'they will also need to be reminded that you have a choice of where your mother resides (what facility) and to whom cares for her, they are not the controlling entity of your mother. (At the same time, depending on how that 'meeting goes, Lyon may need to seek another facility.  And I also agree with the person above, facilities that move complete strangers to then force them to live together are not a facility after the best care for your parent... making complete adult strangers live with one another is purely a financial gain movement for the facility, it is not a proactive nor healthy decision made for the individual. 

Absolutely they should have included you in the planning meeting.

They didn't. Now what?

Make an appointment to see the director of nursing. Get an explanation about why she is being moved. I suspect it has to do with the short-term insurance running out. And then exercise your right to make the decision about where your mother will receive long-term care, or if you agree she needs it at all.

Four of us attended the planning meeting where the short-term place said our mother now needed long-term care, and, whaddya know, they happened to have a bed available in their long-term care unit. We toured it and declined to take it. In fact, we declined to put mother in long-term care at that time, but that is a different issue.

You are your mother's guardian? That must mean she is not competent to make decisions for herself. Then it is your responsibility to make those decisions.