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We aren't exactly looking into a nursing home for my grandma yet but we know that eventually the time might come. We are going to visit one near my house this afternoon and are so overwhelmed by the idea. Does anyone know what kinds of questions are important to ask just so we would feel more prepared if the situation ever arises?

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As a former ombudsman (go-between residents and management) for the State of CT, there's not one question for the nursing home. There are many. Don't judge the home by the number of chandeliers! One suggestion from my 2003 handbook, published as "Conrad Notes - Home Health Care Assisted Living and Long-Term Nursing", is start by downloading the checklist provided for nursing homes by the U.S. Centers for Medicare and Medicaid Services. This website has tons of information...all free and reliable. Good luck!
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Schedule your first visit and take note of how you feel when you first enter the facility. First impressions should not be ignored, if it does not pass the smell test than look elsewhere. Plan on at least two more unannounced visits, in the evening and on the weekend. Does there appear to be adequate staffing, talk with other family members of residents, eat a meal with the residents. There are many checklists available, I have a free booklet available at TexasElderLawAttorney, "Consumers Guide to Nursing Homes and Assisted Living Facilities". This oversight does not end when your your loved one becomes a resident, but rather, it becomes more important to visit on a regular basis and if that is not possible, hire a qualified individual to do so for you. If something does not seem right, then go to the head nurse or administrator and voice your concerns as soon as possible.
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If you can, talk to patients and families and watch, watch, watch. The checklists are great also. Get a list of the activities provided, talk with the social worker, find out who the docs are and how often they come in. there is a lot of research to do.
but it seems that you have time to do it and make a good decision. good luck
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Canard note is so right! DONT BE FOOLED BY HOW BEAUTIFUL THE SURROUNDINGS ARE! Ask questions primarily about the patient to "nurse" ratio. How often is medication distributed? Does the facility have the ability to get ALL of your grandma's medications? If not can you provide it so that doses are not missed? Don't let them tell you that something is "the about same as that medicine". If it's not what her Dr. prescribed, it's not the same. The time each medicine is taken may also make a difference. If it is 3 times a day and the NH only does med rounds 2X a day, that makes a big difference! Does an RN distribute meds or is that delegated to an LVN a or God forbid a CNA. I have seen this more than once and I believe it is illegal.
Ask also, what happens if the patient doesn't make it to the dining room for a meal? Does the staff come to get them so they don't go hungry?
Can your grandma keep her own Drs.? Most NHs require the patient to become the patient of the NH's Dr. They assume the responsibility for all medical care of your loved one. I my experience, 90% of the time this new Dr. doesn't even bother to come and meet and examine your loved one for 48hrs or so. They simply "rubber stamp" the incoming notes and meds. at admission. At that point, medicines should be ordered. There may be delays in getting them so be prepared with backup meds. You will be asked to turn those over to the nurse at the facility but at the very least they should be labeled with grandma's name, etc and help prevent a delay in getting her the medicine she is supposed to get. Nursing homes order their own supply for economic reasons and there is almost always delays and substitutions. Be aware of those and what she is being given. It can make a difference in her health! Not all medicines are equal in terms of efficacy.
I don't want to scare you but DONT BECOME COMPLACENT!!! Quality facilities are out there but there are MANY more bad ones. A lot of which are camouflaged by pretty furniture and a slick brochure. Don't be fooled. What really matters is ratio of staff to patients and cleanliness of the facility as well as general level of contentment of other residents. Don't hesitate to stop and ask residents and their families how they feel about the place and staff etc. the time to ask and investigate is BEFOREHAND not after you admit your grandma.
Best of luck. This is a difficult decision for most families. Nothing is perfect but just know that you are going to make the most educated and compassionate choice you can. Good luck. Keep posting!
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Might you also want to look at Memory Care? If Grandma has dementia but is physically okay, she probably wouldn't need the skilled nursing that a NH provides. Take a look at continuing care communities (those that have a single campus with many options, usually ranging from Independent Living to Hospice and everything in between. Get familiar with what is available in your area and assess (or have a social worker assess) what Grandma's needs are now. It's very hard to predict with any accuracy what an elder is going to need in the future, because there are so many variables such as stroke, falls, fractures and the like. But in retrospect, as a family, we had NO idea what Assisted Living meant, or even that there was an option called Independent Living.

Also, make sure that if you are looking at definitions of levels of care that you are looking at a site that is specific to Connecticut, as regulations vary. For example, in NYS, where Mom lived, being a "two person assist" (meaning that it takes two staff members to get you out of bed, to the toilet, etc) is only available in a NH, while in the State of Connecticut, this is allowed in Assisted Living.

You guys are SO smart to look ahead! Better to do this kind of looking when NOT in emergency mode.
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It's unfortunate that some areas of the country have consistently good nursing homes and others not so good (or even terrible). However, doing your homework is still a good idea.

The staff matters much more than the surroundings. I always watch to see if the interaction between staff and residents seems genuine. Taking into consideration issues that can't be changed (such as paranoia with dementia) how does the staff handle difficult residents? How do residents look when a staff member approaches? Is there a level of trust and comfort overall?

In the end much of this is about the "vibes" that you get when you visit. As has been mentioned, look for official reports such as the one that Medicare puts out and try to talk to other family members if you can.



Beautiful surroundings are nice but people are what matter. You're smart to start asking questions early. Good luck.
Carol
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This might help brightfocus/alzheimers/brightfocus-insights/questions-to-ask-when-looking-for-a-long-term-care-facility.html

Rita
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Well since you asked this question two days ago, I am assuming you have already gone to the nursing home. Usually, a good nursing home will have a folder with all their expenses, what they do, don't do, and frequently asked questions. Ask anything you want to as they should have nothing to hide. Good of you to do your research. Check out as many homes as you want, and then make a decision. It will of course depend on your grandmother's medical condition what type of nursing facility you select. Merry Christmas!
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I agree with Babalou. If dementia is her primary ailment and she doesn't need skilled nursing care, then I would explore Memory Care facilities. And depending on how mobile she is, I would explore one that has a secure unit. I never thought my loved one with dementia would wander, due to her limited mobility, but it happened. I had to move her to a Secure Memory Care facility, due to her trying to get into cars in the parking lot of the assisted care facility.

The first thing I would do if you haven't already is to study dementia and what it brings to a person. I would read a lot about the phases and progression of the disease so you know what phases your grandmother will be facing. Once you know this, you will know what features the facility needs to have to care for your mom.

Don't be turned off to a facility because the residents in the memory care seem severely affected by dementia. That is the normal progression of the disease. My loved one will eventually be that way too. That was something I had to process. Being with those patients does not disturb my loved one, but seems to make her comfortable.

What impressed me with the Memory Care facilities that I toured were the ability of the place to care for her for the rest of her life. They are trained to work with the patient, even after the patient loses their ability to function on many ways. They understand why it's happening and they handle it. Some places don't seem to know how to handle dementia very well and it shows.

I would have a good discussion with the director of the place and let them share with you what options there are for those with dementia and what their experience has been in caring for dementia patients. They should share their philosophy and goals. See if you think it's a good match. They know a lot about dementia. I would make sure I was well read on it too when you meet. Also make sure you have a realistic description of your grandmother's abilities and needs, understanding that those will change over time.

I agree about not getting distracted with fancy furniture. With dementia patients, I've learned all the fancy stuff is for the family and visitors. The patients aren't impressed with that stuff They need compassion, time, care and attention.

I actually ran into a couple of family members in the parking lots of the places I visited. I asked them what they though of the place. I think I got candid responses. Still, your experience is very individual. Your loved one may need a different level of care than their loved one needs.

I would have a backup facility in mind in case the first place doesn't work out. If she gets settled into one place and it isn't working out, I would relocate her. I had to do that and it was the right decision. Even places that are highly rated are not for all patients.

Also, note that most Memory care facilities have a mandated staff/patient ratio that is lower than most other facilities, but you would need to check with your state regulations on that.

Do you research early. Don't wait until your grandmother is in crisis and you desperately need to place her immediately. Most of the places encourage you to place the resident while she is still able to communicate and get used to her surroundings. That way they get a chance to know her likes, personality, etc., before it is very affected by dementia.
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I agree that it's the staff that really matters however a shabby looking place can be depressing so do keep that in mind.
Great idea to try to ask family members who you see what they think. I think you will get a better idea from them.
One issue we didn't find out about until my mother was in a nh was how often they shower. Once a week where she is which I think is not enough.
Also, we found many memory care homes or assisted living won't take people if they have certain health issues.
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In addition to the checklists (which are excellent), talk to the families of the residents, especially the families who take an interest in their family members. The staff knows who they are, and with a little coaxing, they will probably share that information.

Ask the family members for both the good and the bad. Quality nursing home care depends largely upon the staff, and how they interact with the patient. Ask which caregivers are best. That may start a very worthwhile conversation.
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Contradntoe1: Do you have the website link for this site?... Thank you!
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The first thing to ask is if the NH is for profit or a non-profit. Steer clear of the for profit NH. I had my mother in a for profit NH and after her money ran out, they called to tell me they planned to discharge her. I took her home before their discharge date, but it was an extremely unpleasant experience to be hounded by them. They also had administrators walking around my mother's unit and having the patients sign their home over to the NH. Check out the activities available to the residents, and make sure the residents are taken to the activities. My mother was on a ventilator unit with a portable ventilator. They never took her downstairs to the dining room to participate in any activities as they did not have enough respiratory therapists to bring the vent patients downstairs. This also included physical therapy for her. She had physical therapy for 6 weeks and then it stopped. Even though there were activities posted for the vent patients, the events never took place, or if they did, it happened once in a blue moon. Find out when the doctors make rounds and when they are available for you to speak to them. Ask them what happens if there is an outbreak of an illness,and how it is handled. After visiting my mother, several of us noticed red bumps all over her stomach and arms. After my sister asked the nurse what the bumps were, the nurse and a wound nurse when to check my mother. They never told my sister what the diagnosis was. The next day, I was told by an aide that it was scabies, and there was an epidemic of it in the nursing home. She advised me to call the NH the next day and asked that they treat her for scabies. They never called me at home to tell me of this, but they called me several other times to say they were giving the patients antibiotics to prevent them contracting an illness that was going around the NH. As my mother was bedbound, she was put into a chair every day. The first NH I put her into, did not have a chair for each patient, the patients rotated when they went into the chair, and even then, the NH didn't follow the schedule. Go to the nursing home different times during the day. Don't keep a set schedule. Have other family members go, and ask them to report back to you if they see anything strange. Ask the nursing home how they handle when a patient needs to see an outside doctor or go to a hospital. Find out who the doctor is and what hospital they use. Make sure you know of any outside visits, and that you want to go with your parent. Before my mother came home, I had her go to a cardiologist as she had heart issues. If visiting doctors do visit the NH, find out what their specialties are. Ask if a Dentist visits or if the patient will be sent to the dentist's office. Ask about the meals served. How do they handle patients that don't like the food. Do they give them a meal replacement such as Boost, or Ensure? Are they given vitamins? Will the NH call you if they see mental changes in the patient? If the patient is in a double room, how does the NH deal with visitors? My mother had a roommate that had 8 family members visit her all at once. This included a newborn infant and the baby carriage. They were disruptive and treated the place as if they were at home. Ask how many staff are on the floor and how many shifts there are. When my mother was put in the chair, she always complained about her butt hurting, but there wasn't much as I could do about it because we had to wait until the next shift comes in to put her back into the bed. Good luck with everything.
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I worked in many nursing home and things to do are check them out early in the morning about 7 am or weekends early. If you smell poop and pee walk out there are no need for q&a. look to see if the clients are drugged if everyone is in wheelchair and falling asleep walk away. ask how many clients an aide has. when was the last abuse like a bed sores or fall in their home was and how often does it happen with in the month then year. make sure you are able to came at all times. when you take the walk through make sure you look at the aide do they look over work are they nice to the clients and does the client interact well with them. ask the nurse question if he/she is to busy and rude most likely they will be to busy later when your loved one is there. Also if you see a client or two out side before coming in ask them how they like the place they know how it is when family is not there. good luck with this. just watch and go with your gut
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I haven't read any of the answers but I looked on the Medicare website for the ratings which in the end didn't really mean all that much. You can see the complaints, the remedies, etc.

And remember, a nursing home is a business, so you can ask all the questions you wish, you'll get canned answers because they are selling a product.

The rehab where my mother is also serves as a 'nursing home' (I say this because very few nursing homes have nurses anymore). This particular one got a three star rating by Medicare but I think it's great, the CNA's are wonderful, helpful, and my mother loves the place. Lots of activities, clean, etc.

Quite frankly, I think it's a crap shoot, no pun intended.
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I can't remember all the questions I asked but I am sure some of the sites the people listed on here are good. But I don't know about asking the "residents/patients" what they think. They are there due to dementia/alzheimers do if they say they hate it, doesn't mean its not good. I see a lady each time I visit my dad, she says the nurses are mean, she hates but honestly I haven't seen one bad situation, so in this persons mind she just don't like it..........so don't base your findings on what the patients say. NOW not unless you actually see or hear one of the patients being treated badly.
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While it is good to visit possible nursing homes for the future, I would try to come up with a long term care policy, the costs of home care, community adult day care programs, elder transportation and the possible family members who would be interested in grandmom avoiding the nursing home all together if home care is possible with paid help and family picking up the remaining hours each day , when it gets tough.

Many nursing homes have problems and the average person does not have the funds to pay their way in a nursing home for more than a year of so. At that point they will be placed in a Medicaid nursing home placement. Medicaid is not Medicare, but it is the health plan for the elderly who have no money left. Many nursing homes limit the beds for this funding.

In short, I found it best to keep my elderly father at home. Having a home health aide who we paid and who only cared for my father--worked. He got to stay in his home where he was very comfortable. He was happy with the arrangement. Having purchased him a long term care policy made it possible.

Good luck.
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In addition to all the great responses already shared, I would add, dont bother getting on waiting lists, they only serve the interests of he facility you could spend a few thousand being on several such lists, each 100-200 people long and yet not be called at the time when YOU need a room---when you need a room, you need it NOW and you can't be waiting around. It's a gimmick designed by facilities to keep then operating all maximum capacity, encouraging people to move in earlier than really they need to move. It also creates paperwork for your family to answer the facility inquiries "are you ready to move in? We have a lovely 2BR" and also keep track of where you had placed Deposits so you can get them back after you die (or movd somewhere else). Also remember to read all the fine print in Rental Agreements, especially realizing is it a month-to-month lease, or is it yearly? And remember if you need to go to hospital for 3 weeks, you need to pay you rent if you want to keep the room. The only other thought is when you do move into a facility, don't bring anything of value, and what you do bring, put your name on it (even the eyeglasses and toothbrush). Everything is subject to getting lost borrowed stolen or otherwise disappeared. ....and you will have to replace it at your own expense.
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The staff matters much more than the surroundings.
....new Dr. doesn't even bother to come and meet and examine your loved one for 48hrs or so. They simply "rubber stamp" the incoming notes and meds. at admission....
if the clients are drugged if everyone is in wheelchair and falling asleep walk away. ask how many clients an aide has.........
Nursing homes order their own supply for economic reasons and there is almost always delays and substitutions. Be aware of those and what she is being given
....... Get a list of the activities provided, talk with the social worker, find out who the docs are and how often they come in
....ask the nurse question if he/she is to busy and rude most likely they will be to busy later when your loved one is there
.......... Some places don't seem to know how to handle dementia very well and it shows. ....my test question is to ask them how they handle confabulation.........
Some places don't seem to know how to handle dementia very well and it shows.
...Words that should be banned
All you need to do is ask;
Just ask ….
We have that up stairs ...
I'm not your ...
I'll get your ,,,, she's busy ..
Look for simple patient friendly actions
Does staff Introduce themselves every time
On serving food
    just putting food in front of person is not a friendly practice
  Do they     Ask if they need anything else
    Do they          ask if meal is OK while they are eating           
Do the staff say hello to visitors and patients
Is there a photo gallery along the entry way walls with every day carer's- Staff, all department heads and the administrators
Do managers have business cards and email addresses?

read the previous post they are very helpful
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Questions? You mean I got to give them a ride? They spent a lifetime driving everyone away. Thats a lot of extra driving.
I guess if I have to ask a question it's: "How do I keep my phone number out of your system?"
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We are keeping my mom in her own home. My father and I are her main caregivers along with Hospice. We decided as a family not to use a NH because of the care issues involved with Alz. patients. They are not able to participate in their own care and cannot (in the later stages) let you know if something is wrong. That said, I agree with the prior posts, especially using your nose! If there is even a slight smell of urine or feces....just keep on walking! Notice if the aides and nurses are friendly as you walk by...if they don't even look at you and make eye contact ....keep walking. See how long call bells stay on before being answered and the energy with which the staff answers them. If they seem bored or 'put out' i.e. "What do you want now..." I'd suggest somewhere else. Some of them are just beautiful with professionally interior decorated lobbies etc....some have lots of glass, knick-knacks etc, but if the patients are just sitting staring at the walls when you visit and there are no activities going on, or stimulation of some sort I really would be wary of the place. I don't do art with mama but I do sit with her and hold her hand. I will listen to music with her or watch a movie or just chat with her....even if I am the only one talking....think if you would like to be there yourself before you make any decision.
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In my area there is a facility in my area that all dementia are admitted to skilled nursing care. Memory care is traditionally assisted living that is secured to prevent wandering. And as a nursing home the staff/resident ratio is high, but so are the fees which start at about 8K a month. I see several advantages in this approach. Their health will worsen most likely to needing nursing home care. When it does, they do not need to be moved to another location that mayy very well cause a significant decline. Those with dementia need more help and staffing ratios are commonly too high for me to be comfortable with. In my area it is common to find a 1:8, 9 or even 10 ratio. This is way too high IMHO. And memory care usually has add on fees based on level of care necessary. A friend has his wife in a memory care facility and he pays the base rate plus their highest level of care for 7k a month. However, the facility has asked him for an additional 700 a month so they can hire additional staff. Not right as far as I am concerned, this is a facility with a 1:9 ratio. Perhaps a nursing home would be more appropriate? Or a different memory care facility where staff ratios are 1:6. But those ratios are just a guideline. One person can come in that requires more assistance or is agitated and the staffing level may not be what it really seems to be because of some needing more staff time.

It is a situation that needs monitoring consistently and frequently because of new residents.
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you can't always say that if the patients are always sleeping, that depends on what time of day you go in and the advancement of their disease. sometimes I go in and my dad is sleeping, other times he is awake, sometimes after they eat they get drousy. my dad has good and bad days (whether on meds or not), he might be sleeping one day more compared to others. each person in these homes are different and react differently. there is a man where my dad is that is 102, most time he is awake when I see, but when I don't see him, he is probably in his room sleeping..........and apparently his disease is not as bad as my dad's or vice versa.
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Probably the best thing is to ask other people that have dealt with nursing homes. People at the dentist or doctor's office, church, grocery, anyone who may know something. My Mom was in the hospital for a broken arm and the social workers always push for seniors to go into nursing homes for a few weeks for "rehab". I checked the medicare site and found a facility with 5 stars.I regret believing the star ratings and falling for this suggestion..Once my Mom got there I sensed an unfriendly staff though the place was decked out with fancy decor, etc. She developed confusion due to a UTI which they didn't understand, implying she had dementia which she does not. The nursing home doctor happened to be checking on my Mom when she suffered delirium from the infection and he had her sent to the hospital. Upon admittance the nurse asked me if I had seen the wound on her back....I had never been told about this and was shocked to see a stage 4 decubitus ulcer on her back!! No one in this nursing home told me of this bedsore but the physical therapist at this nursing home did manage to howl about my Mom's lack of motivation for physical therapy and yet they just let her lie in the bed and this wound happened. Did they just think a stage 4 wound with bone exposed would go away on it's own if ignored??!!! Osteomyelitis later developed requiring 6 weeks of hospitalization and IV antibiotic. My Mom had started out with just a broken arm!! I don't believe any of those 5 star ratings one bit!!! I should have asked more people about their experiences with nursing homes had I had the time. Needless to say I never sent my Mom back there and she is at home with me.
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when my mom needed subacute rehab I had about 2 days to make the choice.
I did all of the things mentioned above. I just "dropped" in on the facilities and noticed how I was treated and who took the time to give me a tour. I used my nose to detect odors. I looked staff in the eye in the halls, etc and noticed who said hello or smiled. I watched the staff interact with the patients. I looked in patient's rooms. I noticed who was in the hall by the nurses desk in wheelchairs
( a horrible thing)
I did go on line and look at ratings. I contacted a social worker friend and read her the list of the 50 facilities I was given and asked her opinion. i talked to everyone I knew who had placed a relative in a facility.
I finally chose 3 ( I had to give the hospital social worker three names). The one at the top of my list had a bed for sub acute and worked with me to keep my mom in the same room, with the same caregivers if she needed long term care, which she did. She has been there for 7 weeks now. In the meantime everyone I have spoken with (nurses, lawyer who deals with elder care issues, social workers, hospice nurses, therapists) have said that they view this facility as one of
the best in our area
Mom's care has been phenomenol and they are on top of everything. The nurses give us updates whenever we go in. They even call me at home in the evening after the doctor has visited to tell me about changes in her meds, etc. The staffing ratio on days is 6 care givers for 14 patients, on evenings there are 5 staffers. We lucked out. It was a lot of time and energy spent in a short time. By the way, the facility is beautifully furnished, which I know can just be "window dressing". Many of the staff, (activities people, secretaries, hair dresser, house keeping) know my mom's name and address her personally when we pass them in the hall.
My advice is look as hard as you can, talk to others who have loved ones in facilities and ask their opinion, talk to the social worker at the hospital if your loved one is being transferred from a hospital. Do look at ratings, altho they can be misleading.
The best time to do this, of course, isn't when you are under the gun and have to make a quick decision. This whole experience has taught me that, altho we don't
want to admit it, you need to be prepared. WE knew mom was failing but didn't think things would happen so quickly.
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It seems that some nursing homes appear to do well as long as the resident or patient does not have too many problems...which is why our loved ones are there in the first place. I would not depend on "lucking out" nor the sales pitch of nursing home administrators, but talk to people that have loved ones in these places.
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Definitely go by the smell test. Figure out what's most important to your grandma as well as the family.

My mom was briefly in a rehab place/nursing home. It smelled okay, but they ignored two very important things (you can always nitpick about minor things):

1. She had severe arthritis and they would provide sandwiches so tightly wrapped in Saran wrap that even I had trouble unwrapping it for her. What would've happened if I didn't visit? Stay hungry and just stare at the sandwich she couldn't eat?

2. My mom was also a smoker. Non-smokers won't understand this but the lack of nicotine causes a huge amount of anxiety. I made sure her file said to give her a nicotine patch daily. They would use a magic marker/sharpie to note the date/time applied directly on the patch. I noticed she was missing a patch. Again, no big whoop to a non-smoker but a HUGE big whoop to someone who is. I spoke to the nurse in charge and she didn't think it was "necessary." WHAT???? If Coumadin (blood thinner) was also listed in her file would it be okay if she thought that wasn't necessary? Insane. We got her out of there quick smart.
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I've never been a smoker but I understand the patch. A elderly neighbor of mine (I became his primary caregiver) was a heavy drinker. When he broke his hip and was hospitalized there was zero understanding from the doctors about his withdrawal. It was awful and I was really angry.

This was a number of years back - I think they know more now. But smoking would be much the same. People need to be treated and weaned when possible.

Good point about the tightly wrapped sandwiches - Duh! Someone should figure that out.

About the smell - I know that people talk about nursing home smells and I'm sure it happens, but the only time there was a smell issue at the home where my parents were at the end of their lives (or any of our community NHs that I've visited) was/is if there had been an "accident" just prior to my arrival. They kept that place clean and under nearly all circumstances it smelled just fine. My point being that people should judge immediately until they know if the smell is constant or circumstantial.

Great observations, everyone!
Carol
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Hello Carol,

My mom's name was Carol-Ann, so that makes me smile. Not many Carols around are there?

Anyway, thanks for your response. It's a good thing your elderly neighbor wasn't truly addicted to alcohol. I minored in psych, so you are smarter than I but even I know someone who is truly addicted and then cut off could die.

When I spoke of smell it = the smell of urine for the most part - not just "old people" smell. And, yes, I agree....the "smell" should be taken into context. Things do happen, often right before a visitor arrives. Murphy's Law?
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What upsets me the most is something that likely upsets the workers because they don't have the time. Each one of those elders had a full life, including things we may not have agreed with. That should be respected.
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