Who to believe? Mom or staff?

Martha,

I’m so sorry you had bad care for your mom. Hugs!

If you can afford to do it, put a small camera with audio somewhere that it can record what happens - at least in her room.

Although my mother did not have Alzheimer's, she experienced (& I saw for myself) the same things happen. You have to have some form of proof in order to get any results.

Of course the Resident Nurse is going to deny anything as such is happening. It's such a crock because your Mom or someone is paying an huge amount of money so your Mom can be where she is supposed to be well taken care of.

I could write a book on all the things that weren't done right by the staff, etc. when it comes to the care or rather the lack of appropriate care Mom experienced.

Someone has to visit and check things over. My mother has been in memory care for 4 months. First three months, I visited every day for a quick look around. Whatever was missed or overlooked, I would take it upon myself to complete at least twice. Third time, I used my phone to take pictures and would take it up to the unit supervisor. About two more turns with that, and I requested a care meeting with the director of nursing and the administrator. Told them my goal, and asked if it was unreasonable to expect personal care. They said no, we do personal care. Showed them the dated photos, which included the last three days of soiled morning bedding still on the bed at 9:00 a.m. Asked them again if they were able to complete the personal care. I made it clear of what I expected (mom in the a.m. wearing a clean Depends and her bedding is clean for the next night) and they said that they would talk to the unit supervisor. Since that meeting, the unit staff consistently met those specific requirements for two weeks. Recently, I started going every other day. Same thing, quick look around, check my mother's supplies, make sure both her butt and bedding are clean. I believe that you have to be vigilant, but willing to work with the staff. Documentation, dated photographs and regular visits.

just assume what she is saying is truth since you've seen it. she may have dementia at times, but don't let them write off her complaints to that medical issue.

I realize care in AL is expensive. I am just thinking out loud. Some people hire outside sitters through an agency to help out their loved one. Is this frowned upon my AL?

One thing I believe is contributing to situations like this in care facilities is the low wages the workers receive. Just around the corner from my mother's facility is a McDonalds with a sign out front that announces they pay $12+ an hour. I know none of the aides at the facility make that much and their work is much harder and much more important. Why is there this discrepancy in pay? It causes poor morale among the aides and, in turn, some of them become neglectful or abusive to the residents, others leave after a few weeks. The few who stay usually work 1-2 additional jobs. Poor wages are not going to attract good people. I do know that the director is paid quite well and that the facility must be making money.

I have asked my mother many times if she would like to visit other facilities and consider a move. She is adamant that she does NOT want to be moved. She has made a few friends among the residents, caretakers and even the dogs who live there. The location is central to family and friends, close to her doctors and the stores and restaurants she is familiar with (which is HUGE to someone with dementia). It would be very inconvenient for our family to move her, but I would be more than willing if she was receptive to it. My siblings and our children are not in favor of a move either. They live and work in the area and it would be more difficult for them to visit - and she lives for their visits. I do believe that if my mother were fearful of anyone at the facility, she would readily agree to a move - she does have enough lucidity to perceive a threat to her well being. It's such a frustrating situation.

I live in a health care facility with an extremely sharp mind but I can't walk due to a spinal injury. I see it all. There are far too few staff and it does take a long time to get responses so that part is most likely true. But on the other side, if there are memory problems, you can expect some tales to be "phony". It works both ways and there is no real way of telling short of hiding under the bed and watching.

Nannybrister, you mentioned that the NH asked you not to visit after 4 p.m. because of sundowners. I have visited several memory care centers in anticipation of a placement for my mom. Almost exclusively they allow and encourage visits at any point in the day or night. I was actually concerned about this policy because of security concerns and possible disruption during the night. But they allow it to accommodate family members who may work odd hours and can't visit during "normal business hours." So the sundowner explanation sounds shaky to me.

Wow! Nannybrister and commenters have hit the nail on the head. I've found the comments here so heartening. So many family members are identifying the key problem, i.e. understaffing in long-term care homes. I was a CNA and lost my job after complaining about the kind of neglect cited here. I listen to industry experts try to make the case that staffing isn't all that important, it's the training that staff gets. (And of course these industry leaders want nursing homes to buy their training programs rather than hire another aide.) If only we could form a family network,acoss homes and even states, to track the problems and develop leverage to counter the industry lobbyists who fight against efforts to mandate better staffing. Please let's keep the spotlight on this problem of neglect of residents in long-term care homes because of short-staffing.

Nanny, I, too, would have concerns. My Mother, who passed in March, went through all the stages of dementia and died from the disease. I truly have lost count of how many hospital and skilled stays along with assisted then nursing homes then hospice. There are good and there are bad. I've seen everything from creepy male techs to 'caregivers' playing on their phones claiming to be too busy to help my mom to the bathroom to outright verbal and physical abuse. I have also seen compassionate and caring people who went above and beyond. In the US, it is all about profit....not for the caregivers who are on the front lines-certainly-and I could really go 'off' on that subject but won't at this time. All I can advise is that you be diligent, keep an eye out, be present, show up at unexpected times and if your gut tells you something is not right, it probably isn't. All the best to you. Hang in there. You are doing right by your mom.

I've seen things happen with the staff like this at NHs, where the staff is not doing their jobs UNTIL the patient's family member shows up. Then the staff is "perfection." It's hard to know if this happened IN THIS CASE, but it COULD have.

I'm going to answer this without reading any of the other replies first to let you know that this absolutely does happen and in my experience it happens often.
I'm not sure what other things your mother said but I have first hand experience with this. My mom and I are really close it's just been her and I since she left dad when I was six months old. I know it's not cool to say this about my mom but she is my best friend. I green up knowing without a doubt that I was loved unconditionally. So when she got sick a couple of years ago and went to a short term nursing rehab for 3 months I staid the night there three or four times a week. Mom was in beginning stages of dementia and I was in denial.
I got a lot of negative replies when I posted about this before. I was asking a question about mom's behavior and offhandedly mentioned I noticed it when I spent the night at the nursing home. She was in a single room and I had permission from the director. Some of the CNA's and nurses thought it was great some were just really annoyed.
Some of the replies I got on here we're that I was probably in the way and I should just let these "professionals" do their job. That's what they're trained for. I know some meant well but there's no way I could leave her alone when she was going through all this scary new stuff. She had a really bad case of hospital delirium when she first went to emergency room. I had never heard of that but found out it was very common in elderly people who go through a sickness. Something like 40% of people over seventy experience it to some degree. So when she went to the rehab and I found out I could stay with her I was relieved.
I've always known that our relationship was different than most parents and their kids. Mom always watched "Snapped" and we would crack up when they would comment that the murdering mother always had an unusually close relationship with her son. But anyway back to you. I soon noticed that the alarms that were activated when someone pushed the nurses button went on all night. They're were all different kinds of cognitively challenged patients. I noticed that it was different with different shifts. The same employees worked together on their three on four off shifts. The shift on the weekends we're on top of things alone more the the week shifters. The noise volume was so drastically different that I commented to one of the weekend workers and he said he heard that from a lot of people. O also found out that the turn over with employees in the care giving industry was very high at least in my particular area. Their were a lot of young people who went into the profession for the wrong reasons (I actually did a lot of research on this later on. I have way too much time on my hands lol). They're is a shortage of qualified nurses and CNA's everywhere. It seems like you almost have to have a calling to do that kind of work and I have high respect for you all who do this kind of work. I know that this can be a thankless job that doesn't offer a very good financial compensation for the amount of work you do. Inevitably there are a lot of people who can't handle the mental challenge that comes with working with older sick people. I know I couldn't do it. So if someone doesn't have the calling to help older sick people they get burned out quick. At this particular home it was so obvious that the employees somehow ended up working in shifts with other employees that we're like minded. The ones who hated their thankless, underappreciated, underpaid jobs and those who love the huge difference they can make in a few appreciative patients and love the challenge that comes with trying to make a difference. I had a couple of really bad experiences that ended with two CNA's losing their jobs but not having charges filed for obvious abuse. Long story short lol what your mom told you is very common.

The AL is "blowing you off" and please excuse the expression. The excuses I received, is " I don't know", "that wasn't on my shift", "I just got here and do not know how it happen". Believe your Mom, there is truth in what she says. My mom has been in a AL for a month now and I started documenting dates, times, names, and concerns- I have taken pictures as well. I have escalated 'verbally' to the executive director of newly built AL without any results. They are short staffed, like all AL,and the staff has "attitudes" (mostly the younger ones) but we pay 'good money' for the services that are not being completed in a timely manner. My next step is the written documentation with pictures. I'm already looking for other places. Best of luck..and I feel your pain..

Helping77, first bless you for donating your time at nursing homes. The residents need music and smiles. I don't know what the time frames are. We sometimes go mid morning, sometimes after lunch.

Horrible about that lady!!!!! Did y'all report it to anyone? I'm sure you did.

Thanks for writing on this forum! Karen in Texas

When it's her word against theirs, you'll NEVER know for sure. Dementia and UTI's happen, but dishonest and lazy employees in nursing homes abound as well.
You have to make it be their word against theirs by recording. That said, it's illegal in some places, and rehab facilities I've visited for other relatives have signs that say you cannot take video or pictures or have any recording devices. They claim it's to protect the patients, which may be partly true, but it's also to protect themselves.
Videos can be misinterpreted if they are edited to cut out what led up to an event or what happened at the end, so that's another reason they're frowned upon.
BUT, if it were me, I'd still do it and just use the information for MY purposes, not for police or a courtroom. That way you can make the changes you need to make (like taking her out of there) if you discover it's the staff who're lying, but be careful to do some long visits to ensure it's not that staff is stretched too thin. That can be determined from a few visits where you stay for a couple of hours and walk down the halls to observe, go past the nurses station, and look around to see how many room lights are lit up, as well as how long they stay that way.

My mother was in a nursing home for 4 years. I found it helpful about once per month to pay somebody from the outside to come sit with her and observe and have a composition book inside a magazine to write down any concerns. You then have a witness. I took a few hours myself just for “investigating” by acting normal but noting if they came and how long for “potty”, etc. I was armed to the gills when I went to the Administrator’s office with eyewitness notes!! They will lie to you to cover their butts. They are understaffed on CNA’s and the nursing home is only interested in the bottom line. ($$)

put a hidden camera in her room. Sounds like neglect. If its accurate talk to a lawyer...not the nurse (who has almost zero power...and clearly no care)

I have been at the NH on the 3rd shift, when there was ONE aide for 2 entire wings. That means there were only 2 nurses aides in the entire building. Unbelievable!

The laws have to change regarding minimum staffing. But the lobbyists have far too much influence.

Karen in Texas,

If you know that things aren't right it may be time for you to move your mother to another facility and also report the negligence of the facility she is in.

My mother has been in three assisted living places. All are very nice, but yes there are some bad apples, negligant, lazy, etc., ones. Usually staff turnover was high as good management got rid of the drift wood or they left because they couldn't or wouldn't make the change.
Always listen to your mother! You can tell what is real and not real. With dementia comes hallucinations, etc. Memory of past tramaus, fears, etc., can surface & connect with their present physical & emotional world.
For a while increase your visits. Make them short (couple hours) at different days and different times. Probably weekly.
So, you may visit on a Monday one week then Tuesday next week. Coordinate you visits with what activities they have going on. Be a part of that. Switch up every month where you may visit on one, then return next day at an earlier hour. Staff does put their best foot forward and play the PR thing to make it appear a great environment is present or over play act by being extra loving and nice to mother, etc.
Be very observant of things and other residents around the place, Ask staff questions like how is mother doing. Does she need anything. Of course you will ask mother, but by asking staff you will see what they know.
We always make notice of mother's fellow residents and we say hello to them and take a couple of minutes visit with them. Not all of them just ones who may make eye contact or wave to us or especially the quiet ones who look at you. Main thing is interact with them, give them attention and see where they are. We ask if they need anything...do they need water, etc. We may ask them how they are doing. Most time they tell us. If resident responds and needs something else that we can't do we ask a nurse, or go to nurse's station and ask for the resident. This pulls the staff's attention to them.
After a while the residents would willfully interact with us each time we came to visit. Amazing what they would tell us about the staff, persons, things, or just their lives....without us asking. We never ask them about the staff.
In our state it's law or mandatory, resident's loved ones have access to them 24 / 7. That is, if you wanted to come at 2:00am to check on mother for any reason, you should be able to do so. Additional, for review there should be a binder or some folder available to the families, visitors (public) which has record documents of outstanding complaints, infractions, violations, inspection results, etc. Read through this. You can get a good snap shot of core problems the place is facing or has faced. If staff happens to see you reading it...well, it does have an positive affect.
Most importantly, your relationship with the staff is vital. By getting to know them you will get a picture assessment of how they function professionally. Every place will have a difficulties even when the staff is doing their best. We have found that slack manangement is obvious for bad hiring and attitude of the staff. But most places with good personal management it still slacks of solid in house training / experience, which is core. They need to be given things to help them to be successful. Too many staff bring bad habits & experiences with them from other places they have worked. Our goal is to be what ever we can to contribute to their success in caring for our mother, in turn, to the rest of the residents. It's one big family! Having a relationship with staff they will accept our suggestions in how to care for mother and we can become a strength for them. Even with mother's dementia alzheimers her personality still comes through. Helping staff to get to know her is key. Another final key...getting to know the staff, you will come to realize ones who really care and those who it's nothing but a job. One thing is priority with us. We do not tolerate incompitance, rudeness, any abuse (verbal or of any kind), harsness, anything that intrudes or violate there will, dignity, physical person.

The other thing I would add here, not necessarily addressing this particular issue, is if you see drastic personality changes, insist on urinary testing. It is one of the most common reasons that facility patients appear to be out of their head. And for people diagnosed with dementia, my bet would be it is the last thing facilities test for because it's easier to just blame the diagnosis. Always rule out bladder infection. Don't assume everything is the dementia.

Medicare.gov lists all ALF's in every state and their inspection ratings. Check the rating of the one she's in now and find a better one. In the meantime, document and believe your Mom. Good luck

Do not believe the staff over your mother just because they blame it on her medical issues. I witnessed it myself at more than one facility where my mother was rehabbing and tried to blame it on the paid meds (the same ones that I had told them to no longer give her).

Well, she happened to call me in the wee hours of the morning to tell me she had been waiting a long time to go to the bathroom and no one was coming and she thought her sugar was too low. The staff member showed up in the room and didn't realize I was on the phone. My mother was telling her she called me and the lady replied in a very nasty way - I told you not to call anyone and we' re busy - there's nothing wrong with your sugar. I told my mother to put her on the phone. The tone changed when I told the lady (and I use the term loosely) that I had been on the phone for quite some time waiting on someone to show up and that her sugar needs to be checked.

The sugar was low and she was finally taken to the bathroom, but by this time she had peed in the diaper they put on her when she came in to the facility. While they insisted there was two women working that floor, the one and only young girl that was there in the late evening told me, confidentially, that she was the only one on that floor for bathing/toileting each evening. After the state did a visit, I noticed all kinds of people working and the young girl explained they are always allowed full staff when state people show up. They also keep a sign out front they are hiring - again, this was to show state they are trying, but can't get help. This young girl was very believable because a day after state was there, all the adequate staffing went away and the young girl was told hours were reduced again for her as well.

I often found employees congregated at the desk while call buttons went off. I kept a notebook in the room and would write down what time my mother pushed call button and length of time for staff arrival. Quite often it was 30-60 minutes which is entirely too long for older people who cannot hold it that long. I took these notes to the management folks.

They even dropped my mom on day 2 that she was there and denied it. They did admit that she went from standing to on the floor, but said she did not fall. In my books, if you go from standing to the floor without intending to do so is a fall. This fall was not in her chart and never reported until I did so. The state came in after I reported it.

It is time for you to get some sort of camera/audio in her room so you can see what's going on when 'sane' people are not there. For confidentiality reasons, the camera cannot pick up another patient in the room. You will need to be creative in where you place it so no one knows it is there. Have some people stay entire days to time the call response. Also, ask for a copy of the med list and compare it to what she gets each day...look inside the cup and see what is in there, ask for names of drugs in the cup. Compare it to the list. Wrong meds and over medicating is another real problem and most patients don't question what is in the cup.

If you are lazy to begin with, this is a pretty good job to get paid for 8 hrs and only put forth a little effort for about half that time. No one is going to believe those patients who have some memory loss due to medical or medicinal issues so there is very little chance there will be an investigated personnel problem.

I've had similar issues when Mom was in AL. There is a log that is kept when the emergency buzzer is pushed, or cord pulled. Insist on seeing the log - it should show you when (and how often) Mom called for help, and when, how (and who) responded.

If I had money to bet, I'd bet on mom. And I'd be very concerned and pissed about the nurse or whomever is blowing it off to Alzheimer's. How convenient. What it means is that those that person is responsible for supervising or covering for isn't or it's hard to find good staff. YOu can also get in touch with the long term care ombudsmans office.

Place a hidden camera in her room. Then record for a couple of days and see what happens. If what your mother says is true, it needs to be reported to the state ombudsman. Then look into moving her if at all possible to another facility.

I have had a great deal of trouble with this very same issue. My mother will call me with remarkable stories of what is going on at her memory care facility. At first I believed every one of them and would bring them up to the staff, asking that something be done. They always had some logical explanation and I started to wonder whether the stories were just products of mom's dementia. However, I did happen to witness some things that bothered me when I was visiting. Dining room staff manhandling patients and yelling at them, pleas for help from patients that were going ignored, and staff congregating in their break room so they wouldn't have to deal with patients. I let it be known that I was noting issues like this and was not afraid to call the Health Department if need be. However, I have noticed that my mother is being treated with a little less kindness. It was wordlessly made clear to me that if I continued to complain, she would suffer for it. The latest issue is them charging an extra $2000 a month on her bill for "helping her choose her clothes and dress properly." My mother is not in need of this kind of help and I know for a fact they aren't providing it. My next move is going to be putting a nanny cam in her room. I know it's illegal, but so is billing residents for services that aren't being provided. Of the two transgressions, I'm thinking a judge would be more likely to be angrier about the overcharging.

Weero and PiperLee have some good thoughts on this, as do others. If your mom had advanced Alzheimer’s, I would be a little skeptical but, even then, not totally. I am sure many of us have seen this problem. The CNAs have a very tough job, so I try to be charitable in my assessment, but, frankly, some CNAs absolutely should not be doing this work, as they simply do not possess empathy, and empathy is a must requirement for this type of work. The main thing for you is to be there as much as you can for your mom. And, go in at different times. That will keep the less professional CNAs on their toes, if you get my meaning. The head of the nursing facility where my mom used to be before her passing was recently fired. He was lazy and nothing more than a bean counter. Little to no empathy. Enough complaints were filed that he was fired. Sometimes that is the only course of action. If some lazy CNAs get fired, the hard-working CNAs will be grateful for that, as it gives an opportunity for more dedicated ones to come in. But, please always remember that the wages of a CNA are very low and the work is very very hard. Always try to be an encouragement to them. I even took some of the work load off of them when I could and would encourage you to do the same.

A long term care ombusdsman can access the logs and see if they are responding in a timely manner, and will get it corrected. Check with your state to find one.
not sure how to insert a hyperlink so copy and paste the URL below:

https://acl.gov/programs/protecting-rights-and-preventing-abuse/long-term-care-ombudsman-program

I'm sorry to say but I do believe your Mom...Try going in on the Second shift after the supper hour is over with. There are some very caring Nurses and Nurses aids but believe me there are some that should not even be there.. I know this for a fact because I work in a facility and have seen it with my own eyes. If your Mother is starting dementia then she still has some of her faculties and I believe she is telling you the truth. everyone needs and advocate in a NH.. Good Luck