My 96-year-old mother will be going to a memory care facility with skilled nursing. She has dementia, falls a couple of times a week and is ADL dependent. We are thinking of hiring additional help for her in the NH as we can only visit a few hours a day. We are thinking of 4 additional hours of outside help per day. I am looking for advice on what is the best time for the hired help to be there. Thank you.
Before doing anything, tho, stand back and observe your own facility’s staffing needs.
Go ahead and hire a companion for her if you want, but talk to the administrator first to get a sense of how that will work within their organization.
As to what time, at what time are your mother's needs the greatest? That's when you have the helper in there with her.
When she went to hospice care, the coverage was even better.
So I held off.
Unless you are seeing some specific periods of deficit care, I’d hold off.
Call the admins at your facility and ask them when the need is greatest. They would, I would think, be so glad to discuss this with you. Otherwise speak with trusted personnel you already are familiar with when visiting.
If you’re visiting a few hours a day, plus your hiring care, what art you paying the memory care for? Take a wait and see approach.
Many facilities require you to hire from either a specific agency or from a list of pre approved "vetted" people.
Where has mom been living up to this point?
If she has been living with you or a family member you or they are the ones that know her "schedule" and when she needs the most help.
I honestly would wait and see what added help she needs. 4 hours a day is a LOT of extra help and you may be paying someone to watch mom sleep, eat and watch tv. I also think having someone with her will lessen her relying on facility staff and possibly making friends with other residents,.
42 CFR § 483.10 - Residents' Rights
(f) Self-determination. The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.
(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, plan of care and other applicable provisions of this part.
(2) The resident has the right to make choices about aspects of his or her life in the facility that are significant to the resident.
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I would work something out with the facility, via the Care Plan, to ensure a resident has providers to their liking and agreeable (reasonably) to the facility. If the facility pushes back, it is possibly a kickback situation - and I would get a lawyer involved pronto.
Today my 91 year old sister is in a very expensive locked memory care unit. She has fallen out of bed at night but laws prohibit any kind of bed rails to prevent this. Yes, I know of prior problems with bed rails that preceded these laws. Most responses suggest adding private pay staffing which are financially out of reach for many families.
Although I’ve read that these facilities are responsible for assuring safe care, I’ve also read and been told that these responsibilities do not include providing care that the facility determines are too expensive.
Residents are discharged when care needs are too costly to the facility and the families cannot afford to hire private pay extra caregivers. Thus - a no risk/no cost situation for facilities.
When my dad was in rehab, speech therapist worked with him for breakfast, I covered lunch and because his sundowning was very bad the sitter came 5-9. That worked great for him.
Good luck to you!
First, to be clear - you said you can only visit a few hours a day: Presumably that is due to your restrictions, not the nursing home (the law requires immediate access for family 24/7 - among other rights to visitation),
42 CFR § 483.10 (f)(4)
(ii) The facility must provide immediate access to a resident by immediate family and other relatives of the resident, subject to the resident's right to deny or withdraw consent at any time;
Secondly: The nursing home is required to provide sufficient care -- see regulation below. However, this is typically not the case, and is unenforced by regulators, including the CMS.
42 CFR § 483.24 Quality of life.
Quality of life is a fundamental principle that applies to all care and services provided to facility residents. Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care.
It is quite individual as to when additional help is most useful. Typically, I was with my mother from 1 PM (for lunch) until 9:30 PM. Mornings were the most active, and well staffed, even on weekends. The worst time was late afternoon and early evening - management gone, lots of residents needing or wanting assistance for dinner and getting ready for bed. IF you can be there during this late afternoon, early evening window, then I would suggest after lunch for a private aide -- for activities.
Best to you.
I think you are putting the cart before the horse.
The caregivers at the home are responsible for a patients care that is what they are paid to do.
I would evaluate then decide.
Sending support your way!
* Ask staff (management) (and read about) sundowners - when the brain seems to change and a person is more activated.
* Best to get someone in there immediately and then adjust timing as best you can - deciding with staff.
* Thank you for being willing to supplement the care.
* In my experience, staff is stretched 'thin' and they cannot give the individual attention that your mom may need. And all nursing homes are different (with standards of care and individual care provided by CNAs or assistants).
* This extra support will help her ... so I could be careful when anyone here says 'hiring help should not be necessary." The operative words here is SHOULD NOT. And, then, nursing homes do not offer one on one 24/7 care and the quality of care is as different as night and day.
- Try it out and if it doesn't work, you can make adjustments.
The law is clear on two fronts:
1. "Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care." 42 CFR § 483.24
2. "A nursing facility must disclose and provide to a resident or potential resident prior to time of admission, notice of special characteristics or service limitations of the facility." 42 CFR § 483.15(a)(6)
This being said - unless someone gets a lawyer involved, they are stuck with what is typcially subpar and incomplete care.
IMO: Nursing Homes, as they are currently designed, need to be replaced with humane, compassionate, complete care. Personally, I would rather be dead than in a nursing home, particularly one with owners and management who are ignorant of the law and/or just ignore it.
I got lectures from some about how I "don't need" to do this. No, I don't need to do this. It's a choice, to both help your mother and a stressed staff during the busiest times. If you can afford the time and money, it will help your mother immensely. If you can't, don't feel guilty, she will be cared for. But nothing replaces family "boots on the ground." Best of luck to you!
if you can break it up into wake up time and bed time that is perfect. If they require all four hours at once I recommend morning. They can bathe her, make sure she eats. Take her out for a walk if she is able to walk or be in a wheelchair.
it tends to be busiest in a facility in the mornings. That is when residents are getting baths, going to the dining room etc.