Incident report at AL. Any advice?

Hello, just checking in to thank everyone for the information and advice. It was helpful during a stressful time.

We did have a “care conference” with a social worker and a couple of staff members. That turned out to be kind of a nothing-burger. They didn’t really want to talk about the microwave, although my mom was very anxious to tell her side of the story. It did sound as if she was having more difficulties with the abstract controls.

They wanted to have her do OT and PT, as well as a cognitive assessment. I am all for therapy to increase strength and balance, so that seemed like a bonus outcome to me.

My brother asked whether my mom might be able to get help from the aides with microwave tasks, if it was not cognitively safe for her to use the microwave. So the compromise is that my mom can use the microwave by the nurses’ station with help. She is not happy about this but it seems like a reasonable compromise.

It’s been very quiet for a couple of weeks and I was just starting to relax. My mom told me the cognitive testing went well. (She described some of the questions to me and it did seem like she knew what she was talking about.)

This afternoon we got another call about a “care conference.” So now there is something else, no idea what. Maybe the cognitive testing didn’t go that well? I guess we’ll find out. (My brother will be out of town for a few days, so the meeting will be next week.)

Anyhow, thanks again for your help.

Did you witness any conversations that the staff had with your mother about this, or see the volume of smoke, or have any conversations with anyone who was directly involved in the incident (apart from your mother)?

We have to complete incident reports for untoward events and near misses of any kind. The report will detail what the aide saw, what your mother told her, what the aide did about it, who else was involved, what resulted from the incident, who the incident was immediately reported to. What happens next is an evaluation of the incident, a risk assessment or review, and then whatever mitigation measures are appropriate.

Based on what you know so far, removing the microwave would be disproportionate and a deprivation of liberty. But a) the information about what happened does want checking; and b) it wouldn't be disproportionate to suggest that your mother should have some stand-back support when she's using the microwave, and advised to avoid using it for [x, y, z foods].

Tell me how content you would be if the resident in the next room started a fire in her microwave and no one thought anything of it or did anything about it.

Putting a roll on for five minutes on full power is not an easy mistake to make. If she'd intended the roll to heat for fifty seconds she wouldn't have moved far away from the microwave and she would have noticed more promptly that it was taking too long - six times as long as you're expecting is a lot.

The difficulty here is that if your mother is losing awareness of the right steps to follow, then precautions such as avoiding certain foods, or asking for support from a member of staff, or reminders stuck to the door are not going to work. You need to investigate more closely what went wrong, and you also need to check that small things haven't been going wrong for some time before this. Also make sure that she can see the numbers, in the light she actually uses - daylight from a window can make LED displays very hard to see, for example. Similarly, check she's able to read directions on any packets (which can be ludicrously small and confusing).

We wouldn't get very excited about somebody burning toast. In fact, our local fire brigade did use the term "test by toast" in a presentation about smoke alarms. But we would be concerned if someone who was well-used to using a microwave began to misjudge timings or settings or food choices, and we'd respond by monitoring and supporting her until we were sure that all is well.

Without blaming your mother I think it would be a good idea to get cast iron information about the sequence of events, too. Suppose from a different angle it looked more as if the aide had gone into your mother's room and found the oven still on and the room filled with smoke, and your mother only *then* noticed and reacted.

I'm sorry that your mother feels she's being blamed for all this, and that she is "being reported." An incident report is a record of an event, and if it sounds accusatory then it's been written badly. May she heat many more meals of her choice safely yet.

My brother's facility did not allow microwaves in rooms. Or Coffee makers, or that sort of thing. It was ALF divided into cottages. The cottage's rooms were around a central gathering place, one end for meals, the other a communal room for games, TV, whatever. In that central gather area was also an extra bathroom with walk in tub and a small kitchenette with microwave and cabinets. It was specially fit out with detectors (and rooms had smoke detectors as well).
ALFs increasingly has people who are moving onto the spectrum; my brother had probable early Lewy's dementia. As complicated as microwaves can be today I can see this easily happening.
Accidents DO happen. We have ALL done such things at home. I almost set fire to my building with having an electric blanket on low setting for a cat that would only sleep on the back porch--I was 34 years old at the time.

As far as the incident report goes, that is no worry. They HAVE to be made out with any such incident. Routine. We nurses would regularily burn something up (sorry guys, happens) We would get a coffee maker, burn up the plug thingy with it on 24/7, be berated by engineers who were to be called for any plug in devices which needed more industrial plugs put on.
We would set fire to the things we tried to warm in the microwaves back when they had no lovely plug in blanket and compress warmer systems.

Incident reports are done when an "incident " happens. They are gathered and taken to committees that go over them to see if new rules are needed, what violations of safety occurred and so on. They must be shown to JCAHO when they visit. It's the law. That's why facilities hate them.

If they speak to you about mom it will almost certain involve more than this. It will be a set of things. I DO think you need to consider that whatever the dietary needs are they may not now involve a need for cooking or microwaving. But I doubt Mom would lose her position here simply for that. And I do think their policy of allowing microwaves in rooms is a dangerous one. Microwaved food is dangerous in itself for mouth burns for elders and should be carefully done.

Just my guess, all of this, and wishing you the best. Hope you will update us. Speak to admins there if you are concerned.

I think everyone of us has had a 'close call' with a microwave--no matter our age or capability. I know one of my kids cooked a hotdog for 20 minutes instead of 2. I was not home at the time--and when I got home--there was a microwave in the yard and all the fans the kids could find running in the kitchen to move the smell of 'carbonized' hot dog outdoors. She never ever put anything in a microwave and walked out of the room after that!

Of course the microwave was totally ruined and the smell lingered for so long.

My mom, at the end of her life, used a microwave exclusively. She did have a smoke detector and she was pretty cautious--but I know that she wasn't supposed to use it when nobody else was home. Yes, she burned a few things, but chewing her out about it wouldn't have helped.

OK, your mom made a mistake, and yes, she has to think of the safety of all the other residents. BUT--I hope this was handled w/o making her feel 'stupid' or 'incapable'. The worst thing for mom was losing independence and then being made to feel stupid for a mistake that anyone could make.

If mom has the ability to still make her own personal living decisons, then let her. She may not want to stay in this place. They 'sound' like they treated her like a child--and she doesn't need that.

Your role now is one of support and love. No matter our age, being berated for doing something 'dumb' is embarassing.

I feel like you do about the safety aspects of the situation.

I don’t think the facility workers should have berated your mom about accidentally leaving something in the microwave too long.

Have you spoken to anyone outside of the kitchen staff about preparing meals for your mom’s nutritional needs?

How did they explain the details of the incident report? Was this a new microwave or the same one that she has always used?

The reason I ask is because my mom was able to use our old microwave. When that one had to be replaced, she couldn’t figure out how to use the new one. She had Parkinson’s related dementia.

I would ask the facility to set up a scheduled appointment so that you can discuss this situation further to put your mind at ease.

Are you satisfied overall with this particular facility or do you think that you could find a better one?

What incident report will be written and reviewed about how multiple staff members "berated" your mother over an apparent unwritten (and uncommunicated) policy?

I would encorage your mother to take a close look at the facility with more stable leadership and staff. If she is willing, maybe schedule a week of "respite" care for a closer look. As you have discovered, no matter the policy or good intentions of individual staff members turnover severely limits the capabilities of the facility. I understand your mother may not want to risk considering a new home or losing touch with the friends she may have made at the current facility but I think a serious discussion would be in order given the turnover. I personally found the ability to problem solve and work mutually derived solutions concerning my father in MC with vascular dementia and food challenges made a huge difference in both his quality of life and my stress level (particularly in the last year).

I may be wrong but I believe an incident report is something that has to be done when something out of the ordinary happens. There are several instances when an incident report has to be written. It is more for the facility than the residents, it is part of their risk management policy. Family members have to be notified but there is no need for chastisement or blame. Administrators and other staff in charge of course get upset because there is paper work to be completed. This could have turned into a very serious problem like you said and at the very least your mom will not be able to keep her microwave. They may ask her to leave but this will be after a meeting with family members to discuss a plan moving forward. Since your mom's vision is impaired and she also has special dietary needs which will not be provided in AL you may need to consider moving her to a SNF facility where her dietary needs may be met. I am hoping this will help in caring for your LO.

I had Moms microwave taken out before she moved in but she was in the mid-stage Dementia.

I can see the smoke setting the alarm off, but not a sprinkler system. I think heat has to set off sprinklers. I think the staff over-reacted. Mom did not set the microwave on fire, not really sure u can. I may have told her the rules and leave the microwave. If it happened again, then remove the microwave.

You should have gotten a packet at the time Mom entered the AL. It should have had Moms rights as a resident and rules and regulations.

I will tell you why the turnover in Nurses. One Nurse is not paid enough for the work that needs to be done. We have an AL up the street my daughter applied for Nurse job. She said they could not pay her enough to do what they expected from her. She's been nursing for 25 yrs.

Upstate, thanks so much for the update!

Don't you have regularly scheduled care conferences, like every 90 days? We did for my mom. By law, I believe they are required to update the care plan.

Please let us know how it goes!!

What you want here is the proper living environment for mom. A proper cognitive evaluation that will tell you where she falls, number wise, on the dementia scale after taking a fairly short MoCA or SLUMS cognitive test. You say she has "mild cognitive impairment " going on already......which can easily morph into progressive dementia in short order. I saw it happen with my own mother over a period of time. When I finally got her tested as an in patient in the hospital, she was Showtiming up a storm and telling the doc how handsome he was. I said TEST HER. She scored an 18 on the MoCA and drew a blob-like thing for the face of a clock. Meaning her Executive brain function was compromised. Which led her to do odd things like add a zero on the microwave timer in her AL apartment. Or put her pills into a coffee cup up in the cabinet to "take later" and then be forgotten. Or later, to start accusing staff of ripping off my dead fathers memorial jewelry with ashes inside. As if, right? 🙄

I don't know and you don't know if your mom has dementia. But what we do know is she's flustered and maybe struggling with things we find easy like microwave timers but are the FIRST THING to go when dementia sets in. I watched my mother many times try to turn the tv set down with the phone. Or use the tv remote to make the phone louder. No amount of reason or logic will help them learn gadgets again. That part of the brain is now compromised.

If this were my mom, I'd want that microwave out of there and I'd be playing UP how nice it is she can use the unit in the common area. The goal here is safety and that can turn ugly in a New York minute. Don't find out after she's rushed to the ER for something that could've been avoided, God forbid. An incident report is just that.....mostly the CYA principle at work on the ALs part, really.

If she does get a lower score when properly tested, don't move her to memory care AL until absolutely necessary. Idk what rules will be in place in the CCRC she's in.....you're best off finding out NOW and avoid getting gobsmacked later. That was my motto with my folks in managed care for 7 years. How do we play this game so we ALL thrive? What rules do WE follow and what rules do YOU follow so everyone is safe and living their best life?

Don't be afraid to find out the truth here about mom's mentation......knowledge is power. You and your sibling cant help mom till you know what it is you're dealing with! Then you proceed accordingly. Dementia can be an ugly diagnosis, yes, but until we get that diagnosis, we're scrambling to make sense out of chaos. #Truth

I had to move mom to the MC bldg of her AL about 6-12 months too soon. There was little choice in the matter due to mobility issues combined with dementia. She was too far gone for regular AL and not quite gone enough for memory care, in reality. Which is what happens to a lot of elders, unfortunately.

Morningstar is an AL chain in some parts of the country that specializes in "in between" elders. They cater to special diets regular ALs won't touch. They house dementia residents along with non dementia residents w/o the "memory care" rules that often foul everything up. Caregivers are assigned residents to care for their entire shift, 100%. It's a different mentality but comes at a cost (naturally), although not more than a CCRC. Look into it, if you'd like. If I had to manage mom's life over again, I'd have looked into Morningstar myself. It's a regret I have that's too late to fix now.

I know what this feels like and it's not fun. Wishing you the best of luck with all you have going on.