rushtonjj Posted May 2014
My husband is constantly pointing out my faults.
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As I am the one who has the issues, but my mother in law's dementia is increasing. Mother in law is 89, had numerous TIA's over the years, a stroke last spring, a minor heart attack in November which brought her from 30% heart functionality, to now 20% heart functionality. She lives with us, my husband is in the Navy and travels a lot. My sister in laws are not local and are not in a position to care for her. No one wants my mother in law in a home. We watched my father in law in one of those places and it was devastating.
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All the facilities of which I wrote were SNFs for rehab after falls, or for my sister (who chose her own facility) after respiratory failure due to metastasized breast CA.
The nicest facility was a Heartland facility near a medical mecca just east of mid-Michigan. There were 4 pianos, including one in the dementia unit.
I chose the baby grand, which was out of tune and asked the staff if I could pay to have it tuned. My playing was bad enough without using an out of tune piano, and my father really needed the musical support.
The staff instead had all 4 pianos tuned, at their cost! I was so impressed with that facility.
I didn't even tour the places out of her price range because that would be pointless. There are some spectacularly posh places to be had. There are 47 senior facilities in a 10 mile radius of our house and you can pay as much as possible. In our price range, I think mom's getting really good care. Could it be better? Maybe. Probably, but it it meets her needs today and it's a mile from my house. She doesn't want for anything. I checked it out with the state DHS agency to see what their ratings were and any complaints that had been filed in the past year. Nothing provoked a red flag and they had one of the top 5 ratings in their category.
Every floor has a dining area, so she doesn't have to go but down the hall and she is taken there for meal times. There are multiple activity & visiting rooms and a schedule of activities. She gets changed every 2 hours unless she rings for assistance. Her bath day is Friday. She is always in clean clothes when I pop in. Mom opts out of just about every activity because "she'd rather watch grass grow", so they just put her in the activity room anyway. I'm sure she could be in a facility where there is nearly a one to one patient/care aid ratio, lots of ammenities, and professionally decorated rooms with brand new furniture, but I don't know that it would make her less BPD, less angry, or slow her dementia. They got her off her diabetes meds recently, so something is working.
For what the price is, I am satisfied with the quality of care she gets. It's just like finding daycare. I never could afford the place that had professional symphony orchestra violinists come in and play Mozart for the infants at nap time. The sales brochures made it sound like any parent who didn't put baby there didn't love their child. But, at the middle-of-the-road facility, the Montessori place, and at a home care over the course of the pre-K years, I feel like my kids had decent care because of the people who worked there. It wasn't sterling silver/white glove level care, but it was good enough. They are teenagers now and no worse for the wear.
Finding the right place is a complicated equation of what you can afford plus what's important. Plush ammenities & decor might be a lot more important to some than me. And that's OK. Looking at the resolution or findings of complaint reports to the state was important to me. I saw proactive reporting by the facility on incidents and nothing an inspector had found for violations. The food isn't gourmet or prepared by a chef with Michelin stars, but it is tasty and dietetically appropriate for mom. Good variety too. I talked to people who had elders there and got their stories on what the place was like.
There is no one size fits all solution to our very individual care needs and priorities. I am very, very lucky to live in an area with so much competition in the market.
Odors are NOT always going to be present in facilities. We checked out facilities before placing parents there and if there was an odor we just left.
None of the facilities we selected had unpleasant odors at all. In fact some are immaculately clean.
In addition, I too have seen the folks who appear to be catatonic, but they weren't in debilitated conditions as a result of their conditions. They were lined up waiting for therapy, sitting in the hallways watching visitors come by, but not to see them. It's an undignified but more efficient way for the staff to administer therapy.
There are ways to deal with this though. Patients left in the privacy of their rooms could at least watch tv or nap until therapy time. Or they could be lined up in a room with music, even just a CD playing in the background. Or, as in one AL facility we visited, the resident pets could be brought in to comfort them while they waited.
One of the problems of institutional placement is the warehousing of people without adequate mental or emotional stimulation.
I used to take sheet music with me when I visited my parents, and took them to the room where the piano was. Initially it was just Mom and me, with the catatonic folks just sitting in the hallway staring out into space. Once I started playing, they began wheeling themselves into the room and stayed until I finished. And I'm a terrible musician.
It takes a lot of effort and planning, but institutions can be a lot better than some of them are. A lot of research and on-site inspection is required.
The Eden Alternative sounded like an excellent premise, but I've only seen one Eden facility and it was abysmally depressing. But it was also County run.
I'm not challenging your statements, just offering a different perspective.
I think people get scared in NH because they don't understand what they are seeing. They see people who may be tied to the wheel chair to keep them from slipping out onto the floor, and it's not something you or I would want to have happen at this moment in our lives. The see people who are catatonic, or who can only make shrieks and screams because they have lost the verbal part of their brain. Or people who are coiled up in a tight fetal position on their beds. This is not the NH's negligence or doing. This is what dementias do to people and it is very ugly and uncomfortable to look at. It doesn't smell too good either. It's just the raw facts of it.
It's just like looking for childcare. Tour the place. Is it clean? Are employees friendly? Ask about their training. Ask how they like working there. Do residents appear clean? There is just going to be a smell, no matter how diligent staff are about changing the disposable underwear, so just be prepared. Ask about the activity calendar and try to arrange a time where you can come during activities.
OR people remember visiting some great aunt in a hospital ages ago, when people who were "senile" were treated like mental patients. They were tied up, medicated, and it looks so totally barbaric compared to today. If they saw that as a child, it would be as scary as seeing a horror movie, and be a lasting emotional memory.
Watch this Teepa Snow video on Youtube, and it will hopefully help you get a plan together. It's part 6 in a series on "Making visits valuable" for Senior Helpers in Naples FL. I am on part 11, and have found the entire thing terrifically valuable so far. youtube/watch?v=dmPQLf9IUNI
He's probably blaming you because he's not prepared to deal with the reality of his mother's illness. But that's not your fault.
If by heart functionality you mean ejection fraction, at 20% she's at high risk of a fatal cardiac event.
Military men like to think that they can control situations even if they can't, and with a 20% ejection fraction rate, there's not a whole lot he can do. Does she have a pacemaker and has it been discussed?
Perhaps you could print out some information on her cardiac condition and give it to him. He needs to "see the light" and realize how unstable she is, NOW, or he may blame you if/when something happens.
Then, do what Pam suggested. Start calling around and get options. Not all nursing homes or Assisted Livings are the same. Some are bad, some are okay and some are excellent. That's where you do your research. You have also the option of putting MIL in an adult day care (but don't call it that to her or hubby.) Find out the cost, etc.... Get your game plan in place.
Then when you have all that down, practice in front of the mirror what you want to say to hubby. You know that you did good when you can look at yourself in the eyes (via the mirror), smile or show seriousness and still talk about what You want to discuss with regards to your marriage and MIL. I did the mirror thingy when I was attending college and had to do a speech in front of the class. When it was time to do my speech, I thought I was going to have a heart attack. I was ale to do my speech, look at my classmates in the eyes, smile, and had them laughing. I was very introverted - walked looking down, and rarely looked at people in the eyes. This was my speech class. It was mandatory that I look at the audiences eyes (or their ears or shoulders). Once you get it down, you do what Jeanne recommended - to tell him to knock off the criticism and be supportive.