Spanky, is your loved one in a private room? Will it be OK for the sitter to doze off if all is quiet?
My mother was very agitated at night when she was first in NH. I spent several nights in her room. I'd doze off on the empty bed in the room but would hear her if she woke up. I'd reassure her that this was a safe place, and there were people here to help her if she needed it. Once she got a roommate, this wasn't practical. Fortunately by then she was on a night sedative that helped and she was more comfortable about her setting.
I'm just thinking of how this will work with your loved one.
Did the facility suggest this? Are the in favor of the idea? Can they make suggestions about where to get such a sitter and what to expect to pay for it?
Call an agency or two to see what they would charge.
I work for a private duty service and nursing agency, and we often are called upon to provide sitter services for those in skilled nursing facilities. It can be a necessity at times when certain patients are agitated, major fall risks, and generally require one-on-one care around the clock. Regarding payment, it likely is a matter of your state regulations and the contract you signed with the individual facility. If the facility is recommending the care, it is likely because they are concerned for your family member and know that they require more attention than can realistically be provided to keep them safe. I often meet with family members that don't understand why they need to pay extra when the facility is supposed to provide 24 hour care. What I can say in that regard is that it depends on the contract you sign with the individual facility, but it helps if everyone understands that only so much care is paid for by the state and by Medicare/your insurance.
I work as a CNA in a nursing home and I see a lot of you are acting as if it's not right the facility require a sitter. But where I work, you have to provide care for 15 plus people everyday, you cannot sit in on room where a resident continuously gets up and is a fall risk, just because one resident requires more care than others does not mean we give them all our attention and leave the rest to their own devices. Usually nursing homes are short staffed, and you're given a certain amount of people you're required to care for, not just one. They're requiring a sitter because they're telling you, they can not provide one on one attention for this resident and continously be in the room. In my opinion, it's best to get a sitter or else your father will fall/hurt himself while others are being cared for, the facility is just looking out for the residents best interest. As for looking at other nursing homes, it will not make a difference, you're required to still care for a certain amount of people, not just one person. Nobody gets special treatment.
Kathleen - these people were the "second" rudest and laziest staff you've seen out of 50 homes? I hesitate to ask what happened with the ones who topped your list.
I can't think of anything more counterproductive than a professional caregiver giving the amateur relative a lecture on not worrying about his or her loved one, especially not when the reason the relative is worrying is that the loved one is apparently not receiving the care he needs from those same professionals. It makes your heart sink.
I agree with Appaloosa that if you want something done it's best to make your request fair, simple and direct, and then if there's a good reason for not doing it you'll hear what it is. Most of the time this works well, especially if you add a pretty please with sugar on it; but I share your sense of grievance at this particular man's attitude. Maybe he was having an off day, whatever; if he was really out to soothe your nerves he made a lousy job of it.
I rarely go ballistic at staff because, good manners aside, it gets you nowhere and risks making your loved one unpopular; but the time I left my mother on an acute stroke ward at 2:00 am (in safe hands, I thought), then returned at 8:30 am to find that nothing - and I do mean nothing - had been done for her was one occasion when I did see red. And I was getting the same brush-off from a senior nurse (also a man, as it happens) until, happily, another nurse just coming on duty intervened.
Moral? Some - only a tiny minority of - nurses are a disgrace to their profession. Steer your relative around them.
There have been some good questions raised, and good answers. I try to deal with staff in a manner to state what is needed and wait a reasonable length of time before I go back and get frustrated. Best of luck, make sure it is an agency that you hire for sitting.
A sitter is sometimes used an alternative to bed alarms and restraining people in wheelchairs who are a serious fall risk or might otherwise endanger themselves if not watched closely. They're not hired for companionship although many of are very chatty and love to keep their clients company.
In hospitals in Texas, they have to provide a sitter for free if they're needed but they won't do it if you're going to be there (because you can do it for free). Sometimes they can't get a sitter 24/7 and there are periods the patient has to go without. In nursing homes and assisted living here, you have to pay for it. it would be spelled out in the contract that was signed when someone enters. Sometimes you can hire one yourself, other homes require you to hire one thru them.
KathleenPlano, in your post, you said you told the nurse you didn't want anything when they rudely asked what you wanted. When you want things done for your father, you have to state clearly what you want and ask what the reason is if they don't do it. If they say they are busy, ask for a timeframe for when it will be done or when you need for it to be done. For example, "My father has been in his chair for 6 hour. He's falling asleep and uncomfortable. Please put him in bed. I need to see him comfortably settled in bed so I can go home."
If the chair particularly bothers you, ask why they keep him in the chair when he is falling asleep. They might be keeping him in the chair during your visit so that you can interact with him. They might be keeping him in the chair because the doctor ordered it (for example, people with some illnesses are less likely to choke or get aspirant pneumonia if they eat sitting up than in bed; some people need to sit up for a while after taking certain meds or after eating to prevent acid reflux of a particularly nasty kind). They might be keeping him in the chair because it's easier and less traumatic than restraining him in bed, if he is a fall risk. That last reason might actually be illegal in your state; laws on "restraints" vary. You can ask the ombudsman in your area about it, or your elder care lawyer.
I know it really stinks to have to be asking all these questions and pestering people to do what seems like the obvious right thing when you just want to visit and spend quality time with your dad. I have similar feelings when my husband goes into the hospital. But the medical establishment is what it is and you have to figure out how you can make it work to your dad's benefit. I have to keep in mind that not everything my husband wants to do is the right thing for him to do. I try to let the hospital deal with those things as much as possible but make sure they do it in the least annoying or agitating way they can.
Everyone keeps mentioning the residential homes or private care homes & while (private pay wise) they may be cheaper they also are usually not medicare or medicaid homes which most families in America could not afford long term for a loved one. Medicare 100 days & Medicaid exist for a reason & are running out of budget for a reason. I do not believe there are any residential or small run out of family homes care places that would be large enough to qualify for Medicare or Medicaid so whether they are cheaper or not is a moot point. I cannot comment on the need for a sitter since you don't mention whether the home has requested it or you want it. I would think that would affect how the sitter was paid for. I also want to mention that I was surprised that some of the nursing homes in my area will not allow the family to hire a sitting agency for some hours of the day. They are some of the better homes, better meaning newer prettier buildings but not better as in caregiving. There are some nicer homes that will allow the family to hire out of pocket sitters from agencies. If the facility is requesting that you hire one (not your idea) then you might want to visit other nursing homes in the area to see if they would be better able to meet his needs without having to involve the sitter option. I always like the idea of entertaining as many options as possible to make the better choice for the patient. The first place I would start is touring other facilities and asking many many questions about how they handle the issues your current home is presenting as the need for a sitter. While touring it would probably be best not to mention the need for the sitter as you may never get as far as the evaluation your patient would need to get in & that info will come out only when it needs to & at least you won't be shooting yourself in the foot. Just because 1 place says it needs a sitter doesn't mean the next home wouldn't be able to care differently & meet his needs w/o it. More staffing is likely in another place & maybe more funding for it.
When looking at other homes, please keep in mind that the older a home is the more money/funding they have. When a home is beautiful & 5 years old they are still trying to catch up with all their upfront expenses for equipment, building the building, mortgage, and so forth where for instance a building 10-15 years old they have caught up & have a profit with which to pay for better staffing so while the building isn't as pretty & expensively appointed it has more money in the till to provide better staffing & care. On the other hand in some states a really older home like 20, 25 years & older can have archaic staff, building rules & certifications regarding physical restraints & how they meet needs. So there is a happy medium in there somewhere but I have learned my lesson on this 5 yr. old beautifully appointed nursing home 5 mins away from my house. The staff is the 2nd rudest & laziest staff I have seen in 50 nursing homes. It all comes down from the top. Management, nursing supervisors, whoever fills the shifts doing the schedule. Yesterday I (the daughter) was yelled at by a nurse from another hallway at the nurses station because I was simply standing there being quiet & minding my own business waiting for our aide to get a second one to come put him back to bed. I was not addressing anyone, I wasn't looking at anyone, I wasn't speaking to anyone. I was just standing outside the room so dad could sleep w/o distraction in his wheelchair. He had been in the chair for 6 hours & is otherwise bed bound. The nurse looked up and said "Just exactly what is it you need" I said nothing. I am just standing here. And he said, you should not be worried about your father's care. That is our job. You should let us do it. Now this is considered a good nurse at this facility & he has risen to the top of the food chain & has five days a week on that hall opposite my dad. Now I have been told that when my aid is looking for asst. to lift dad back to bed that any nurses & aides from another hallway are supposed to help her. That would be including this nurse who was too busy on his computer to go & help an old man get back into bed. I ended up having to leave the facility at 8pm with him still in the wheelchair sound asleep & periodically trying to stand up & get back in the bed. He had been in the chair since 2pm for pt. I finally left at 8pm with instructions to his nurse that when he fell trying to get in the bed (since they wouldn't put him back to bed) that I wanted the ER at Methodist Richardson rather than Baylor Garland since they use both facilities. The problem is if I am ever up there they will never put him back to bed. I have to actually leave to have him back in bed. I am thinking of leaving him to the system like I did my mother & going back to Florida. There is no reason that nurse couldn't have helped get him back to bed instead of yelling at me for just standing there.
Lake- This is not the first time I have heard this. Facilities request the sitter option when they have a resident that need the companionship and distraction than they can provide. While this does not seem right, the facility has standards that they are required to maintain, residents that all have individual needs that need to be met, and insufficient staffing to have individualized attention for those that need it. Another way to think about it, if your dad did not need the individualized attention but another did, the facility would need to raise its rates to everyone to pay for the few that need it.
Residential homes have a lower ratio of resident to caregiver and may be an option you want to consider.
Very sad. It just shows how lacking and understaffed nursing homes are. You should not have to do that. Try to find a private care home like we run in your town. It is an alternative to a nursing home. They are 1/3 less the cost and are run by loving people that give one-on-one care.
Is your dad in a nursing home or an assisted living? Your profile says assisted living, but this question says nursing home...maybe he's recently moved into the nursing home? Anyway, these are two very different types of care facilities with very different rules. The rules also vary from state to state, and whether he is privately paying for his care, or if he's on his state's Medicaid. Generally, in most states this additional care would be privately paid, even if the person is on Medicaid, because the state is already paying for 24-hour care. Is the facility requiring the 12-hour/day sitter, or has the family decided this is something your father needs? Sorry for the 20 questions! Regardless of the answers, my suggestion to you would be to consult with an accountant/CPA- you may be able to write these expenses off as dependent care. The CPA would know your state's rules. Good luck!
In Canada medical expenses can certainly be written off. My husband, getting treatment and diagnosis for prostate cancer, will be able to claim mileage, parking fees ($13/day), and the like. We will also be staying in the Rotel, the hotel for cancer paients, at $50/ night the night before his surgery.
Lake, my best advice to you is to consult a tax CPA. I think some expenses are tax deductible but have certain stipulations and some can be deductible if they exceed 7.5% of the gross income. It's confusing and snakey so present your situation to a qualified expert in taxes. As far as the private sitter is concerned, I believe you "should" report any payments to her above $1800 but if you are paying her under the table, that's a different story. Somewhere in the midst of all that confusion is taxes on her income. Complicated! I'm all for more in my pocket and less in Washington!
If your dad receives public assistance to pay for his stay, the facility may be required to pay for the sitter if they cannot meet his needs. Check with your state facility inspection department for pertinent rules and regulations since the facility does not seem to be able to meet his needs.
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My mother was very agitated at night when she was first in NH. I spent several nights in her room. I'd doze off on the empty bed in the room but would hear her if she woke up. I'd reassure her that this was a safe place, and there were people here to help her if she needed it. Once she got a roommate, this wasn't practical. Fortunately by then she was on a night sedative that helped and she was more comfortable about her setting.
I'm just thinking of how this will work with your loved one.
Did the facility suggest this? Are the in favor of the idea? Can they make suggestions about where to get such a sitter and what to expect to pay for it?
Call an agency or two to see what they would charge.
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I can't think of anything more counterproductive than a professional caregiver giving the amateur relative a lecture on not worrying about his or her loved one, especially not when the reason the relative is worrying is that the loved one is apparently not receiving the care he needs from those same professionals. It makes your heart sink.
I agree with Appaloosa that if you want something done it's best to make your request fair, simple and direct, and then if there's a good reason for not doing it you'll hear what it is. Most of the time this works well, especially if you add a pretty please with sugar on it; but I share your sense of grievance at this particular man's attitude. Maybe he was having an off day, whatever; if he was really out to soothe your nerves he made a lousy job of it.
I rarely go ballistic at staff because, good manners aside, it gets you nowhere and risks making your loved one unpopular; but the time I left my mother on an acute stroke ward at 2:00 am (in safe hands, I thought), then returned at 8:30 am to find that nothing - and I do mean nothing - had been done for her was one occasion when I did see red. And I was getting the same brush-off from a senior nurse (also a man, as it happens) until, happily, another nurse just coming on duty intervened.
Moral? Some - only a tiny minority of - nurses are a disgrace to their profession. Steer your relative around them.
In hospitals in Texas, they have to provide a sitter for free if they're needed but they won't do it if you're going to be there (because you can do it for free). Sometimes they can't get a sitter 24/7 and there are periods the patient has to go without. In nursing homes and assisted living here, you have to pay for it. it would be spelled out in the contract that was signed when someone enters. Sometimes you can hire one yourself, other homes require you to hire one thru them.
KathleenPlano, in your post, you said you told the nurse you didn't want anything when they rudely asked what you wanted. When you want things done for your father, you have to state clearly what you want and ask what the reason is if they don't do it. If they say they are busy, ask for a timeframe for when it will be done or when you need for it to be done. For example, "My father has been in his chair for 6 hour. He's falling asleep and uncomfortable. Please put him in bed. I need to see him comfortably settled in bed so I can go home."
If the chair particularly bothers you, ask why they keep him in the chair when he is falling asleep. They might be keeping him in the chair during your visit so that you can interact with him. They might be keeping him in the chair because the doctor ordered it (for example, people with some illnesses are less likely to choke or get aspirant pneumonia if they eat sitting up than in bed; some people need to sit up for a while after taking certain meds or after eating to prevent acid reflux of a particularly nasty kind). They might be keeping him in the chair because it's easier and less traumatic than restraining him in bed, if he is a fall risk. That last reason might actually be illegal in your state; laws on "restraints" vary. You can ask the ombudsman in your area about it, or your elder care lawyer.
I know it really stinks to have to be asking all these questions and pestering people to do what seems like the obvious right thing when you just want to visit and spend quality time with your dad. I have similar feelings when my husband goes into the hospital. But the medical establishment is what it is and you have to figure out how you can make it work to your dad's benefit. I have to keep in mind that not everything my husband wants to do is the right thing for him to do. I try to let the hospital deal with those things as much as possible but make sure they do it in the least annoying or agitating way they can.
Good luck everyone, and happy Thanksgiving!
When looking at other homes, please keep in mind that the older a home is the more money/funding they have. When a home is beautiful & 5 years old they are still trying to catch up with all their upfront expenses for equipment, building the building, mortgage, and so forth where for instance a building 10-15 years old they have caught up & have a profit with which to pay for better staffing so while the building isn't as pretty & expensively appointed it has more money in the till to provide better staffing & care. On the other hand in some states a really older home like 20, 25 years & older can have archaic staff, building rules & certifications regarding physical restraints & how they meet needs. So there is a happy medium in there somewhere but I have learned my lesson on this 5 yr. old
beautifully appointed nursing home 5 mins away from my house. The staff is the 2nd rudest & laziest staff I have seen in 50 nursing homes. It all comes down from the top. Management, nursing supervisors, whoever fills the shifts doing the schedule. Yesterday I (the daughter) was yelled at by a nurse from another hallway at the nurses station because I was simply standing there being quiet & minding my own business waiting for our aide to get a second one to come put him back to bed. I was not addressing anyone, I wasn't looking at anyone, I wasn't speaking to anyone. I was just standing outside the room so dad could sleep w/o distraction in his wheelchair. He had been in the chair for 6 hours & is otherwise bed bound. The nurse looked up and said "Just exactly what is it you need" I said nothing. I am just standing here. And he said, you should not be worried about your father's care. That is our job. You should let us do it. Now this is considered a good nurse at this facility & he has risen to the top of the food chain & has five days a week on that hall opposite my dad. Now I have been told that when my aid is looking for asst. to lift dad back to bed that any nurses & aides from another hallway are supposed to help her. That would be including this nurse who was too busy on his computer to go & help an old man get back into bed. I ended up having to leave the facility at 8pm with him still in the wheelchair sound asleep & periodically trying to stand up & get back in the bed. He had been in the chair since 2pm for pt. I finally left at 8pm with instructions to his nurse that when he fell trying to get in the bed (since they wouldn't put him back to bed) that I wanted the ER at Methodist Richardson rather than Baylor Garland since they use both facilities. The problem is if I am ever up there they will never put him back to bed. I have to actually leave to have him back in bed. I am thinking of leaving him to the system like I did my mother & going back to Florida. There is no reason that nurse couldn't have helped get him back to bed instead of yelling at me for just standing there.
This is not the first time I have heard this. Facilities request the sitter option when they have a resident that need the companionship and distraction than they can provide. While this does not seem right, the facility has standards that they are required to maintain, residents that all have individual needs that need to be met, and insufficient staffing to have individualized attention for those that need it. Another way to think about it, if your dad did not need the individualized attention but another did, the facility would need to raise its rates to everyone to pay for the few that need it.
Residential homes have a lower ratio of resident to caregiver and may be an option you want to consider.
Generally, in most states this additional care would be privately paid, even if the person is on Medicaid, because the state is already paying for 24-hour care. Is the facility requiring the 12-hour/day sitter, or has the family decided this is something your father needs?
Sorry for the 20 questions! Regardless of the answers, my suggestion to you would be to consult with an accountant/CPA- you may be able to write these expenses off as dependent care. The CPA would know your state's rules.
Good luck!