Both my parents are in a nursing home and miserable. Any advice?

Maybe look for a nursing home that is family owned and operated, though they are few and far between. My mother had been in such a care facility until she passed last week. It's an older one floor building, the staff are fantastic (some been there 30 years) and there are activities all day and evening for anyone who wishes to participate. Care facilities that are corporate owned and run only care about the bottom line, i.e. profit.

Thank you again, everyone. I cannot tell you all how much your answers have helped me.

Surprise, your answer was exactly what I needed to see this morning after a day of difficult phone conversations with my mother yesterday. She is angry much of the time and takes it out on me. The staff describes her as pleasant. I occasionally need to be reminded that I am doing everything that I can and I should not put her mental state ahead of the other parts of my life. Thanks for the reminder.

And GA, great list! As I read each point, I thought about the AL facility where my mom lives and, except for the four star chef, it passed. I needed the positive reinforcement.

Janners, I have a several page checklist; I think it's filed away with the last nursing home data so I'll have to dig it out. Maybe the general issues could help in the meantime:

1. Activities - pet therapy, music therapy, and how often? Daily printouts of activities, including a "this day in history" as well as activities for that specific day.

Can residents' families bring in their own music and play? (This was mandatory for us). Best facility Dad was at had a baby grand which was slightly out of tune. I asked if I could pay to have it tuned so I could play for my father. The activities director had all 4 pianos in the facility tuned!

Are there player pianos in game or activity rooms?

2. Gardening therapy - are there outdoor areas with umbrellas where residents can go on nice days to just sit and relax? The last rehab facility I took my father to was surrounded on 2 sides by forest. Staff told me that occasionally deer would wander down and could be seen by the residents.

3. Meals - are they prepared on site, or prepared elsewhere, frozen and shipped? Same facility I mentioned had its own chef, with menus similar to those in restaurants except a bit more limited.

4. Staff to patient ratio - very important. Same facility I mentioned had a good ratio; response was generally within 5 minutes or so. Sometimes there was a longer wait, but after I made special effort to become acquainted with the staff, it improved even more.

5. Staff and management longevity. How long have the key admin people been there? What's the average turnover rate for various levels of staff?

6. Meds. Best solution I've seen was keeping them in a locked top dresser drawer in the resident's room. No med cart being pushed up and down the hall, with possibility for confusion because people interrupted while meds were being dispensed.

7. Problem solving. Is there a method in place (they'll say there is) and if so, what is it? What about friction with a supervisor, such as an alpha male PT director (true situation). What about unruly residents? Wandering residents? Are there different wings for different categories of residents' needs?

8. Holiday activities - what are they? Lot of nursing homes have standard activities such as bingo, etc., but some are a bit more creative and bring in carolers, have warm cider, barbershop quartets, etc.

9. Staff limitations as to responsibilities....last facility (the one I keep mentioning) had a chef who was formerly with a 4 star restaurant. No stranger to fame and rich lifestyles, he was also very humble and even pushed residents in wheelchairs back to their rooms.

10. Other amenities...barbershop/hair salon, meditation room, massage therapy?

One I toured was really top notch; it even had a cut off front portion of a vehicle so residents could practice driving, even if it was just getting re-used to steering, etc. There might have been a program creating different scenarios (such as the simulators in which aviators can train) but it's been quite a while and the only thing I can picture is the subtle and calming pale green walls and that 1/2 of a car.

Good ones have librairies. Very comfortable, peaceful, quiet and consoling libraries.

11. Tour facilities - I went through one that I had strongly considered but found a dirty bathroom floor, not just dirt, but apparently someone had an accident and not all of it was cleaned up. That did it for me - that facility was off my list.

12. Odors. Shouldn't be any except flowers and food.

13. Amenities for guests. Last facility offered resident's family one free meal, any choice (no prime rib on the menu though). Free coffee with flavor packs was always available.

14. Private rooms for family get-togethers. Some of these rooms are beautiful enough for corporate conferences.

15. Common areas. I used to take my father to some of the common areas that had better views. One was like a high class lounge - only problem was someone was watching football with his family so we went elsewhere. There was a lot of privacy for a family that wanted it, and just wanted to get out of the resident's room.

There were a lot more issues on my checklist; I'll see if I can locate it in the next few days.

Surprise, thank you for very well said answer. I would also would like to 2nd Irishlass's answer...turnover is very common. In my fathers facility, there is turnover among nursing staff....BUT...all of them seem pleasant and caring. Generally, these places are staffed by folks who are still working through their nursing training, work seasonally or part time. And we all KNOW how elders will not tolerate any change in their routine. I would be more concerned with cleanliness, nutrition, etc. You should feel comfortable calling the facility any time. There will always be a "nurse in charge" or social worker you can check in with.

One of the signs of declining mental state is constant anger. It seems to be directed at whoever is close by all the time, so that could be part of the issues. You could mention this to whomever handles his medication/dr visits because there is a medicine for that. I would rather be a sleepy happy old person than to be wide awake and angry with my situation of being old. I would also see if the family can put a Do Not Resuscitate order on their charts so they can go "home" when the time comes and not be burdened with living on this earth longer than required. Being old stinks, and your dad's mental state reflects that.

You need to take care of your family and not sacrifice it to your parents. In their right minds, would they really want you to give up taking care of their grand babies and to give up a good marriage to serve them on their way up to eternity? Your children and your husband have futures here on earth; your parents have lived their lives already.

This is one of those difficult times of life where you have to turn to prayer to get everyone through. You know the facility is nice and you know there are people there who are tending to your parents, even if your dad forgets who they are. That is pretty much the basics you need covered. Someone is acting as director to schedule shifts, so the fact there is no one filling the position does not bother me.

You do have to qualify in a new state for Medicaid when you move, but honestly, it will be so difficult trying to look out for them while you are in another state and have limited ability to travel. And for them to be in a NH that has questionable care.....I can see why your concerned.

Since your siblings are no help, I would explore the details for a move to your state, even though it's not an ideal measure. Moving seriously ill seniors is a last resort, but in your situation, I would question their well being and the risks of moving them. I wouldn't just look at whether they are unhappy, but are they actually getting good care. The answer to that would help guide me in making my decision.

Perhaps some others here can give you details on residency requirements, qualifications, etc. I would think that if you found a place near you that accepts Medicaid, their admissions office might know the proper steps. Or you night check with the social service agency in your county where Medicaid applications are processed. See if there can be a smooth transition and you can make the plans for medical transport, etc.

You might google for some general information on Medicaid change from state of residency in advance, before you speak with anyone to make sure you have your ducks in a row.

Medicaid will not cross state lines (you stated that you live 4 states away). So if you move them near you, be prepared to get them qualified in your state all over again. And each state's benefits are different. Unfortunately, Medicaid beds are also limited so you may have fewer choices in moving them than you would like. Contact your Area Agency on Aging in Texas for help there or in their state for ideas there. Holding good wishes for you.

Are you planning on staying in your home for a long time? I don't know all the details of your situation, but have you thought of moving them to a facility near your home? Your mother and father might enjoy visits from their grandchildren. The "bad paperwork sister" could drive them to the new facility. How are her driving skills? (joke)

I don't have much of a solution but I wanted to share with you that while the NH where your parents are may have a particularly high turnover rate with their employees, all NH's have a high turnover rate. Some more than others, as I said, but they all have that issue. If you move your parents to another facility you may be going from one bad situation into another.

Thank you Garden Artist. My mistake. My two siblings have not been particularly helpful with the big decision issues. I don't know why they have not stepped up but the oldest asked to be removed as POA and my other older sibling just claims to be "not very good at this stuff" (i.e. logistics and paperwork). Therein lies the problem. I do not have in town (or state) to do the groundwork on this issue.

I think a checklist is a great idea and may help focus my father and mother while I start researching. If any one knows of a great place in the central texas region that would be great to hear a suggestion!

Any suggestions for check list items?

Have you considered finding another facility that doesn't have the staff turnover issues? It's well within your rights.

I don't know about the Medicaid issue but others here will. Assuming that that can be addressed, I'd make a checklist of what you're looking for, including stability and better staff to patient ratios, and start touring.

If I read your post correctly, your siblings are in the same state as your parents, so they can do the onsite tour while you can do the Medicare comparison ratings and online research for them.