My Dad has dementia and is in a nursing home. The nursing home does not have the training or staff to adequately care for my Dad. For example, my Mom has asked the staff to "walk" my Dad. He is primarily confined to a wheel chair, but he has the ability to walk. Unfortunately, it is difficult to get him to stand up, not because of physical limitations, but b/c the dementia prevents him from understanding how to stand up & also he becomes combative when you try to force him to stand or sit. So it can easily take 10 minutes just to get him to stand up. I can understand how it is difficult for the nursing home staff to accommodate this care request, and that's why I am wondering if anyone on this forum has heard of "in-home care" working with someone who is a resident of a nursing home. That way there would be someone who has the time to help my Dad get up and walk and sit, and in general, just deal with him as a patient with dementia and not just shove him in a wheelchair and out the way.
Also - my Dad is a Veteran; I had heard he may qualify for benefits that help pay for "in-home care".
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You've also covered the PT question (but others keep bringing it up!) PT and OT is only good for so long, even if approved, which in this case it is not. Also PT/OT is somewhat pointless because if one doesn't practice what they are asked to do, they lose any gained ability/strength again. Dementia patients are not likely to continue any exercises on their own during or after the sessions, so this would be why it isn't approved.
As to some asking why the concern about him walking - my mom used to harp at my dad not to sit so much. Don't use it, you lose it. I think someone posted about their LO going in with walker/cane and coming out wheelchair bound because there are not enough resources to keep patients walking. The benefit of walking is 1) not losing the ability and 2) physical, mental and social stimulation are all good for dementia patients.
As far as hiring outside help, your best bet is to ask the administration of the NH. There have been posts on this site about people in regular AL who have been told they are not allowed to bring in self-paid outside help - however there might be "approved" agencies they will allow. You really need to check with them first and then consider the cost as it will likely be self-pay.
On a different topic - the aggression/combativeness: even if you can hire outside help, this may be an issue for them as well. Has any medication been considered? I'm not recommending anything that will dope him up but rather something like what mom got when UTI made her unmanageable - a very mild dose of Lorazepam. It doesn't take days to build up in the system (perhaps 10-20 m to "work".) It is just enough to calm down and maybe help him be more "compliant." There is a minimal fall risk that is associated with any of these anti-anxiety meds, but given the alternative, it isn't much. Once he is helped up and because he would be "aided" walking, this shouldn't be a concern. Perhaps consider getting a walker as well, to assist with balance.
My Dad is on a 100mg (I think) dose of Seroquel for his aggression.
And, yes, he's been given Lorazepam to help him calm down a few times.
My family and I are worried about the NH giving him too much medication, as in the last few days they upped his seroquel....and then he barely wants to do anything at all....and if my Mom gets him to stand up....he can't walk very well. We don't want to see him be "snowed"....not yet anyway. He's only been in the nursing home since September and he's only 79.
Walking is something he really enjoys (once we get him up); it's where he acts the most like his old self. So we're going to do everything we can to keep that function in his life.
The good news from my Mom yesterday was that the NH decided to NOT up his dose of seroquel; they're going to stick with what he is already on and add something else....my mom could not remember the name, but we'll get the report next week. I hope it is an anti-anxiety or something of that nature.
Oh, and as for the walker....he has one in his room, but it confuses him. :(
Dementia patients get frustrated and when a nurse or OT comes in and (many times they are extremely busy or short staffed) their patience can be felt by your dad. I honestly don’t think it would be bad to have someone come in, on your own dime if you can budget it in, to help with some of these tasks. I did it for my mom. She was ornery as heck in the nursing home for her one month stay. I asked the administrator and she said that would be fine. I called a recommended company and the two ladies met (administrator and caregiver) and it was a match for my mom that lasted 4 years. Even if you can do it for 3 weeks and find a company that matches based on personality and care abilities (nurse credentials, etc.) it will help your dad and you with peace of mind that he’s getting the care he deserves. Plus many of these companies are used to calming their “patients” when they get upset. Just find a good one that is well reviewed and not a lot of turnover.
You are amazing to just be asking this. Many daughters or sons would just expect the NH to deal with it and then ignore that it’s an issue.
My sister and I are going to continue researching the type of help we can bring in and see if we can find some veteran's benefits to help with the cost.
It's a bit difficult due to the fact that my parents live in a remote-ish part of South Dakota. We hope we can find something/someone relatively close to the NH.
:(
Find another facility that has a program and therapists set just for this type of issues.
You’ve said his temperament is hostile when staff attempt to help him stand to walk. Perhaps they are afraid your father may harm them and from what you’ve said, that possibility is real.
It sounds as if he would benefit from 1:1 which is NOT what NH provides.
Thus, instead of losing valuable time and not have your father forget how to walk, maybe paying out of pocket a few hours per day for your father to achieve your goal to walk him daily.
Its an unfortunate situation but it is what it is.
I don’t think VA Aide & Attendance applies in a NH as far as paying for a CNA to sit 1:1.
I just re-read your post where you said it can take ten minutes just to get him to stand. To a NH staffer, 10 minutes is a very long time when she/he has 7 other patients needing their attention.
There are no easy answers to many of these NH problems.
Also your dad should be able to get Veterans Benefits according to different rules that apply to different types of benefits.
My dad got help in the assisted living with VA helping on the bill. Medicare will pay on physical therapy.
As far as him walking, you might talk to your doctor to see if they can order physical therapy to keep him moving as long as possible.
Guess who will be blamed if the resident falls and breaks a hip???? It wont be the resident. It wont be the family that wants to warmly remember the resident walking. What if he forgets how to walk ten steps out from the bed? You said he forgets how to stand/walk. He cant without huge amount of support. 2 cnas trying to cajole, coax, beg, and maybe slapped or punched by a resident to try to get him to walk stops them from caring for their 13 residents. It is VERY unsafe. He doesnt have the muscle tone or the memory. The cnas will be blamed if anything happens.
Residents get up and try to walk on their own all the time. They fall. Guess who gets blamed for not catching them, or not seeing them fall?
The ratio is like 13 residents to 1 cna. Residents bone density is nill. Is it worth having them break a hip? Severe pain and virtually little healing. It is better to have the resident SAFE.
Even PTs have put a gait belt on a pt and had them fall breaking a hip. Very dangerous when they are unsteady.
Your caring is wonderful, but the walking is unrealistic. You are remembering him the way he was yrs before. Not in his present state.
My father is now unable to walk and the plan of care (made by me, the POA and members of staff) no longer includes PT. There is no point as his Alzheimers is advanced. I am more concerned about the safety of the staff at this point. When he could walk he told one of the CNA’s that he would fall on purpose to get attention. We moved his room next to the nurses station as he refused to use the call button. He is very combative as well. Cursing at and hitting the nurses. When he first started falling almost daily I could tell the staff was terrified I would blame them for inadequate supervision. I know there is no possible way for them to keep an eye on him every second. Tethering him to the bed (jokingly suggested by me) is not legal. The staff at his facility are all saints to me. They call me when they change a bandaid. Instead of thinking of him as being a pain, his antics are looked upon as amusing. They always tell me they’ve dealt with worse.
There are a lot of us who understand very well how understaffed, underpaid and highly regulated senior care is but it is extremely difficult to navigate on both sides.
Reason is that the aide (CNA) ratio to "residents" is not one-to-one.
Nursing homes and those ratios are highly regulated, and few places staff above the minimum requirements. In my mother's nursing home, each aide has responsibilty for 8 residents. And, her "unit" has 16 resisents. So, that's two aides total. If one resident requires suddenly extra help bathing one day, or is having unexpected bathroom issues, then the other residents that aide takes care of will not be responded to as quickly. However.....a good nursing home makes sure that all staff on shift.....even a unit secretary....respond to the call bells even if all they can do is reassure the resident that her aide or a nurse will come soon.
Unfortunately, a lot of residents expect a one-to-one....come on demand....relationship with an aide. Especially if they had been receiving one-to-one care before moving into a facility.
Also, in some places, all staff, including the floor nurse, has to help out in the dining room for 3 meals a day. And, that's why they try so hard to get all residents into the dining room for meals. They have to get everyone into the dining room, and serve the meals -- making sure to follow any dietary restrictions----and bring more beverages when requested, and sometimes feed people, and then take residents back to their rooms....and then, sometimes, there's an immediate bathroom need. That makes it difficult for them to respond immediately to call buttons.
And.....non-meal time ---- if there is a common area with a TV, where you see residents in their wheelchairs watching TV......in many places a CNA must always be in that room to monitor residents who are in that room, taking away from CNAs who can go to individual rooms to respond to call buttons.
And, it's hard for any of the aides to respond during a shiift change, because there's usually 15-30 minutes when the floor nurse and aides are being briefed by the shift that is leaving.
Please find out the phone numbers of all of the nursing "supervisors." There should be at least one supervisor on duty all day and night. Those supervisors can be extremely helpful to you if you are getting frantic calls from your LO saying that nobody is answering her call button.
One place where my dad lived had one, yet when we moved, I ended up buying one myself direct from the manufacturer, so I got better price.
It's been a god-send!!!!!!
In-home care is ok. Yet don't you have to pay for it? It was not sustainable for my family's expenses.
All the best!!
Good luck,
🙏🏻🌹🙏🏻
My mom was in a similar situation during her residential care.
Is he getting PT? they should be walking with him if he is compliant or if the Dr. determines it would be helpful.
If he is a Veteran he might be eligible for some services. And depending on where and when he served he may be eligible for quite a lot of additional services. The VA has "Homes" they are small houses that are set up like a home the ones near where I am are called "The Green House" they are community houses and the staff to "patient"/resident is great.
But another thing to note...the facility where your dad is might have restriction on who can come in and help him out. You might be required to hire from a specific agency.
Another comment here and this is my personal opinion but if the facility where he is is not "trained or have the staff to adequately care for your dad" you might want to think about moving him. I do not say this lightly as moving someone with dementia can be difficult but it is concerning that they are not trained nor have the staff to care for him.
I would recommend to contact your social worker, and have your requests put in writing have therapy involved. So you do not get in trouble, as they want you to believe, they have total control. As with my father, his decline has been very disappointing. But the care is substandard. As it has been 20 minutes to get a glass of water, 1hrs 7 minutes to get staff to take him to the toilet. He is a veteran, however help is based on income. Contact Veterans administration, have had discharge papers and his income. They can help if the income is within the range. Nursing home were my father is $10528. Per month...substandard care..
Best of luck.
After the therapy was over, they arranged a "walking" protocol by which the aides would walk my mom some distance (I think it was 100 feet each day).
It may take some investigation on everyone's part, but I think you need to find out if there is some "trigger" that can get dad to cooperate. If his dementia is very advanced, this may be impossible. However, if he can respond positively to "now it's time to walk to the dining room for ice cream/cookies/hot coffee", you may be able to entice him into cooperation. Make sure the aides are not asking "would you like to.....?" For most, the answer is "no!"
And PT was ruled out a week after Dad arrived at the NH b/c he can't follow any directions.
Maybe you can post and tell us if your Dad can walk without a cane or a walker? That would help with responses.
The aide to "resident" ratio in accredited nursing homes does not have enough aides to walk your Dad. I know, because I have requested the same thing for my mother and done the research.
As far as I know, there is no free in-home care when in a nursing home. Your Dad is not in-home, literally. Having anyone come in from the outside is private care...and the expense is your expense. However you are able to pay for it. Neither Medicare nor Medicaid will pay for it.
Please make friends with the director of rehab: physical and occupational therapy. Have your Dad evaluated. Maybe they can get him qualified from his insurance for some PT or OT. If he qualifies, then the PT or OT will get him out of his chair and walking. But, that won't last long. Maybe 2-3 weeks, because insurance won't pay for anything that is not designed to cure a medically related situation.
As far as the VA: I can only speak from my experience, in Florida, but, even if you had already gotten your Dad eligible for pension or aid & attendance benefits while he was still at home, once he went into the nursing home the VA would reduce the benefit to $90 a month which he would be able to keep and spend. And, it's a cash benefit, and based on your Dad's income and medical expenses. Generally, it takes 4-9 months for the VA to process a claim. You can try. But, I don't think it will solve your problem.
Sorry.....really. But, unless you have the funds to pay for an outside trained aide, I cannot come up with any viable solutions. For my mother, we were only able to get a volunteer companion from a religious based foundation for 2 hours a week, and the companion does not, and cannot be asked to, do anything that an aide would do. She's just a "friend."
Medicare will pay for this and Medicaid if a Dr. orders it.