Communicating with ALF staff. Any advice?

The assisted Living facility momma is in is suppose to be one of the best in her town. She pays over $5000.00 a month. I have had issues with them since she moved in. We have never had a care meeting in four years since she has been there. Don't know if all assisted living facilities are like this but the facility is always having a constant changeover in staff and nurses. They are never on the same page. When there is a problem I start at the bottom of the food chain. Does no matter if you go to the head of the facility or not because you don't get your problems fixed. I get a bunch of blah blah and blah. You can do ths because you have medical poa and then the facility does not enforce their own rules even if they have evidence on video tape. They backtrack and cover their ass. I do believe they care about momma but I feel like they need better training for nurses and staff.

"Compliment sandwich" approach:
1 - Start by telling them how much you appreciate them... (be specific).
2 - Condense your requests to 3 crucial items that need to improve.
3 - Thank them again for being there and caring,

Send a letter using "compliment sandwich" approach to administration and give copy to nurse in charge of your loved one.

Msblcb: The assisted living facility should be holding routine care meetings during which time you can voice your concerns in regard to your mother's care. You could begin with a positive note, i.e. 'I really appreciate your great care of my mother.' Then go on to state your issue/concern. While certainly it's often hard to critique, if you say nothing, everything is assumed to be up to scratch. In closing your discussion with them, follow up with thank yous again to reiterate your positive approach.

Just talk to the the head of nursing. You can schedule a meeting via phone or in person. I don't think it is your job to talk to every staff member. It is the head of that depth that should.

Why did the nurse have to be there for the dog groomer? Can the groomer do it in the room/bathroom?
As for psychiatrist, that is the best person for prescribing the correct dosage. Docs can, but a lot of time it can be woefully too little.
They have docs that do home visits. Call up and ask for the names. Then ask if they schedule or should you. Then go from there.
Good luck

They don’t hold care meetings for my MIL. I wish they did every 3 months. We only find out when things go wrong.

As it is my husband has a bad relationship with his mother and I don’t like her either. She is exceedingly combative, has several mental illnesses and recently dementia added to it. We struggled to help her after my husband’s father passed 2 years ago. She wanted to move in with us but refused to give up her dog which was not house trained. I did not want my house to turn into her hoarder house smelling of urine and feces and full of fleas.

My husband and I both asked th ALF to provide a psychiatrist or neurologist for her. They said we would have to take her to the neurologist or psychiatrist. We said we could not because she is uncooperative. Once out of the facility, she would refuse to return. She would not cooperate with any doctor unless they come to her.

The facility says she refuses to assist in keeping her room clean and that the dog continues to relieve himself all over the room. We have told them that they are in charge and that they have the experience to deal with people like her and that her room can be forcibly cleaned by either moving her and the dog to the bathroom or the courtyard.

The dog needs to be groomed. We found a groomer. The groomer arrived on a day the RN wasn’t there. She will have to return. The agreement with the RN is that if my MIL doesn’t cooperate, the dog has to go. It would be devastating to her, but it has been bad for her health to live in those conditions. The dog is in bad shape and it is animal cruelty.

I just wish it hadn’t come to this point. I had asked about the anti-anxiety medication she was receiving and didn’t think the dosage was high enough for her to function properly. She’d become more reclusive. There was less communication.

My husband is unconcerned and said he didn’t want her sent into insensibility. I said the issues isn’t that but her uncooperative nature with the staff means there are still problems. Now she will lose her dog.

So I bug him to call. She is his mother. I would not want to be in her shoes, but it is difficult to deal with her and distance makes it harder. So I understand the communication issues.

It's great that you talked to them. You might want to check your state laws for assisted living; care planning with family and resident involvement is required in at least some states. Also, every facility should have a poster and contact information for the long-term care ombudsman, who helps residents advocate.

You have to address concerns for your mom. If you say nothing, they have no problems with continuing in same manner. Give details and during same meeting emphasize the things they do well.

I see so many people post that they see staffing issue and have empathy that employees are stretched to far. With that said, there is also the obligation for the facility not to house more patients than they can properly care for. That has been a historical problem with facility care - they fill all the rooms, but have seldom had enough people on payroll to properly care for patients.

I even learned that for licensing purposes, one facility near me keeps a large sign in front of the building that says they are hiring. People fill out applications all the time but are never put to work. If an issue comes up that resulted because of staffing shortage, the facility has the appearance of doing 'what they can' to hire people. Preadmit, was told they had X number of employees per wing, or each person on the wing cares for 4 patients. When you're walking around looking at the facility to make a decision, you have no idea how many people are on that floor at any given time. Once you put the patient in, you find out it's really 1 person for 15 beds on each shift....but....they claim to be trying to hire more. Facility care is scary.

Start with thanking them for all the things they are doing right. This sets the tone. Then move to what you are concerned about and ask them how they feel these worries can best be addressed. This also creates the dynamic that family and staff are on the same team, with both looking at how to best achieve the resident’s goals.
Wishing you the best of luck with this.

You should not speak to the aides you talk to the RN incharge or even to an LPN. Approach it like is this a normal thing. I have noticed...no accusing. My daughter worked 20yrs in NHs so I would ask her what I should complain about because you want the aides on your side. Its like "could u please".

The one thing I complained about was the way my Moms bathroom was left. I guess she had an accident while showering her. It was on the shower chair and the floor of the shower. The dirty washcloth was thrown in the sink. I had left Clorox wipes for clean ups. Another time, she had an accident in bed. The only reason I knew it was because I went to make her bed because it hadn't been made. When I picked up the comforter, they had used it to cover the mess. So the comforter was soiled too. Even though I did her wash, accidents were suppose to be washed by them.

At my daughter told me "pick ur battles". And I am surprised they don't have care meetings at least ever 3 months. Even though private facilities they do answer to the State.

Sorry, Memory Care or Assisted Living?

In our case they were housed in the same building, but services were quite different, and communication was as well.

BECORE COVID, I had easy access to the administrator, nursing specialist, and on-floor staff. Later, I called with questions, and was almost always connected right from the switchboard.

I actually asked when LO was admitted what the chain of communication was, and was given the numbers for social services, nursing, and the contact on the floor.

Hope things clear up for you soon.

The MC should definitely be holding quarterly care conferences with you, short staffed or not. Your concerns should be brought up to whoever is in charge....its how you say something that's important. Just don't use an accusatory tone or get them all defensive, just point out what you feel needs to change with your mom's care, and give examples. Then follow up with examples of what you think they're doing a good job with and thank them for their care, etc.

The Executive director and the care coordinator would contact me quarterly for our meetings when mom was in Memory Care. When covid hit, we'd meet by phone instead of in person. It served a two way purpose, they could tell me how they felt mom was doing and if she needed anything more than she was getting, and I could tell them my perceptions about how I thought she was getting along and what she needed. The meetings lasted about 40 minutes or so.

Don't feel like your voice shouldn't be heard because they're overworked......you are not getting a reduced rate due to their short staff issue, right? If they want to operate a facility short staffed, fine, then they'll be expected to run it fully and professionally, and that includes addressing your concerns and fixing the issues that exist. If they can't manage to do that, then close up shop. It's that simple.

Good luck!

We had regular care meetings when my mother was in care, designed to address concerns. Ask for a meeting, be sure to include the areas you’re pleased about as I’m sure positive words will be appreciated, and state your concerns. Don’t apologize for the concerns, you’re mom’s advocate and looking out for her best interests