Incident report at AL. Any advice?

What you want here is the proper living environment for mom. A proper cognitive evaluation that will tell you where she falls, number wise, on the dementia scale after taking a fairly short MoCA or SLUMS cognitive test. You say she has "mild cognitive impairment " going on already......which can easily morph into progressive dementia in short order. I saw it happen with my own mother over a period of time. When I finally got her tested as an in patient in the hospital, she was Showtiming up a storm and telling the doc how handsome he was. I said TEST HER. She scored an 18 on the MoCA and drew a blob-like thing for the face of a clock. Meaning her Executive brain function was compromised. Which led her to do odd things like add a zero on the microwave timer in her AL apartment. Or put her pills into a coffee cup up in the cabinet to "take later" and then be forgotten. Or later, to start accusing staff of ripping off my dead fathers memorial jewelry with ashes inside. As if, right? 🙄

I don't know and you don't know if your mom has dementia. But what we do know is she's flustered and maybe struggling with things we find easy like microwave timers but are the FIRST THING to go when dementia sets in. I watched my mother many times try to turn the tv set down with the phone. Or use the tv remote to make the phone louder. No amount of reason or logic will help them learn gadgets again. That part of the brain is now compromised.

If this were my mom, I'd want that microwave out of there and I'd be playing UP how nice it is she can use the unit in the common area. The goal here is safety and that can turn ugly in a New York minute. Don't find out after she's rushed to the ER for something that could've been avoided, God forbid. An incident report is just that.....mostly the CYA principle at work on the ALs part, really.

If she does get a lower score when properly tested, don't move her to memory care AL until absolutely necessary. Idk what rules will be in place in the CCRC she's in.....you're best off finding out NOW and avoid getting gobsmacked later. That was my motto with my folks in managed care for 7 years. How do we play this game so we ALL thrive? What rules do WE follow and what rules do YOU follow so everyone is safe and living their best life?

Don't be afraid to find out the truth here about mom's mentation......knowledge is power. You and your sibling cant help mom till you know what it is you're dealing with! Then you proceed accordingly. Dementia can be an ugly diagnosis, yes, but until we get that diagnosis, we're scrambling to make sense out of chaos. #Truth

I had to move mom to the MC bldg of her AL about 6-12 months too soon. There was little choice in the matter due to mobility issues combined with dementia. She was too far gone for regular AL and not quite gone enough for memory care, in reality. Which is what happens to a lot of elders, unfortunately.

Morningstar is an AL chain in some parts of the country that specializes in "in between" elders. They cater to special diets regular ALs won't touch. They house dementia residents along with non dementia residents w/o the "memory care" rules that often foul everything up. Caregivers are assigned residents to care for their entire shift, 100%. It's a different mentality but comes at a cost (naturally), although not more than a CCRC. Look into it, if you'd like. If I had to manage mom's life over again, I'd have looked into Morningstar myself. It's a regret I have that's too late to fix now.

I know what this feels like and it's not fun. Wishing you the best of luck with all you have going on.

Thanks for the update. My one question is...why were you or brother not there? Even early on in my Moms Dementia journey, I was with her in every doctor visit. She actually did very well on the Neurological test but u still could see she was not 100%. I have sat with Mom, we leave and she says the Dr said this and that and I am saying "no, thats not what he said". So many things can be missed.

Upstate, thanks so much for the update!

Don't you have regularly scheduled care conferences, like every 90 days? We did for my mom. By law, I believe they are required to update the care plan.

Please let us know how it goes!!

Hello, just checking in to thank everyone for the information and advice. It was helpful during a stressful time.

We did have a “care conference” with a social worker and a couple of staff members. That turned out to be kind of a nothing-burger. They didn’t really want to talk about the microwave, although my mom was very anxious to tell her side of the story. It did sound as if she was having more difficulties with the abstract controls.

They wanted to have her do OT and PT, as well as a cognitive assessment. I am all for therapy to increase strength and balance, so that seemed like a bonus outcome to me.

My brother asked whether my mom might be able to get help from the aides with microwave tasks, if it was not cognitively safe for her to use the microwave. So the compromise is that my mom can use the microwave by the nurses’ station with help. She is not happy about this but it seems like a reasonable compromise.

It’s been very quiet for a couple of weeks and I was just starting to relax. My mom told me the cognitive testing went well. (She described some of the questions to me and it did seem like she knew what she was talking about.)

This afternoon we got another call about a “care conference.” So now there is something else, no idea what. Maybe the cognitive testing didn’t go that well? I guess we’ll find out. (My brother will be out of town for a few days, so the meeting will be next week.)

Anyhow, thanks again for your help.

There are paid services near where I live that cook and bring meals to the home. I also had a friend who cooked for elderly people in her neighborhood and took the food to them (for a fee). I don't know about special diets, but there may be services for those too. Also there's Meals on Wheels, though I'm not sure about special diets with them.

Investigate the idea of brother changing his plans so that he can bring her meals more frequently. He could always hire someone to deliver them to her if that's the problem.

I tend to believe that if she overcooked the roll, she's having more severe problems than you think.

An incident report is generally required in any well run establishment. In most ALs it is only submitted to administration and safety committees to make sure their current procedures are being followed and do not need to be modified. Continued incidents of the same or even a different nature that might be harmful to staff or other residents may need a re evaluation of the ability of the facility to meet the residents needs.

I don't think the staff should have "berated" your Mom or anyone in your family although they certainly should have mentioned the incident to her and you. When your Mom signed the contract and moved into the AL, she should have received a packet and a copy of the contract which should have spelled out all the regulations. These contracts renew annually and can change so it is wise to review them at that time (if you are not a legal eagle reading these contracts can be ...... frustrating to say the least!). As a certified assisted living administrator, I can tell you that the original American concept of ALs (1990s) was really to "assist" older folks who no longer wanted to cook, clean or do heavy house chores, but who wanted to social and enjoy fine dining. Most ALs hire chefs who could work at 3 or 4 star restaurants and who are not trained in cooking for medical requirements. Skilled nursing facilities generally hire cooks who get a lesser salary because they have less training but who may opt to get medical cooking training so that they are familiar with diets calling for "mechanical chop, puree, soft" etc.. The AL world, like the country is far more diverse and global so that cultural preferences can often be accommodated but medical diets sometimes remain out of the sphere.
You are quite right that the best choice for medical diets seem to be in the non profit CCRC because their kitchens (often more than one) have to handle everything from independent livings (definitely looking for 5 star restaurant food) to short term rehab (diet restrictions while recovering) to long term and hospice (soft/ pureed, etc). The older CCRCs are also experiencing staffing shortages but to a slightly lesser degree because many have built in career ladders which lead to better salaries and benefits for those (kitchen, housekeeping and CNA) on the lower rungs. It also gives them a glimmer of hope that they can move up so they tend to stay longer. But CCRC's require that large entrance fee in addition to the monthly "rental".

Check your Mom's contract to see what it says about incident reports. Talk to the Exec Director. If you feel the aide and the supervisor over reacted and talked to your Mom as if she were a child you need to bring that to the attention of the Administrator; Mom, with or without a cognitive impairment, is not a child. If their talk upset her, they need to change their delivery tactics. I sincerely doubt that the diet situation will improve at this facility. At some point if Mom can't operate a microwave (assuming that they replace it) you will have to seek another facility. Just remember .... they will promise you anything to get you in. The question then becomes can they deliver? Most states will not permit non staff to tour kitchens for health reasons so when you seek a new facility rely on the experience of doctors, dietitians and families of people who are already residing there.

Good luck on this tough road. Please keep us updated.

Did you witness any conversations that the staff had with your mother about this, or see the volume of smoke, or have any conversations with anyone who was directly involved in the incident (apart from your mother)?

We have to complete incident reports for untoward events and near misses of any kind. The report will detail what the aide saw, what your mother told her, what the aide did about it, who else was involved, what resulted from the incident, who the incident was immediately reported to. What happens next is an evaluation of the incident, a risk assessment or review, and then whatever mitigation measures are appropriate.

Based on what you know so far, removing the microwave would be disproportionate and a deprivation of liberty. But a) the information about what happened does want checking; and b) it wouldn't be disproportionate to suggest that your mother should have some stand-back support when she's using the microwave, and advised to avoid using it for [x, y, z foods].

Tell me how content you would be if the resident in the next room started a fire in her microwave and no one thought anything of it or did anything about it.

Putting a roll on for five minutes on full power is not an easy mistake to make. If she'd intended the roll to heat for fifty seconds she wouldn't have moved far away from the microwave and she would have noticed more promptly that it was taking too long - six times as long as you're expecting is a lot.

The difficulty here is that if your mother is losing awareness of the right steps to follow, then precautions such as avoiding certain foods, or asking for support from a member of staff, or reminders stuck to the door are not going to work. You need to investigate more closely what went wrong, and you also need to check that small things haven't been going wrong for some time before this. Also make sure that she can see the numbers, in the light she actually uses - daylight from a window can make LED displays very hard to see, for example. Similarly, check she's able to read directions on any packets (which can be ludicrously small and confusing).

We wouldn't get very excited about somebody burning toast. In fact, our local fire brigade did use the term "test by toast" in a presentation about smoke alarms. But we would be concerned if someone who was well-used to using a microwave began to misjudge timings or settings or food choices, and we'd respond by monitoring and supporting her until we were sure that all is well.

Without blaming your mother I think it would be a good idea to get cast iron information about the sequence of events, too. Suppose from a different angle it looked more as if the aide had gone into your mother's room and found the oven still on and the room filled with smoke, and your mother only *then* noticed and reacted.

I'm sorry that your mother feels she's being blamed for all this, and that she is "being reported." An incident report is a record of an event, and if it sounds accusatory then it's been written badly. May she heat many more meals of her choice safely yet.

I had Moms microwave taken out before she moved in but she was in the mid-stage Dementia.

I can see the smoke setting the alarm off, but not a sprinkler system. I think heat has to set off sprinklers. I think the staff over-reacted. Mom did not set the microwave on fire, not really sure u can. I may have told her the rules and leave the microwave. If it happened again, then remove the microwave.

You should have gotten a packet at the time Mom entered the AL. It should have had Moms rights as a resident and rules and regulations.

I will tell you why the turnover in Nurses. One Nurse is not paid enough for the work that needs to be done. We have an AL up the street my daughter applied for Nurse job. She said they could not pay her enough to do what they expected from her. She's been nursing for 25 yrs.

I left something out about incident reports; the incident report belongs to the facility and that is where it will stay. It will not follow your mom and will not even be mentioned in her medical record.

I may be wrong but I believe an incident report is something that has to be done when something out of the ordinary happens. There are several instances when an incident report has to be written. It is more for the facility than the residents, it is part of their risk management policy. Family members have to be notified but there is no need for chastisement or blame. Administrators and other staff in charge of course get upset because there is paper work to be completed. This could have turned into a very serious problem like you said and at the very least your mom will not be able to keep her microwave. They may ask her to leave but this will be after a meeting with family members to discuss a plan moving forward. Since your mom's vision is impaired and she also has special dietary needs which will not be provided in AL you may need to consider moving her to a SNF facility where her dietary needs may be met. I am hoping this will help in caring for your LO.

What incident report will be written and reviewed about how multiple staff members "berated" your mother over an apparent unwritten (and uncommunicated) policy?

I would encorage your mother to take a close look at the facility with more stable leadership and staff. If she is willing, maybe schedule a week of "respite" care for a closer look. As you have discovered, no matter the policy or good intentions of individual staff members turnover severely limits the capabilities of the facility. I understand your mother may not want to risk considering a new home or losing touch with the friends she may have made at the current facility but I think a serious discussion would be in order given the turnover. I personally found the ability to problem solve and work mutually derived solutions concerning my father in MC with vascular dementia and food challenges made a huge difference in both his quality of life and my stress level (particularly in the last year).

I think everyone of us has had a 'close call' with a microwave--no matter our age or capability. I know one of my kids cooked a hotdog for 20 minutes instead of 2. I was not home at the time--and when I got home--there was a microwave in the yard and all the fans the kids could find running in the kitchen to move the smell of 'carbonized' hot dog outdoors. She never ever put anything in a microwave and walked out of the room after that!

Of course the microwave was totally ruined and the smell lingered for so long.

My mom, at the end of her life, used a microwave exclusively. She did have a smoke detector and she was pretty cautious--but I know that she wasn't supposed to use it when nobody else was home. Yes, she burned a few things, but chewing her out about it wouldn't have helped.

OK, your mom made a mistake, and yes, she has to think of the safety of all the other residents. BUT--I hope this was handled w/o making her feel 'stupid' or 'incapable'. The worst thing for mom was losing independence and then being made to feel stupid for a mistake that anyone could make.

If mom has the ability to still make her own personal living decisons, then let her. She may not want to stay in this place. They 'sound' like they treated her like a child--and she doesn't need that.

Your role now is one of support and love. No matter our age, being berated for doing something 'dumb' is embarassing.

My brother's facility did not allow microwaves in rooms. Or Coffee makers, or that sort of thing. It was ALF divided into cottages. The cottage's rooms were around a central gathering place, one end for meals, the other a communal room for games, TV, whatever. In that central gather area was also an extra bathroom with walk in tub and a small kitchenette with microwave and cabinets. It was specially fit out with detectors (and rooms had smoke detectors as well).
ALFs increasingly has people who are moving onto the spectrum; my brother had probable early Lewy's dementia. As complicated as microwaves can be today I can see this easily happening.
Accidents DO happen. We have ALL done such things at home. I almost set fire to my building with having an electric blanket on low setting for a cat that would only sleep on the back porch--I was 34 years old at the time.

As far as the incident report goes, that is no worry. They HAVE to be made out with any such incident. Routine. We nurses would regularily burn something up (sorry guys, happens) We would get a coffee maker, burn up the plug thingy with it on 24/7, be berated by engineers who were to be called for any plug in devices which needed more industrial plugs put on.
We would set fire to the things we tried to warm in the microwaves back when they had no lovely plug in blanket and compress warmer systems.

Incident reports are done when an "incident " happens. They are gathered and taken to committees that go over them to see if new rules are needed, what violations of safety occurred and so on. They must be shown to JCAHO when they visit. It's the law. That's why facilities hate them.

If they speak to you about mom it will almost certain involve more than this. It will be a set of things. I DO think you need to consider that whatever the dietary needs are they may not now involve a need for cooking or microwaving. But I doubt Mom would lose her position here simply for that. And I do think their policy of allowing microwaves in rooms is a dangerous one. Microwaved food is dangerous in itself for mouth burns for elders and should be carefully done.

Just my guess, all of this, and wishing you the best. Hope you will update us. Speak to admins there if you are concerned.

Re: kitchen staff, we’ve discussed this with the head chef many times over the last year and a half. After a hospitalization and a new diagnosis for diverticulitis, he called for a consultation with a dietician who works for multiple facilities in the region. The chef had never heard of diverticulitis or a low-residue diet, did not know how to comply with the medical orders but seemed interested in learning. That quickly collapsed after the dietician visited my mom and wrote up a plan. The plan ended up being buried in my mom’s digital records and none of the aides could figure out how to access it. Also there are new aides literally every month, so many are unfamiliar with systems/policies/individual patient needs. The chef, after an initial effort at compliance, basically told my mom he couldn’t make special meals for her all the time.

I went over her dietary needs in detail with a new supervising nurse in December, but the nurse lasted about two and a half months. We’ve had at least five nurses in that position over the last two years.

Currently there are a couple of nice women who work in the kitchen and make an effort to cook something for my mom when they happen to be on duty. Otherwise it’s pretty random and she makes her own meals a lot of the time.

I wanted to go to management about the dietary problems, but my mom thought it was pointless. She just wanted to prepare her own meals (e.g. sandwich, frozen dinner in microwave) when the facilities’ menu was unsuitable. She also has IBS, so she has a lot of medical needs with respect to diet. But she fears making waves and so far, we’ve taken a wait-and-see approach. That may need to change.

The microwave is the same one she’s used since moving in about two years ago. She does have mild cognitive impairment (based on minimal screening, not a thorough neurological work-up). It is possible that these difficulties are worsening. It is also possible that she made a mistake and is not experiencing any substantial change in cognition. I guess I’ll have to be open to either possibility.

The facility is increasingly short-staffed with unstable leadership and ownership. There have been three different owners and multiple directors (three or four) in the last two years. Most employees last only a few weeks or months.

My brother and I feel that the staffing shortages and overall lack of policy/communication are safety issues. There are only a couple of other reasonable options in the area. The best seems to be a large non-profit organization with more stable leadership and staff.

So far my mom has been strongly opposed to a move. She is legally autonomous and makes her own decisions. When I spoke to her last night, though, she was upset. “I’ll be out of here, if they take away the microwave.”

I guess I will see about scheduling an appointment. Not looking forward to it! Thanks for the input.

They are always on the lookout for cognitive decline and signs a resident no longer is suitable for the level of care they can provide, I imagine too many red flags would lead to a discussion about that (as it should). I doubt they will ask her to leave over one incident but there was always going to come a time when she couldn't prepare her own meals, I think now is a good time to begin exploring what other options are available and whether there is room for some flexibility in her dietary needs.

I feel like you do about the safety aspects of the situation.

I don’t think the facility workers should have berated your mom about accidentally leaving something in the microwave too long.

Have you spoken to anyone outside of the kitchen staff about preparing meals for your mom’s nutritional needs?

How did they explain the details of the incident report? Was this a new microwave or the same one that she has always used?

The reason I ask is because my mom was able to use our old microwave. When that one had to be replaced, she couldn’t figure out how to use the new one. She had Parkinson’s related dementia.

I would ask the facility to set up a scheduled appointment so that you can discuss this situation further to put your mind at ease.

Are you satisfied overall with this particular facility or do you think that you could find a better one?