I am POA for my relative who had to be placed in a Nursing Home a year ago from Assisted Living as he needs FT Skilled Nursing Care. Though not perfect, the facility is rated in the top tier of US News and World Reports. Figured stats would be objective.They are stretched thin with staff and can be abrupt at times but I also see the caring moments towards him. We have hired 2 private aides who combined provide coverage of 5 hrs/day and give him the warm personal connection that isn't always possible with staff. The facility is immaculately clean; was free from Covid in residents for almost the entire pandemic to date; with the first mild cases only in the last few months.
A family member is strongly suggesting we move him to a different home which is essentially rated the same on major categories. The original move was handled by Hospice and was done terribly, with no warning, delayed transportation by 3 hours etc. He has dementia (a diagnosis said family member is vehemently disagreeing with). Whatever the label, in his mid-90's he has moments where he is confused; he now needs to be fed more often than not, he is wheelchair bound, he sleeps a lot and memory is failing. He frequently states how he hates being there; is ready for heaven etc. He has had a DNR, DNI, etc. for almost 2 years. He was released from Hospice Care a few months ago as his status was unchanging, though I see it continuing to decline.
I feel that he will not be happy at any facility and to move him to a new home that is essentially the same (but "approved" by said criticizing relative) would be too disruptive/unsettling to him. She has had words with staff and will never like them. Staff is not perfect but I try my best to work with them in the interest of my uncle. About a month ago, he did take a fall as an inexperienced staff aide helped him with the bed pan. He was not injured. RN and Director took immediate responsibility as they should, met with family to answer questions/concerns and told us what steps were taken with aide to reinforce safe moving. My uncle is a tall man and weighs close to 200 lbs; he often requires 2 people to transfer him; this day there was only one and private aide was not there.
More recently, he did have to be moved temporarily to a different room while they awaited a part for his bed. He was upended and anxious even with a move of rooms within the same home; wouldn't a move to an entirely different home be way too much stress on him at this point?
At my wits' end here. What is a legitimate reason to consider a move?
Thank you for any insight on this tough and sad situation
I would only consider moving him if:
* A different facility offered treatment or care that his existing facility did not and that treatment or care would improve the life he has left
OR
* There is some mis-treatment or neglect going on at his existing facility
At no point should you move your Uncle. Just moving to a different room at his current NH while his bed was being repaired upset him. A move to an entirely different facility? I don't think so.
You are doing a great job looking after his best interests. Tell the meddling relative to step back.
People who don't carry the load are often those who press others with their unsolicited opinions.
Arguments for moving:
Mistakes on the SNF's part (is the relative also satisfied with the response? - I see you are, and it sounded good to me)
"Words" with members of staff - do you know what about?
How about location?
Any cost implications?
Arguments Against
The arguments against are a teensy bit undermined by their having moved him internally not long ago, but as a counterweight they did so for the best of reasons and demonstrated effective safety checks into the bargain. So we'll let "not changing his surroundings" stand as an argument against the move.
Then there is "better the devil you know."
Established relationships, which at least give you something to build on.
To be considered:
Any concerns about individuals' approach?
Happy with their reporting systems?
Is it possible that the relative has witnessed incidents that give him/her concerns that are difficult to explain? - you can just not be happy about an atmosphere or a manner or a something you can't put your finger on. I should take it seriously, even if there are better ways to address any concerns than uprooting your uncle - it might be possible to appease your relative and then everyone can sit easier.
Transfers and new admissions between facilities, even hospital to facility, are frequently a nightmare of rough handling and lack of communications. My own transfer from a hospital to a Rehab Facility remains one of the singularly WORST experiences of my life.
So much of what you describe about current facility sounds good that it seems unwise to make a change.
You will have to embrace being the POA. That is what you were trusted to do.
If you get the opinion of every single person out there you will end powerless and confused.
You were trusted to act as POA. You are the POA. You should not be discussing all of your reasoning with everyone. Simply make the best choice you are able to for the person who charged you with this duty; that is your mission, your obligation. You will have a very full plate and will not have time to explain your reasoning to everyone, nor should you explain it--the private business of the principal and of you is now a sacred trust, a legal trust between you.
You do as you think best.
Will it always be the perfect decision? Not unless you are God and we failed to know that. You will make mistakes.
Time to tell family and friends "I understand you are well meaning, but I cannot listen to the differing opinions of every member who cares, and still fulfill my function. I will be making the decision and I have to tell you I am not open to a whole lot of discussion about this. It is not a panel who was assigned to fulfill this duty. It is me. I have to protect myself from argument in order to fulfill this Trust. I appreciate you care. If you notice something you think is untoward do bring it to my attention, but do know also it must be evidence based and clear.." I was POA and Trustee of Trust for my bro. I did it all , and there were times I felt so alone. But I must say, it is something sometimes I was thankful for as well. It may interest you to know that doctors serving on a tumor board where they decide the best mode of treatment for cancer patients will fight tooth-and-nail for their own best treatment. As a nurse I knew the dissension and was so confused by it I had no idea which end was up.
I wish you great good luck.
Stand tall; embrace the duty you took on, let them know YOU ARE IN CHARGE. Tell them that the nice part of that is that when something goes wrong you will own it all.
It sounds as though the critics have no good reason(s) to move him.
You have POA.
HE May NEVER be “happy” anywhere, and moving him may make him even less so.
My LO took a LONG time to adjust, but ultimately did very well until COVID.
Stick to your guns, and ignore the “help”.
FYI elders fall at home all the time, right in front of the watchful eyes of their loving families, so the fall scare argument is a non-starter. If the suggested other facility has any other benefits (like, it is closer to you, has more activities, has more continuum of care, is less expensive) then I would consider it.
If the bossy relative keeps interfering and upsetting your LO with her visits, politely inform her that you have the authority to ban her from visiting. Then do it if necessary or she will never stop being a thorn in everyone's side.
If this continues I would tell family you will be forming a "phone tree" for updates. That you will be sending updates about condition to one person who will then call the next of the tree, who will inform the next and etc. Let them know that POA is a duty that isn't discussed. It involves acting as/and for a person who can no longer represent him/herself, and is not something to discuss with others.
You were appointed to this important duty. I have done it. It isn't easy. The last thing you need is the interference of others, well meaning or not.
You may have to gently insist that further discussion be avoided unless there is an instance of some abuse seen, in which case the two of you will attend an administrator at the home together to discuss.
Nothing in your post indicates to me any major reason to move your uncle other than preference from one relative and that to me isn't a reason at all unless I'm missing something. In fact, to me it could cause more problems.
Your uncle may not be happy, but I'm guessing the vast majority of people in his shoes probably aren't super happy about being move to a SNF in the first place. But he is probably settled, he has his space, he has his routine, he has his private aides and he is getting used to the facility he is in. Is this 'new' facility the other family member wants to move him to closer to them? Further from you? What is the possible benefit of moving him? Because I could probably list a number of drawbacks - but I think you already know what they are.
If I was in your shoes, I wouldn't even consider moving him unless there was some egregious issue on the part of the SNF that could not be remediated. But that is just my opinion. That sounds like a lot of work and literally starting from square one for no reason whatsoever except to silence a disgruntled relative and who is to say that said relative won't come up with another reason to move him 6 months from now?