Saturday, June 7, 2008


Here's stupidity and bureaucracy for you:

When I moved my mother into assisted care they had us meet with an ombudsman, the director, and the R.N. who would be in charge of the whole kit and caboodle of her specific care plan. One of the things the ombudsman told me was that my mom would most likely settle into the move quicker and easier than the family would, that we all would probably have a difficult time leaving her in their hands, turning the care-giving over to professionals who would be providing her better care than we could. I looked at him a bit askew when he said this but made a choice not to take offense. I did say, "well, we'll see." My mom was ready to move out after two nights in the place.

They insist on having a physical therapy assessment so they will know the best way to offer support to the new residents. My mother has had physical therapy several times in the past and I've found them both a blessing and a bane. On the one hand they teach some nifty little exercise routines while breaking up some of the monotony of an elderly person's day. That's a good thing. On the other hand they often stress safety to such an extreme that they can scare the bejeebus out of an older person, making them afraid to walk or do much of anything on their own. I watched this happen each and every time a physical therapist was working with my mother and I've have my work cut out for me reversing the state of paranoia their advice would leave her in.

So once again, the physical therapist is working with my mother and has left instructions for the care-giving staff that she is not to get up and move around without an escort. I've been battling with them over this for three weeks now. While my mom was still in her own apartment her level of care had increased to the point of where we rarely left her at home alone, certainly not for any extended periods of time. Occasionally she would be on her own for a couple or few hours in the afternoon, when all her basic needs were covered and she had a phone nearby to call us if she needed anything. And then, one or more of us were calling her frequently to check in. So even though we had upped her care level to almost 24/7 she was still pretty much dressing herself and using her walker on her own to and from the bathroom and her bedroom.

She's started falling almost daily since moving into the assisted care so they put up a sign in her room which says Do Not Get Up! Call For Help. I took a marker and crossed off the do not get up, and changed it to Use Your Walker! Call For Help When Needed. She has never fallen while using her walker, only when she is walking without it. I'm certainly concerned about the possibility of her falling and breaking a bone but she is more likely to fall the weaker her legs get. And once she is wheelchair bound, it's unlikely that she will ever regain the use of her legs and I'd like to forestall that happening for as long as possible. My mother has a wheel chair which we purchased to take her out and about for long distances. The distance from my mom's room to the dining room where she takes her meals is farther than the distance she was used to walking at her old apartment and I was told that they would escort her to meals with her using her walker as far as she could make it and they would follow along with her wheel chair if she got too tired to continue. That made sense to me. Well, they've been neglecting to walk her to meals but rather just sticking her in her wheelchair right in her room and wheeling her back and forth. I've been bringing this to both the management as well as the individual caretakers attention who have assured me time and time again assured me that they will walk her to meals. It still isn't happening, at least not consistently and when they do walk her, it's usually for only a very short distance even though I have had her walk all the way to the dining room myself so I know she has the strength to make the walk. At least she did have the strength. Her legs are getting weaker and weaker and they keep chastising her when he they discover her up on her own. She feels like a prisoner in her room as she would never venture out of it on her own at this point. This is a big fancy and expensive care home and it's not like we aren't paying for this extra care. They have a basic rate they charge for the room ($3,000. per month) and then depending on the level of extra support a resident needs, they charge extra. We are paying them $1,500. a month extra for these services.

To make matters worst, my mother retains water in her ankles and has a prescription from the doctor to take a water pill as needed in the morning when her ankles are swollen. Now my mom isn't a pill popper and neither am I so she rarely took these pills unless her ankles were quite swollen. They have gotten more and more swollen since she has been living in this assisted care home (and this makes it more difficult for her to walk also.) I'm not sure why her ankles are more swollen now except that's it's probably related to the fact that we massaged her legs when they were swollen and made sure she drank enough water and encouraged her to put her feet up. Also, her diet was better too. Anyway, as needed prescriptions don't work well in assisted care homes because they don't allow residents to keep and take their own medicines and they don't allow the care-givers to deem when a medicine is needed. Only their R.N. can make that judgment, not the resident or a resident's family member. Problem is, the R.N. isn't always on duty and even when she is, she doesn't check in to look at my mother's feet, even though they originally explained that to me as part their procedure. They have decided to weight my mother everyday and only if her weight indicates that she is retaining water, are they allowed to give her a water pill. Well, as it turns out, her weight never indicates water retention even though her ankles are obviously swollen. Today I told them that their system isn't working and if they don't start giving her a water pill when her feet are this swollen that I will need to get some and give it to her myself. Their response was "Don't tell us that!" Well of course I'm going to tell you if I give her some medication, I responded, I certainly wouldn't want you to double up and give her some when I had already done so. But that doesn't work for them.

This reminds me of a Starbucks policy to not give someone a cup of hot coffee without the a lid. I'm sure that this rule came about from some liability--remember the woman who sued McDonald's and won when she scalded herself with hot coffee? It also makes some sense (as do the rules at my mother's assisted care home) that they are trying to protect a customer's well being. Except for the fact that awhile back they were using these really tight lids that were difficult to get off. I asked them to not bother putting the lid on because I had to take it off to put my half and half in anyway and that's when they told me that they weren't allowed to give me coffee without the lid and that it was to protect me from burning myself. When I explained to them that I was more likely to burn myself while struggling to get the lid off they simple repeated the rule. This suggested to me that they really weren't as concerned about me burning myself as they were about me suing them if I burnt myself. Of course, the poor little barista was just following the rule. They certainly aren't paid to break a corporate rule by using their brain and doing something that makes more sense. They'd probably get fired for doing that.

I don't think that anyone at the assisted care home is willfully endangering my mother's well being by being negligent with her care. At the same time, she's getting weaker and weaker everyday because they discourage her to get up and walk on her own and they push her to her meals in a wheelchair rather than taking the time to walk with her. And then there is the problem with the water retention...

You should have heard the marketing director boasting about how strong and healthy she was going to get living there with all of their assisted care and exercise programs! I have a meeting with the R.N. and physical therapist on Tuesday to go over her personalized care program.

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