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Memory care unit has failed to provide care for my 99 year old mother who recently has refused care, become agitated during 3rd shift. My mother was prescribed Serequel recently in an effort to alleviate her anxiety, but it was only prescribed PRN and not OD to provide any kind of results. As soon as I wrote up an incident report of my mother's unclean condition (pull up soaked, feces caked in pubic area and labia) the unit nurse and head nurse took immediate offense and turned to the defensive position of "we can no longer provide the care your mother needs". This information was presented to me in an interview with the director and the head nurse. Nothing in writing. I requested an interview with the in-house nurse practitioner who prescribed the serequel and I am prepared to request further monitoring of my mother's behavior and appropriate modification or additions to her meds. That being said, I believe I have 30 days from a formal, written request to remove my mother from the unit(?) Should I wait for the written document then request an appeal to buy time while planning the transition to memory care in a skilled unit?

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Did she have an evaluation by a trained geriatric behavioral specialist who is qualified to prescribe?

You probably wouldn’t get a decent recommendation for a behavioral specialist from your/her current facility, so try googling “Geriatric Behavioral Management Specialists In (your city).

When you have a good thorough meaningful evaluation in hand you’ll have a better discussion base for finding her a new residential setting that serves her better.

Long shot- were you able to get any photos of her less than desirable care on your phone? Every little bit of information you can use to back up your attempts to get her a new placement will help,

It may be worth mentioning in any contacts with her present care staff that you are having a formal behavioral evaluation done.

We happened to luck into a situation in which there was an EXCELLENT specialist already in my LO’s facility. She carefully crafted a detailed plan for behavior management AND meds, and it was very soon successful.

I hope this helps!
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GAinPA Sep 2021
Thank you for your helpful advice. Yes, I did take photos (I did not share them) and I had the aide on duty be present to view the "evidence" as well as shower and redress my mother. The aide did not see me take photos, nor did I share the photos with my written report. I wanted to see where it all was going first. And now, I know. They were fine with the verbal but balked at the written now they want to close ranks and get rid of the "troublesome" patient.
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It depends on if your mother is in a facility certified by Centers for Medicare and Medicaid (CMS) . If so, there is a procedure that must be followed. You get 30 days written notice and you can appeal. Also, they must discharge her to a place with ability to care for her. They can not just put her on the street or demand you take her.

If not CMS certid, will depend on what your state regulates - if anything.

CMS allows a facility to discharge someone if they can not meet their needs. But changing diapers does not qualify. The “ cannot meet needs” refers typically to complex medical needs that require equipment and skilled personnel a memory care unit may not have.

Common for care facility to want to kick out someone if family complains. And lack of incontinence care pretty much biggest issue. It is disgusting and can cause infections, It takes time and most care facilities horrifically under staffed.
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This is horrible. So sorry you have to deal with this unprofessional behavior.

I would ask to have the med changed from PRN to giving it to her at a certain time each day.

In general, how is her condition? I'm assuming not great given her age, but my 95yo MIL is probably doing better in all departments than my 78 mom!
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IMO, like Assisted Livings, Memory cares are limited in the care they can give. Have you ever tried to clean up or give a shower to someone who fights you all the way? They are also privately run so not sure if there is an appeal process. Need to read the contract you signed when admitting Mom. My Moms did say we had to give 30days notice so I would think its goes the other way around.

I realize a NP can write a prescription but I would hope she/he consulted with the doctor who oversees her before prescribing Seroquel.

You may want to look for another MC now. Just because you complained doesn't mean things will improve. Mom may now need a Longterm care facility.
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GAinPA Oct 2021
Yes, I have cleaned up and bathed reluctant 90+ year olds. (12 years MIL. Six years mother. )
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