Facility Living: Empowering Ideas For Better Care

How to get better care in facility

by Karen Keller Capuciati

“Feeling of defeat: When you realize the place where you have moved your loved one gives less than desirable care and there is no place better to go to. I had to accept that this was as good as it gets.”

This comment was written by Martha in a recent post to In Care of Dad.  She had done her due diligence, checking all the memory-care facilities in a 50-mile radius surrounding her home, eventually locating the very best place for her father. But she is frustrated because the care her father is receiving doesn’t match up with her expectations for the facility.

Martha explained that all the personalized care details that she communicated at intake — her father’s food likes and dislikes, his special skin care needs, etc. — are not being communicated to the folks who are caring for him. Furthermore, the activities provided by the facility are not engaging.

So Martha’s question is, what can be done?

I asked some professionals in the field of geriatric care for ways to help a person in Martha’s situation. Here are some of their suggestions:

Joan Blumenfeld, a geriatric care manager:
I’d like to have some help with this myself. Even “good” places often fall short of our expectations and their promises. Sometimes our expectations do not jibe with reality and that’s frustrating. So we have to make some adjustments to our expectations.

Consider the following:

  • Pick your battles and set priorities. Not everything is worth a confrontation.
  • If there is an issue of health or safety, speak to nursing or administration, not to the aides. Facilities are hierarchical. Power to fix, change or adjust comes from the top.
  • Visit regularly and randomly, so you can see what is really going on.
  • If you can afford it, a part-time private duty aide might be of service, though it may create conflict between staff and the private aide.

Kathryn Freda, a gerontologist and eldercare manager:
Hire a Care Manager. This type of professional can often make more progress than a family member because they have a sense of authority and could very well have established relationships with personnel at the home. They can also pick up some of the slack within the facility, even though they shouldn’t have to. The second set of eyes and ears, as well as the advocacy they provide, is invaluable.

Karen Keller Capuciati, co-founder of In Care of Dad:

  • Build alliances with all the people who surround your loved one, from the head nurse to the people who clean your loved one’s room. Extending respect and kindness to those around your loved one goes a long way in creating useful and helpful relationships.
  • A bottomless bowl of snacks. Along the same lines, In Care of Dad contributor Lisa Bassi suggests keeping a bowl of healthy treats, regularly replenished, in your loved-one’s room. It tends to create frequent visitors among aides and nurses. This is also a good way offer a thank you for their care.
  • Post a simple, easy-to-read (even colorful) list of personalized care preferences on the wall in the room right above the bowl of treats. If the facility employees don’t read, or aren’t privy to, your loved one’s chart, they can’t help but see the list each time they visit the treat trough.

Mary Underwood, VP of Memory Care Services at Artis Senior Living:

Partner with the team. First and foremost, don’t lower your expectations. If you don’t stand up and advocate for your loved one, no one else will. But, instead of looking at unmet desires as a failure of the community, figure out how to work in partnership with them. As a professional in the world of assisted living, I know that the majority of staff members are doing their best and want to do the right thing for the residents.

Some ideas to build the partnership are:

  • Make an effort to point out when there is something going well. Recognize and commend staff members when they meet or exceed your expectations, rather than only when they fall short.
  • Be open to new possibilities. Sometimes what you may think is your loved one’s preference may no longer be the case. This is possible for a variety of reasons. They may now eat foods that they didn’t like, or vice versa, before because people change as they age. Look at it this way: if it doesn’t bother your loved one, then try to let it go.
  • Offer to lead an activity. If your loved one has an interest or hobby — for example, a game or craft — perhaps during a visit you can offer to lead a program of that activity.

Donna Fedus, a gerontologist:
Bonding with the staff and using a professional care manager can be invaluable. Here are a few other ideas for consideration:

  • Bring in photos, memorabilia, etc. and talk with the staff about your loved one at different points during his or her life. The staff may be more inclined to extend special care for a person they’ve come to know as an individual.
  • Call a meeting or ask to attend an existing team meeting to share your concerns and brainstorm with the staff about how to improve the care plan.
  • A different family member or an ombudsman may be useful if one family caregiver is not succeeding and the family is unable to afford a private geriatric care manager.
  • Consider your expectations. If the facility is not providing compassionate and sensitive care in accordance with your loved one’s preferences, that should be remedied. If you are expecting extended one-on-one care when your loved one has to share the nurses and aides with other residents, then you may need to revise your expectations.
  • While another move would certainly be daunting, it may be worth considering.

Laura Kaplan, licensed clinical social worker and geriatric care manager:
Explore the emotional impact. Along with implementing the excellent ideas from my colleagues, families may need to process how painful it is to have your loved one living in a facility. Although this may be the appropriate living arrangement for your loved one, it still provokes a multitude of emotional responses for affected families. Those feelings sometimes make family members hypersensitive, critical and unable to accept the situation. Not to underestimate their concerns, I think it could be useful to talk about the emotional aspect with a professional (i.e., social worker in the facility, geriatric care manager, therapist or geriatric psychiatrist).

Having had a mother in a nursing home, I remember feeling ambivalent, hyper-vigilant, guilt-ridden, sad and grateful all at the same time. In retrospect, I feel mostly grateful because I realize now even more acutely that I couldn’t have given her the extensive care they, nor could I have done it as well.

Looking back over the many ideas shared in this blog, we want to thank Martha for prompting the discussion. We certainly hope that she was able to put some of these suggestions to good use and improve her father’s situation at his memory-care facility.

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