I have been working with a lot of families who are not familiar with the differences between types of services that are provided at the independent living, assisted living, and nursing home care levels. The result is that they waste a lot of time touring communities that are inappropriate for their loved one. It is even worse when a loved one is placed in a community at the wrong level because it is cheap. I have seen instances where an admissions director often convinces an uneducated family that their loved one can survive at a level of care that is inadequate for their needs. Bear in mind, there are a lot of communities with low censuses and apartment/rooms that need to be filled. The bottom line is that if the senior cannot function at a level of care that is too low for them, s/he is the one who suffers!
A Real Life Story Continued From Chicago Senior Living Advisors Blog November 18, 2012
I had written a partial Real Life Story about this incident recently. Here is part two of the story. My client is an 86 year old woman. I am her Power of Attorney For Health Care. She has severe short term memory issues, is incapable of handling her finances and medications, and as of late needs standby help with her activities of daily living. Her former Power Of Attorney For Healthcare (who resigned from the position and resides out of state) placed her at the independent level because it was cheap. Independent living means the senior can function on their own, with some help with housekeeping and meal preparation. I was assigned to the position the day before she was supposed to move. She was already objecting to the move. It was too late and she really needed to be in an environment that had some semblance of supervision. In my opinion, she really needed to be in an assisted living community with a memory care unit. Memory care units provide structured activities, 24 hour supervision, and heavy cuing plus standby assistance with activities of daily living.
After the move took place, I continued to monitor her progress. After several visits, I noticed that the studio was dirty, even though housekeeping was part of the package. She was becoming more disheveled. There was evidence of incontinence because the apartment smelled. Her clothes were dirty, so I ordered laundry services. Yet, the staff at the community (where I noticed it was not full) kept on insisting on how well she was doing and attested that she was attending the activities.. I saw the additional charges including those for medication reminders begin to offset the cheap price and resemble assisted living charges. The fact she was beginning to decline bothered me.
One day when I was thinking about how unfair the incorrect placement was to my client. Although I hesitated somewhat to move a person who has dementia once they are familiar with their surroundings, I felt I had given the current scenario enough of a chance. I was in the neighborhood visiting with another client and I decided to make an impromptu visit. I did so without an announcement so nobody at the community had time to change anything. Since it was Christmas time, there was a lovely children’s choir singing carols in the lobby. I looked around and saw no sign of her. It was 11:30 A.M. and I found my client in bed complete with pajamas. She was very confused and the apartment was dirty. I decided it was time to confront the community nurse.
Upon my arrival in her office, the nurse said she was going to call me because my client was “neglecting herself.” The recommendation was that she be sent to a behavioral psychiatric unit to be evaluated. Although my heart sank, I saw it as a perfect opportunity to move her. I put my blessing on the evaluation.
After a week in the psych unit, my client was stabilized. I arranged her admission to an assisted living memory care unit and awaited her release. However, the move was delayed three times. First, she caught an intestinal virus. Second, she caught the flu. Third, she ran a temperature of 102. She finally was able to move to her new community where she seems to be adjusting and participating in the activities.
When I abruptly showed up with the moving truck, the staff at the old community was resentful that I was moving her. However this is the fourth client I have had to move from this community and several of its affiliates due to lax admission procedures. Note, the initial placements to these communities were not mine.
So to summarize, my client was subject to an incorrect placement and was transferred to a psych unit as a result. She then suffered from a virus, flu, and a high temperature before being transferred to a completely new environment. I am hoping the latter is the last stop.