Among Friends

[Isobel Archer]

---

@Georgiagrama wrote:

It is my understanding that assisted living is just that -- assisted living, not 24 hour observation. 

Perhaps you should have extended your care givers hours.  Very expensive, I know. My sister and I finally did have to do just that. My Mother lived at home, refused to go to an assisted living home, and would never have agreed to a nursing home,  but, she had 24 hour care. We hired wonderful caregivers and my Mother loved them.   Even with 24 hour care, my sister  and her partner living in the same house, a fall finally killed my Mother. 

---

Yes, it is heartbreaking, but still true, that if our elderly relatives are determined that they don't need help getting up and walking, they can fall.  Even 24/7 caregivers have to go to the bathroom themselves and/or may be in the process of preparing food thinking the person - who has just been to the bathroom - is now seated for a few minutes safely etc. etc.

Maybe in OP's case, a toileting program would have helped - and then again, maybe not.

[Somertime]

@hyacinth003   I would never be critical of the choices you have made regarding your father's estate and it's aftermath.  As a nurse, you have an insight that the majority of posters do not regarding the care of your father.  You took all the steps necessary to insure his safety.  You have taken a year to consider your choice of action and were astute enough to enlist the advice of an attorney regarding a lawsuit.  None of this was undertaken lightly by you.  Some of the cruel remarks aimed at you are unwarranted as well as callous.

Your decision is your decision...............no one else.  You have the right to honor and defend your father in whatever way you see fit.  Not that you need it but I support whatever action you undertake because you have the right to your choice.

[Isobel Archer]

The stereotype of people in nursing homes is the person sedated beyond ability to function sitting in a wheelchair staring into space.

While this is a truly horrible picture, at least there is no fear they will try to get up and then fall.  

With all the concern about the "high cost" of even AL, how do you think lawsuits and settlements figure in?

And finally, what is the alternative.  Maybe toileting scheduling would have helped.  I can assure you it wouldn't have helped my mother.  First of all, she would have vehemently objected to anyone telling her - or even suggesting to her - that it was time to go to the bathroom.  She would have refused even if she had an accident as a result.  She actually did this when she was in skilled nursing after her first fall at home.

I definitely get the grief over the OP's father's fall and even the need to prevent it happening to others.  And, as noted, maybe checking on him more frequently would have helped.  I just don't know.

[pitdakota]

@hyacinth003, 

To pursue the legal avenue in order to possibly get answers & ultimately improve care for others is certainly a worthy endeavor if the information you receive warrants that direction.  If not, there is nothing lost if you find out protocols were in place and followed.  Your attorney will advise you if there is evidence of negligence or not and give you advice as whether to proceed with the law suit or not.

And yes, I hear you.  Lots of people out there think assisted living is the same as independent living and we know it is not.  Different standards, different protocols.

A couple of years ago I went to visit a distant relative at the request of a cousin.  The facility he was at is a huge independent living, assisted living, memory care, and skilled care facility.  It is so big it has its own zip code.  When I got there I suggested to this cousin that he request an x-ray to be completed in house.  When he followed up on that he found out there was no registered nurse on duty in the entire facility.  In our state at the time, LPNs could not take telephone orders.  So that meant if something happened to any of the patients or residents there was not a nurse that could take orders from a physician unless they were on site writing the orders.  It also meant that there was no nurse on site anywhere that could take a telephone order for an x-ray and they only way to obtain an x-ray would be to take the resident via ambulance to the emergency room. Wow!   The case of this x-ray was not that serious and could wait, but it was chilling to realize that with all those residents that if something happened there wasn't a nurse on site that could legally take an order from any physician or NP.  

It was after hours, but I went to the phone and called the ombudsman who just happened to be leaving his office.  He immediately came to the facility, substantiated the claim, and notified corporate management of that facility.  They quickly sent a relief RN supervisor for coverage.

Needless to say it caused a fairly big stink.  That was a major oversight and according to some of the LPNs there it happened frequently.  That was substantiated as well.  Seems the main RN supervisor had gone on vacation and when planning coverage for her vacation there were multiple shifts and a couple of days where she had not been able to assign a relief supervisor she just left it undercovered.  Long story but let's just say it was reported to the state, there were major actions taken, and improvements were made.  In the meantime, the vast majority of residents and family members were really never aware there had ever been such a serious problem.  So sometimes taking action does help to ensure adequate care for others out there. 

At any rate, good luck to you in whatever direction you decide to go.

[Drythe]

@hyacinth003 

I am sorry for your loss.

Having had many years experience in a large multi-level facility, and still holding a NH Administrators License, I want to add the following.

I agree that you shouldn’t have had to pay extra for your Father to be provided with the level of care he needed, and it is sad that he did not receive it.

Had I been the Administrator of record - working with him, you, and his care team, I would have strongly recommended a level of care change for him to Skilled Nursing Care.  The fact of your feeling the need to provide an added 12 hours a day of private care care for him would have been a huge red flag to me that we were not meeting his health and safety needs.

I know the tiransition of care from assisted living to skilled care can be difficult to consider, but from this distance I feel that I would have recommended a Level Of Care change for your Father’s health.

Just FYI, I did not allow more that 2 hours a day of Private Care, for the exact reason that 1) providing care was our duty, 2) it can create a false sense of complacency with the regular staff.

Best Wishes with whatever course you decide to follow.