Addressing Problems After the Move

If things go badly after moving into a facility, “buyer’s remorse” takes on a whole new meaning. Unfortunately, good money is paid for high levels of care, but many deficiencies in care are rationalized and accepted by both providers and families. Let’s discuss some faulty beliefs, as well as legitimate fears, that we have seen become obstacles to better care.

Belief #1: If my loved one is a compliant, friendly resident, then the staff will provide better care and lots more attention. What really happens is the resident who yells, hits, wanders, argues with staff, or is found crying is the resident who receives lots of attention (even though not all positive), more family communication by staff (to report all the behaviors and problems), and more consults from mental health care providers. It is the quiet, friendly resident who is left alone, because he or she seems “obedient” and fairly self-sufficient.

Obviously, we are not advocating that residents—or families—should cause problems to get attention, but residents and families should make their needs known to the appropriate staff members, climbing the management chain if necessary. Once you have made the needs known, you must request an action plan and hold the facility accountable.  

Belief #2: If I am friendly and compliant, my loved one will get better care. Yes, the staff is friendly to compliant residents and families and is glad to see them, but the friendly behavior is most likely because the staff doesn’t perceive compliant consumers as being demanding. Too often, staff members become defensive if questions are asked, even if those questions are genuine and not posed in a confrontational way. Still, it is important to continue to ask questions; participate in care plans; keep an open line of communication with caregivers, social workers, and administrators; and attend family or resident council meetings. It goes without saying that threats, bribes, and tantrums do not constitute open lines of communication.

Belief #3: If my loved one causes too much work for the staff (or if I complain), we will be asked to find another facility. Sadly, there is usually little you can do once a facility decides you or your loved one is no longer “appropriate” to visit or stay there. The best thing to do is to make sure that you take steps to address problems as soon as they arise while reassuring the facility that you are not looking to start a legal battle. If a loved one develops behavioral problems, spend more time with him or her—and quietly observe—so that you have real information to discuss with the staff, rather than relying on second-hand reports. Often “behavior problems” blamed on a resident are actually behavior management problems, which should be rectified by the facility. If there is a sympathetic nurse, aide, or social worker involved, enlist that person’s help in correcting the situation. Urge consultation with a psychiatrist or psychologist experienced in dealing with dementia.

Finally, be open to the idea that this might not be the best place for your loved one. The facility might honestly be telling you that despite their best efforts, they are unable to provide your loved one with the care he or she needs. Wouldn’t you rather have your loved one in a safe place that is qualified to care for him or her appropriately?

Belief #4: If I complain or make a fuss, the staff will take it out on my loved one. We are certain that if training and family-resident-staff communication were improved, families’ fear of retribution would be diminished because the staff would feel less frustrated and angry—and therefore less likely to take out frustration on residents.

However, if you are in a situation where you are concerned about retribution, here are a few things you can do. Stay with your loved one or hire a sitter. Document any threats and any changes in appearance, nutrition, or demeanor of your loved one. If you think retribution has occurred, report it to your state’s regulatory agency.

For families facing life transitions, there are really no easy answers. Elder care is complex, and the very nature of aging ensures that as soon as you have cleared one hurdle, there will be another. We discuss this and other issues more fully in our book, The Insider’s Guide to Dementia Care: What You Should Know About Assisted Living, Alzheimer’s, and Dementia Care.