My mother became a nursing home resident about six months ago. Since then, she seems to be increasingly less active, depressed with loss of appetite, and declining in general health. The nursing staff doesn’t seem to have many answers and says it happens often. What can I do?
Sometimes this situation occurs when a family member fails to accept placement into a skilled nursing or assisted living facility. It’s not the home they know and feel safe within. Unfamiliar people, sounds and routines surround them. Every daily event, from socialization to meals and showers are more scheduled and often conflict with their normal way and time of doing things. Such routines, as the time they eat and what they eat, may be far from what they’re used to. For some, lack of personal control over these matters may be difficult to accept.
It’s also possible that an underlying health condition is at the root of her decline, or that specific medication may be influencing her physical and emotional status. Family members are often not aware of the medications being given, or that some have depressive qualities, yet are given as “anti-anxiety” medication.
While such changes and the resulting effect upon a new resident are understandable, allowing the diminishing health status to continue without intervention is unacceptable. The Nursing Home Care Act provides that a facility is responsible to take action that meets the specific needs of a resident, whatever those needs might be.
By law, when a resident’s physical and mental state changes or declines, a new care plan assessment is required to be completed. A care plan is a physical document with three parts that remains effective in a resident’s chart at all times. The three-part document includes:
- the needs and physical/mental status of the resident;
- the goals of the care plan;
- and specific actions that will be taken to fulfill those goals.
More importantly, but less known to residents and family members, the facility is required to not only inform a resident that an initial comprehensive, or new care plan assessment is being arranged, but they must also invite both the resident and their family to be present at all planned care assessment meetings and to participate fully.
You should request that a new care plan assessment be completed, including all department supervisors, and request notification of the date and time of the meeting so that you can attend. By attending the care plan assessment meeting you will have the opportunity to discuss your concerns and personal observations, and should receive specific details about how your mother’s care plan will be changed to address your concerns. You should present those in attendance with a written list of your concerns and observations, and ask that you receive a copy of the new care plan that will be kept within her medical record.
If your mother has not already assigned you or another family member as her healthcare power of attorney, now is the time to get it done. The facility may have forms readily available, but if not, forms for healthcare POA are easily available on the Internet to download and print. Should your mother reach a state in which she can no longer speak for herself or make her own medical decisions, you will need such a document to speak on her behalf and obtain medical records.
The #1 thing a family member can do to ensure adequate and timely care is given to their loved one is to become informed as to what specific services are planned by facility staff in the course of daily care, and to become involved and ENGAGED in the process. When a resident’s mental or physical status changes, a new care plan assessment must occur as a means of addressing those changes proactively. New goals and service requirements must be enacted in a timely and beneficial manner. A care plan assessment is a document of accountability, and perhaps your most important tool at present, as well as in the future.