Well yesterday was fun. I assisted a family in placing an Alzheimer’s patient in an ALF that has a “secure” Alzheimer’s wing. Mrs. A is pretty high functioning and despite the fact that we worked for over a week educating the administration, executive director, physicians, nursing staff and admissions department, the day of placement was a complete disaster. After choosing this ALF, we had numerous and lengthy conference calls to make absolutely sure that they fully understood that Mrs. A would do everything possible to get out of their facility. They were completely aware of her cognitive level, her medical and social history and they were told that she would make it her mission to get on the elevator, find an open door or slip away as soon as she could. On the day of admission, I arrived early to find that they placed her in a room directly off the elevator. To make matters worse, despite assuring us to the contrary, they had not followed up with Mrs. A’s physician to make sure that they had written orders to properly medicate her should she require it.
Mrs. A arrived and after lunch in the private dining room, was escorted upstairs for a visit. The minute she got off the elevator she knew. She began screaming and yelling that she wanted to go home. She pushed and shoved and repeated over and over again that no one has the right to do this to her. She repeatedly stated that she will get out and she attempted to get on the elevator, open the emergency door and even tried to open the second story window. The Director of Nursing was present and admitted that they did not have an order for medications. They were clearly not prepared to accept Mrs. A as a new resident nor were they equipped with the staff necessary to smooth her transition. The family had previously arranged 24 hour private duty care for the first few days to help Mrs. A adjust. Upon the aides arrival, the DON informed me if Mrs. A went to sleep or asked the aide to leave the room, rather than have the aide remain on the floor, as is the normal protocol, she wanted me to instruct the aide to take a chair and push it against the door and sit in it to barricade the patient in her room. The aide was eventually able to get Mrs. A to go into her room, her new home, and was able to calm her and speak quietly with her. The staff of the ALF provided no assistance whatsoever and when I left hours later, they had still had not obtained any physicians orders.
When I said goodbye to Mrs. A, she looked me directly in the eye and said “I hope one day someone does to you what you have just done to me”. Today was Mrs. A’s first full day in her new home. Although it was better than yesterday, she remains insistent that whatever it takes, she will get out.
Lesson learned: Filling the beds in the ALF is more important than taking the time to properly prepare for a new admission.
Policy Updated: Find a new ALF.
Elayne Forgie has been a professional geriatric care manager for over 20 years and was a founding Board Member of the Florida Geriatric Care Managers Association. She is the President/CEO of ElderCare at Home, Inc. and The Alzheimer's Care Resource Center. Information on this website or contained in this article is not intended to replace the medical advice of your doctor or health care provider.
