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Important Information for Caregivers

The following has been provided to assist Caregivers learn about and adapt to the challenges their loved one is facing. Experience has shown us that flexibility, positive language, a sense of humor, and support from others can make a big difference in the quality of life you share with your loved one. If you have questions please feel free to contact us for help provided freely.

Emergency Services / Acute Care Nursing Facilities
Always accompany your loved one if he/she is sent out to a hospital for emergency services. If a family member is not available, a primary caregiver and/or care staff from the residing facility should accompany your loved one. The family and/or caregiving staff can properly convey your loved ones needs to the medical staff, and help comfort him/her in these stressful times.

Medical personnel work in a fast paced environment and don’t necessarily have the time to provide the same level of one-on-one care that your loved one is receiving in a facility or home care environment. This lack of someone one familiar, could potentially cause Resident anxiety, stress, and in some cases, combativeness. Oftentimes the result is to prescribe the Resident an anti-psychotic, which is what you want to avoid.

Pay close attention to the following regarding your loved one and respond accordingly:

  • - Dirty hands and/or fingernails, and any odors– Notify Supervisor on duty
  • - Proper support of head and neck – Request assistance and/or more pillows and support

Sanitize bed-rails, doorways, bathrooms, door knobs, bedside tray, chairs, remotes, etc. –Utilize the anti-bacterial wipes that are provided for additional sanitary precautions. Be mindful yourself of touching surfaces in acute care facilities. Generally, this is an environment that cares for very sick people, and we don’t want you or your loved one to contract any additional diseases or infections from the environment.

Mealtimes – It is best if a family member/caregiver is there for mealtimes to encourage and assist your loved one if your loved one is not a self feeder, and sometimes when they are a self feeder the confusion of the environment, different staff, or medical diagnosis causes issues with self feeding. And staff are sometimes too busy with other tasks to provide this assistance. Cut up food and if any portion appears dry and hard to chew, request an applesauce for moistening to assist with ease of chewing and swallowing. If you are unable to be there for meal periods, always ask the staff what percentage of each meal was consumed. It has been my experience that a resident who normally eats 80%to 100% of meals at home with us will decrease their consumption rate to 20%-30%. Feel free to request a supplemental protein drink (e.g. ensure) if this is the case. If this does not work, put the ensure in a cup of ice cream (works every time.

Fluids - Hydration is generally provided via IV fluids, which is excellent, but the simple act of having a drink of water can be calming and keeps one in touch with their humanity. Acute care staff may not always be able to provide this service, advise all visitors to provide encouragement to drink water.

Mobility – If your loved one has the ability to walk, it is important to walk him/her as much as possible, and as tolerated, even if just a few feet at a time, or standing up on the side of the bed, or you may also request staff to transfer to a chair. This will also keep the muscles and joints moving and functioning. Medical personnel do not always have time for this task and oftentimes will not provide this service for numerous reasons, however, you can. The biggest reason seniors are at higher risk of developing pneumonia in hospitals is because of spending too much time in bed. They may also have more difficulty with deep breathing due to pain, fatigue, medications or surgical incisions. The simplest way for a senior to reduce the risk of developing pneumonia in the hospital and any care facility is to get out of bed and make movement.

Communications – Be sure to ask as many questions as necessary to understand the situation and diagnoses with your loved one. Take a notebook and write things down, especially medical terms that you may not understand. Conduct your own research at a later time to help you better understand options, procedures, tests, etc ., that may be available for a cure or relief. Bring your research and provide a written list of additional tests and/or questions addressed directly to the medical personnel assigned, to ensure you have a full understanding of the situation at hand.

Dementia / Hospice Care – Occasionally, when a Resident is admitted to the hospital for a temporary medical incident and they also have a dementia diagnosis, the doctors may encourage hospice care. Hospice is a great service if a Resident is truly at that time in his/her life; however, this is not always the case. Please be cautious of a premature hospice care recommendation. Please refer to my what I learned caring for mom

Aspiration Risk – Aspiration is a term used to describe anything other than air entering the lungs, including mouth secretions and food which may contain bacteria, and may cause an infection / pneumonia. Elderly aspiration pneumonia is often caused by difficulties swallowing. Issues with swallowing are common in conditions such as stroke, dementia and Alzheimer's, and on some occasions due to incidental medical condition, or overall weakness of fighting an infection, and most especially during a hospital stay. If diagnosed "aspiration risk" staff will typically not feed a patient, if this occurs, it is important to request, and be present for a “swallow evaluation.” A licensed professional or Speech therapist will try different thickeners to see at what level a patient can tolerate swallowing for continued health, welfare and quality of life. One other thing to consider is if they are able to cough and still have gag reflex, and indicate they are hungry and desire to eat, you may be faced with the decision to risk aspiration pneumonia / feeding tube / end of life care / hospice. Be mindful , follow your heart and own instincts of what your loved one desires and what feels right to you. And you may need to be available for feeding your loved if staff refuses. Please refer to my what I learned caring for mom

Pneumonia – Pneumonia is common in the elderly and generally caused from spending too much time lying in bed and being inactive. If your loved one does develop pneumonia, or are at risk of, while in the hospital, they may be given incentive spirometer, a small plastic device designed to help take deep breaths. Encourage your loved one to use it often. Other causes of deep breathing difficulties may include: pain, fatigue, medications and surgical incisions. Getting your loved one up into a chair, walking, moving to and from the bathroom and completing any functional activity such as getting dressed or grooming at the sink will be beneficial. Being in an upright posture allows the senior's lungs to expand more easily and makes it easy to cough and clear those lungs. The simplest way for a senior to reduce the risk of developing pneumonia in the hospital and any care facility is to GET OUT OF BED.

Before choosing a Care Facility it is very important to ensure the care being provided is of a superior level. When you tour the facility and are initially greeted by an Administrator/Owner of a Care Home, be sure to ask what hours of the day the Administrator is there providing oversight, then re-tour the facility when the Administrator is absent. This is important to ensure the level of care is consistent at all times, even when the Administrator is not present.

Most importantly, get to know the primary Caregivers; it is the Caregivers who will have the most exposure, hands-on care and socialization with your loved one. We all want our elder loved ones to have a friend and someone to talk to, and this close bond will occur between Caregivers and Residents, so correct staff training on the development of bonds with Residents is extremely important.

Questions to Ask When Considering a Care Facility

What is the employee turnover ratio?
A high turnover of staff could be problematic. The bond and trust built between Residents and Caregivers is done over time, thus the importance of long-term employees.

What is the experience level of the employees?
Generally those with more experience are more able to ensure that the little things don't get missed, and with experience comes a greater understanding of the needs of elder care.

What kind of basic care documentation is used?
Ask to see a sample. Check for daily care notes documentation. Examples include: urine/bowel output, water intake, mobility, etc. Depending on the Resident's ability to self -care, you want to be sure that residents are assisted and reminded for toileting if incontinent, and also that staff assures that they wash their hands. This hygiene step is imperative for safety, to reduce any possible cross-contamination to other residents, staff and community visitors. There should never be a urine odor, this usually means that residents are not properly cleaned and cared for on a regular basis. It also could be a tell-tale sign that hydration reminders and assistance are not provided.

Is the facility clean and sanitary?
The first thing you will notice when walking into a facility is the overall odor. Take note of an odor of urine, feces, body odor, etc. Check the carpet, floors and furniture for cleanliness. Check the cleanliness of doorknobs, wall surfaces, remote controls, and things of this nature.

How are Residents monitored during the night?
This is usually the time when Residents get into trouble; without proper monitoring they may fall and hurt themselves. Proper night monitoring also helps to avoid accidents that may occur if a Resident does not get to the Restroom as needed.

What is the frequency of Resident bathing/showering?
Twice per week is optimal, and with assistance it is imperative for hard to reach and private areas to be cleaned properly to avoid infections and skin breakdown. Ask if sponge baths are given in between shower days. Check to see if the skin of Residents appears dry, and ask if they apply lotion, if so, how often. Check the overall cleanliness and odor of Residents, included but not limited to: hair, skin, fingernails, and clothing

What level of oral/mouth care is provided?
Dental hygiene is often missed in many facilities. It is imperative for staff to provide stand-by assist and reminders to brush teeth, at a minimum, twice daily. If your dentist tells you that your loved ones teeth are in bad shape and have a great amount of tartar build-up, this could lead to potential pain and agitation when a Resident has an infected tooth, as well as medical complications from the infection.

What is your activity schedule and what are the activities?
Activities are best provided per a regular schedule since the body and mind will more favorably respond to an activity that has been done on a routine basis. In addition, the simple act of performing group activities aids in socialization, and is a helpful motivator. Ask about the activities and the schedule of these activities. Activities aid in the following: social interaction, eye-hand coordination, engagement in something fun, creative and interesting awakens the mind, and inclusion in the community helps to avoid potential isolation, loneliness, depression, agitation, and a failure to thrive (watching television is not an activity).

What is the Ratio of Caregivers to Residents?
Caregivers cook meals, clean the facility, provide Resident care and monitoring, and participate in activities and exercise with the Residents. It is absolutely necessary to have a minimum of two staff per six Residents between the hours of 7:30am-8:00pm. Additionally, if a care facility claims to be “24/7” there should be at least one AWAKE staff member at night.

What fall prevention measures are in place? Do they have a call button system, or a personal body alarm?
A call-button system is a great option for Residents who do not suffer from memory impairment or loss. A Resident who has memory difficulties may not remember to hit the call button for assistance prior to ambulating. Look for a facility that has personal body alarms for those Residents at risk for a fall. In addition, how will the Staff know if a Resident is getting up at night? Some facilities have infrared cameras that will sound an alarm once their feet touch the floor, while others have floor mat alarms, which sounds an alarm when their feet touch the floor. The bed/mattress alarms, which sounds when a Resident gets up, is not the best option as the Resident is already standing before the alarm sounds, thus too late if there is a fall. The best options are personal body alarms and/or floor mat alarms.

What if a Care Facility is sub-standard in any manner?
You should address your concerns with the Care Facility Administrator. Sometimes Administrators are not aware of sub-standard activities in the home until brought to his/her attention by a third party. If you are afraid of retaliation by lodging a complaint directly with the Administrator, you may also file an anonymous complaint with Community Care & Licensing or with the Ombudsman. You should advise them that it is confidential and you would like to remain anonymous. The licensing agency will then conduct a thorough visit and assessment of the Care Facility.

The only way things will change in these communities is if they are held to higher standards and subjected to the Licensing / Regulatory authorities. Please keep in mind if you are noticing lack of care for your loved one, consider the other frail elderly residents whose family members unaware of lack of care issues.


Golden Moments Care Home - FAQs

What Does Golden Moments Program mean?
Providing compassionate, loving, and enthusiastic Staffing trained to recognize individual care needs for social, recreational and emotional well-being of each Resident. Maintaining Resident's comfort and stability while preserving their dignity and independence by fostering an environment of activity and celebration through a wide variety of group and individual activities.

What services does Golden Moments provide?
Golden Moments specializes in care for people with mild to severe memory loss (dementia). The Golden Moments Program has been recognized by the Caring.com website as "Caring Stars of 2013" based on our ability to provide quality care, and reviews of our care by families and friends. Golden Moments provides intensive dementia care training to both Staff and family Caregivers and maintains a minimum 2-3 to 6 Staff-to-Resident ratio to meet dementia care needs. A sampling of daily activities include singing, dancing, socializing with peers, gentle exercise and age appropriate arts and crafts projects. Golden Moments Staff are also trained to monitor and care for the personal needs of each Resident, including assistance with mobility, toileting, hygiene, oral care, nutrition and hydration. We provide hands on care with all of our Residents, including lotioning skin daily, and monitoring urine and bowel output.

Is Golden Moments a licensed Residential Care Facility for the Elderly (RCFE)?
Yes, we are licensed by the State of California Department of Social Services Community Care Licensing Program. Which visits and evaluates our site annually for performance standards specifically related to dementia care. As a licensed RCFE, Golden Moments Staff submits to a rigorous background check with the FBI and DOJ, including our own in-house clearances, before they are employed by the program. All Staff participates in monthly in-service trainings on various topics regarding the care of elderly and medical conditions and monitoring parameters. RCFE's are also known as Care Homes, Board and Cares, and Assisted Living Facilities.

What about end of life care?
The average Resident is in their 70s-80s and has some memory loss, though the age range for participants varies widely from ages 50-100. We have a hospice waiver when the need arises for End-of-Life Care. Because a Resident becomes a part of our family and we become so attached to them, it is our preference to provide care and comfort to the end. We feel it important that our Residents have the familiarity of primary care Staff during this transition.

What if we are not ready for this transition?
Looking for the right assisted living facility is a challenging task for many people, so if you are here because you need advice, we understand what you are going through, and are here for you. Please don't hesitate to call us anytime, we are open 24 hours per day and 7 days per week, and we would be honored to help you with any part of your caregiving journey. Phone anytime: 916-489-2578.