Mom is in assisted living and they manage her medications as she was forgetting to take them. The NP has made some adjustments to her cardiac meds and ordered to have moms BP taken with their standing blood pressure monitor instead of a wrist monitor? as it is not accurate. Since he placed these orders, the aides have downright refused to use the standing BP monitor. One aide told my mom ,“ This is an assisted living we do not monitor blood pressures.” The NP provider has talked to the DON regarding this but the aides continue to take the BP on her wrist. I have messaged the DON several times to explain that without an accurate reading, the provider cannot adjust medications accordingly and mom will continue to have uncontrolled BP. Has anyone had similar experience with aides in assisted living?
Speak with the administration; what we say is only a guess as each ALF is an individual operation with its own rules and regulations.
First of all, MD is correct. Wrist and finger monitoring is notoriously inaccurate and in my personal opinion should never be relied on.
Secondly, this is what should be tried, as it works at most places:
1. Have the MD write an order "-----------name of med BID; hold for cuff BP < ______usually is 100 systolic, but up to the MD".
2. This means that much like the diabetic who needs the fingerstick for monitoring blood sugar before insulin is given, the med tech must do a cuff measurement (you order; about 30.00 amazon. Get Omron (in my humble opinion the best) before giving the blood pressure or heart medication.
This often works, but this may also bump up the level of care, which is very costly.
I hope that this can be worked out, because if too much BP med is on board it is almost certainly going to decrease already poor balance and lead to a fall.
If this cannot be worked out then you are looking at a different level of care, or simply acknowledging that a medication will be given no matter the BP, BP will not be measured, and the chips will fall as they do.
Elder care is full of tough choices. Costly ones, as well.
Long answer made short: Speak to the administration for options in this case.
I have high blood pressure. I have to monitor my BP at home. I am on two medications and it has been stable.
My doctor does not recommend a wrist monitor. She doesn’t feel like they are accurate.
Noting I have zero experience with ALF's just reacting to your situation.
Doing BP readings and doing them correctly and then notating the info to provide to a MD or NP plus RX distribution on a time schedule is asking a lot of an AL aide who is a minimum wage worker.
Most AL take the approach of anything related to daily and regular medication management is a separate cost. Extent of what type of “management” that can be sensibly done is up to the AL to decide. It will be in the contract.
Also if the aides right now are basically saying they cannot do what is needed for BP readings, and you force the issue, mom is going to get incorrect readings. And that too has to own problems.
Personally I think you should start your research into higher levels of care facilities for your mom. You don’t want to be caught off guard on this and having to find SNF placement asap.
It’s a good place, but this was not a plus.
Agree w Alvadeer that upper arm is better than wrist, but if they refuse to do it, that is probably how it is.
You do it yourself for your FIL. What happens when a person doesn’t have a family member to take their BP? Is it ignored completely?
Do you report your FIL’s BP results to the facility? Do they ask? Or is it not a concern for them at all?
She also had me bring in my BP machine into her office to measure it for accuracy. The reading from my machine lined up with the reading from hers.
Ideally, your mom should have her BP read twice a day, on a daily basis.
Why are the aides saying that it is too difficult to do this on her upper arm? Is it a problem with the size of the cuff? They make different sizes of cuffs. If it is a problem with the cuff, they can order the correct size.
Ask the Don, or better yet, write a letter to the DON, stating your concerns. I have found that when a person receives a letter and reads about an issue in black and white, they take it more seriously than a quick phone call.
Good luck getting this situation resolved. It shouldn’t be this big of a deal for them to do this minor thing.
In others where there are no nursing staff, it may require getting visiting nurses/ home health agency to come in a couple times a week to do that.
At my dads, they have no nursing on staff, so one has to get visiting home health people to do such monitoring
Have you used the visiting nurses for your dad? Is it costly?
You’re right that it depends on the ALF.
When I toured a few places I found that everything was a la carte. Anything extra was an additional charge.
In your case, if the facility doesn’t have a nurse on staff, then you have to use an outside source.
Could you bring your child to work with you? I certainly couldn’t and wouldn’t have done it even if I could have.
That DON is crappy!
How many freaking hoops does she want you to jump through? You have already stood upside down on your head and done backflips. My gosh!
That’s enough shenanigans.
Tell her that you have reached your threshold of pain.
Hahaha 😝, my husband tells pushy car salesman that line and walks out. Inevitably, they call him back and make the sale at the price he wants.
Sorry for my facetious behavior but that DON would work on my last nerve!
When I went to get Mom a B/P reader, I was told by the Pharmacist not to get a wrist one. I purchased a cuff reader. Is the problem that the ALs cuff reader has to be walked to Moms room? Ask her doctor about a portable cuff. If he says OK, then ask the Nurse if thats the problem, and if so, purchase a portable one. I think Moms was $30 7 yrs ago.
You tell us this:
"I have been in healthcare management for most of my career. What is happening results from poor management and failing to hold staff accountable. Mom has an upper arm monitor in her room. "
This is such helpful information. I wish we had known it going in.
Given that you are in this position you understand that in the cases of most ALFs they are not held up to any standards that are statewide directives under the law (like nursing homes). Therefore the residents have little power in a bad ALF, and I am sorry to say given all the things you have told us (worker's children asleep on the med room floor! Oh, my!) this facility is not holding itself to high standards.
If this facility doesn't hold itself to high standards there is little you can do other than move you mom. I doubt you could even get an ombudsman involved (for all the good they ultimately do). I am surprised in all truth that you haven't been politely shown the door in the usual manner of inadequate ALF by being told "You clearly are unhappy with the care. Perhaps mother would be happier somewhere else". Translation on that of course is "We couldn't care less. Stop bothering us. If you aren't happy go somewhere else".
I wish you good luck. I hope that you will get better care going forward. You clearly are doing your very best for your mom and she's so lucky to have you as her advocate.