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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?

I don't know what level of care your mom is on, but this is something to consider.
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.
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Tajann Jun 6, 2024
She was at a level 3 upon moving in. Now after her surgery, she is at a level 1. It’s not important to me what level she is at or if it needs to be increased due to this new blood pressure issue. All I expect is the QMAs to follow orders from their onsite provider. If, they do not take a simple blood pressure with the accurate monitor then the provider and DON need to inform me she needs a home health nurse to come in. Also, mom has a cuff monitor in her apartment. But it’s hard for to get on by herself. The QMAs could use it, they won’t.
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Keep in touch with the DON to resolve this issue.

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.
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Nurse practitioner already wrote very specific orders and blood pressure parameters. The aides are not following his direction. The DON knows. I don’t know if she is unable to find replacement staff but from what I’ve seen, the aides do what they want. I advised corrective action. We will see. The one aide told my mom it’s too difficult for her to do BP on upper arm.
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casole Jun 6, 2024
Wow. I really hope this gets resolved. For upwards of what is probably 5k per month to not be able to follow simple instructions for a basic blood pressure reading then what is the point.... Sorry you have to deal with this. Keep complaining till it gets remedied.

Noting I have zero experience with ALF's just reacting to your situation.
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If this AL takes the position that its residents should be able to do the usual ADLs on their own with only occasional assistance; that the type of assistance is more helping them get dressed / undressed, or get down something heavy in their closet, serving food, helping with activities, or going into their room or bathroom if the resident pulls an alarm bell, it is what it is. & if so, the aides at this AL are more about personal care assistance rather than health care assistance.
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.
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Tajann Jun 6, 2024
Mom is not in an independent living facility but in an assisted living. She receives medications three times a day from a QMA. Other than that, she is able to dress and bath herself without assistance. She doesn’t need a higher level of care. She needs the QMAs to follow directions by the facility provider who is managing her blood pressure.
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It is very variable by facility. My father-in-law is in a memory care, so even more than assisted living, and (to our great surprise) the RNs and LPNs there are not allowed to measure his blood pressure. We actually drive over and measure it ourselves when he has a med change.

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.
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NeedHelpWithMom Jun 6, 2024
What a shame that the facility doesn’t do this.

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?
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When my BP was running really high my doctor told me to check it twice daily. Once in the morning and once in the evening.

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.
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Tajann Jun 6, 2024
Thank you for the suggestions. I have several emails documented to the DON with my concerns. Today, she personally came to my mom’s apartment and took it herself. As far as the aides not wanting to take upper arm BP, they said they don’t have time to mess around with clothing etc. they only have time to slap on a wrist monitor. It’s quicker but inaccurate.
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it depends on the place, and whether they have appropriate clinical staff around to do this. Some places with nursing on site will agree to do this.

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
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NeedHelpWithMom Jun 6, 2024
A visiting nurse is a great suggestion! It’s another expense though for the OP.

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.
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In order to qualify for home health services covered by Medicare, there would need to be a skilled need for a nurse to come out. Measuring blood pressure is not considered skilled, but perhaps your mom has other medical needs that might qualify her, at least briefly.
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on a side note and one reason the defiance with using the correct BP monitor doesn’t completely shock me is one of the QMAs brings her child to work. I came in on a weekend and stopped in the MEDICATION room to find her daughter laying on the floor with a blanket. Not a safe place for a child to be. I also reported this to the DON. No response. This is not an inexpensive facility by any means but the oversight could be better.
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NeedHelpWithMom Jun 6, 2024
This is very unprofessional behavior.

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!
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Talk to the RN in charge again. She is the CNAs boss and they should be doing what she orders them to. If they won't do it, then the RN should do it.

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.
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Tajann Jun 7, 2024
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. So far today, staff are taking the BP as ordered. Let’s hope this continues.
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Yes. Whatever the in house doctor or NP ordered, the AL staff carried out, as expected.
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I have read your responses to us, Tajann. Thanks for being such a great participant in the Forum. You have no idea how often people come, make a post, and then move on without a single response. It makes us feel they are made up out of thin air. It's so helpful to have responses.

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.
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