Chapter 2: The First Day

1.  Move in on a weekday.  

Your mother should move into the nursing home on a weekday.  

Many nursing homes are minimally staffed on weekends.   The Director of Nursing, the usual nursing staff, and your mother’s regular CNA (if she has one) will probably not be there.  Nor are the rehab (therapy) staff likely to be present.  

Moving in on a weekend means, at the least, that you will be trying to introduce your mother and her needs to over-burdened nursing staff who do not have the time to learn what they need to know about your mother, and that she will have to meet a whole new set of staff almost immediately after moving in.  At worst, it means that medicines may not be ordered or special diet orders filled, and that precious days of care for which your mother or her insurance are paying (including limited Medicare days), are being wasted. 

So aim for a weekday.  Tuesday is good: people are settled into their weekday routine, and she could have four straight days of working with the same people (and, if she is on Medicare, getting daily therapy) before the next weekend.


2.   If the nurses do not have your mother’s transfer orders, let them copy yours. 

Talk to the nurse in charge of your mother’s care, to make sure she not only has the transfer orders, but knows what they say.  Ask if there are going to be any problems following the orders.


3.  Make sure all your mother’s medications, and any special supplies or equipment she needs, are in the nursing home.

If your mother’s medications and other supplies are not already there, make sure they have been ordered.  You can call the pharmacy to make sure they have the order, and that the delivery will be made in time.


4.  Introduce your mother to the staff who will be caring for her. 

You want the staff to see your mother as their fellow human being, not as a body to which they do things. 

Part of what you want the staff to know, is how your mother communicates, including if she can initiate requests and respond when she is given choices.  If she can, and is comfortable doing so, your mother should be part of your conversations with the staff.   

Here are some of the things you may want to discuss, especially with your mother’s CNA:

  • your mother’s personal history, including her current marital status, her children (living or dead) and grandchildren, and any other people who are important to her or likely to visit;
  • where she grew up, and under what circumstances;
  • the kind of work she and her husband did;
  • if she wants to be addressed using her first or last name;
  • any problems she has hearing or seeing, if she use devices such as a hearing aid or glasses, and if she needs help putting them on;
  • if she uses dentures, and if she needs help inserting, removing or cleaning them;
  • what radio or television programs she likes, and if she needs help using the radio or television;  
  • what kind of help she needs to eat, bathe, dress, move, toilet herself, and perform other everyday tasks.  Be specific.  For example, if your mother can brush her own teeth, but needs someone to put toothpaste on her brush and put the brush in her hand, say so.  
  • issues affecting her safety or that of other persons.  These may include if she has fallen recently, and what help she needs walking or transferring (to or from bed/chair/toilet.)  It is perfectly all right  to watch the staff transfer her, to make sure they have the necessary equipment and are using the right technique;
  • safety issues.  These  include unsafe smoking, such as smoking in bed, or dropping lit cigarette butts on herself or on the floor; eating inedible items; hoarding; and wandering.  Many people in the early stages of Alzheimer’s disease or another dementia tend to wander. Some go through a stage known as “sundowning,”  in which, in the early evening, they believe they have to go somewhere to meet a particular obligation (milk the cows, go to work, go home to make dinner.)  The staff needs to know if your mother tends to wander, or if she has confused periods when she thinks she must leave to be somewhere else;
  • how they can distract your mother or change her mind when she is confused or frightened or trying to do something dangerous, and how to persuade her to do something she does not want to do;  
  • anything she hates doing or having said to her; 
  • if she prefers a bath or a shower;
  • how she likes to spend her day;
  • any problems she has communicating, or doing so in a language the nursing staff understands.  You may want to leave at her bedside, special instructions about how to communicate with your mother.  If her ability to speak is limited, you may want to ask the  rehab staff to make her a “communication board” to help her to communicate by pointing or spelling.  If your mother speaks only a language the nursing staff does not understand, you can make a list of helpful words and phrases the staff can use, or recognize when she uses.  


5.  Make sure the staff know how to find you at all times.

Check your mother’s file: there should be a set of records kept on the same floor as her room.  Ask if instructions about who to call in an emergency are kept anywhere else: in the administrator’s office, for example, or in a computerized record.  Make sure every record has correct information about how to reach you (or whoever should be called in an emergency) at any time of the day or night.  This means home, office and cell phone numbers.  

Make sure all the records make it clear that you want to be called immediately, regardless of what time it is, if your mother becomes sicker or has an accident (such as falling), or if the staff cannot give her the kind of care she is supposed to get.  Make sure they write this in the file.  For example, you would want to be called if your mother refuses to take prescribed medicine, go to therapy, or eat.

You should always thank the staff when they call you to update you on your mother’s condition.  Even if you think the call is unnecessary, your being polite and receptive makes it more likely that they will call you at critical times, instead of thinking you don’t want to be bothered.


6.  Make sure the staff knows to whom they can give information about your mother’s health and health care.

Not only do you want the staff to call you in an emergency, you want the staff to tell you how your mother is doing, if you call.  In Chapter 1, we told you what documents needed to be signed to make sure the staff can give you this information.  (If you are not already acting as your mother’s health-care agent, your mother or whoever is acting for her must give you permission in writing to get information about her health and her health care.)  

Keep the original document your mother signs, but give your mother’s nurse a copy for her file.  Make sure all the correct people (her whole family, if this is what she wants) are on the list of who can be given health care information when they call or visit.  A copy of this list should be in her file at the nurse’s station, and every other place the nursing home keeps this information.


7.  You and your mother should be prepared to answer a lot of questions.

Over the next two weeks, the nursing home staff will be doing an assessment of your mother’s abilities and needs.  You can see the form they are required to use -- it is called the MDS (Minimum Data Set) -- here.  

As much as possible, the staff should be doing the assessment by talking to and observing your mother.  They may need to ask you questions she cannot answer, but -- as much as possible -- she should be the person they talk to.  You should probably tell her that they are going to be asking her a lot of questions, not because they are nosy, but because they need to know the answers to give her the best possible care.  

We tell you more about the assessment process in Chapter 6.  

Part of the admissions process will require the social worker to ask your mother about creating a health-care power-of-attorney (as we discussed in Chapter 1.)  The social worker should also be asking if she wants medical intervention (such as resuscitation) performed if she stops breathing or her heart stops.

Obviously, this is can be a difficult and scary conversation for your mother, and for you.  If it is not done well, it can sound as if your mother is being told to expect to die right away.  Consider talking about it with your mother ahead of time, and then being present for the social work interview.  

 If she is not sure what she wants to do about what is called a “DNR (Do-not-resuscitate)” order, she can wait to decide.  If she makes a decision and then changes her mind, she can do that, too.

The doctor may also talk to her about a DNR order.  We tell you more about meeting with the doctor in Chapter 5.


8.  Remember the Golden Rule.

Just as you want the staff to see your mother as a person, not a body, you should remember that the nursing home staff are people, not job descriptions.  So talk to the staff.  If  you are comfortable doing so, you may want to ask your mother’s CNA, for example,  about subjects such as how she came to be a CNA, how long she has been doing the work, or been at your mother’s nursing home, or even about her family. Find out if she works for the nursing home, or is agency staff.   Ask what days she usually works.  As time goes by, make sure the CNA’s know you appreciate the good, hard work they do taking care of your mother.


9.  Try out the call buttons.

If your mother is able to use them, show her where the call buttons (to get the nursing staff) are in her room and her bathroom.  Make sure she can reach them  call buttons are supposed to be in reach.  Warn the staff you will be doing so, and then have her practice using them.  


10.  Show your mother around.

If your mother is able, go with her on a tour of the home.  Introduce her to  people.  If you do not want to overload her with too much information, you may want her to see at least where she will be eating, and any pleasant places such as a garden or chapel.


11.  If you see them, introduce yourself to your mother’s roommate’s family. 

Give her roommate’s family and friends your phone number, and ask for theirs.  Ask when they usually visit.  Tell them you would like to regularly exchange information about what you each see when you visit.  If her roommate has no visitors while you are there, ask her nurse or CNA if you can have a relative’s name and phone number, or ask when they usually visit, and plan to be there at that time.


12.  Stay for at least one meal, to make sure your mother is getting any special food she needs, and that the staff gives her the help she needs to eat and drink.


13.  Before you leave, reassure your mother about when you or someone else will next be visiting or calling.  

Most nursing homes say their visiting hours are from 10 a.m. to 8 p.m., which is the minimum Illinois law requires.  Nursing homes in the Medicare or Medicaid programs must let you visit any time your mother wants (even if Medicare or Medicaid is not paying for her nursing home care,), so long as you do not interfere with her care or bother other residents.  (For example: if you visit late at night, you may have to meet in a different room so you do not wake up your mother’s roommate.  You also cannot be present during sterile wound care unless you follow infection control procedures)  

If your mother needs more reassurance, and she cannot make or answer a phone call by herself, you can arrange for one of the nursing staff to call you at a pre-arranged time and put your mother on the phone. 

Some nursing homes tell families not to visit for several days, or even a week or more after moving day, to let a resident “settle in.”  This is dangerous nonsense.  Ignore it.  


14.  Call her before bedtime, and again in the morning.