30 Days Since We’ve Seen My Mother-in-Law in Her Assisted Living Facility: The Checklist We Can’t Live Without

by Linda Chamberlain

This Sunday marks 30 days since we’ve last visited with my mother-in-law (MIL). While it’s great she still calls me every morning to chit chat, it is also very sad that much of that time is spent with her complaining that we have just stuck her in the assisted living facility and then never have come to visit. Her awareness of time and of the current pandemic needs to be brought to her attention daily. By the time I calm her down she is ready to get off the telephone.

Not Visiting the Assisted Living Facility Brings Anxiety

In the meantime, we’ve been worried, maybe worried isn’t the right term to use, but concerned as to what really is happening with her and how she is doing overall. The only person reaching out to us from the assisted living facility is their marketing department, and that’s only been a generic email.

The Resource That Helps: Our Care Manager

In order to give them the benefit of the doubt, I’m assuming they haven’t called me because they are speaking with our Aging Life Care Manager. We are fortunate to have a Care Manager facilitating my MIL’s care, talking with the assisted living facility team members taking care of her and speaking with the home health physical therapist providing treatment for her broken wrist.

All the Challenges of Aging with Dignity

Aging with dignity is a challenge when you are depending on others for your care.  Sometimes you need care that includes things you just don’t talk about or don’t want to think about. A few months ago, when I accompanied my MIL to her wound care treatment appointment (a skin tear on her leg) the nurse removing her bandages decided to put lotion on her legs while waiting for the doctor to come to examine the wound. My MIL’s skin is so dry, and she was happy for the nurse to apply the lotion. Thank goodness my MIL was able to lie there and enjoy the lotion application and not see the amount of dirt that came out from between her toes. (She has been immaculate with her self-care throughout her life.) It literally made me sick on my stomach to see it. The facility confirms that she is showered with assistance twice a week but after seeing this we surely know a washcloth is not being used on her feet.

We did think ahead and supplied a blow dryer, shampoo and dry shampoo for her hair since the beauty salon at the assisted living facility is closed. However, I’m wondering if anyone has assisted her with brushing her teeth, soaking her dentures, filing and trimming her nails. And, then there’s the big question – are they plucking those crazy black hairs on her chin? Because I promised many years ago I would make sure they were plucked. The checklist our care manager runs through with the facility has been a lifesaver for feeling reassured in the midst of this anxiety-provoking crisis.

Worried about a loved one in an assisted living facility you can’t visit?

Click here for a free checklist for your calls to the facility.

Contact us to consult with one of our care managers about monitoring your loved one’s wellness at an assisted living facility. This is something we do for many clients in the Tampa Bay area, and we can also do via telephone and video call for clients anywhere. Our care managers know the ins and outs of assisted living facility care. They know what to ask and how to ask it. They can also relieve you of a lot of stress, allowing you to be the family member once again.

Here is an idea of what our care managers do when monitoring and coordinating for a client in an assisted living facility:

They start by finding out the designated caregiver/representative at the assisted living facility. They schedule a time for a video call, including the family when desired. Using a list of the items we regularly check up on sets the agenda for the call and ensures we track the key factors. The care manager creates a spreadsheet or checklist with some standard items like these below, as well as things personalized to the particular client.

  • How is the client overall?
  • Any new issues or concerns regarding the client?
  • Review their Activities of Daily Living and IADLs:
    • Ambulation – Are they up and moving around, what steps are being taken to ensure they are walking and getting movement daily?
    • Bathing – How many times a week are they bathed? Is the person doing their bathing instructed and/or supervised to ensure all parts of the body are cleansed? Do they need any supplies for bathing? How is their hair being washed and/or dried? (The care manager will personalize this, knowing the client, to ask about parts of the body that they cannot reach or that have been problematic before.) Is their skin being evaluated for redness or breakdown?
    • Continence and Toileting – Do they help with toileting? What is the toileting program and have there been any issues? If they use incontinence wear, how is their supply? Any concerns about a urinary tract infection? (We often spot such infections when they have not been…our experts know many of the signs that get overlooked since elderly clients often present differently and may not feel the same pain and discomfort.)
    • Dressing and Grooming – Are they getting dressed daily? Has their laundry been done? Who is helping them with their daily grooming? Face, teeth, dentures, hearing aids, glasses, fingernails, toenails, shaving, plucking hairs?
    • Diet and Meals – Are they eating well? What % of the food provided do they eat? How is their weight? How often is the client weighed to ensure no rapid decrease or increase? Is there any meal and/or food you could send them or they are requesting? Does the facility have enough food until the end of the month? What types of meals are they serving?
    • Medications – Are they receiving prescribed medications? Have there been any changes to the medications? (Our care managers are sure to confirm details to check that this is being done properly and no changes have been made without the parties being informed.) Does the facility have an ample amount of the prescribed medications?
    • Laundry – Who is changing their bed linens and towels and how often are they washed? Do they need any supplies?
    • Communication – Is their telephone working correctly? Are calls or video calls being coordinated for families, if so, how and when? How can we schedule?
  • Prescribed Treatments – Are they receiving skilled home health? If so, what is the treatment status and any concerns? Are they receiving wound care? How is the facility addressing this need?
  • Is the client getting any socialization or cognitive enrichment? What are they doing to help with isolation?
  • Does the client understand why the family is not visiting? How is the facility helping their residents understand the need for self-isolation?

The care manager evaluates the client’s care plan to see what they need to be following up about. Every assisted living facility and nursing home is required to complete a care plan on each resident. The healthcare surrogate is entitled to receive a copy.

Additionally, the care manager might follow up on various contingency plans and how the facility is handling things in the crisis. For example, what if the client needs a doctor (not an emergency room visit)? Who is covering at the facility? Are they using telehealth? Which system and how is that working?