My father is now pre-diabetic. The Assisted Living refused to take the sugar packets off the table. And my father eats 3-7 packets before his meal is served. They are supposed to serve him diabetic ice create (no sugar), he sends it back asks for multiple scoops of regular ice cream and they serve it claiming residents rights. If they explained instead it's for his health and preventing diabetes, he would likely be amenable to the diabetic ice cream. I want to know as POA do they have to follow the dietary instructions that I and the doctor give? Is it legal for them to disregard those orders?
I would speak to a director or the head of nursing. It is very wrong that they provide him with additional sugar packets. Those could be substituted with Splenda. Yes he will eventually die but the road there could be made worse with constant menu choices that are clearly in violation of doctors orders. I would emphasize that point to those bringing him his meals.
In Aus where I am all Aged Care Residences must abide by The Aged Care Act & Quality Standards. Diet & Nutrician is one of the standards. Every resident has rights, having their meals meet their Care Plan would be part of that. Changes to diet by a Doctor need to be adjusted to the Care Plan & the kitchen notified.
Diet type by choice eg vegetarian.
By medical need eg diabetic, celiac, low salt. By texture eg softened, puree etc. Religious/cultural needs may be noted too eg no pork.
At an AL place I volunteered they had various dining areas. Some for people able to manage their meal independantly, other tables that included staff to sit & supervise. Others for those that needed hands-on assistance.
Placing the sugar bowl (+ anything else, pepper, butter, spare cutlery etc) away from residents that require a little supervision is just common sense to me.
Why wouldn't you want your fathers final months/years to be happy and stress free, enjoying what he likes, instead of imposing on him strict dietary rules?
Often time folks with dementia do crave sugary items. It goes with the disease.
I always say that one has to pick your battles when dealing with someone with dementia, and I'm just not sure this is a battle worth fighting, as it's not like your father is going to get any better anyway, but will only continue to get worse.
So let the poor man enjoy whatever time he may have left on this earth, and you just get back to being his loving child instead of the carb police.
Your father has dementia. I think preventing diabetes is the least of your worries. Have you really researched and read about what dementia does to a person?
Longevity with dementia is a curse because eventually his own body will stop being able to swallow, etc. Let him eat what he wants and to hell with this pre-diabetes nonsense his doctor gave. Does his doctor even understand that your dad has dementia and what dementia does? It sounds like he is also clueless.
It might be a different story in MC. Please talk to the admins at his facility to get clarity and maybe a solution.
would eat dessert 1st. Mom never even had sugar in our home when I was growing up. It was granted when I was there.
The next facility served good family meals in a bowl to her circle table. Dessert was served after meal was eaten. Well done.
Her weight dropped back to her normal weight.
She enjoyed her new home. Though her disease progressed till she retreated to her bed and quit eating. Natural death followed 2 weeks later.
But know that in general asking for very special guidance is asking for a HUGE jump in fees.
In general ALFs are not held to federal law standards, only to state:
From the internet:
"Many state guidelines state that assisted living facilities may accommodate a special diet when the resident’s health care provider deems it necessary, while other requirements state that facilities must consider residents’ preferences."
ALFs are not nursing homes. They are not held to the same governmental standards. Recently we kind of "had this out" on Forum when someone claimed they DO have to obey laws. In one sense they do as regards FEDERAL laws, which are broad and general, but they often not subject to state laws. Most ALFs insist that a resident be at least somewhat cognizant, including ability to manage meals without depriving all residents of sugar, salt, condiments on the table because ONE resident cannot eat it, if you see what I am saying. An inability to do so could mean a move to memory care.
If you wish to know what their standards and practices are and what laws are involved do make an appointment or call administration.. They will explain what they can do and what they must do and what they DO do. They may even tell you that they are not, perhaps, the right facility for your loved one, and you should perhaps explore other options for his future.
There is also that fact that any "special care" will bump up the care levels (usually I through IV or V) exponentially, resulting in huge jumps in fees added to the residential cost of room/board.
As to what they do or do not do about varying diets? That would be something discussed upon admission and made clear in admission packets in most facilities. It is individual to the facility. Most demand a doctors evaluation and explanation of needs.
They would/should lay out exactly what can be expected and what cannot. Many good facilities do have low sodium or heart healthy or general diabetic meals for individuals. Some actually do not. And it is often up to the resident with or without help to make best choices on menus. In my brother's ALF he always asked for fresh salad at lunch rather than the corndogs that were putting weight on him.
So do make an appointment with the administration to discuss.
PS Really, as an elder with dementia, it is VERY unlikely that pre-diabetic has any meaning whatsoever. So consider discussion with his doc. Prolonging his life at this point isn't very realistic. Depriving him of pastas? Why? If he hasn't become diabetic by this point it is honestly so very unlikely that would happen. Or that it would claim his life. Your dad has already beat the odds and --as I have done--passed the "sell by" date. The rest is GRAVY. Why not make it the best tasting gravy he every had? Discuss with doctor.
AL is private pay and gets to establish their own rules which are handed out when the contract is signed. So yes, it's legal for them to not provide certain services.
When my mother needed a mechanical soft diet for awhile after getting aspiration pneumonia, it's a good thing she was in Memory Care Assisted Living at the time as they were able to accommodate that diet. Had she still been living in AL, I'd gave been scrambling.
I'll tell you this, though. It's my opinion that elders with dementia should be entitled to eat whatever they want. They crave sweets especially with dementia. Their lives are already compromised horribly, why try to extend their lives with restrictive diets???? The only reason mom needed a soft diet for awhile was while she recovered her swallow reflex. I brought her junk food weekly, I didn't care how it affected her health. It was her ONE remaining pleasure in life.
Good luck to you.
By law, the AL cannot keep Dad from doing what he wants. He wants real icecream, let him have it. He is prediabetic not diabetic. I agree that after a certain age and with Dementia in the picture, let him have what he wants.
The sugar packets do bother me. No one should be eating 7 pks. No one should eat 7 pks of a sweetner either. Actually, in sugar free candy, the ingredient used in place of sugar gives people the runs. I had to stop buying it for Dad. Aspartame can cause seizures.
Coffee contributed to her Gerd problem. Her Dr. told her to cut it out. Her AL was told not to give her coffee. I was there one day at dinner time to see an aide asking if Mom wanted coffee, I said no, she is not allowed to have it, I got a funny look from the aide. Mom was probably getting coffee everyday.
If your father had the potential to live many more years in comparative good health, I could understand the doctor's directive and see the point of being strict with his diet. Unfortunately, that's not the case.
Let your father eat the food he recognises while he can. It's too late now for your dad to learn new ways and change his diet.
she’s home now
This attitude about older people that oh well they’re old and they’re gonna die soon let them have whatever they want when they don’t really have the capacity to make good decisions is also wrong A high carb diet is really bad for their mind and just throws them into worsening health. Try to leave some fruit for him because the sugar from fruit is not the same as the sugar from processed carbohydrates with orders to give him that for a snack
If you can go there and take him some food and tell the Help to use it instead of the garbage they feed him. Maybe it would help some otherwise he’ll probably end up on Metformin.
You on the other hand are cognizant and know that keeping the diet you need will keep you healthy and prevent problems.
I expect that eating right and doing what you are doing you will have a normal life span.
A person with dementia will continue to decline and will not live a normal lifespan.
No, the AL cannot do whatever it wants. If they disregard this order what else will they ignore?
If the POA has been activated and you are the legal decision maker now, make an appointment with the AL's director and discuss this.
1. I think that a person with dementia should be in Memory Care not AL.
2. The facility SHOULD follow ANY diet that has been ordered by a doctor.
If the facility either can't follow the doctor's orders or refuse to that should be reported to the Ombudsman and I would also notify his doctor that the facility refuses to follow his order.
I would also report this on the Medicare Website. They do take complaints and facilities are listed with they types of violations that have been found during inspections.
I would ask them if the doctor ordered a blood pressure pill to be taken each day would they make sure the pill is taken or do they document that the resident refused the medication. If that is the case who do they notify that the resident is non compliant with medication? And what is their solution.
However, ALF is not a nursing home. Residents have autonomy, which means they are allowed to refuse the fake ice-cream and ask for the proper stuff made with sugar and cream. Btw, low fat foods are not necessarily best for people with diabetes or pre-diabetic condition, as fats slow down the processing of carbs, preventing a sugar spike.
If someone needs decisions made for them, then they need to live in a facility that can do that, not ALF.
(This is separate from the issue of whether it's practical or desirable to get a person with dementia to follow a strict diet.)