How to address weight loss problem in adult family home?
April 28, 2023 8:19 PM Subscribe
My relative has a mental illness and has recently moved into an adult family (aka group) home. The adult family home provides all meals. After relative moved in, relative kept telling us they were hungry. So we had relative's doctor look into it.
Relative had lost 7 lbs in 11 weeks at the adult family home, so doctor ordered larger food portions. Adult family home is blaming relative's increased walks on the weight loss (relative maybe walks 1/2 mile a few times per week at the park across from the home since the weather has become nicer ... for about the last month). Adult family home has increased the food portions, but now they don't allow relative off the premises because they say the walks are what made relative lose weight, and they want to prevent further weight loss. We've spoken to management, but they just deflected and changed the subject, although they did say perhaps relative is not a good fit for their facility. We're at a loss as to how to proceed. Any insight/advice would be greatly appreciated.
Relative had lost 7 lbs in 11 weeks at the adult family home, so doctor ordered larger food portions. Adult family home is blaming relative's increased walks on the weight loss (relative maybe walks 1/2 mile a few times per week at the park across from the home since the weather has become nicer ... for about the last month). Adult family home has increased the food portions, but now they don't allow relative off the premises because they say the walks are what made relative lose weight, and they want to prevent further weight loss. We've spoken to management, but they just deflected and changed the subject, although they did say perhaps relative is not a good fit for their facility. We're at a loss as to how to proceed. Any insight/advice would be greatly appreciated.
Walking so little won't produce weight loss. What might have an impact, on the order of 7 lbs in 11 weeks, is a better diet. What was the relative eating before? If the relative went from a high fat/high carb diet to something more plant-based, yes, you'll see a dramatic drop due to lower calorie intake and water loss.
posted by SPrintF at 9:00 PM on April 28, 2023 [13 favorites]
posted by SPrintF at 9:00 PM on April 28, 2023 [13 favorites]
Decreasing what little exercise your relative is getting sounds like a bad idea if your relative is most people. Per the CDC (How much physical activity do adults need?) your relative is probably not getting enough exercise.
posted by aniola at 9:22 PM on April 28, 2023 [10 favorites]
posted by aniola at 9:22 PM on April 28, 2023 [10 favorites]
relative maybe walks 1/2 mile a few times per week at the park across from the home since the weather has become nicer ... for about the last month
If that could take off 7 lbs in 11 weeks life would be easier for us all! Even at a leisurely amble, that's a 15-minute walk, tops. Relative's diet should not be so tightly controlled that that much activity causes significant weight loss, and if there's some other medical reason (not impossible, as mentioned by others), they should be on top of it enough to explain it to you.
now they don't allow relative off the premises because they say the walks are what made relative lose weight, and they want to prevent further weight loss
I'm sorry to say that it sounds like what they actually want to prevent is further hearing from you about how they're not meeting his needs. I'm seeing some red flags here. Strictly limiting someone's freedom of movement to prevent them from engaging in modest amounts of mild exercise is absurd.
posted by praemunire at 9:29 PM on April 28, 2023 [52 favorites]
If that could take off 7 lbs in 11 weeks life would be easier for us all! Even at a leisurely amble, that's a 15-minute walk, tops. Relative's diet should not be so tightly controlled that that much activity causes significant weight loss, and if there's some other medical reason (not impossible, as mentioned by others), they should be on top of it enough to explain it to you.
now they don't allow relative off the premises because they say the walks are what made relative lose weight, and they want to prevent further weight loss
I'm sorry to say that it sounds like what they actually want to prevent is further hearing from you about how they're not meeting his needs. I'm seeing some red flags here. Strictly limiting someone's freedom of movement to prevent them from engaging in modest amounts of mild exercise is absurd.
posted by praemunire at 9:29 PM on April 28, 2023 [52 favorites]
My gut reaction, as someone who's worked with people in group homes, is that the management is annoyed with you for asking for more food, is punishing your relative in retaliation, and is threatening to kick them out if you object. They may be doing super-vindictively or they may be doing it simply to protect their food budget, but that would be my read on what's happening. If your relative otherwise likes the place, then you can likely solve it by playing nice and getting Ensure (sometimes you can get it covered by Medicaid if it's prescribed, I believe); if they don't, you might want to look for a new place. Either way, it'd be worth talking to your relative about their priorities and what they'd like to do, and letting them lead the conversation.
posted by lapis at 9:32 PM on April 28, 2023 [24 favorites]
posted by lapis at 9:32 PM on April 28, 2023 [24 favorites]
Yeah, losing that amount of weight in that amount of times takes some effort. Your relative could be hunger striking and lying about the facility in order to get out of it.
posted by Melismata at 9:37 PM on April 28, 2023
posted by Melismata at 9:37 PM on April 28, 2023
I don't know where you are, but in my state (WA) residents in adult family homes have rights including the right to be free from retaliation. Please check with your local and state authorities.
posted by brookeb at 9:55 PM on April 28, 2023 [4 favorites]
posted by brookeb at 9:55 PM on April 28, 2023 [4 favorites]
Major red flag that they are prohibiting walks, which are beneficial for health, stress, etc etc. I would escalate. Also red flag that they would say someone who lost weight is not a “good fit for the facility.” I’d ask them to spell out what that means exactly. In those settings it’s often a warning shot they may try to discharge soon. You want to be ahead of that.
And good tip about the ensure above.
posted by namemeansgazelle at 10:30 PM on April 28, 2023 [11 favorites]
And good tip about the ensure above.
posted by namemeansgazelle at 10:30 PM on April 28, 2023 [11 favorites]
Yeah "you complained so your relative no longer gets to leave for a walk around the neighborhood" would be a colossal red flag for me. Walking has so many health benefits. This seems like a place that's more focused on money than residents' health.
posted by potrzebie at 12:02 AM on April 29, 2023 [12 favorites]
posted by potrzebie at 12:02 AM on April 29, 2023 [12 favorites]
On the one hand, there may be benign reasons for the weight loss. Depending on what their weight was to start out with, their dietary habits prior to moving etc losing weight during a change of circumstances may well be about to stabilize at an acceptable level. Less overall may simply be less crap and/or less overall, if they were overeating.
On the other hand, the way the facility is handling your reasonable concerns is clearly vindictive and should give you pause about leaving your family member in the care of these people long-term. Do the other residents seem to be well cared for in general? Do they look like they are eating adequately, happy, healthy or are there indicators they are scared of the carers?
How did you approach this? Did you go straight to the doctor or did you talk to the facility first? If so, what did they say? By involving the doctor and having more food prescribed you have basically outed yourselves as trouble makers. In a lot of areas, spots in residential homes are hard to come by. So they can kick out your family member and replace them with somebody with less troublesome family without delay. That's what they mean when they tell you they may be a 'poor fit'.
So you'll have to be a lot more strategic than you have been. If there are no overarching indicators of abuse or neglect, does your family member want to stay there? Do you feel they would be safe for now? If the answer is yes, figure out how to get them a regular supply of snacks and food replacement shakes. And make nice with the facility and monitor for the time being. Make sure they retain access to you and you to them.
If there are other causes for concern, figure out how to get them moved elsewhere asap. That may take a bit of time, unless your family can get your family member situated outside a dedicated facility in the short-term. If that is not possible, you may still have to make nice and monitor/support your family member in ways that don't 'cause trouble' until they can move elsewhere.
posted by koahiatamadl at 4:31 AM on April 29, 2023 [1 favorite]
On the other hand, the way the facility is handling your reasonable concerns is clearly vindictive and should give you pause about leaving your family member in the care of these people long-term. Do the other residents seem to be well cared for in general? Do they look like they are eating adequately, happy, healthy or are there indicators they are scared of the carers?
How did you approach this? Did you go straight to the doctor or did you talk to the facility first? If so, what did they say? By involving the doctor and having more food prescribed you have basically outed yourselves as trouble makers. In a lot of areas, spots in residential homes are hard to come by. So they can kick out your family member and replace them with somebody with less troublesome family without delay. That's what they mean when they tell you they may be a 'poor fit'.
So you'll have to be a lot more strategic than you have been. If there are no overarching indicators of abuse or neglect, does your family member want to stay there? Do you feel they would be safe for now? If the answer is yes, figure out how to get them a regular supply of snacks and food replacement shakes. And make nice with the facility and monitor for the time being. Make sure they retain access to you and you to them.
If there are other causes for concern, figure out how to get them moved elsewhere asap. That may take a bit of time, unless your family can get your family member situated outside a dedicated facility in the short-term. If that is not possible, you may still have to make nice and monitor/support your family member in ways that don't 'cause trouble' until they can move elsewhere.
posted by koahiatamadl at 4:31 AM on April 29, 2023 [1 favorite]
The reason you even took your relative to the doctor is that they said they were hungry. This place is not giving them enough to eat to meet their needs even when they say they're hungry. If they're hungry, they should get more to eat. No one should live in a place where they're so hungry they dramatically lose weight.
The only reason that much weight loss could be anything other than a red flag is if your relative is morbidly obese and loses that much weight easily. But that would have nothing to do with walking a little.
So the restriction of exercise on top of them not responding to relative's hunger? This is upsetting to read about.
posted by little striped mule at 5:10 AM on April 29, 2023 [14 favorites]
The only reason that much weight loss could be anything other than a red flag is if your relative is morbidly obese and loses that much weight easily. But that would have nothing to do with walking a little.
So the restriction of exercise on top of them not responding to relative's hunger? This is upsetting to read about.
posted by little striped mule at 5:10 AM on April 29, 2023 [14 favorites]
If your relative on one of the meds that has a well-demonstrated association with weight gain and type 2 diabetes? There might be some form of calorie restriction in place for that which overshot its objective.
However, very hard to see any clinical justification for banning walks, given the overall benefit to health and the really minimal calorie burn.
posted by MattD at 6:04 AM on April 29, 2023 [1 favorite]
However, very hard to see any clinical justification for banning walks, given the overall benefit to health and the really minimal calorie burn.
posted by MattD at 6:04 AM on April 29, 2023 [1 favorite]
Walking 2 miles a week will only burn a couple hundred calories at most. The very best case they might maybe drop half a pound from that much walking in a month. But probably less.
Walks are generally considered positive for mental health.
The facility is interfering with your relative’s doctors orders.
This place does not have your relative’s health in mind. I agree that it sounds like they’re trying to get rid of them, though food is not a huge budget item at a place like that so I suspect there’s something else going on. At any rate, living under a landlord that doesn’t want you there is a miserable experience.
Start the process of looking for another facility and when you’ve done the footwork, bring those options to your relative. In the meantime smuggle in snacks.
Oh, and document everything. If you get your relative out of there, there are probably some state institutions who would like to know.
This sucks. I had family in a similar situation recently and the only thing we could do was get them out. We found out later that the red flags we saw were just the top of the iceberg.
posted by Ookseer at 6:16 AM on April 29, 2023 [4 favorites]
Walks are generally considered positive for mental health.
The facility is interfering with your relative’s doctors orders.
This place does not have your relative’s health in mind. I agree that it sounds like they’re trying to get rid of them, though food is not a huge budget item at a place like that so I suspect there’s something else going on. At any rate, living under a landlord that doesn’t want you there is a miserable experience.
Start the process of looking for another facility and when you’ve done the footwork, bring those options to your relative. In the meantime smuggle in snacks.
Oh, and document everything. If you get your relative out of there, there are probably some state institutions who would like to know.
This sucks. I had family in a similar situation recently and the only thing we could do was get them out. We found out later that the red flags we saw were just the top of the iceberg.
posted by Ookseer at 6:16 AM on April 29, 2023 [4 favorites]
Why isn't he just getting to eat as much as he wants to, especially if he's underweight or losing weight?
This sounds cruel. Geez. Let him have granola bars and running water in his room. Let him order pizza. Don't forbid people from having _as much food as they want_ if there's no health reason against it.
posted by amtho at 7:35 AM on April 29, 2023 [2 favorites]
This sounds cruel. Geez. Let him have granola bars and running water in his room. Let him order pizza. Don't forbid people from having _as much food as they want_ if there's no health reason against it.
posted by amtho at 7:35 AM on April 29, 2023 [2 favorites]
Just a note that people in group homes often don't have a lot of extra spending money (for snacks, etc) and that board and care or room and board rates don't normally include a lot of snacks. There can also be prohibitions against food in rooms due to pest problems.
posted by lapis at 7:49 AM on April 29, 2023
posted by lapis at 7:49 AM on April 29, 2023
Yeah, sorry, I should have been clearer: It's absolutely not right that they are letting your relative go hungry and restricting their movement. Given this home's response to a doctor's prescription to solve the former triggered the latter, I suspect that if you raise the issue of this not being right, they will evict your relative. That's not morally right, but that's the likely outcome. Where I am, at least, beds in these sorts of facilities are hard to get.
So you and your relative need to decide how you want to navigate that reality -- play along and be less "demanding" (you're not, in reality, being demanding); play along a bit and advocate a bit and figure out where the boundaries are in what you can push for with these particular people; or possibly find a new home. That's why I'm suggesting talking to your relative, to see what their priorities are or what their ideal situation would be, so you can all have a better sense of the desired outcome.
There's not a right solution because the situation is wrong, not just with this one home but with the entire way we as a society treat people with disabilities, including funding and infrastructure and attitudes. So you're navigating in a warped system, which might require more strategic thinking. I think it's helpful in developing strategies to understand the likely risks, as well as what's considered "normal" right now as a society and in this industry.
I'm sorry you're all dealing with this.
posted by lapis at 8:27 AM on April 29, 2023 [4 favorites]
So you and your relative need to decide how you want to navigate that reality -- play along and be less "demanding" (you're not, in reality, being demanding); play along a bit and advocate a bit and figure out where the boundaries are in what you can push for with these particular people; or possibly find a new home. That's why I'm suggesting talking to your relative, to see what their priorities are or what their ideal situation would be, so you can all have a better sense of the desired outcome.
There's not a right solution because the situation is wrong, not just with this one home but with the entire way we as a society treat people with disabilities, including funding and infrastructure and attitudes. So you're navigating in a warped system, which might require more strategic thinking. I think it's helpful in developing strategies to understand the likely risks, as well as what's considered "normal" right now as a society and in this industry.
I'm sorry you're all dealing with this.
posted by lapis at 8:27 AM on April 29, 2023 [4 favorites]
I suspect one of two things could be at the root of this.
One is that another resident is eating your resident's food. If this is the case the staff will be reluctant to tell you that it is happening. If they could easily prevent it, they would have, so you may have a situation where they are not allowed to stop a resident who is obsessively eating, as that would require restraint, sedatives or increased staffing. The first two are violations of Frank's human rights and the third is completely out of the budget. The staff may all know that "Frank" constantly grabs stuff from the kitchen, or from other resident's trays but have no way to stop it.
The second possibility could be that the staff in the group home are expected to eat with the residents to provide a "home like environment" and they are eating most of the food themself. Underpaid staff members will sometimes strip the kitchen bare and bring it home. Floor staff would not be willing to admit this to you, and the supervisors at the home may be unaware of the situation if that is what is going on. I know of one group home where the day the groceries were bought the freezer would be stuffed, and the next day there would be nothing left but frozen meatballs, which is what the residents ended up eating. I don't know how many of the workers were bringing food home, but several hundred dollars a month were walking out the door.
I'm not saying that either of these are definitely happening, but the deflection and saying your relative is not a good fit goes with a situation like this. "Not a good fit" could mean that they have been come the victim of other residents. "Sorry, but Frank keeps grabbing the food off his plate..." is not something that the staff wants to share with you, because you will respond with, "Then stop Frank from grabbing his food!" and they will not want to replay, "Nah, it is much less of a problem to let him, because otherwise he bites people."
There are other possibilities which I am going to mention below, but I think they are less likely than the scenario where insufficient food is getting to your relative.
A third possibility is that your relative has an un-diagnosed metabolic disorder and prior to getting the placement in the adult family home they had been eating massive amounts of food. Once in the home they are being given a regular ration and it's not enough. I assume they were tested for diabetes and other possibilities by the doctor who wrote the order for larger rations?
A fourth possibility is that your relative does not like the food in the home and is not eating it. The staff may not have observed that they are not eating it either because they are not looking or because your relative is concealing their refusal to eat the group home food, or else the staff may not have any other options to offer your relative and do not want to get into an argument with you regarding the quality of the food. Could be that your relative can't stomach bargain brand institutional grade frozen meatballs.
A fifth possibility may be that your relative has gotten into calorie burning behavior, like desperately pacing.
The first thing I would do is ask if you can supplement your relatives rations. If they say sure, and you can manage it, that might be effective.
I'd also look into getting your relative moved, but if the option is a different group home under the same type of management the problem could continue so a change of residence will not definitely fix things.
posted by Jane the Brown at 8:45 AM on April 29, 2023 [4 favorites]
One is that another resident is eating your resident's food. If this is the case the staff will be reluctant to tell you that it is happening. If they could easily prevent it, they would have, so you may have a situation where they are not allowed to stop a resident who is obsessively eating, as that would require restraint, sedatives or increased staffing. The first two are violations of Frank's human rights and the third is completely out of the budget. The staff may all know that "Frank" constantly grabs stuff from the kitchen, or from other resident's trays but have no way to stop it.
The second possibility could be that the staff in the group home are expected to eat with the residents to provide a "home like environment" and they are eating most of the food themself. Underpaid staff members will sometimes strip the kitchen bare and bring it home. Floor staff would not be willing to admit this to you, and the supervisors at the home may be unaware of the situation if that is what is going on. I know of one group home where the day the groceries were bought the freezer would be stuffed, and the next day there would be nothing left but frozen meatballs, which is what the residents ended up eating. I don't know how many of the workers were bringing food home, but several hundred dollars a month were walking out the door.
I'm not saying that either of these are definitely happening, but the deflection and saying your relative is not a good fit goes with a situation like this. "Not a good fit" could mean that they have been come the victim of other residents. "Sorry, but Frank keeps grabbing the food off his plate..." is not something that the staff wants to share with you, because you will respond with, "Then stop Frank from grabbing his food!" and they will not want to replay, "Nah, it is much less of a problem to let him, because otherwise he bites people."
There are other possibilities which I am going to mention below, but I think they are less likely than the scenario where insufficient food is getting to your relative.
A third possibility is that your relative has an un-diagnosed metabolic disorder and prior to getting the placement in the adult family home they had been eating massive amounts of food. Once in the home they are being given a regular ration and it's not enough. I assume they were tested for diabetes and other possibilities by the doctor who wrote the order for larger rations?
A fourth possibility is that your relative does not like the food in the home and is not eating it. The staff may not have observed that they are not eating it either because they are not looking or because your relative is concealing their refusal to eat the group home food, or else the staff may not have any other options to offer your relative and do not want to get into an argument with you regarding the quality of the food. Could be that your relative can't stomach bargain brand institutional grade frozen meatballs.
A fifth possibility may be that your relative has gotten into calorie burning behavior, like desperately pacing.
The first thing I would do is ask if you can supplement your relatives rations. If they say sure, and you can manage it, that might be effective.
I'd also look into getting your relative moved, but if the option is a different group home under the same type of management the problem could continue so a change of residence will not definitely fix things.
posted by Jane the Brown at 8:45 AM on April 29, 2023 [4 favorites]
shipping someone a case of ensure (???) when they are telling you they are hungry & want food to eat is one of the most baffling cruelties I can imagine. ensure is for when your appetite's suppressed or you're nauseous or your jaw's wired shut, not when you're hungry and asking for food.
this isn't an eating disorder or bariatric surgery recovery rehab, is it? in what other treatment setting should a physically healthy person asking for food meet with any reaction but the free provision of food? if you have to arrange to bring them food or take them out for regular restaurant meals in the interim period before finding a humane living situation, go ahead and do that. but like. set mealtimes is one thing; treating a resident like oliver twist is another. this is shocking.
posted by queenofbithynia at 9:01 AM on April 29, 2023 [3 favorites]
this isn't an eating disorder or bariatric surgery recovery rehab, is it? in what other treatment setting should a physically healthy person asking for food meet with any reaction but the free provision of food? if you have to arrange to bring them food or take them out for regular restaurant meals in the interim period before finding a humane living situation, go ahead and do that. but like. set mealtimes is one thing; treating a resident like oliver twist is another. this is shocking.
posted by queenofbithynia at 9:01 AM on April 29, 2023 [3 favorites]
Don't forbid people from having _as much food as they want_
'Specially old people, not long in this world. I expect this is actually one of the five situations described by Jane the Brown, above.
posted by Rash at 9:13 AM on April 29, 2023 [1 favorite]
'Specially old people, not long in this world. I expect this is actually one of the five situations described by Jane the Brown, above.
posted by Rash at 9:13 AM on April 29, 2023 [1 favorite]
Mod note: Comment removed. Per the Ask Metafilter Guidelines, please avoid chastising other commenters and stay focused on answering the OP's question, thanks.
posted by Brandon Blatcher (staff) at 10:11 AM on April 29, 2023
posted by Brandon Blatcher (staff) at 10:11 AM on April 29, 2023
Is there any chance this person is a diabetic? You asked a question once before about a diabetic family member. It is REALLY easy to lose weight if you are a diabetic and your food intake and diabetes medicine intake do not match. You can eat massive amounts and still lose weight.
Young women with diabetes frequently destroy their bodies by doing this on purpose because they get so much good feedback when the weight melts off. Everyone tells them it's healthy but it leads to kidney failure, amputation and blindness.
posted by Jane the Brown at 11:14 AM on April 29, 2023
Young women with diabetes frequently destroy their bodies by doing this on purpose because they get so much good feedback when the weight melts off. Everyone tells them it's healthy but it leads to kidney failure, amputation and blindness.
posted by Jane the Brown at 11:14 AM on April 29, 2023
Just as an anecdote, I once suggested to the nursing home's management that I contact the nursing home's ombudsman, which is usually an independent path to reporting concerns/complaints, to help me look into how I could be better communicating the needs of my grandparents who were residents. This request alone produced a persistent and immediate response of wanting to understand how to help me communicate my grandparents' needs. I wonder if your group home has a similar communication channel or ombudsman that you could inquire about - wondering if you could find some way of figuring out how to communicate to help them in meeting your relative's nutritional needs.
(I found this request akin to other work or school situations where suggesting that we gather everyone, every single person, involved so we could have a long and thorough meeting to discuss all the ins and outs of the issues and hammer out a detailed plan for resolution somehow ... resolves the situation without having a meeting.)
posted by RoadScholar at 5:26 PM on April 30, 2023 [1 favorite]
(I found this request akin to other work or school situations where suggesting that we gather everyone, every single person, involved so we could have a long and thorough meeting to discuss all the ins and outs of the issues and hammer out a detailed plan for resolution somehow ... resolves the situation without having a meeting.)
posted by RoadScholar at 5:26 PM on April 30, 2023 [1 favorite]
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If you are otherwise happy with the place then I would just set up some auto shipments of Ensure for him to supplement with. But the not letting him take walks bit is super weird.
posted by Jacqueline at 8:25 PM on April 28, 2023 [3 favorites]